Scarlet fever

ATLANTA -- If you're like most people, getting a shot is something you dread. Just thinking about it is scary: A cold-handed stranger grabs your arm and jabs a long, thin needle into your skin. Ouch!

Still, despite the pain, a lot of people are more than eager to get shots lately--flu shots, that is. Around the nation, lines of people snaked through clinics, pharmacies, and doctors' offices to receive the vaccine.

At some sites in New York City, lines formed at 2:30 in the morning. At one city clinic, police were called to quell a crowd of angry elderly people who were denied the shot after the clinic ran out of the vaccine. "[They] can't do this to people, especially the elderly. It's criminal!" a New York Times reporter overheard 77-year-old John Gruen shouting.

In New Jersey, officials told of people in wheelchairs and others carting oxygen tanks waiting for hours to get a shot. In California, two women collapsed on line. A third woman, who had spent hours waiting, hit her head in a fall and died.

In Aurora, Colo., police reported that 620 doses of the vaccine had been stolen from a pediatrician's office. Some pharmacies reported price gouging by distributors. A pharmacist in Wichita, Kan., for example, told reporters that distributors offered to supply a vial of 10 shots of the vaccine for $600. The normal cost is $80.

Flu Shot Freak-Out

Why all the frenzy for a flu shot? On October 5, Chiron--one of two flu vaccine suppliers to the United States--announced that it would be unable to ship the 48 million doses that it promised because of problems at one of its plants. That's almost half the nation's expected supply. Last year, 83.1 million doses were distributed in the United States.

Health and Human Services Secretary Tommy Thompson said that the government is scouring the world for supplies and that an extra 2.6 million doses will be available in January. But with flu season beginning this month, that may be too late for many people who need to get a shot.

The Centers for Disease Control and Prevention (CDC) in Atlanta has advised health-care professionals to dispense the available shots to those most at risk of suffering complications from the flu: people 65 and older, children 6 to 23 months old, people with chronic illnesses, pregnant women, and health-care workers in contact with patients.

Some towns are getting creative. In Bloomfield, N.J., for example, there's a flu shot lottery for the 300 available doses there. Only high-risk patients are eligible. "We are hoping the public sees this as the most fair and equitable way to do this" Trevor Weigle, Bloomfield's health director, told reporters.

Nothing to Sneeze At

According to the CDC, the flu (short for influenza) can be a killer. It kills an average of 36,000 people a year in the United States and puts about 200,000 in the hospital. Most of those people--about 90 percent--are elderly.

The disease is caused by the influenza virus, which infects the respiratory tract (nose, throat, and lungs). Flu season typically runs from November through March. The disease is highly contagious and spreads through droplets when a person coughs or sneezes.

The best way to prevent the flu, of course, is to get the vaccine. But for those unlucky people who can't get flu shots, the CDC recommends that they avoid contact with sick individuals, wash their hands regularly, and do not touch their eyes, nose, or mouth. For the really unlucky people who do contract the flu, the CDC advises: Stay home! Avoid spreading germs.

The good news is that health officials say this will be a milder flu season than once feared. "The Southern Hemisphere [where winter is just ending] saw a moderate year, so we're hoping we will too," said CDC spokesperson Dave Daigle.

However, the flu is unpredictable, warns the CDC. Influenza strains are constantly changing, so it's not unusual for new strains of the influenza virus to emerge at any time of the year.

More good news is that tests indicate that the flu strains now circulating match those in the vaccine. Researchers guess which strains are most likely and develop the vaccine several months before the flu season begins.

Health officials say something needs to be done to prevent a vaccine shortage from happening again. Some say the U.S. government should oversee the nation's flu vaccine supply, rather than relying on private pharmaceutical companies. Others say strict regulations enforced by the Food and Drug Administration (FDA) make it too difficult for companies to produce vaccines. Expensive equipment and strict quality-control requirements make it hard to profit from developing vaccines.

