By Lubna Abdel-Aziz To add to the fire and frenzy of the election season in the US, a shortage of the flu vaccine is fermenting into a political crisis. How things have changed! It was not so long ago that the vaccine was struggling to gain acceptance with the public. People had to be coaxed and cajoled into getting a flu shot, and now even non-believers are up in arms that supplies are not enough. "Those who under normal circumstance wouldn't be a bit interested in a vaccine, now want it because they can't get it," says Barbara de Baun of the Infection Control Center. That is human nature, after all! Statistics have shown however, that many of us still believe that "a cold is a cold is a cold". In truth the "influenza virus", commonly known as the flu, is serious business. It has killed tens of millions in the past and will decidedly kill again. Both the "cold" and the "flu" are upper respiratory tract infections and share similar symptoms. The cold's "rhinovirus" causes more infections in humans than any other micro- organism, but its symptoms wear off in 3 days. The flu is another matter. How do we know if we have a cold or the flu? Flu symptoms are more severe than those of the common cold, but the most telling is the sudden onset of the flu while a cold tends to come on gradually. If you have a fever that lasts a few days, a headache, fatigue, or severe muscle aches you are to see your doctor. A stuffy nose, sneezing, and a sore throat are indications of an irksome common cold that will disappear in a few days. So what is that dreaded influenza virus! Why is it so dangerous and why is a flu shot essential? History suggests that influenza pandemics (worldwide epidemics) have probably occurred during the last four centuries unbeknownst to us. In the last century alone the flu has visited and revisited the human race extolling a higher price in human sacrifice than war's "blood, toil, tears, and sweat". "The only defence is an offence" and in the mid-20th century scientists were able to curb its incredible appetite. The year 1918, saw the bloodiest and costliest war in modern history to date winding down. They called it The Great War, which took the lives of eight million people, with two million more unaccounted for, as many as all the wars from 1790 to 1913 combined. The world was yet to see a greater catastrophe against which all modern disasters are measured. The severity of that virus has never been seen again. It killed quickly and indiscriminately. Many would feel well in the morning, sickly by noon, and dead by night. It was the great leveller of young and old, rich and poor, strong and weak. The pandemic affected a fifth of the world population. After circling the globe its toll was estimated between 20-50 million. 1918 may have brought peace in the world, it was also the year of the greatest suffering and death known to mankind. "The Spanish flu" goes down as the most devastating pandemic in recorded history. Something had to be done. A new allegiance to science encouraged the medical and scientific communities to create new technologies to define and defeat this deadly illness. It was not until 1940 that the United States Army developed an influenza vaccine with the help of Dr Thomas Francis Jr who had researched chick embryo virus cultures since 1935. In 1945 the first vaccine was commercially available in the US made by injecting the flu virus in chicken eggs. Since then the vaccine has undergone constant improvement because the flu virus is constantly changing. Influenza viruses are divided into types A, B and C. Type A is the most widespread and can infect animals. Sixty per cent of strains are type A, 40 per cent type B which is less common and tends to be less severe and infects only humans. Type C causes mild symptoms and disease, and most people recover in a week or two. Almost every winter, "influenza" visits the human race, and despite a fierce fight, manages to infect 5-20 per cent of the world population, causing suffering, hospitalisation and death. Is a "flu shot" the answer? Because the virus tends to mutate, the influenza vaccine is only 75 per cent effective at either preventing or reducing the severity of the disease. Who then should get the vaccine? Topping the list are children, the elderly (65 and older) and those who suffer from chronic illnesses. Ideal months to be vaccinated are September to November. It takes one to two weeks for the antibodies against the virus to develop. You are at increased risk if you are a caregiver, doctor, nurse, social worker, teacher, etc, or if you are taking care of a high risk patient. If you are pregnant be wary; some studies suggest that pregnant women in the third trimester and the postpartum period are especially vulnerable. We are all at a greater risk from November into March, even the young and the restless. Ideally we should all get annual flu immunisation. Who should not get the vaccine? Because it is primarily made of egg protein, those with severe allergies to eggs should avoid the vaccine for fear of an anaphylactic reaction as well as those who have had an allergic reaction to a previous dose, or have had a previous fever illness. Why is there a vaccine shortage especially in the richest country in the world? Because it is not cost-effective, and manufacturers have deserted its production. Chiron lab in England, suffered a bacterial contamination at their Liverpool plant preventing production of 100 million doses that were earmarked for the US. Some people will die unnecessarily from this setback, as influenza kills 36,000 people annually in the US alone, mostly the very young, the very old, and the very sick. But there is hope. A new vaccine is in the making. The "flu mist", the first made of live virus, is another option that is gaining ground. It is needle free and administered easily by nasal inhalation, and experts say it is a welcome boost to the flu vaccine supply. Louis Pasteur said: "I never think of finding a remedy for a disease, but of preventing it." Such a time is not here. Many diseases caused by viruses have no remedies, certainly not for this rather innocuous virus, with an impact so swift and powerful, once it attacks the human body. It keeps coming and coming like a wolf to a chicken coop demanding its share of victims. During the last century the toll of the flu on the human race was extensive. Prior to the vaccine 20-50 millions fell victim to the Spanish flu in 1918. Post vaccine pandemics include the Asian flu 1957, and Hong Kong flu 1968, which together are responsible for more than 10 million deaths worldwide. Since then several scares have occurred. "Swine flu" 1976, "Russian flu" 1977, "Asian flu" 1997, the "Avian flu" 1997. Continued presence of viruses in birds and their ability to infect humans is an ongoing concern, threatening pandemics at any moment. Until such time as prevention or cure is found, and without a flu vaccine shortage to boot, we are left with what we have always had, our common sense in basic hygiene. It is essential we stay away from those infected. "Coughs and sneezes, spread diseases", we should cover mouth and nose when coughing or sneezing, wash our hands regularly, take responsibility for our health, and take the time to keep fit. "Feeding a cold and starving a fever" has nothing to do with food. Feeding a cold is in reality overlooking symptoms and neglecting treatment. In so doing we feed the cold until it develops into a fever -- a more serious disease -- influenza, perhaps. At the onset of a flu see a doctor, "if you are too smart to see a doctor, you had better be too smart to get ill." Meanwhile we hope and pray that our next epidemic or better still our next pandemic will be one of good health. He that will not apply new remedies Must expect new evils For time is the greatest innovator Francis Bacon (1561-1626)
