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Hospitals are braced for FluMist

Five times as costly as a flu shot but a lot less painful, the nasal treatment poses concerns with its potential for infecting vulnerable patients.

By LISA GREENE, Times Staff Writer
Published November 5, 2003

Infectious disease specialist Dr. Clinton Holder gets vaccinated against flu every year.

This year Holder has a new choice: He could use the widely publicized FluMist nasal spray, which the FDA approved this summer. Instead, Holder rolled up his sleeve and got an old-fashioned flu shot.

Holder's concern was not his own health, but that he could spread the flu to patients because FluMist uses live, weakened flu virus, rather than dead virus cells, as the flu shot does.

It's a concern shared by several Tampa Bay area hospitals, some of which have told their employees that if they get FluMist, they can't come to work for three weeks. That's the rule at St. Anthony's Hospital, where Holder chairs the infection control committee, as well as at Bayfront Medical Center, Morton Plant Hospital, Mease Dunedin Hospital and Mease Countryside Hospital.

They're taking those steps - in some cases going far beyond federal health care guidelines - because of the small risk that people who take FluMist could infect someone with immune system problems, such as cancer, HIV or an organ transplant. After taking FluMist, a person can have the weakened, but still live, virus in their nasal passages and could spread it to others by coughing or sneezing.

Other hospital precautions include planning to keep some patients who have had FluMist in isolation.

"Elderly and immuno-compromised patients aren't good candidates for this vaccine," Holder said. "Our concern in the infectious disease realm . . . is that's precisely who's in the hospital."

Influenza kills about 36,000 Americans each year, making the vaccine a crucial lifesaver. Vaccines work by dosing the patient with dead or weakened live virus. That prompts the body's immune system to make antibodies, protecting from future infection.

FluMist made a big splash this summer, when the FDA approved the spray vaccine for the flu. The company that makes it, MedImmune Inc., hasn't released sales figures, but is making 4-million to 5-million doses of the spray this season.

FluMist is marketed as an option for healthy people between the ages of 5 to 49 - especially those who don't like needles. The company has said from the beginning that people shouldn't use it if they have vulnerable immune systems or are in close contact with such patients.

But St. Anthony's is taking those concerns more seriously. The hospital will not admit patients for elective procedures if they have had FluMist in the last three weeks. The hospital is asking people who have recently gotten FluMist not to visit vulnerable patients. And any patients who have recently used FluMist will be isolated.

Officials at H. Lee Moffitt Cancer Center and Research Institute in Tampa also would isolate FluMist patients, although it's unlikely they would have any, since cancer patients have immune problems. Bayfront also plans to isolate FluMist patients if they are showing cold symptoms.

All Children's Hospital would keep FluMist patients away from patients with immune problems and probably delay elective surgeries for FluMist patients, said Dr. Juan Dumois, chairman of the hospital's infectious disease division.

At MedImmune Inc., spokeswoman Jamie Lacey pointed to the advice from the federal Centers for Disease Control and Prevention. The CDC has advised health care workers to stay away from patients with immune problems for one week after they've had FluMist.

"When new technologies come around, sometimes people wait and see," Lacey said. "But a lot of people recognize the flu isn't very much fun to get. And if they don't like needles, having an intranasal delivery is an exciting possibility."

The CDC estimates the risk of transmitting flu virus after getting FluMist at 0.6 to 2.4 percent. Even then, the risk of the infected person getting flu symptoms is unlikely because the virus has been weakened, the CDC says.

But at Bayfront, the CDC's guidelines are just the beginning, said Shelly Wilt, director of patient safety.

"We like to err on the side of caution," Wilt said. "I consider those to be minimum guidelines."

But at Tampa General, hospital officials plan to reassign workers for a week, not send them home, and only if they work with vulnerable patients.

"If you read the literature, it's very, very rare," said JoAnn Shea, director of employee health at Tampa General.

Holder said FluMist shows promise at fighting the flu - for the right people.

"It's probably going to be great for immunizing younger, healthier people who don't have contact with weakened patients."

But so far, there doesn't appear to have been a wave of Tampa Bay residents receiving FluMist. Some hospital officials said they haven't had to enact their new policies. And at two Pinellas walk-in clinics, most patients get flu shots.

"I don't think we've given one FluMist, because people hear the price difference," said Dr. Michael Murray at Walk In Medical Care in Seminole. "They say the heck with that, give me the shot."

The clinic offers $10 flu shots, but charges $50 for FluMist. MedImmune charges doctors $46 per dose. At Doctor's Walk-in Clinic in Pinellas Park, head nurse Carol Ruohomaki said workers have given out just one dose in the past few weeks. People just haven't heard about it yet, she said.

"People who really want to get away from shots and have a terrible fear of them, this is a wonderful way to do it," she said.

That's little comfort to Spring Hill resident Joan O'Connell, whose 5-year-old son Kevin has a rare immune disorder. O'Connell already limits his contact with others. She worries that FluMist will increase his risk of getting the flu.

"Someone sneezes and I don't know what they have," she said. "I won't take him out during flu season at all. Nowhere."

Spray or needle?

FluMist nasal spray is approved for:

- People who are 5 to 49

- Healthy

- Not pregnant

Flu shots are recommended for:

- People 50 or older

- People with chronic heart, lung, kidney, immune or other diseases, including HIV, diabetes and asthma

- Residents of long-term care

- Women more than three months pregnant during flu season

- Those in close contact with people in high risk groups

- Source: Centers for Disease Control and Prevention.

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