I suggested in last week's column that public health officials be excused for "honest" mistakes inadvertently leading to two postal worker deaths from inhalation anthrax. But their bad advice about the flu shot as an aid to the diagnosis of anthrax is another matter.
Since mid-October, public health officials have recommended the flu shot to help separate flu cases from possible inhalation anthrax cases. The initial symptoms of inhalation anthrax are flu-like — fever, achiness, runny nose and cough. The idea was that doctors would be able to rule out the flu, perhaps in favor of inhalation anthrax, in patients who report to doctors and emergency rooms with flu-like symptoms.
Department of Health and Human Services Secretary Tommy Thompson, the top U.S. public health official, said in an Oct. 22 interview, "I'm encouraging people to get their flu shots. … Flu has similar symptoms to anthrax, and medical professionals will be overloaded with concerned people who have flu and think something else is happening."
But the next day, the Centers for Disease Control and Prevention recommended the opposite. If everyone rushed to get flu shots, the CDC warned, those most at risk for influenza could have trouble getting them. Thompson promptly reversed himself.
The CDC's message, though, was inexplicably lost on many others at all levels in our public health system.
"The best thing this flu season really is to go get the flu vaccine, so you can at least rule [anthrax] out," Dr. Mohammed Akhter, executive director of the American Public Health Association, recently told the media.
"We are all worried about anthrax," Mark Eickbush, a hospital official in Charleston, W.Va., said in his statements to the press. "The symptoms of flu and anthrax are very similar. But if you've had your flu shot, you may be able to cancel out one of those things," Eickbush said.
"All of us are pushing the flu shots so we can cut down on symptoms that look like anthrax," said Dr. Barry Prystowsky, a New Jersey pediatrician featured in an Associated Press article.
Harvard University told students to get a flu shot to prevent confusion with potential anthrax patients.
Even the nation's top infectious disease official, Dr. Anthony Fauci of the National Institute Allergy and Infectious Disease, joined the misinformation bandwagon.
"Don't let the high-risk influenza people get lost in the shuffle. Let them get it first," Fauci recommended. The implication was that taking the flu shot to help diagnose anthrax infection was a good idea, as long as vaccination was prioritized appropriately.
Why shouldn't we stampede to doctors and hospitals for the flu shot in hopes of diagnosing anthrax? We don't have enough flu vaccine and it's a lousy idea anyway.
Flu vaccine makers will only produce 85 million doses. There are about 285 million Americans. High-risk populations — perhaps as many as 60 million seniors, children, asthmatics, diabetics, heart patients and those with weak immune systems — need ready access to the vaccine as the flu kills 20,000 Americans annually.
The vaccine does not keep recipients from experiencing colds and flu-like symptoms during the winter. Perhaps as much as 90 percent of the time, flu-like symptoms don't indicate the flu. People who have been vaccinated may be even more likely to panic about potential anthrax infection if they're feeling bad.
"Influenza is one of hundreds of viruses that can cause the symptom complex that we call 'the flu.' You're more likely to have just the common cold and have onset of flu-like symptoms," says Dr. David Sullivan, an assistant professor of molecular microbiology, immunology and infectious disease at the Johns Hopkins School of Public Health.
The right reason to get a flu shot is if you need to worry about the flu. "We're not saying people ought to get it to prevent confusion with the symptoms of anthrax," said Dr. Walt Orenstein, head of the National Immunization Program. "What we are saying is get it to prevent getting influenza."
Public officials may be excused for not performing flawlessly amid a sneak anthrax attack that wasn't foreseen. But the misinformation about the flu shot is less excusable.
The benefits and limitations of the flu shot are well known from years of experience. Recommending the flu vaccine as a screening tool for anthrax should be an obviously flawed idea to any health professional who gives it more than casual thought.
Should an anthrax-induced shortage of flu vaccine cause problems this flu season, heads should roll.
Steven Milloy is the publisher of JunkScience.com , an adjunct scholar at the Cato Institute and the author of Junk Science Judo: Self-defense Against Health Scares and Scams (Cato Institute, 2001).
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