Flu Season Warning

This winter's flu season is likely to be particularly severe,
the U.S. Public Health Service warns. Three to five times the
usual 10,000 to 20,000 flu-related deaths may occur. Worse
yet, the harsh "Beijing" strain of influenza that first
appeared in February mutated at the end of last year's flu
season, and no one is immune to it unless they came down with
flu in April or May.

The U.S. Public Health Service is recommending that all
persons at special risk for flu complications get the updated
version of the flu vaccine by November 15. Among these "at
risk" groups are people with HIV. A poster presentation
(#2249) at Berlin's International Conference on AIDS found
that flu vaccine coverage in the U.S. is "sub optimal," with
only about a third of people with HIV receiving the vaccine.
Also in Berlin, three posters described a low response rate
to the vaccine, especially among people with greatly reduced
helper T-cell counts (posters 500, 1264 and 1276).

Stephen Follansbee, M.D., a San Francisco AIDS specialist who
is following the issue, nevertheless urges anyone with HIV to
be vaccinated. Complications from infection with the
influenza virus include bacterial pneumonia, which can be
fatal. For people with low T-helper cell counts, Dr.
Follansbee suggests that all housemates also have themselves
vaccinated. This would create a kind of sanitary wall around
the person most in danger.

However, those with a history of allergic reactions to flu
shots or to eggs should not be inoculated; and those with
fevers should wait until the fevers subside. The vaccine
consists of killed influenza virus that was grown in egg
cells.

Two posters (209, 1929) in Berlin also dealt with the
question of whether flu vaccination increases the level of
HIV in the body, due to the immune stimulation the inoculant
provokes. Increased HIV replication might spark a further
decline in the immune system.

One of the posters said the vaccine does increase viral load
for several months; the other found no change. To look at the
question further, Dr. Follansbee and a group of associates
are planning a short, 30-person trial involving HIV-infected
volunteers at different helper T-cell counts. HIV levels and
immune function will be measured for 28 days after
vaccination.

The trial is now completely enrolled, and a full analysis of
the data will not be completed until December at the
earliest, well after the recommended vaccination period is
over. But Dr. Follansbee says, "I don't want the study to
undermine people getting shots." Any negative effect of the
flu vaccine is probably minor, compared to the damage the flu
could cause.