A Shot at the Shot

As health officials debate the best way to prevent future flu shot fallout, people continue to queue up for a chance to get the shot. Although panic might not bring out the best in some people, others find a way to make the best of a bad situation. Cecile Windels, of Stamford Pediatrics in Connecticut, told The New York Times, "Some people are being rude and panicking, but there is good in many others. We had a ... woman with four children, two of whom have chronic illnesses. She said, 'I'll give my two [children] who need it most the shots, and I'd like the other two doses to go to somebody who really needs it.'"

Time Trip

In 1918, a vicious strain of flu swept through the world--a flu so virulent that it killed more people than did the guns of World War I (1914-1918). The disease struck suddenly and violently, wiping out babies in their cribs, old people in their beds, and young men and women in the prime of their lives. No one was safe. Everyone was terrified.

Experts estimate that the worldwide death toll reached more than 20 million. Some 1 billion people were afflicted with the disease--half the world's total population.

Because Spain was the first country to report on the flu outbreak, the scourge became known as the "Spanish flu." (The Spanish, however, preferred to call it the "French flu.") The disease was so rampant in Spain that 8 million people died in one month.

In the United States, 20 million Americans became infected and more than 500,000 died. Even President Woodrow Wilson suffered a bout while in Paris negotiating the Treaty of Versailles, which formally ended the war.

The disease particularly ravaged war-torn troops. Victor Vaughn, acting surgeon general of the U.S. Army, remembers visiting sick soldiers at Camp Devens, near Boston: "Every bed was full, yet others crowded in. The faces wore a bluish cast; a cough brought up the bloodstained sputum. In the morning, the dead bodies are stacked about the morgue like cordwood."

Doctors tried everything to combat the disease, but to no avail. Many towns and cities closed theaters, churches, and other public places. Ordinances made it illegal to spit, cough, or sneeze in public. In New York City, those who did so faced fines of up to $500. When people ventured outdoors, they covered their mouths and noses with gauze masks. (See photo.)

The deadly disease disappeared almost as fast as it spread. Within 18 months, the pandemic had passed. Scientists still don't know the exact cause of the Spanish flu or why it was so lethal, and many public health officials live in fear that a similar strain will one day strike again.

History Quest

People may be clamoring to get vaccinations now, but when this man invented them in the late 18th century, the British government had to force people to get them. Called the father of immunology, this man noted that people who contracted cowpox did not get the disease's deadly cousin, smallpox. He inoculated an 8-year-old boy with cowpox and then exposed him to smallpox to test his theory. The boy did not get sick. The vaccine eventually won people over, and the world was declared smallpox-free in 1980. Who was this man?

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Get Talking

Ask students: What is the flu? Have you ever gotten a flu shot? Tell students that there is a shortage of the flu vaccine in the United States this year. Ask them what effect that might have on the country.

Notes Behind the News

* According to the Centers for Disease Control and Prevention (CDC), about 5 percent to 20 percent of the U.S. population gets the flu each year. Symptoms of flu include: fever, headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose, and muscle aches. Gastrointestinal symptoms, such as nausea, vomiting, and diarrhea, are much more common among children than adults.

* Some of the complications caused by the flu include bacterial pneumonia, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes. Children can develop sinus problems and ear infections.

* The flu spreads in respiratory droplets caused by coughing and sneezing. It usually spreads from person to person, though occasionally a person may become infected by touching something with the virus on it and then touching their mouth or nose.

* Adults may be able to infect others beginning one day before experiencing symptoms and up to seven days after getting sick. That means that you can give someone the flu before you know you're sick as well as while you are sick.

* There are two types of flu vaccines: The flu shot is an inactivated vaccine (containing killed virus) that is given with a needle. The nasal-spray flu vaccine is made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for "Live Attenuated Influenza Vaccine"). About two weeks after vaccination, antibodies that provide protection against influenza virus infection develop in the body.

Doing More

Have students do further research on the 1918 flu pandemic. Ask students to make a list of the factors that contributed to the rapid spread of the disease.

Link It

* Centers for Disease Control and Prevention: http://www.cdc.gov/flu/

* The American Experience; the 1918 Influenza, from PBS: http://www.pbs.org/wgbh/amex/influenza/

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