Tuesday, October 27, 2009

Pandemic con-flu-sion

Public health could learn a lot from Madison Avenue about telling people what to do. Advertising for designer jeans, sports cars or chocolate sells a product and even a life-style with a single image and a couple of words. The same cannot be said for public health communication about the flu.

One simple decision illustrates the confusion: Should my kids get the H1N1 vaccine? Every year my children and I get the flu shot, primarily to avoid transmitting it to those more susceptible to complications. This year the health department says every case of flu currently being experienced is H1N1. Since there is little if any laboratory confirmation, anyone with “flu-like symptoms” is considered infected with H1N1. These include fever, runny nose, muscle aches, and other classic “upper-respiratory” symptoms caused by many viruses, including the common cold. Recommendations call for all school-aged children to receive H1N1 vaccine. But pediatricians were told not to vaccinate anyone 6 or older, since schools have been supplied with vaccine for those kids. So our pediatrician wouldn’t vaccinate my 6-year old son. No problem, he can get it at school right?

Wrong. Last week the school nurse at a local high school officially dispelled a circulating myth that 20% of students had the flu. Unfortunately, the following morning that “myth” ran on the front-page of the local paper. Now those promised doses of vaccine are not being delivered, so schools have begun to cancel or postpone vaccination clinics for children 6 and older.

I’ve suggested earlier that every flu season amounts to a pandemic, but how much worse is H1N1? Its clear that student absences from school are much higher than normal this year. But it’s likely that every kid with the common cold is being diagnosed with swine flu and kept home. On any normal year such kids may have trudged off to school, stuffy nose and all. H1N1’s death toll among school-aged children is close to 90 in the US, higher than we typically see during an entire flu season. But it’s not clear if these children have some risk factor in common that made them especially susceptible. And if it is true that up to 20% of school-aged kids have H1N1, 90 deaths would amount to an exceedingly low death rate.

Despite the media and public health communication frenzy built around the flu this year, no one anticipated the increased demand for regular flu vaccine which has depleted many stockpiles. It will be interesting to see how vaccination rates are affected next year. I anticipate regression to the normal rate, or lower as people decide not to worry about regular flu after surviving the promised plague of H1N1.

Personally I’ve given up on the regular flu shot this year. My doctor has run out, and a flu clinic I was scheduled to attend was canceled. We’ll take our chances with H1N1. How has vaccine communication been in your community: Clear as Madison Avenue or muddy as chocolate?

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