Flu vaccine made for people 65 and older is stored in a refrigerator at the Alexian Brothers PACE facility on Thursday, Sept. 22, 2016, in Chattanooga, Tenn. Annual flu vaccines are particularly important for seniors to whom the flu can be life-threatening.
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Dr. Norman Desbiens talks about how all the staff and patients at the Alexian Brothers PACE facility are vaccinated for the flu on Thursday, Sept. 22, 2016, in Chattanooga, Tenn. Annual flu vaccines are particularly important for seniors to whom the flu can be life-threatening.


*When and how often should I get vaccinated?
*Everyone 6 months and older should get a flu vaccine every year by the end of October, if possible. However, getting vaccinated later is OK. Vaccination should continue throughout the flu season, even in January or later. Some children who have received flu vaccine previously and children who have only received one dose in their lifetime, may need two doses of flu vaccine. A health care provider can advise on how many doses a child should get.Can I get a flu vaccine if I am allergic to eggs?
*The recommendations for people with egg allergies have been updated for this season.

  • People who have experienced only hives after exposure to egg can get any licensed flu vaccine that is otherwise appropriate for their age and health.
  • People who have symptoms other than hives after exposure to eggs, such as angioedema, respiratory distress, lightheadedness, or recurrent emesis; or who have needed epinephrine or another emergency medical intervention, also can get any licensed flu vaccine that is otherwise appropriate for their age and health, but the vaccine should be given in a medical setting and be supervised by a health care provider who is able to recognize and manage severe allergic conditions. (Settings include hospitals, clinics, health departments, and physician offices). People with egg allergies no longer have to wait 30 minutes after receiving their vaccine.
How much flu vaccine will be available this season?
*Flu vaccine is produced by private manufacturers, so supply depends on manufacturers. For the 2016-2017 season, manufacturers projected they would provide between 157 million and 168 million doses of injectable vaccine for the U.S. market. (Projections may change as the season progresses.)When should I get vaccinated?
*Getting vaccinated before flu activity begins helps protect you once the flu season starts in your community. It takes about two weeks after vaccination for the body’s immune response to fully respond and for you to be protected so make plans to get vaccinated. CDC recommends that people get a flu vaccine by the end of October, if possible. However, getting vaccinated later can still be beneficial. CDC recommends ongoing flu vaccination as long as influenza viruses are circulating, even into January or later. Children aged 6 months through 8 years who need two doses of vaccine should get the first dose as soon as possible to allow time to get the second dose before the start of flu season. The two doses should be given at least 28 days apart.
*Source: Centers for Disease Control and Prevention

Dr. Norman Desbiens is eager to show off his latest weapon in the never-ending battle against the influenza virus.

In a back office at the Program of All-inclusive Care for the Elderly [PACE], he points to a small white plastic box, about the size of a loaf of bread.

"This little machine is a molecular laboratory in a box," he said, shaking his head in amazement during a visit Thursday to the Alexian Brothers comprehensive day care service for seniors. Within 15 minutes after taking a swab from a patient's mouth, the Molecular Rapid Flu Test can tell him whether they have a common cold or influenza, which is far more deadly.

"When you are doing real-time care with a patient who is frail and elderly, you have to decide whether to treat them now," he said. "If you are waiting for test results to come back a week later, the patient is dead by then."

This is the first full flu season Desbiens has used the device, and he hopes it gives him an even better advantage against an old foe that is constantly changing.

The Zika virus gets heavy media attention — while having caused only one confirmed death in the U.S. — but the flu is a certain killer. Although the number of flu-related deaths varies each year, the federal Centers for Disease Control and Prevention estimates the toll fluctuates from 3,000 to 49,000 annually.

Last year, eight people died from the flu in Hamilton County, according to data from the Tennessee Department of Health. But that figure may be too low, because the flu may also hasten the deaths of people who already suffer from other illnesses such as heart disease, C.O.P.D. (which includes emphysema and chronic bronchitis), or diabetes.

