Flu season may bring rise in ER visits over Ebola fears

As the flu season gets underway over the next few weeks, public health officials have been preparing for a unique set of challenges. Some people are still looking for a last-minute flu shot due to delays in immunization shipments from two manufacturers, and those experiencing fever, aches, and fatigue from the flu may be more likely to head to the emergency room this year due to concerns about the Ebola virus, which causes similar symptoms.

“I’m speculating, but there’s no doubt in my mind that more people will be hitting the emergency departments this flu season suspecting that they or someone close to them has Ebola,” said Dr. Eugene Litvak, president and CEO of the Boston-based non-profit Institute for Healthcare Optimization.
Some people who normally don’t get a flu shot — only 53 percent of Massachusetts residents were immunized last year — may seek one out this year spurred by fears of false alarms concerning Ebola. “Friends have told me they’re going to get vaccinated this year because of their Ebola fears,” Litvak said, often worried that they’ll be stigmatized by friends and co-workers if they come down with Ebola-like symptoms.
Dr. Benjamin Kruskal, chief of infectious disease at Harvard Vanguard Medical Associates, said he’s heard “occasional comments” from patients asking about flu vaccinations in the context of Ebola, though he’s not certain this led to an uptick in the seasonal immunization.
(Harvard Vanguard made headlines last month for sending a patient suspected of having Ebola to Beth Israel Deaconess Medical Center in Boston; the patient, who had recently traveled to Liberia, was not found to be infected with the virus.)
Complicating matters, immunization shipments were delayed by two of the biggest manufacturers, which left physician offices, clinics, and pharmacies with a smaller supply during September and October, a peak time for administering the vaccine.
Sanofi Pasteur, which plans to fill orders for 65 million doses of Fluzone influenza vaccines this year, said in a statement that it informed customers about delayed shipments including its quadrivalent vaccine, containing four strains of viruses, and trivalent vaccine, which contains three strains. “We shipped the majority of doses in October but some of our doses will continue to ship into November,” the statement said.
GSK, which also manufacturers flu vaccine, attributed its two- to six-week delay in shipments to “production difficulties” experienced at one of its facilites in Quebec. “Vaccines manufacturing is an inherently complex undertaking,” said GSK spokesperson Robert Perry. “When batches fail quality-assurance tests at any stage of the process, we discard them and essentially start over.”
He added that most of the vaccine doses that were pre-ordered months ago have been shipped or delivered.
“It was a bit of a hiccup in our practice,” Kruskal said. “Normally we do most of our immunizations in early October, but this year we had to push them to the end of the month.”
The Boston Public Health Commission received complaints from a handful of providers about vaccine shortages. “A few places had a little trouble getting it but they have plenty now,” said Dr. Anita Barry, director of the Infectious Disease Bureau at the city health department.
But places may not have all of the varieties of flu vaccines that consumers may request such as a high-dose shot that appears to be more effective in seniors and a nasal spray containing a live attenuated form of the virus that the Centers for Disease Control and Prevention recommends for children ages two to eight years old.
Target pharmacies in the Boston area have dwindling supplies of Sanofi Pasteur’s high-dose Fluzone vaccine and were alerted last week by the manufacturer that they won’t be able to supply any more for the season. “We have a few doses left,” said Hannah Lupinacci, pharmacy manager at the Boston South Bay Target store, “but we’re running out of our inventory.”
The pharmacy typically gets flu vaccine shipments through January and often experiences a surge in customers coming in for flu shots after the season gets underway in December, she added.
An August study published in the New England Journal of Medicine found that the high-dose flu shot is 24 percent more effective at preventing flu in people over age 65 compared to the standard-dose shot, but Barry said seniors should not skip their vaccination this year if they can’t get the higher dose.
“The CDC hasn’t recommended a preference for high dose over regular dose for seniors,” Barry said. “It’s far more important to get vaccinated with any available immunization than to delay past the start of flu season.”