Like frostbite, chapped lips and wind-burned cheeks, the common flu has been a part of New England winters for centuries. But until recently, the general demand for winter flu vaccines was never great. As recently as several years ago, the medical community found itself repeatedly pushing vaccinations and was forced to exert great energy into encouraging better awareness of precautions against the flu.
Yet today, many Massachusetts residents face a struggle to obtain a flu vaccination. The Boston Globe reported earlier this month that at many clinics, shipments are used as quickly as they are made available. And this fall, Maxim Health Services - a national provider of flu shots - recorded a 30 to 40 percent increase in demand over the same period in 2003.
This surge in demand may be linked to the appearance of avian influenza. To date, 68 human beings have died of the deadly strain of avian flu, H5N1. An additional 130 people are estimated to be infected. The fatality rate for this flu is dramatically higher than the common flu that affects humans: In bird populations, the flu can kill an entire flock within 48 hours.
Although usually deadly once contracted, the avian flu has not been shown to have the same contagiousness in humans. Virtually all cases of humans infected with avian flu have resulted from direct contact with infected birds. Not a single case has been recorded of humans contracting avian flu from one another.
"The avian flu currently affects only birds and humans who have a lot of contact with birds - particularly butchering them and stuff like that," said Civil and Environmental Engineering Professor Mark Woodin, who specializes in epidemiology.
"The way the avian virus is set up genetically, right now, there have been no documented cases of human-to-human infection," he said, adding that "cases have been traced back to direct inoculation by knives or poultry blood or feathers. People are either cutting themselves and injecting themselves or breathing it in or getting exposed to it in other ways, but it's always from infected poultry."
According to Woodin, the likelihood of the avian flu outbreak turning into a pandemic is tough to predict.
"The big issue is that nobody really knows how likely it is that it will become a pandemic," Woodin said. "In 1977, the whole U.S. was told we were going to be infected by the swine flu, which was very deadly, and we started a large-scale vaccination... and it never developed into anything. People were almost 100 percent sure that it was right on top of us."
Woodin said he "wouldn't be surprised" if some birds with avian flu make it to North America. He emphasized, however, that at this point, much of the discussion revolving around avian flu is speculative in nature.
"We just don't know if this virus will reorganize itself and mutate to become a really lethal person-to-person pandemic strain or whether it won't," he said. "That's the main question, and that's the question that absolutely nobody can answer. We just don't know."
Officials and community leaders are working to prepare their communities for the annual flu explosion, as well as the possibility of more serious pandemic.
Tufts Health Services has struggled to meet the demand for flu shots, initially making them available only to those with high-risk conditions, such as diabetes or asthma. As new shipments arrive, Health Services intends to provide vaccine clinics for the larger population in the coming weeks.
"They are shipping [the vaccine] in very small amounts this year," Health Services Medical Director Margaret Higham said. "As we keep receiving shipments we will keep scheduling vaccine clinics."
In order to avoid contracting any strain of flu, common practices are highly recommended. Higham said she urges students to stay home when they're sick, cover their mouths when they cough and avoid touching their mouth and nose.
"A key concern I have is that students on this campus tend to go to class when they are running a fever," Higham said. "You aren't going to learn when you have a fever, and you are going to infect other students."
One of the concerns surrounding the flu and flu vaccine is its effectiveness. A fundamental characteristic of human influenza is its ability to adapt. Every year, a slightly new strain appears on the scene.
Due to the seasonal nature of the annual outbreak, scientists must develop vaccines long before the flu arrives. Up to eight months before the beginning of flu season, a vaccine is developed based on whatever form of flu is available - often a sample from the previous year.
"The people who are in charge of vaccine development try to predict what the strains that year are likely to be like," Higham said. "Every year, the strands are a little bit different. The vaccine is 80 percent effective."
But it is not effective against avian flu. The two viruses are different in their genetic makeup and cannot be treated with the same products.
"We could make a vaccine against the form that is affecting birds right now - the problem is that that it's not the type that will infect humans," Woodin said. "Because in order to go from birds infecting humans to infecting humans from person to person, there would have to be genetic mutation. So anything we vaccinated for now would not be effective."
Becca Dince contributed to this article.
