Why Older Americans Will Have to Wait for Swine-Flu Shots by Betsy McKay

On a visit to his doctor last week for a blood-pressure check, Neil Johnson, a former mortgage lender, dutifully got his annual flu shot. Having suffered from flu in the past—"you ache, you cough...you have fever all over"—he wanted to make sure to get his shot early.

But Mr. Johnson, an 81-year-old resident of an assisted-living facility in Sandy Springs, Ga., will have to wait quite a while before he can roll up his sleeve for a vaccine against this season's best-known virus: the H1N1 swine flu. People age 65 and older are nearly last in line for that shot.

Older Americans are normally at the front of the queue for shots against the seasonal flu viruses that circulate every fall and winter, and public-health officials and doctors strongly urge them to get one each year. There's little wonder why: An estimated 36,000 people die in the U.S. every year from the seasonal flu, and 90% of them are 65 or older.

Perk of Age
But so far the new H1N1 flu is largely sparing the 60-plus demographic, instead hitting children and young adults the hardest. While it has spread like wildfire through secondary schools and colleges, and claimed more than 2,800 lives world-wide, few older people have even gotten sick.

That's because many people 60 and older were exposed to H1N1 viruses that circulated between 1918 and 1957. Those earlier viruses were similar to the new H1N1 virus, so the immunity that some people built up then is helping them now.

A study by scientists at the Centers for Disease Control and Prevention found that about one-third of adults age 60 and older had antibodies that protected them against the new H1N1 virus. By contrast, children had none.

The pattern is similar to one seen in the deadly 1918 pandemic, in which death rates were highest among young adults, according to infectious-disease experts. One possible reason is that older adults had been exposed to similar flu viruses in the 1800s.

Be Patient
With the risk of infection lower for older adults, federal health officials are allotting the swine-flue vaccine first to pregnant women, children and young adults, and anyone under 65 with asthma, diabetes or another medical condition that can increase their risk of complications from the flu. The CDC says older adults should be offered the vaccine only when there's enough medicine for all the other priority groups.

That's likely to take a few months. The federal government expects to receive and distribute 195 million doses of swine-flu vaccine by year-end. Officials estimate that 159 million people make up the top-priority groups—not including older adults—though not everyone in those groups is likely to opt for a shot. The new vaccine is free, and many insurance companies have said they will cover administration fees for the shot.

Budgie Amparo, senior vice president of quality and risk management for Emeritus Corp., which operates senior-living facilities, including the facility where Mr. Johnson lives, says it's working on getting swine-flu vaccine for its residents as quickly as it can through its regular supplier of seasonal-flu shots. "We've taken some proactive steps," Mr. Amparo says. "We were reassured that once it's available, we're going to get it."

Extra Precautions
In the meantime, nurses at Emeritus properties plan to spend more time educating residents about ways to protect themselves from the flu, such as washing their hands, Mr. Amparo says. They will also more actively monitor residents' health, to reduce their chances of complications should they get the flu. "We want to make sure we're managing their overall medical condition," helping residents get medications in a timely fashion, or helping those with respiratory conditions such as asthma see doctors quickly, he says.

One reason for the extra precautions: While older adults account for the fewest U.S. cases of swine flu, the proportion of those who have died is higher than for other age groups, according to CDC data. "Once you do get infected, your risk is higher," says Charlotte Yeh, chief medical officer for AARP Services Inc., part of the Washington-based advocacy group. Many older Americans have chronic conditions that affect their immune status, making it harder to fight off any flu, she says.

Moreover, the seasonal-flu vaccine may not offer full protection this year against a long-circulating virus that traditionally is linked with more hospitalizations and deaths among older adults than other strains. A new variant of the H3N2 seasonal flu virus has been identified on several continents that differs from the H3N2 strain covered by this year's vaccine. So far it's in the minority of H3N2 circulating viruses, and it's unclear how widely it will circulate in the U.S. this flu season, particularly given the current dominance of the swine-flu virus. But officials at the CDC and the World Health Organization say they're keeping a close eye on it.

Doctors can't quickly determine what strain of flu a patient has. "If you come in with all the signs of flu, we can't tell you which flu you have," Dr. Yeh says. "The critical thing is that if you have fever, aches, congestion, cough, dizziness, that is something you should talk with your doctor about." A doctor may prescribe an antiviral such as Tamiflu, which can't cure the flu but can shorten its duration and severity if started early.

Read Why Older Americans Will Have to Wait for Swine-Flu Shots for more information.

By Betsy McKay is deputy chief of The Wall Street Journal's Atlanta bureau.