[Sarasota] Schools brace for a flu-filled fall:

http://www.heraldtribune.com/article/20090803/ARTICLE/308039997/2055/NEWS?Title=Schools-brace-for-a-flu-filled-fall

Some districts push vaccines, but they don't target swine strain

By Anna Scott

Published: Monday, August 3, 2009 at 1:00 a.m.
Last Modified: Saturday, August 1, 2009 at 10:50 p.m.

With school starting in weeks but a swine flu vaccine still months away from being widely available, school districts are making a big push to give seasonal flu shots.

In past years, as few as 10 percent of students received seasonal flu shots. This year, Charlotte schools hope to vaccinate 50 percent of elementary students by offering the vaccine in schools. Alachua County is pushing for 70 percent, also through a school drive. Manatee County school officials, fearing that closings would be necessary if a quarter of staff becomes ill, is considering for the first time buying seasonal shots for all teachers and staff.

The districts hope the vaccinations provide some protection against the new virus or at least mitigate an expected spike in the rate of sickness.

There are no state requirements, meaning each district is on its own. Some, including Sarasota, are making no extra efforts to inoculate students.

Despite the push by some districts, it is unlikely that mass inoculation with seasonal flu vaccine will prevent what health experts foresee as potentially broad-scale outbreaks of the swine flu virus at schools.

The mingling of students in school and cooling weather annually leads to a rise in flu cases. The Centers for Disease Control and Prevention predicts up to 40 percent of Americans could contract swine flu, also known as the H1N1 virus, in the next two years.

"We're sort of caught in a public health dilemma because on one hand we want everyone to get vaccinated because of concerns about flu this fall but we don't have the right vaccine available," said Dr. Glenn Morris, director of the Emerging Pathogens Institute at University of Florida.

The push to give students seasonal flu vaccine points to limited options facing schools and health officials. Unlike the seasonal flu, the swine flu has affected those ages 5 to 25 at rates four times higher than older age groups, according to the CDC.
While the seasonal flu vaccine will be available in September, a swine flu vaccine is still undergoing clinical trials and will not be widely available until October.

There is no evidence the seasonal shots will protect against the new virus. But some doctors say the shots might offer some degree of immunity and could have a positive effect on potential mutations of the H1N1 virus as it mixes with seasonal strains.

Even if the seasonal vaccine proves useless against H1N1, cutting down on cases of seasonal flu will at least hold down infection and absenteeism rates that could reach 30 percent in schools this fall and winter, health experts say. Plus, knowing whether a case of flu is seasonal or of the new H1N1 variety can help doctors determine treatment.

"The hope is that the seasonal flu vaccine may protect and may create antibodies that will help ward off or make H1N1 swine flu less intense or lessen the symptoms," said Donna Olson, nursing director for Charlotte County health department in charge of the vaccination campaign. "We don't know that, but that's the hope."

Morris, who is helping with the Alachua County vaccination campaign, said a crossover effect is "theoretical only," but that "there is a better chance we will get a little bit of effect with seasonal flu vaccine than with nothing."

The effort has several challenges, not the least of which will be convincing students to get vaccinations. Few parents and students are used to getting them. A previous effort in Alachua County schools, for example, reached only 20 percent of the population. Students need to return parent permission slips, and several doctors said parents unfamiliar with seasonal flu shots may be skeptical of them or believe them to be unnecessary.

This year's seasonal flu vaccine is being concocted to protect against the three types of flu strains expected to circulate. Even a slight genetic mutation in the makeup of those strains over the course of flu season will likely make the vaccine only 5 to 25 percent effective against the new strains.

The new H1N1 virus is a whole new type of virus, meaning the chance that the seasonal flu vaccine will protect against it is extremely low, said Dr. John Bradley, director of infectious diseases at San Diego Children's Hospital, and a member of the infectious disease committee of the American Academy of Pediatrics.

"If there is some protection we would be very lucky and only at the end of next year, after the CDC analyzes the data, will we be able to tell," Bradley said. "I wouldn't expect it at all."

Vaccinating children for seasonal flu will also help target treatment if those children later get swine flu. If a vaccinated child gets the flu, doctors will know it is likely H1N1. One of the strains of seasonal flu is resistant to the antiviral drug Tamiflu, which has shown to be effective in treating the new H1N1 strain. Because the rapid flu tests commonly used in doctor's offices do not test for swine flu, a doctor could end up having to give a child more than one kind of drug for an unknown case of flu.

Neither the CDC or state health department officials said they were coordinating a bigger-than-normal push for seasonal flu shots this year, because they make a big push every season. Seasonal flu can be deadly, especially for children with complications such as asthma and diabetes.

The CDC recently strengthened its recommendation that children between the ages of 6 months and 18 years receive flu shots, but that decision was made in 2008, before swine flu appeared.

Other than seasonal flu shots, local school districts plan to continue the practices they started in the spring by cleaning classroom surfaces with virus-killing products, emphasizing hand-washing and instructing teachers to be on the lookout for sick children.

"Our message is that parents should be prepared," said Sherri Reynolds, supervisor of pupil support services for Sarasota County schools. "We are going to continue making sure that sick children, anyone with a fever, be sent home."

But even the best efforts to quarantine ill children could fail, making a seasonal flu shot the next-best precaution, said Dr. Carola Fleener, a Sarasota pediatrician who tracks flu cases for the state.

"Mom might send a kid off to school in the morning and by mid-afternoon could have a raging cough and fever. Meanwhile the kid went to school and exposed 30 people," Fleener said. "Put that together with the bad economy, with parents under pressure not to be missing work, and the kid gets pushed into the school system. The schools are going to have their hands full trying to keep these kids home when they're actually sick."

This story appeared in print on page A1
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