The true meaning of terror

By Andrew C. Eisenberg, M.D.

Having just weathered one of the worst storms in recent memory, being on a barrier island in the Gulf and waiting anxiously as the erratic path of oncoming destruction headed our way, I found my attention drawn to the possibilities of the upcoming seasons. In these heated days of animosity, terror, and fear we have oft neglected those things which Mother Nature can and will in her way spring upon us. As was the case with Hurricane Charley, we in public health can often predict an upcoming event, give warnings as to its possibilities, and see that many heed our advise and remain safe.

The case in point that I allude to is the upcoming influenza season. At least here in North America, we find that the winter heralds the usual arrival of a long time human nemesis, the flu. What might be important to remember is that the devastation of this disease is considerable, both in the toll on human life and the economic repercussions of its passage. The swath hewn by the annual path of this disease is far wider and more insidious often than that which we witnessed in this hurricane. The death toll has exceeded the half million mark in a single year (1918) in our country alone, and over 4 million around the world.

This true biological terror is often downplayed as just “the flu,” and often our warnings and admonishments to protect oneself and family go unheeded. I heard and read about those same human sentiments in the day prior to the arrival of Charley. “Oh, it wont hit here,” “What difference does preparation make,” or just the extreme procrastination of those who waited until the last minute and then had no way out, stubbornly dismissing the odds.

Our world gets smaller every day. Global travel has accelerated the exposure of citizens from all walks of life to new and potentially harmful pathogens. Albeit many of these have been rare visitors to our shores, their numbers increase yearly: SARS, measles, anthrax, and avian flu, all potentially deadly, many potentially prevented.

Influenza vaccination can be a gift of a second chance or even the gift of life to you and your loved ones. Your patients, friends and families all deserve at least this small amount of attention to their well being. While the call for mandatory influenza vaccination has not yet come down from the Advisory Committee on Immunization Practices and the Centers for Disease Control and Prevention, it will be here as the capacity to do so increases. Current recommendations are for everyone over age 50, anyone with chronic medical conditions, children between the ages of 6 and 24 months as well as the close contacts of any of these people. Furthermore, all health care personnel, who readily transmit the disease if not immunized, pregnant women, and anyone who wishes to prevent the disease are indicated recipients of the vaccine.

As physicians we are in a position to set an example for our coworkers, patients and communities. It is incumbent on us to actively promote and educate the minimal risks, and outstanding benefits to influenza vaccination for all. Current recommendations are not to prioritize delivery, but to begin in early October and vaccinate as many as you can or refer them to a place that will. The concept need be that prevention is of paramount importance. We too often deal with the acute and crisis situations that we are presented with and pay little heed to the preventive things that we could be doing. It does not take more than a few seconds, have your nurses ask and give vaccine with standing orders. Talk to your friends, colleagues and staff about the importance and above all lead by example and vaccinate yourselves.

The coming years will have an influenza pandemic. The question is not if but when, and just like the path of Charley, we can only guess how, when and where it will strike. Yet unlike that grand force of Mother Nature, we have a relatively effective weapon available for influenza. Lets keep our country safe from this biological terror.