H1N1

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Flu, Part Two: ‘No One Is Really Safe’

More on my search to understand why it’s only this year that all adults and children alike are being told to get flu shots, when we’ve long known that flu kills tens of thousands of Americans each winter.
(My first post on this topic was here, and this is Nathan Alden Robinson of Newton, a talented 15-year-old boy who died of flu complications in 2008.)

I spoke first with Dr. Thomas Sandora, a staff physician in infectious diseases at Children’s Hospital Boston.

“The impact and severity of flu are often underestimated,” he told me. Many group it with the common cold. Concerns traditionally centered on people with higher risk of bad outcomes: infants, children under 5, elderly people and those with underlying diseases.

“The pandemic last year really opened a lot of people’s eyes,” Sandora said. “They began to realize through reports that healthy people can also get very ill or die from flu, including school-age kids, pregnant women and healthy adults with no underlying diseases.”

Part of the reason for the change in vaccine recommendations, Sandora said, is that health authorities thought the message should be clearer, that “We can’t really predict who’s going to do badly when they get flu, and even if you’re healthy, you could have a very bad outcome.” It was just “growing experience over time that no one is really safe from the flu,” he said.

Though the total number of H1N1 flu deaths relative to those infected was not much higher than with a typical seasonal flu, Sandora said, there were more deaths among children and pregnant women than usual. And the media coverage of flu was suddenly huge. Plus health authorities emphasized the message that “the vaccine is safe, effective and easy to get. There’s really no reason not to be vaccinated,” he said.

Everything Dr. Sandora said rang true, but I found myself badgering him a bit: Aside from H1N1, what really changed? The change began before H1N1, in 2008. Why? And why, really, had we been so cavalier before, when the giant death toll was long known?

Perhaps, I thought, I needed to talk not with a doctor in the trenches, however expert, but with someone who was inside the decision-making bodies that makes the vaccine recommendations. So I did.

(Next installment tomorrow: The CDC spokesman on flu and a leading academic expert who’s on the international panel that makes decisions on flu.)