In an average year, with a full supply of flu shots, an estimated 36,000 Americans die from to flu-related complications.
But amid a severe, nationwide vaccine shortage and with the World Health Organization tracking dangerous bird flu outbreaks in Asia that can spread to people and set the stage for a pandemic outbreak, this year is shaping up to be anything but typical. Federal health officials are giving no assurances.
"We hope the season will be mild, but we can't say that for sure," said Karen Hunter, a spokeswoman for the Centers for Disease Control and Prevention in Atlanta.
Penrose-St. Francis Hospital and Memorial Hospital in Colorado Springs are braced. Neither hospital has projected what a lack of vaccine means to their bottom lines. But both say that with less vaccine, there is a much greater probability that emergency rooms will be packed with people with flu symptoms, many of them uninsured.
Dr. Thomas Q. Davis, chief medical officer for Penrose has his "fingers and toes crossed" that this year won't be as deadly as last year -- the worst outbreak in at least a decade. Roughly 13,000 Coloradans became ill in 2003, nearly 2,400 were hospitalized and 12 children died, sparking a run on flu shots that were only partially effective because they didn't contain inoculation against a major variant of flu that had been circulating.
Strains of the flu are already "sporadic" in Colorado and 16 other states this week, as health officials continued what has been a monthlong scramble to find a vaccine.
The pharmaceutical company Aventis Pasteur has yet to ship 17 million doses of the 55 million that health organizations have ordered, Hunter of the CDC said. The CDC hopes those doses will be delivered over the course of the next month, she said.
Aventis is the sole provider of flu shots in the United States because roughly 48 million vials manufactured by Chiron Corp. in Liverpool, England, were contaminated and held.
The shortage leaves federal, state and local health officials asking healthy people between the ages of 2 and 64 to forego vaccination, even though a year ago federal officials wanted everyone older than 50 to get vaccinated.
"This is obviously not where we want to be," said El Paso County Public Health Administrator Rosemary Bakes-Martin.
In 2002, the county had 4,700 doses of vaccine available for residents. This year it has 1,750 doses -- 1,000 short of what it ordered.
There's not even enough vaccine to guarantee that all nursing home patients, vulnerable because of their advanced age and their proximity to others, will get flu shots, Bakes-Martin said.
Wash your hands
In the wake of the failure, Merck and Co. will triple its production of pneumonia vaccines to 18 million doses after being urged to do so by Secretary of Health and Human Services Tommy Thompson. The additional pneumonia vaccine indicates concern that more people will experience severe flu complications because of the flu shot shortage.
Bakes-Martin said the county has had to place additional resources into health information. Officials have fielded countless calls as the search for vaccine for vulnerable residents continues.
For other residents, the county's core message is this: Be patient. Until then, wash your hands often, use facial tissue when you sneeze and take time off work if you are ill.
The shortage has already meant trade-offs as public health officials grapple with state and county budget cuts of recent years. In 2001, the department had $15 million for a population of 533,500 residents. This year, the budget is $13.7 million for a population of 554,000. As a result, fewer resources are currently going to restaurant inspections and non-flu childhood immunization clinics, Bakes-Martin said.
"We've had to cut down on some things," Bakes-Martin said. "We have to make decisions, it seems, daily. Where do we stopgap?"
Potential for pandemic
The flu shot shortage, along with budget crunches and other immeasurable scenarios make the public much more vulnerable to a pandemic flu outbreak -- which Davis describes as a "wild card" that could be played out this season.
The World Health Organization is tracking outbreaks of highly contagious bird flu in Thailand and Vietnam. The combination of the viruses, should people suffering from human flu also catch the bird virus, can create a new strain to which people have no immunity, sparking a potential pandemic like the Spanish flu outbreak in 1918 that killed between 20 million and 50 million people worldwide.
The WHO, wary of short vaccine supplies, this week called an emergency summit to bring attention to potential crisis.
Davis, who said Penrose Hospital would have had difficulty vaccinating all its direct-care health workers if Memorial Hospital hadn't sold them additional vaccines, questioned the market-based system for manufacturing vaccines because it has failed public health needs. Thirty years ago, 25 companies manufactured flu vaccine. Today, there are just a handful.
"It's a big, big quandary right now," Davis said, adding that federal officials should work to address the problem.
-- Michael de Yoanna