Schools, health officials retool flu clinics to offer vaccine injections only

At Medstar Union Memorial Hospital, Karmalla Johnson, medical assistant, gives flu shots to children. (Algerina Perna, Baltimore Sun video)

Fall has arrived — and with it the flu season and those persistent reminders from school, work and elsewhere to get vaccinated.

But protecting children from the flu this year will be a bit more painful. The FluMist nasal spray version of the vaccine popular with needle-averse kids, and their parents, is no longer available.


A task force advising the U.S. Centers for Disease Control and Prevention recommended earlier this year that people not use it after studies found it ineffective. Schools, health departments, drugstores and doctors' offices are now stocking up on the injectable flu vaccine. School flu clinics are being retooled for the more time-consuming, angst-producing shots. And worried parents may bring their children to doctors' offices so they can be there for them.

Paige Matthews cried a bit when she got pricked by the needle this week at MedStar Union Memorial Hospital but soon forgot about the flu shot, said Sharon Robinson, her grandmother.


"It's very important to get a flu shot so you won't get the flu," said Robinson, who brought Paige in and lives with the girl and her mother in Northeast Baltimore. "Now that she's in school, the kids are always sick. They're always touching and sharing."

While influenza vaccination isn't required by schools in Maryland, public health officials and doctors still expect students, who are good at spreading the flu bug, to get vaccinated against the nasty virus that sickens millions across the country every year from early October to late May.

Children are particularly vulnerable because of their frequent and close interactions at school, said Dr. Howard Haft, the state's deputy secretary for public health services.

"It is important for parents to make sure they get their children vaccinated against the flu, a virus that can be transmitted through the air and by casual contact and that still can prove fatal," he said. Although the no-muss, no-fuss nasal spray typically made up just 8 percent of the nation's total vaccine stocks, about a third of children older than 2 were getting it, according to the CDC. Nonetheless, Dr. Tom Frieden, director of the CDC, said there should be an ample supply of injectable vaccine since about 93 million doses already have been shipped, with a total of 168 million expected.

Last season, only 46.6 percent of the U.S. population got inoculated, the CDC found. Frieden urged everyone to get vaccinated by the end of October, especially children and seniors, who have the highest rates of flu complications.

Because there is no nasal spray, two county school systems — Anne Arundel and Harford — either won't offer in-school flu clinics this school year or could significantly scale them back.

In Anne Arundel, the county health department is working with schools to determine how best to offer free vaccinations to students. It's considering evening and weekend clinics for public- or private-school students at community health centers and some schools. The Harford County Health Department, meanwhile, is recommending that parents take their children to their doctor's office or go to one of a few county clinics for students that will be held on evenings and weekends.

The shots take longer to administer than the nasal spray, eating into the school day and staff time, and some parents might not want their children to face a needle without them, said Tiffany Tate, executive director of the Maryland Partnership for Prevention, a nonprofit that works on school immunization programs.

About 100,000 students in Maryland — a quarter of those in elementary school — normally are vaccinated with the nasal spray in school clinics every fall. State health department officials said Wednesday that 19 Maryland localities responded to a department survey that found 68 percent planned to hold school-based clinics.

Tate said she didn't expect parents to abandon the vaccine this year because there is no nasal spray.

"Parents are educated about this and know the vaccine is important," Tate said. "They understand that an injection may be a little less comfortable, but they are committed."

Abigail Bozarth, a spokeswoman for AstraZeneca, parent company of the Gaithersburg-based FluMist maker MedImmune, said the company continues to investigate problems with the nasal spray found in recent seasons, with the goal of returning with a new spray vaccine formulation next year.


Meanwhile, other localities do plan to offer injections to students in school clinics. Howard County will offer shots to all elementary and middle-school students starting Oct. 18; Baltimore County expects to offer clinics at schools with large numbers of students from low-income families, possibly beginning in late October; Carroll County plans to give injectable vaccines to elementary and middle school students in October, November, and December; and Baltimore City also expects to offer clinics in schools, according to Tate.

Schools that plan in-house clinics anticipate sending notices home soon with dates and consent forms.

Veronica Jensen of Parkville already took her 11-year-old and 6-month-old boys to their doctor at MedStar Medical Group at North Parkville for flu shots.

She didn't much care which version of the vaccine her older son, Valentine, received. Baby Soren wasn't old enough for FluMist even if it had been available; it was recommended only for children 2 and older.

"My family has a history of illness, respiratory illness, and once when I got the flu I ended up in the hospital," Jensen said just before a medical assistant, Teresa Schroyer, gave Soren his shot, which the smiling baby didn't seem to notice. "I don't want them to go through that. And I don't want other kids to get sick because my kids aren't vaccinated."

Jensen said she was worried other parents would skip flu vaccination because there was no nasal spray or school clinics were canceled.

Everyone in Heidi Whiting's family will be vaccinated this year, including her 14-year-old daughter, Aniyah Clark, who got a shot Wednesday from the family doctor in Westminster. Whiting works in the intensive care unit at MedStar Union Memorial Hospital and sees pneumonia cases every year, some of them the result of complications from the flu.

She prefers the injection to the FluMist, which was made from a weakened live virus and had a few more limitations on who could use it, including those with weakened immune systems or asthma.

"Flu can be very serious," Whiting said. "Vaccination is good to help stop spread of communicable disease. It's keeping us healthy."

The CDC recommends everyone 6 months and older be vaccinated, though flu vaccines aren't universally effective even when they are well matched to circulating strains. Two seasons ago the vaccine and strains weren't well matched. The dominant strain in the United States mutated a bit after it was included in the vaccine, giving the vaccine far less punch. Several years ago a new strain, H1N1, popped up and required manufacturers to make a new vaccine after the season started.

A manufacturing problem last year with FluMist led to delays and cancellations of in-school clinics and a scramble among parents to get the nasal spray for their children in retail settings.


CDC officials say it's too early in the season to know if this year's vaccination formulations of three or four flu strains will match those circulating, but they and doctors say that vaccines are the best protection against infection. An annual dose can lesson symptoms, even if it doesn't prevent sickness.


Dr. Aaron Milstone, a pediatric infectious-disease physician at Johns Hopkins Hospital, said there have not yet been locally transmitted cases of flu at the hospital. But he said Hopkins treated hundreds of people for complications from the flu last year, including young, healthy people, and some died.

About 20,000 children under age 5 are hospitalized with flu-related complications every year, said Dr. Patricia Whitley-Williams, division chief and professor of pediatrics at the Robert Wood Johnson Medical School at Rutgers University. About 90 percent were not vaccinated.

"I ask parents why they would put their child at risk" by not vaccinating them, said Whitley-Williams, who also spoke at the CDC press event. "Certainly no caring parent would get into car and not belt their kids in. ... This protects your otherwise healthy child."

Milstone hopes the lack of FluMist won't deter parents from vaccinating their kids. Children handle flu shots and all kinds of other shots well, he said.

Other precautions are important, Milstone said, such as frequent hand-washing and sneezing into your elbow. But vaccination "needs to be a priority," he said.

"The vaccine is important and it does save lives," he said. "I don't want to see people's kids in the hospital with severe influenza."

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