Scrambling For Shots

On Thanksgiving, 20-month-old twins Dezmond and Diego Huckabay of Pueblo, Colo., were happy, playful and "full of pumpkin pie," according to their father, Brian. Six days later, Dezmond was dead and Diego was in a hospital ER, both victims of the influenza outbreak that has reached epidemic proportions in two dozen states, killing at least 25 children and an undetermined number of adults.

As frightened Americans waited in long lines last week for influenza vaccines that were in painfully short supply, health officials across the nation did their best to prevent panic and inform the public about the realities of this year's flu. Influenza hit earlier and harder this season, in part because it "drifted," or mutated, from the bug that the latest vaccine crop was designed to fight. "This mutation has increased the number of susceptible individuals, and that's why we're seeing a lot more disease," says Walt Orenstein, director of the national immunization program at the Centers for Disease Control and Prevention in Atlanta. Despite the severity of the Fujian strain of influenza--it seems to take weeks after the 102-degree fever has broken for the dry cough to subside--this year's outbreak is nowhere near the pandemic proportions of the 1918 Spanish flu that left 675,000 Americans, and some 30 million others, dead. But influenza remains a lethal scourge, killing some 36,000 in the United States each year, most of them elderly, very young or with compromised immune systems.

For reasons epidemiologists don't completely understand yet, Colorado has been hardest hit in this flu outbreak, with 11 children dying so far (the state doesn't keep a running count of adult flu mortalities, so the full toll won't be known until officials review death certificates in several months). Influenza first popped up in October in Fort Collins, in the northern part of the state; by the following month, about 20 percent of the student population at the city's Webber Junior High School had called in sick, forcing the school to cancel its annual band and choir concert. The sudden outbreak has caused a run on flu shots. "The line was out the door and around the corner" at Avista Adventist Hospital in Louisville, Colo., last Thursday, says spokeswoman Tammy Smith. By the end of the day, 900 people had gotten shots.

At least they got them. Late last week federal health officials were scrambling to ship 100,000 adult dosages to combat vaccine shortages from Massachusetts to Maui. Blame simple economics for the shortage: the private companies that make flu vaccines produced 95 million doses for last year's season, but sold only 83 million. So this year they cut production to 83 million doses. As of last week, according to the CDC, about 79 million had been sold, and most of the remaining vaccine was the newly licensed nasal spray FluMist, which is available for use only in healthy patients from the ages of 5 to 49. The shortage has led to a lot of hand-wringing in health circles. "There's not a specific mechanism for public-health authorities to regulate the amount that's made," says Dr. Darshak Sanghavi, a clinical fellow at Children's Hospital in Boston and Harvard Medical School. "It is unclear to me whether we are really going to have any additional vaccine left this year." To make matters worse, this year's vaccination was designed to fight a different strain of the bug, the Panama strain of influenza A, and not the Fujian, which is accounting for about three quarters of current infections.

Health officials have been trying to ration shots to those at greatest risk, while educating everyone else on some common-sense preventive measures: "Respiratory etiquette," advises the CDC's Orenstein, plus frequent hand-washing, since "a number of respiratory viruses are on hands and can stay on hands." Even as he deals with the loss of his son Dezmond, Huckabay, who works as a cook in Pueblo, has made it his personal mission to urge parents to wash their hands--and their children's--frequently. When it comes to this epidemic, every ounce of prevention helps.