Stuck Without a Flu Shot

Most years, Ayisis Clarke would be halfway finished with her Christmas shopping by now. But this year she’s afraid to go to the mall because she hasn’t yet had her flu shot.

“I don’t feel safe unless I’m protected, so I’ve been staying home,” said the 27-year-old Los Angeles woman, who is pregnant and who suffers from severe asthma. Like millions of other high-risk patients and seniors, she has not been able to get vaccinated because of delays in getting flu shot supplies to clinics, pharmacies and employers. And the delay has been more than just an inconvenience for Clarke: Two winters ago she caught the flu and her asthma turned to pneumonia, landing her in the hospital for three weeks.

“If I get the flu, I could die,” she said. “And this time, so could my baby.”

Federal and local health officials have attempted to quell such fears by insisting that there is no vaccine shortage--just a delay in shipments. They say that new vaccine supplies already are arriving and that there will be enough vaccine for most people to get their flu shots before flu season hits.

But health professionals on the front lines remain skeptical of these promises. For them and many older Americans, the chronically ill and others at high risk for flu-associated complications, the situation is too much like this year’s presidential election: a race cut too close. A spokesman for the federal Centers for Disease Control and Prevention in Atlanta said that in his 21 years at the agency, he cannot remember when the vaccine arrived so late, so close to flu season.

In prior years, suppliers have shipped all the flu vaccine by October. And the people who were most at risk--and who wanted a flu shot--typically had received them by November.

This year, however, flu vaccine manufacturers had shipped just 70% of U.S. orders by late November. The remaining 30% is supposed to arrive this month, according to the CDC. That will bring the nationwide supply to 75 million doses; last year, 74 million flu shots were issued nationwide.

While most health officials would not use the word “crisis” to describe the situation, it “is not too strong a word,” said Dr. Debra Lerner, a family physician at the Pediatric and Family Medical Clinic in downtown Los Angeles. The clinic serves several thousand patients and had yet to receive a single dose of the vaccine by late last week.

“This is too close,” Lerner said. “People have a tendency to play this down and say, ‘Oh, it’s just the flu.’ People die from the flu. It’s very serious.” The flu is associated with about 20,000 deaths annually, according to the CDC.

Also concerned is Richard Mendoza, owner of Adriana Elderly Care Home in Mission Viejo. About 60% of the facility’s 36 residents have not received a flu shot, and neither have most of the employees. Many residents are in poor physical health and suffer from some form of mental impairment. “Our residents are already very fragile,” he says. “Their immune systems are weak.”

If the flu season arrives earlier than usual--say, by mid-December--Mendoza and others worry that the delay in the vaccine’s arrival could spell trouble for people who have not been able to get a flu shot or who got one too recently to fully benefit from the vaccine. But health officials say that scenario is unlikely because it does not appear that the flu season will arrive early or that this year’s strain will be any worse than usual.

Though sporadic cases of influenza start showing up in October around the country, the flu season doesn’t usually hit hard until late December, usually peaking in January, said Dr. A. Nelson El Amin, medical director for the Los Angeles County Department of Health Service’s immunization program. After receiving the vaccine, it takes about two weeks for your body to produce enough immunity to fight off the virus. Some experts say it takes a bit longer to achieve maximum immunity.

Based on this pattern, officials say, you should be safe if you get your immunization this month. “Even if you get the vaccine in late December or early January, that’s still better than not getting it,” said CDC’s Fallis. “Sometimes the flu season stretches into March.”

Lerner agrees that getting a shot late is better than not at all, but adds: “We’re playing with fire. We’d better hope the season hits late.”

As of last week, 20 states had reported sporadic cases of the flu. Two other states, Texas and Kentucky, reported more widespread regional outbreaks, according to information collected by the CDC. No cases of the flu had been reported in California.

And California health officials insist that the problem should resolve itself over the next several weeks. The state Department of Health Services said last week that by Tuesday, all county health departments should receive their full supply of the vaccine. However, that public supply accounts for only about 10% of California’s total vaccine supply. Doctors, hospitals and other medical organizations order their vaccines from private companies, and an estimated one-third of those orders are still outstanding.

While the vaccine supply trickles in, health officials urge that those with the greatest need get their shots first. That includes people over age 65; with immune disorders, such as asthma, diabetes or cancer; and women in their second or third trimester of pregnancy, who could go into preterm labor if they came down with the flu. The second priority goes to health-care workers because of their daily contact with people who are at risk, and people age 50 to 65.

To find out about the availability of the vaccine, the health department’s El Amin recommends that people keep in contact with their doctors or other providers and watch for flu clinics at pharmacies, supermarkets and other locations.

Meanwhile, the continued scarcity is driving up demand. People who usually would have received a flu shot from their doctors are flooding clinics because their doctors don’t have the vaccine.

In a typical year, according to El Amin, about 8% of the county’s seniors will receive their shots at county health clinics. But doctors and officials at residential care facilities have been referring patients to county clinics because they didn’t have the vaccine in hand.

“We’re seeing 50% to 100% more people than normal at clinics already in short supply,” he said.

As a result, many scheduled flu clinics have been canceled. Sylvia Puente, public health nurse for the Whittier Health Center, said her clinic canceled three out of eight scheduled clinics. At clinics where the shots have been offered, people have sometimes waited in line for hours.

Hermina Beck, of Camarillo, is frankly tired of the lines. The 79-year-old has been to three flu clinics and still hasn’t had her flu shot. “Each time the line went on for blocks, and I knew the supply would run out before they got to me,” she said. The waiting is hard on her. Beck suffers from neuropathy, a chronic pain condition, in her legs. “People who are well can stand in line and wait. I can’t.”

Beck’s friend, Mabel Bell, 92, also of Camarillo, stood in the same lines as Beck. But after waiting in the lines, she came home and spent hours on the phone and found a clinic in Oxnard where she was able to get the shot.

“The whole thing was a fiasco,” said Bell, who has gotten her flu shot faithfully every October since 1958. “It will be nice to get something else on my mind.”

For those who still need a flu shot, El Amin recommends patience and persistence, which is just what Clarke, the Los Angeles woman with asthma, is practicing. She checks in regularly with the clinic where she goes for asthma treatment and the hospital where she goes for prenatal care. She hears the same thing from both: She needs the shot, and the supply should be here any day.