Call it the Ebola effect. A lot more Marylanders are volunteering for that shot in the arm that may protect them from the flu this year.
Flu vaccinations were up about 30 percent in September around the state to more than 95,000, according to early data reported to the state by pharmacies, health departments and some doctors' offices.
Officials can't explain the rise, but say some people might have been motivated to roll up their sleeves by all the publicity given to the small number of Ebola cases in the United States stemming from a deadly outbreak in West Africa.
Public health officials have been using Ebola to remind people to get flu shots, said Dr. Joshua Sharfstein, the state health secretary.
"It's good seeing more influenza vaccination than last year," he said. "Obviously, what people read about Ebola causes anxiety, and one productive way to handle that is to realize there is much more present infectious disease out there like influenza."
The Anne Arundel Health Department center in Glen Burnie has seen a steady trickle of patients in recent weeks.
"I'm not worried myself about Ebola, but maybe some people think there is a little Ebola juice in there," said Wendy Greenwaldt, 60, of Glen Burnie, who came to the local center with her boyfriend Bill Bogdan, 72, of Pasadena, for flu shots.
Greenwaldt said she just wanted to fend off the flu and potential complications because she has health problems.
Doug Dehner, 73 of Severn, with his wife Carolyn, 69, said he thinks more people get vaccinated every year because they are now "more accepting of preventive medicine." And an aging population wants to protect themselves from as many maladies as possible, he added.
Sharfstein and others say there is little chance average Americans will contract Ebola and they are much more likely to get the flu.
"Flu season is the biggest threat to public health in the U.S.," not Ebola, Gov. Martin O'Malley said.
O'Malley encouraged Marylanders to get flu shots in part because it may help eliminate unnecessary Ebola scares. In its earliest stages, Ebola infection can produce nonspecific, flu-like symptoms.
Preventing the flu also can free up hospital resources for legitimate Ebola concerns, the governor said.
But the deadly Ebola virus and the West African outbreak that's killed thousands remain on people's minds. A Gallup poll released this month found the virus among the top 10 issues facing the country, behind the economy, dissatisfaction with government, unemployment and others.
Yet, so far, only one person has died from the disease in the United States, and he traveled from Liberia with it, while seven Americans have survived it after treatment here.
Historically, the flu is far more deadly here, medical authorities say.
It's believed to kill thousands every year, mostly old, young and those with underlying health conditions, though complications mean otherwise healthy people may need hospitalization and die, said Andrew Pekosz, an associate professor of microbiology at Johns Hopkins University Bloomberg School of Public Health.
"For average U.S. citizens, of the things they should worry about in terms of infectious disease, influenza should be close to the top," Pekosz said. "It's easy to protect from influenza by getting a vaccine this time of year. The perception is it's not that bad of a disease or that the influenza vaccine isn't a good vaccine. Both of those are wrong."
About half of Americans typically don't get a flu shot, according to the U.S. Centers for Disease Control and Prevention, which also reported that there are more than 150 million doses available this season.
Pekosz said people seem to have "accepted the level of risk and the anxiety is somehow reduced."
There also haven't been many cases reported yet this year, though the flu usually peaks in December and January. Pekosz said officials typically get the formulations right, making the vaccine effective in warding off the unpleasant, and sometimes dangerous, illness.
This year, the vaccine has at least three of the strains expected to be circulating. One of those strains was confirmed in the first case of flu recorded in the state earlier this month in a Washington-area adult. Most cases are not lab-confirmed or even reported because sufferers do not seek medical care.
There is no Ebola vaccine, though testing is underway in Maryland and elsewhere on some promising candidates.
Such a vaccine would primarily benefit West Africa, where Ebola has killed close to 5,000 or about half of those infected. There have been only two cases of Americans contracting the disease inside the United States and both were health care workers who cared for an infected patient from Liberia. Both recovered and have been declared free of the virus.
Pekosz and others hope the cases would spur people to take viruses seriously and get the vaccine that is available for the flu.
He said novel viruses tend to get the attention: A scare in 2009 with a flu strain heavily affecting children — called H1N1 but known as swine flu — motivated millions across the country to get vaccinated. It caused long lines at health centers, which were largely controlling a specially manufactured vaccine, and ended with fewer people than usual contracting any flu.
Local health departments report that they are seeing more people for immunization this year but couldn't explain why. Michael Schwartzberg, spokesman for the Baltimore City Health Department, said officials gave out more than 100 vaccinations at six clinics for seniors this year, double the number last year. The vaccine was handed out later in the season last year, he said.
In Anne Arundel County, the health department reported that about 2,000 more parents consented this year than last year for their children to be given the nasal spray flu vaccine in school, an uptick of about 15 percent. Spokeswoman Elin Jones said a factor could be concern not over Ebola, but an uncommon strain of enterovirus now circulating and affecting primarily children with asthma.
She said the subject had gotten a lot of attention on the department website. There is no vaccine for enterovirus.
Baltimore County's health department will be offering a drive-through flu shot clinic from 8 a.m. to noon Sunday at the Community College of Baltimore County, Essex Campus. Call 410-887-BCHD or visit baltimorecountymd.gov/health.
Dr. Jacqueline Douge, pediatric medical director for the Howard County Health Department, said that at the county's first health clinic, close to 1,000 people got a flu vaccine, which she said was a "good turnout."
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She couldn't say if Ebola played a role, or if public health officials had done an effective job in relaying the importance of the flu vaccine.
While Ebola can only be transmitted by coming into contact with the vomit, blood and other bodily fluids of highly sick patients, the flu virus passes easily in the air through coughing and sneezing and through contact with door handles and other contaminated surfaces, Douge said.
The most important things people can do to prevent major illness is hand washing, covering coughs with a tissue or sleeve, staying home when sick — and getting a flu shot.
"If people are encouraged to go out and get vaccinated, good," she said. "They are more likely to contract the flu than Ebola. … People do tend to get excited about something novel."
Baltimore Sun reporter Scott Dance contributed to this article.