Some people are afraid of flying. Others dread the dentist’s chair. But lack of vaccine this year has caused many among us to fear the flu.

When will it hit? How bad will it be? What can we do to safeguard our health?

These are all questions county residents ask as they approach the cold-weather months without a flu vaccination.

Some health care providers did get the vaccine they ordered last spring, said Dr. Tom McGill, chairman of infection control at Butler Memorial Hospital. Many providers did not, however.

As most of us know by now, the shortage occurred when a regulatory agency in England suspended the Chiron drug company’s license to make the vaccine. Since Chiron is one of only two flu vaccine manufacturers, available supplies were reduced by half.

McGill said some rumors suggest more vaccine is on order, but he is doubtful it will arrive in time.

“It’s not an easy thing to manufacture,” he said. “Last year we had a very early flu season: It was in November. It could be an early year this year, too. … It all depends on when it hits.”

Although the U.S. Centers for Disease Control and Prevention has posted guidelines for administering available vaccine according to who is most at risk for complications, McGill said the county will likely run short of the doses needed strictly for high risk residents.

Despite the shortage, McGill said options exist for those who want to take a proactive stance against the virus.

Four anti-viral prescription drugs can shorten an influenza illness and make it less severe: amantadine, rimantadine, oseltamivir and zanamivir, the latter of which comes in spray form.The important thing to know about these four drugs is timing.“You have to take them within 48 hours of the beginning of the illness for them to work,” McGill stipulated.“People have to recognize they have influenza. Their doctor’s office has to be able to respond quickly enough that you’re not missing that window of opportunity.”The first three can also be used for prevention, he said. “So if a doctor has someone who’s very high risk and unable to obtain a vaccination, (that person) can take them for prevention during flu season — which typically lasts for about six weeks sometime between November and March.”FluMist, another nasal spray, is a form of vaccine available. However, the drug is more costly than the other vaccines and is often not suitable for those at risk for complications, McGill said.“Really, it’s a vaccine designed for people who don’t need to be vaccinated,” he said.“If you have a chronic condition, you’re not supposed to take it. If you’re over 64 or under 2, you don’t take it,” he said, explaining the same conditions that put a person at risk for flu complications preclude them using FluMist.FluMist can, however, be an option for healthcare workers and public safety workers who aren’t vulnerable except for their contact with so many potentially sick people, he said.Pneumonia can be a serious result of the flu for some people, so McGill suggested those at risk for complications get a pneumonia vaccination.“In older people (the vaccination) is less effective in preventing pneumonia than in younger people, but it’s very effective in preventing death,” he explained.The pneumonia vaccination is administered every five years and once after the age of 65.

Since cold and flu germs target the nose, throat and lungs, the most common way to transmit the viruses is through coughs and sneezes.However simple as it may seem, experts say a key way to prevent spreading the flu is for infected people to avoid other people by staying home and by covering their own coughing and sneezing.Although frequent hand-washing for 30-second intervals is also recommended, McGill said flu germs survive only a short time in the environment, beginning to lose their potency within minutes as cough and sneeze fluids evaporate.In addition to hygiene, nutrition offers defense against flu.Carol Landis, a therapeutic dietitian at BMH, maintains nutrition obtained from foods is the primary key to a healthy immune system.“Eating an orange is going to give you vitamin C, it’s going to give you fiber, its going to give you fluids — so you’re going to get multiple things,” she said of the benefits of food versus vitamin supplements.Landis also said avoiding alcohol during the flu season will help maintain a healthy immunity. “(Alcohol) restricts your vessels; it interferes with absorption,” she said. “Alcohol reduces the body’s immune response and its ability to fight infection.”As for the herbal supplements some people seek out, Landis said their effectiveness is often unproven from a scientific standpoint.Of those that have gained the most attention, some literature shows echinacea and elderberry extract to be beneficial, she said.“Echinacea seems to be one that probably warrants the most benefits in terms of the flu … because it does help prevent the bacteria and virus from growing,” she said, adding that the limited controls in herb production and marketing do little to ensure consistency in the products.“People really need to look at a very reputable source when doing anything in terms of herbs,” Landis said.She also pointed out people with HIV, tuberculosis and other ailments can experience side effects from using herbs.Marcy Leeds, a registered dietician with a Ph.D. in science education, agrees nutrition plays a primary role in wellness.But Leeds said good prevention should include a holistic approach to wellness. In the classes she teaches at Slippery Rock University, Leeds points to nutrition, sleep and relaxation, stress management and spiritual health as components of overall well being.“I never separate out nutrition by itself when I’m talking about a healthy life and a healthy lifestyle,” Leeds said.“It’s always a holistic approach: Everything can affect positively and negatively your immune function.”While many people look toward nutritional supplements and herbal products to strengthen their immune systems, Leeds agrees with Landis that eating nutritious whole foods adds most to overall wellness.Leeds suggested following food pyramid guidelines that emphasize multiple servings of fruits and vegetables each day — paying closer attention to vitamin C during the flu season.As for the other aspects of wellness, stress also plays a role, Leeds said.“The more stressed you are, the more your immune system will be challenged,” she added, reiterating that food is only one part of the puzzle.“Research shows people with work stress have much higher incidence of colds and flus. Research shows their response to the flu vaccine is not as positive when they’re highly stressed.”“It’s very interesting that you see certain people that breeze through (the cold and flu season). Once every two or three years, they might get a cold. But typically those individuals have a healthier lifestyle,” Leeds said.“Sometimes there’s a percentage (for whom) it’s genetic, but the majority of them are helping out their genes: They’re doing the right things.”