The flu virus is making its way towards Israel and Europe.
According to official forecasts, the flu season could arrive
at any time. Years of experience show a flu outbreak is bound
to strike this year, just as every year, leaving hundreds of
thousands of people bedridden with high fever, body aches and
other symptoms.
Some flu patients, particularly the elderly and the
chronically ill, are expected to develop complications that
lead to thousands of mortalities every year. Hospitals will
be filled to capacity and before long beds will spill out
into the corridors. Children's wards will be even more packed
due to the appearance of a relatively new strain we will
discuss below.
But this is merely a description of the annual routine, which
pales in comparison to the serious alerts. Saddam Hussein?
Nope. Al Qaeda? Wrong again. Today Europe is terrified of a
much worse threat: a deadly worldwide flu epidemic called
super flu.
The forecasted epidemic, which the epidemiologists call a
pandemic, is liable to claim hundreds of thousands of victims
in Europe alone. And if Europe is overtaken, in the age of
the global village the entire world would also be at serious
risk. Virologists and experts from across the continent were
summoned to an emergency conference in Malta recently to
discuss preparations for the anticipated epidemic.
European experts have little to say to allay our fears. "It's
not a question of if, but when," warns Albert Austrahaus,
Professor of Virology at the University of Rotterdam and one
of the heads of the conference in Malta. Sounds frightening?
Certain Israeli health officials have been heard to express
satisfaction over the scare headlines. They increased the
public's response to calls for vaccination.
Thirty Years Since the Last Pandemic
Following requests by the World Health Organization, the
Israeli health system is also preparing for the possibility
of a worldwide pandemic outbreak. If it's any consolation,
Dr. Alex Leventhal, head of public health services at the
Ministry of Health, says the danger is nothing new. "There
have been concerns in recent years, every year, with or
without headlines . . . I have not found any supporting
evidence in scientific sources for this new warning. Every
year there are fears that a new flu strain not found in the
vaccination might appear. From this perspective nothing has
changed this year. There is nothing new under the sun."
Nevertheless the Health Ministry is not taking the warnings
lightly. Dr. Leventhal, who heads a special Health Ministry
committee set up to formulate a contingency plan for Health
Ministry readiness, explains that flu epidemics have a
cyclical nature and according to statistics there has been a
high risk of an outbreak over recent years.
The last outbreak took place in 1968 and was called Hong Kong
fever. Since then there has not been a pandemic outbreak,
because three strains of flu were always observed and were
included in flu shots. The exception was the Sidney virus
four years ago, which was not included in the vaccine and
caused a relatively high disease and fatality rate, but
besiyata deShmaya not of epidemic proportions.
If and when a new strain not included in the vaccine appears,
the disease rate could be massive, both because the
vaccination will not help defend against the flu and because
the population will have no immunity against it.
Children Under Eight at Higher Risk
Dr. Amnon Kiro, an expert in the study of monitoring
influenza and director of pediatrics at the Ministry of
Health in Tel Aviv, explains how disease rates for the coming
year are predicted. "As the flu season approaches, an
assessment is performed according to what transpired over the
winter in the southern hemisphere, during our summer months.
For example, Madagascar posted particularly high flu
activity; 155 mortalities were observed there as a result of
the flu wave. A World Health Organization study found the
virus, the Moscow strain, was not so aggressive and the high
mortality rate there was attributed to malnutrition and
inferior health conditions.
In the southern hemisphere the flu abates in September and
then the first new viruses begin to appear in the northern
hemisphere. The flu generally arrives in Israel around the
middle of November. According to this year's initial
forecast, the anticipated active strains are Moscow A, New
Caledonia A and Hong Kong B.
Due to the Hong Kong virus, newer than the other two, the
disease rate during the coming winter could be higher than
usual. Since it has been inactive for seven years, children
under the age of eight face an increased risk of contracting
this type of flu because they have never been exposed to it.
Adults, on the other hand, have some immunity against it.
The Hong Kong virus was already active last March, during
relatively warm weather, therefore increased activity is
expected from it this winter. Not that Hong Kong A or the
other two viruses are particularly aggressive.
Preparing a Pandemic File
If the three current viruses are not any worse than usual,
why is a pandemic outbreak expected to develop? What has
changed?
According to Dr. Kiro, a historical survey shows the flu
virus activity appears in cyclical outbreaks. Unlike most
viruses, against which a single vaccination provides
resistance for an entire lifetime, the flu virus constantly
undergoes genetic changes, evolving rapidly. To be more
accurate its mantle changes and our immune systems fail to
recognize the new mutation as a hostile force.
Every 20 to 30 years a significant genetic alteration takes
place. The virus becomes unrecognizable to the immune system,
the body lacks antibodies against it and, if the change takes
place suddenly, the flu shot for that year will not include
the new strain, and it is liable to cause a deadly, wide-
scale epidemic.
The 1918 strain, known as Spanish flu, was particularly
deadly. To this day scientists are unsure how it caused such
a large number of fatalities: tens of millions dead in Europe
and 100 million around the world. Other pandemics broke out
in 1957 and 1968, causing 40 million deaths.
