Flu shot time is now, officials say

It is not yet flu season, but it is now officially flu shot season.

Thomas Frieden, director of the Centers for Disease Control and Prevention, rolled up his sleeve at a news conference in Washington on Thursday to emphasize the need for more Americans to protect themselves and the people around them from the common, and potentially deadly, disease.

He didn't flinch as the needle pierced his skin. "I hardly felt it," he said cheerfully.

While Frieden predicted an ample supply of vaccine for the season, which typically runs from October through March, some local hospitals are reporting delays in shipments. Picking a vaccine is also more complicated than it used to be, with experts recommending different vaccines for children, the elderly, and those in between.

Flu shots are now recommended for everyone above the age of six months and are typically covered by insurance. Last year, about 46 percent of Americans were vaccinated, Frieden reported at the event, organized by the National Foundation for Infectious Diseases. He called vaccination of health-care workers "a patient safety issue." Last year, 82 percent of hospital-based health-care professionals were vaccinated.

The shot most Americans will get this year covers the same three virus strains as last year's. Because immunity wanes, people need a new shot each year.

It's too early to know what this flu season will be like, but William Schaffner, a Vanderbilt University infectious disease specialist and past president of NFID, said a colleague had a 90-year-old patient who got the flu 21/2 weeks ago and died. The viruses, he said, are always circulating.

"It hasn't taken off anywhere in the country yet," he said, "but it's out there lurking, ready to strike."

There was a time when no one got a flu shot before October, but pharmacies now have been urging customers to get vaccinated for weeks.

Herb Cushing, an infectious disease doctor who recently became chief medical officer at Temple University Hospital, said the idea that people should wait until October to maximize protection is "totally out the window now." The shot takes two weeks to take effect and it is never known when flu season will start, he said.

Temple got the 2,500 vaccine doses it ordered, but David Pegues, medical director of health-care epidemiology, infection prevention and control, at the Hospital of the University of Pennsylvania said his system was told to expect delivery delays of vaccine it ordered for employees and patients. Penn Medicine, which requires employees to get the shot, has gotten half of its 50,000 doses so far. For now, it is prioritizing patients who are at risk for flu-related complications, Pegues said.

"Everybody who really wants a vaccine ought to get able to get it," he said.

Two big vaccine producers, Sanofi Pasteur and GlaxoSmithKline, have told customers to expect delays. A Sanofi spokesman said Thursday that it "will take beyond September to get back to our initially planned supply timing," but the company expects to deliver all of the 65 million doses that have been ordered.

Anna Padula, a GSK spokeswoman, said her company plans to ship the "majority" of the 28 million to 33 million doses ordered by mid-October, but does not yet know the "full impact" on supply.

Depending on their age, patients this year will have the choice of a nasal spray vaccine or shots that protect against three strains of virus (trivalent) or four (quadrivalent). There are special shots for people who are allergic to eggs, which are used to produce most flu vaccine. And people over 65 or those with compromised immune systems can consider high-dose vaccines.

The CDC recommends the spray for kids ages 2 to 8, when it's available. After that, it's no better than the shot, but is OK for people up to age 49. Pegues said it is an option for people who do not like needles.

Infectious disease experts said the high-dose vaccine provides better protection for older people. The CDC has not yet specifically said it prefers the more potent vaccine.

There's less agreement about trivalent vs. quadrivalent vaccines.

The extra coverage in the quadrivalent shot is for a strain of influenza B, which tends to be milder than A. "I'm not convinced of the greater clinical benefit of that," Pegues said.

Neither is Cushing, but he expects the quadrivalent version to gain ground. "Doesn't four sound better than three?" he asked.

Ellen O'Connor, medical director of University Health Services at Thomas Jefferson University, thinks she got a "brief but very intense" case of influenza B last spring. She ordered quadrivalent shots this year. "We really believe that the extra coverage was worth it," she said. The quadrivalent shots cost about $6 more.

Because of the delays, however, Jefferson is taking what it can get, which is "mostly" quadrivalent.

The CDC and NFID this year are recommending that seniors get a new shot to protect against one of the deadly complications of flu: pneumonia. Those 65 and over are recommended to get a conjugate shot in addition to the widely used polysaccharide vaccine. Both are one-time vaccinations.

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@StaceyABurling