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Call it a shot in the dark.

The work of matching America's flu vaccine to the annual influenza strain is a game of odds - a highly educated guess, perhaps, but a guess nonetheless.

Some years, it's a perfect match and the vaccine works wonders. Other years - like last year, for instance - it's a less-than-perfect marriage, and many get stung twice, first by the needle and later by the flu bug.

“Last year, it was a good match at the beginning of the season, but not so good by the end,” said Liz LeLacheur, supervisor of the state of Montana's immunization program.

The problem, she said, is that the flu keeps evolving. Most diseases - polio or mumps or whooping cough - are pretty stable, and so the vaccines never change. Not so with flu.

“One of the biggest challenges in the fight against influenza is producing new vaccines every year,” said Jesse Goodman. “There is no other instance where new vaccines must be made every year.”

Goodman is director of the Food and Drug Administration's Center for Biologics Evaluation and Research, which helps decide which flu strains to include in the yearly shot. There are always three - two A-types and one B-type.

Usually, there's some overlap from year to year, and a couple of the previous season's strains are repeated in the new dose. But this year, public health officials have taken the unusual step of scrapping last year's trio and starting entirely from scratch. A couple of A-Brisbane strains and a B-Florida bug are this season's targets, and six different manufacturers have been busy for months.

Together, they expect to produce 146 million doses of vaccine, a record amount that should be on shelves by month's end. That's up from 132 million doses last year, and 120 million the year before that.

The work to determine what the current cocktail would look like began a full year ago, at more than 100 national influenza centers in 84 countries. They collected the data, strained the strains and peeked Down Under to see what winter woes had waylaid the Southern Hemisphere.

Then FDA made its picks and set those manufacturers to manufacturing, because it can take six months to grow a big batch. If they hit it right, vaccine effectiveness can approach 90 percent. If not, maybe half of those vaccinated still will get sick, armed with the wrong antibodies.

Antibodies are how humans fight the flu. The virus attacks, and the immune system responds by “learning” which specialized antibodies it must make to defeat the invader.

The flu shot is the early warning training ground, where the body first meets the virus and decides which antibodies to make. Make the right ones and you're bullet-proof. Make the wrong ones and you've left the castle gate unguarded.

Last year, the nation prepared with flu type A-Solomon Islands; the year before that, A-New Caledonia.

In a usual year, with the usual slow genetic drift of flu strains, even a slightly mismatched vaccine can help ease the symptoms. But sometimes evolution lurches ahead, and a whole new flu type emerges that can leap the species barrier. Think bird flu, or swine flu. Think a whole new flu we've never encountered.

That's the sort of combination that brought us the Asian flu pandemic in 1957, and the 1968 Hong Kong flu outbreak, and the Spanish flu pandemic of 1918 that killed, perhaps, 50 million people worldwide.

Even in a “usual” year, influenza and its complications kill some 35,000 in this country and hospitalize 200,000 more.

The best defense, LeLacheur said, remains a good offense, “and hopefully, the vaccine match will be good this year.” But, she added, “it will probably be a month or two before we know.”

The flu shot contains only dead virus and is advised for pretty much everyone except the youngest infants. The flu spray, spritzed up the nose, contains a live but weakened virus, and is not for young kids or anyone over 50.

And this year, public health officials are recommending vaccination for all kids up to 18, rather than just preschoolers. The old age limits were driven primarily by a supply concern, LeLacheur said, but this season that's not a problem.

“There's lots of supply,” she said, “even with the preservative-free vaccination for younger kids.”

Beyond the shots, both officials and mothers continue to offer the same advice - cover your mouth when you cough, wash your hands and keep your finger out of your nose (or your mouth or your eye or whatever).

And stay home while you're sick, officials said, because even though viruses have no way of moving around on their own, we've proven more than willing to pick up hitchhikers - only to drop them off where our friends wish we hadn't.

The Montana flu season, which begins in early October, already is under way, and will stretch into May with a peak, probably, sometime in February.

And this season, as in last, most will succumb to a form of type A - Caledonia or Solomon or, most likely, Brisbane - although they likely won't care what it's called.

Because they'll be too busy suffering, with fevers and chills and aches and pains, sore throats and coughs and splitting heads.

They'll be infectious a full day before they feel it, and then for a week after that. But by then, of course, it's too late.

Anti-viral drugs can help ease symptoms, LeLacheur said, but officials insist your best shot remains a shot, which should be available now at your local health department or medical provider.

“The vaccine is really the way to go,” she said. “It's an awfully cheap shot of insurance.”

Reporter Michael Jamison can be reached at 1-800-366-7186 or at mjamison@missoulian.com.

 

Need a shot?

County health department contacts in western Montana:

- Missoula County: 258-4750

- Flathead County: 751-8110

- Lake County: 883-7288

- Lincoln County: 293-7781, Ext. 4

- Mineral County: 822-3564

- Sanders County: 827-6925

- Ravalli County: 375-6670

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