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New Needle-free Flu Vaccine Targets Small Audience

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Knight Ridder Newspapers


AKRON, Ohio - No one wants to suffer the hacking, fever-racked malaise that is the flu.

For some people, though, their trypanophobia (fear of injections) overpowers their pyrexiophobia (fear of fever). To these folks, rolling up their sleeves for a flu shot is not an option.

Now they have another choice in protecting themselves from the flu. It's not a shot, but a snort.

FluMist - a flu vaccine delivered via a spritz up the nose - was approved by the U.S. Food and Drug Administration in June, but only for those between the ages of 5 and 49.

Just don't count on finding it at your local health department.

FluMist is expensive (somewhere between $45 and $65 per dose, compared to $8 to $15 per shot), difficult to store (requires a nondefrosting freezer) and doesn't fit the target audience most health departments are shooting for (the chronically ill and those over 65).

Plus, FluMist uses a live virus, as opposed to traditional flu shots that use dead viruses. What that means, said Akron Health Department nursing supervisor JoAnn Wilson, is that FluMist can "spread to other people. It's a risk to close contacts of those who get immunized."

That may not be much of a risk for healthy people with healthy families. But for those who have weakened immune systems, or live with someone who does, the risk is real.

In approving FluMist, the FDA warned that it should not "for any reason" be given to anyone with a suppressed immune system, such as those fighting AIDS or cancer, or patients using steroids and other immune-suppressing drugs.

The FDA also said that FluMist's safety in people with asthma and other airway diseases has not been established, so it shouldn't be given to people with a history of such problems.

In children younger than 5, those who used FluMist showed an increased rate of asthma and wheezing within 42 days of vaccination, compared to placebo. For those 50 and older, the FDA said FluMist's safety has not been established yet. (The most common side effects from FluMist in healthy people are nasal congestion, runny nose, sore throat and cough.)

Traditional flu shots are OK, even strongly encouraged, for those being kept away from FluMist.

Still, the nasal spray offers "another weapon in our armamentary. Those who may have avoided vaccination for fear of injections, there's a new option. We were pretty excited to see it," said Dr. Marguerite Erme, the Akron Health Department's disease control medical officer.

Dr. Blaise Congeni, head of infectious diseases at Akron Children's Hospital, sees FluMist as a fallback for now, a second choice for kids (older than 5) who are opposed to needles.

So he's not sure that FluMist will have the hoped-for effect of getting many more Americans vaccinated.

"Of 90 million doses of vaccine dispensed, only 4 million to 5 million will be FluMist, so you're not seeing a substantial impact," he said.

It's estimated that 10 percent of the population suffers from a fear of needles. How many avoid the flu shot because of it is unknown, but health-care workers are convinced that the more who get vaccinated, the better.

"The question is, are Americans going to take the FluMist because it's administered differently? And what will the public's acceptance be? I don't know. I think it should be pretty good, but I don't know," said Dr. James Tan, chair of Summa Health System's infectious disease department. "We should encourage as many people as we can to be immunized because I think we can save a lot of money and lives by having these people immunized, especially people with chronic disease and the elderly."

Most people see the flu as a seasonal inconvenience, but it's really much more serious than that.

The highly infectious lung disease can lead to pneumonia. Each year about 114,000 Americans are hospitalized by the flu, with nearly 36,000 people dying each year. Most who die are 65 years and older. But children younger than 2 years old are as likely as those over 65 to have to go to the hospital because of the flu.

Both the American Academy of Pediatrics and the U.S. Centers for Disease Control and Prevention are encouraging that all children ages 6 months to 23 months be vaccinated against the flu. Plus, the academy is pointing out that a flu shot "can be administered" to any child older than 6 months.

Those recommendations are as much for the health of the children as it is for the adults around them.

"Studies have clearly shown that the best way to protect high-risk adults is to immunize their children," Congeni said.

Should all healthy children be vaccinated? The guidelines don't say that yet, Congeni said, because recent vaccine shortages meant diverting most doses to those at the most risk. Now that vaccine is in good supply, though, there may be more of a push to vaccinate all children.

"My children have been immunized every year for years," Congeni said. "I just think it makes good sense."

Flu season in the United States is considered October through April, though flu rarely hits the Akron area before late December or January. Last year, the local flu season peaked the second week of February.

The past couple of flu seasons have been mild, despite annual fears of a major influenza pandemic.

"That may lull people into a sense of complacency," Erme said. "We haven't seen a severe year for a period of time and we tend to have a very short memory for influenza years and how bad they are. I can see people saying, `We haven't seen it in a while, so what's the point'" of a vaccination?

For most people, Erme said October is a good time to be vaccinated, usually offering protection through April.

One other question with FluMist is whether it may provide better immunity than flu shots, Tan said. Because it uses a live virus and because it's delivered in a nasal spray, there's some belief that it will provide better protection where it's needed most - in the upper respiratory tract, where the virus enters the body.

But like the question of whether the American public will be interested in the new vaccine, only time will tell, he said.


(c) 2003, Akron Beacon Journal (Akron, Ohio). Distributed by Knight Ridder/Tribune News Service.

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