The statements came the same day that new figures from the U.S. Centers for Disease Control and Prevention showed that not only was flu vaccine coverage significantly lower last year than in prior years because of a much-publicized vaccine shortage, but even high-risk groups turned out in lower numbers for flu shots.
"The public health need is that every person in the country should be getting a flu shot this year," said Dr. Rex Archer, president of the National Association of County and City Health Officials (NACCHO). "If you want to talk about being a citizen in this country and having a public responsibility and duty, we should all get a flu shot."
Archer spoke at a news conference sponsored by NACCHO.
Worldwide interest and concern about influenza has increased dramatically recently, both because of last year's vaccine shortage in the United States and because of a larger-than-normal number of deaths in Asia from H5N1 avian flu.
Experts worry that the avian virus could mutate, enabling it to pass easily from animals to humans and from humans to humans, resulting in a deadly pandemic.
Preparations are being made to deal with such an eventuality. On Sept. 15, U.S. government officials announced that Sanofi Pasteur had been awarded a $100 million contract to produce avian flu vaccine. GlaxoSmithKline was also awarded a $2.8 million contract for 84,300 doses of the antiviral drug Relenza to be added to the nation's Strategic National Stockpile.
But even dealing with "regular" flu has proved a challenge in recent years. Because of last year's vaccine shortage (the result of production problems), overall coverage for Americans aged 50 to 64 decreased from 52.4 percent to 28.1 percent, according to this week's issue of the Morbidity and Mortality Weekly Report, a CDC publication. The decrease for those in poor health was less: only 24 percent.
The CDC defended the figures. "Those at highest risk were those that received the vast majority of vaccine," said CDC spokesman Curtis Allen. "That was our objective, and that was a good thing."
This year, the CDC is predicting a supply of almost 100 million doses of flu vaccine, more than enough to meet expected demand.
But not enough to meet true public health need, according to Archer. And, in fact, not even enough to include all high-risk people and the people who come into contact with them.
"We've got to gear up, and be willing to throw away vaccine each year," Archer said. "It doesn't cost that much compared with the cost of illness."
The rationale for universal vaccination comes from the concept of "herd immunity," which posits that with more people vaccinated, less overall virus circulates and people, especially frail people, have less chance of contracting the illness.
But this argument comes on the heels of a study in The Lancet that showed that even with people for whom the vaccine is most recommended (the elderly), protection can be as low as 30 percent.
Public health officials dismissed the significance of those findings. "We've always known they're not 100 percent effective, and we also know that the immune systems of those at high risk have the most difficulty responding," Archer said. "Twenty-five to 30 percent is the low range of effectiveness. Some studies show upwards of 50 percent. That's a heck of a good deal for the cost of a shot."
Perhaps more alarming, problems with vaccine production and distribution highlight cracks in the system that may affect a response to an avian flu pandemic, experts said.
According to Michael P. Williams, director of the Division of Communicable Disease Control and Emergency Preparedness in the St. Louis County Department of Health in Missouri, local jurisdictions do have plans for avian flu, but they're on paper only.
"We're in pretty good shape on paper, but that's not enough," he said.
"It does point to how critical it is to build public health infrastructure in this country," added Dr. Nancy M. Bennett, deputy director of the Monroe County Public Health Department in Rochester, N.Y. "We are in a situation where much of the infrastructure has been eroded over the last 10 years. This country must invest in that infrastructure, or we won't be able to respond to any kind of public health emergency."
More information
Visit the U.S. Centers for Disease Control and Prevention for more on the flu and flu vaccine.
Caregivers living in unsafe neighborhoods are at greater risk of having poor blood sugar control, new research suggests.
The study of 147 people found that those who cared for elderly family members with dementia and also felt that they lived in an unsafe neighborhood were at increased risk for poor blood glucose control and related health problems.
Each fact on its own did not impact glucose levels, the Duke University researchers note. It took the combination of those two factors to influence glucose problems.
"I think it's important that health care providers take into account not just single risk factors but the joint impact of multiple factors on health. We typically focus on issues such as depression or anxiety among caregivers, not on the combination of factors. But that's not the way the real world works," Dr. Redford Williams, a Duke professor of psychiatry and one of the study authors, said in a prepared statement.
This is the first study to investigate the combined effect of neighborhoods on the stress already experienced by people who are caregivers to people with dementia.
"We know that caregivers are under a significant burden of stress," added study lead author Beverly Brummett, assistant research professor in medical psychiatry at Duke.
It's not clear how unsafe neighborhoods might influence blood sugar. "We didn't find any direct evidence that it was a caregiver's perception of stress that mattered, or things like [lack of] social support," Brummett said. "Although we couldn't verify this, we think that people who fear crime in their neighborhood may be less likely to leave the house for health care, [to] pick up prescriptions or even to get some exercise," she added.
"We have to find ways to ensure that caregivers who live in neighborhoods they perceive as dangerous have adequate health care access and follow-up. There may also be strategies for helping them cope better with their concerns about crime. Any change that helps people deal better with health issues would be beneficial," Brummett said.
The findings appear in the September/October issue of Psychosomatic Medicine.
More information
The Family Caregiver Alliance has advice about self-care for caregivers.