What makes PACE special is also what makes it particularly vulnerable to the flu or any other contagious disease. Some 250 patients, all of them elderly and many suffering from debilitating ailments, are brought to the two contiguous PACE centers off Third Street from across Hamilton County every weekday, where they mingle with nearly 200 staffers and then go home at night and on the weekend to their families.

They get comprehensive care from PACE — free vaccinations for contagious diseases, medical checkups, access to a pharmacy, and social activities — throughout the day.

But just being around other people puts them at risk.

The way Desbiens and the PACE staff protect their patients is a good lesson in how to approach the coming flu season.

First, all staffers, from nurses to social workers to van drivers, are required to be vaccinated.

Second, all of the patients are required to get a flu shot, as well, unless their caregiver has a specific reason for objecting. The caregivers, too, are offered free vaccinations, Desbiens said.

"If you want to protect frail, elderly family members, then everybody in the family should get a flu shot," he said.

If a patient shows signs of sickness, they can be isolated, away from the clinic, until the cause of their illness can be determined.

A nurse monitors employee illnesses to be sure they don't come to work if they have the flu or some other contagious disease.

If a staffer or patient shows any signs of the flu, then PACE officials may start administering the drug oseltamivir, better known by its brand name Tamiflu, to those who were in contact with them. That can shorten the length of the illness, weaken its symptoms, and prevent hospitalization.

Last year, the program worked almost perfectly. Not a single patient contracted the flu, although 10 employees did. Desbiens blames that on ineffective vaccines or employees who became infected before they were vaccinated. The flu never goes away, he noted, even in the summer months in the U.S. when it instead rages in the Southern Hemisphere.

"So much of this is still guesswork," he said. "A patient comes in and you don't know what they have. You do your best guess, you aim on the side of treating them. That's the best you can do."

Seniors are particularly vulnerable because their immune systems often are weakened and don't respond as strongly to the vaccine as do younger people.

Infants also need special protection. Babies who are less than 6 months old are too young to be vaccinated, so everyone who comes in contact with them should get a flu shot, said nurse Sharon Goforth, a special projects supervisor and flu specialist at the Hamilton County Health Department.

Children ages 1 to 5 are also at risk because their immune systems are still immature, so they may not get the whole benefit of the flu shot, she said.

The flu vaccine works like all vaccines — its effectiveness depends on how many people in a community are protected. If everyone got a flu shot, there would be no place for the flu virus to grow, but health officials know that won't happen. But the more people who get a flu shot, the harder it becomes for the flu to spread, Goforth said.

Health officials don't know yet how serious this year's flu season will be. Last year, it began very slowly, with the peak in flu-like illnesses not coming until March and April, according to data from the health department. But in the two previous years, the peak occurred in December and January, leading health officials to urge everyone to get a flu shot now.

There are three main strains of the flu virus expected to show up in Chattanooga this year, Goforth said, and the vaccine is designed to build immunity to those strains. They are known to researchers as A-California, A-Hong Kong, and B-Brisbane.

There is a fourth strain, P-Phuket, that some vaccines will also include.

Researchers at the CDC and the World Health Organization decided which virus strains to include in this year's vaccine back in February, based on what strains showed up last year, and on what happened in the Southern Hemisphere during its recent flu season. The decision is always inexact because the flu virus can mutate in a matter of months, while the drug manufacturers need several months' lead time to produce millions of doses of the vaccine and distribute them to doctors, health departments, and pharmacies.

In one change from last year, the CDC is recommending against using a nasal mister to deliver the vaccine. Over the past several years, the misters were not as effective as a shot, the CDC concluded, although some manufacturers may still make them available, Goforth said.

Flu shots are already available at area pharmacies and will be offered by the health department by mid-October.

Because the flu virus can be transmitted by sneezing or touching, health officials say if you believe you are infected, stay at home and do not mingle with other people. One of the most effective ways to avoid spreading the virus is simple, Goforth said: "Wash your hands regularly."

But most importantly, don't ignore the flu threat.

If PACE's patients do get influenza, "there is a fair chance of them dying," Desbiens said. "We treat it very seriously."

Contact staff writer Steve Johnson at 423-757-6673,, on Twitter @stevejohnsonTFP, and on Facebook,