The last outbreak took place in 1997, but was stopped in
time. Then, too, the entire world was in a state of
trepidation over the bird flu, which was spreading quickly
around Hong Kong and had caused a number of fatalities. The
panic that erupted led the authorities in Hong Kong to take
action immediately. They destroyed hundreds of millions of
birds, thereby stopping the epidemic in its tracks.
The thirty-year cycles between pandemics indicate the next
outbreak could come at any time. Every year the likelihood of
a pandemic increases. European influenza researchers are
convinced the next outbreak is unavoidable.
According to Dr. Kiro, "The World Health Organization and
health ministries in various countries have prepared a
`pandemic file.' Important findings are transmitted to five
centers worldwide: in Geneva, London, Atlanta, Rio de Janeiro
and Tokyo. Flu laboratories with top experts perform precise
genetic classification of the virus and pass the data on to
the companies that manufacture the vaccine.
"We estimate that with the appearance of the new,
unrecognized virus, we will have four months, which will
allow us to prepare millions of vaccines. To accomplish this,
we need a monitoring and response system that can function
faster than the new virus's contagion rate. As of now we are
under the impression the matter is in control."
Only 50 Percent are Vaccinated
Drugs against influenza, relegated to the realm of fiction
until the last decade, have become part of the array of
medications at our disposal. But the flu vaccine is still the
most effective means of fighting the illness.
The flu vaccination season started over a month ago, but
vaccination is available even after the flu season is already
underway. Now the various kupot cholim have finally
realized the economic importance of the vaccine and have
begun to encourage their members in high-risk groups to get
vaccinated.
While in the past the official recommendation was for those
over the age of 65, today vaccination is recommended for
everyone age 50 and over, following epidemiological studies
that showed the rate of complications is also higher starting
at that age.
Vaccinating hundreds of thousands of people within a short
period is no easy task. According to Dr. Michael Rosenblatt,
deputy director of medicine at Klalit Health Services, says,
"This is the largest routine community project in existence,
held annually at this time of the year. The problem, of
course, is that the virus changes from year to year. The
level of antibodies does not remain for an extended period,
therefore the vaccine has to be re-administered every year.
It is a never-ending project.
"Our target population is the 450,000 people in the risk
groups. We would very much like to reach a vaccination rate
of 70 percent of the population, a goal similar to that of
other countries that has had a major impact in terms of
reducing the disease rate."
As of now the rate of vaccination is around 50-55 percent of
the population at risk, although presumably the recent
headlines regarding the super flu have boosted vaccination
rates. Dr. Rosenblatt estimates vaccination rates are similar
at other kupot cholim as well. These figures, of
course, represent the national average. Some segments of the
population have a vaccination rate of nearly 100 percent
while others hover around the 0 mark.
Vaccination is of great importance both for the individual
and the public. In most cases influenza is not a particularly
severe disease, notes Dr. Rosenblatt. "One or two weeks of
fever and other symptoms and it's over with. But in some
cases there are complications that can be dangerous, which
makes it important for individuals to get vaccinated.
"From the public's standpoint influenza is a disease that
spreads very quickly and the fewer cases of flu circulating,
the fewer people will be contaminated and contract the
disease. From a medical standpoint the most pressing matter
is to vaccinate segments of the population more prone to
illness, those who will not be done with the illness after a
few days of fever but will develop severe complications."
A Question of Budget, not Medical Expediency
The various kupot cholim offer flu shots to members at
different prices. Maccabi provides the vaccine for people
over the age of 55 and the chronically ill at no cost; for
others the price is NIS 12. Meuchedet offers free vaccination
for members age 50 and over and patients in risk groups;
other members pay NIS 12. At Leumit the vaccine is free for
members aged 50 and over, holders of supplementary insurance
policies and risk groups; others pay NIS 11.
Providing free flu shots for everyone is in the health funds'
best interest, but the matter is really a question of
budgeting policies, explains Dr. Rosenblatt. "Last year the
Health Ministry determined vaccines should be part of the
basket of services and indeed they were given to the elderly
at no cost. This year vaccination is not included in the
basket of services and Klalit decided on a policy of adding
it . . . Klalit also focuses on the 65 and over population
group, not 50 and over. Our experience has shown the
population group more prone to illness also has a high rate
of vaccination."
Many parents are undecided whether to vaccinate their
children. Recently the US Department of Health issued
instructions to vaccinate children between the ages of six
months and two years against influenza, but the Israeli
Ministry of Health has not adopted this policy.
According to Dr. Leventhal, Israel generally follows
directives issued by the World Health Organization. "At this
age children generally overcome the disease relatively
easily. All people age 50 and over should be vaccinated.
Personally I always make it a point to get my shot every
year, but even within the health system I don't see everyone
getting vaccinated."
From a medical perspective there is no debate: experts
unanimously recommend parents vaccinate their children to
spare them an illness that may not be easy and could involve
complications, particularly this year since the disease rate
is expected to be higher among young children.
The cost of vaccination is not high and the side effects, if
any, are minimal. If you have not yet gotten vaccinated it is
recommended you do so and that you take the younger children
with you, since they are generally the ones who introduce the
chain of infection into the family.
