Area coping with shortage of flu shots

NASHUA – On Oct. 4, the day before the nation learned it was facing a severe shortage of flu vaccine, Southern New Hampshire Medical Center mailed 9,000 letters to patients in its affiliated medical practices reminding them of scheduled flu clinics. Eight days later, a second letter followed, announcing their cancellation.

“We want to make sure the vaccine is given to the right people, those at highest risk,” said Dr. Michael Marshall, medical director for Foundation Medical Partners. “At the moment, we are preparing for the worst, following CDC guidelines to triage every patient.”

Marshall’s group, part of the medical center, isn’t the only one. Across Greater Nashua, health care organizations are doing likewise: assessing flu vaccine supplies and making difficult decisions about who is most in need.

“It means I’m having to make some really tough decisions today,” said Dr. Deborah Dennis, a family practice physician with SJ Family Medical Center in Nashua. “People who for years I’ve pushed to get the flu vaccine, I have to tell I don’t know if I can give it to them.”

Dennis said the five family medicine practices affiliated with St. Joseph Hospital have received 34 percent of their order for flu vaccine. That translates into 120 doses for her group of three physicians, or 40 doses per physician.

“We usually get three shipments. The initial shipment is used for the highest risk patients, the next shipment for the rest of the high risk, and the third is opened up,” Dennis said. “This year, this may be all we get.”

Dennis said even triage – deciding who is most at risk among patient populations – is being redefined according to vaccine availability. Asthmatic patients, for example, are usually high on the list of high-risk patients, but this year, because of the shortage, healthy patients with asthma may be asked to forego the flu shot. In addition, children younger than 2 may not be included in the first round.

Dennis said this isn’t the first year she has worried about vaccinating her patients at medical risk of complications from the flu. Even in the absence of a dire shortage, the doctor and her patients have had to deal with late shipments of the vaccine.

“We’ve had this angst every year,” she said, but added that “it’s never been this pressing before.”

Dennis said the SJ Family Medicine practices ordered most of their vaccine supply from Aventis Pasteur, one of two companies contracted to supply the nation with flu shots. But that doesn’t mean the practices will get what they ordered: The Centers for Disease Control has said it may have to reallocate limited supplies to promote a more equitable distribution of flu vaccine.

Paul Etkind, deputy director of the Division of Public Health and Community Services for the city, said all city flu clinics have been postponed. Ten were planned prior to the announced shortage.

“We don’t know how much vaccine we’ll get or when,” Etkind said.

It’s the same message the Public Health Department has posted on its two entrances, one on Mulberry Street, the other on Elm Street.

“We’ve had calls. People are walking in asking us, ‘Can I get my flu shot?’ ” Etkind said. “Signs on the doors say we have no vaccine here.”

Meanwhile, public health officials are encouraging enhanced infection control, including hand washing, cough and sneeze etiquette, and staying home from school or work when illness strikes.

“If you are hit with a sudden fever, upper respiratory tract infection, we encourage you not to be a hero. Stay home from work or school, don’t spread it,” Etkind said.

Registered nurse Susan Ducharme, director of nursing services at the Hunt Community, said she is referring residents to their private physicians, the Senior Activity Center and pharmacy clinics. About 250 people live in the community in independent apartments or in a health care unit there.

“We’re limping along, but it’s still early,” Ducharme said. “I’ve spoken to the CDC, the state. We have to reprioritize.”

Like other institutions, Ducharme said her organization is emphasizing hygiene practices, encouraging both employees and residents to take extra precautions.

“You really enforce infection control. Hand washing is the major defense, and if you’re sick, don’t come to work,” she said. “Don’t bring ill people into public areas of the building, keep (antibacterial) gel on your person.”

In addition, Ducharme said the community will “pump up” its housekeeping efforts, making sure surface areas are disinfected regularly.

“This is the first year in my career there’s been no flu clinic,” she said.

Following announcement of the shortage, area pharmacies pulled posters announcing flu clinic schedules. Shaw’s supermarket on Main Street, for example, held a flu clinic on Oct. 4, the day before the news of the shortage broke, but cancelled one set up for Oct. 19. Likewise, Walgreens held a clinic on Oct. 8, but cancelled future clinics. And Hannaford supermarkets announced that it will hold its last clinics Saturday – including one at the store at 79 Bicentennial Drive in northern Manchester, and another at the store at 301 Pleasant St. in Dracut, Mass. Both clinics are from 10 a.m.-2 p.m.

The shortage was particularly bad news for members of the Senior Activity Center of Nashua, site of annual flu clinics run by the city’s Public Health Department for at least two decades.

Pat Francis, the center’s executive director, said in years past, the health department has administered up to 600 shots in a two-hour period at the activity center.

“We’ve been inundated with calls. . . . People have been calling and checking,” Francis said. “There’s a major scramble.”