With more cold days and severe winter weather still ahead in many parts of the country, Japan is already suffering a major outbreak of influenza. At the moment the epidemic appears heavily concentrated in the Tokyo metropolitan area, where close to 9,000 cases have now been registered, but many other prefectures are counting victims in the thousands. Deaths caused by influenza among the elderly are climbing daily. In too many instances, care facilities for the aged are reporting multiple fatalities from pneumonia triggered by the flu virus.

Health authorities report that the strain responsible for most reported cases this year is the Type A Hong Kong virus, identical to the strain that last winter caused Japan’s worst flu epidemic in a decade. Why then wasn’t the health-care establishment better prepared for this year’s onslaught? One reason appears to be the presumption that the public develops a general immunity to a strain of the virus after an especially severe attack and is not as likely to be affected in the following year. That theory is being sorely tested now, with the Health and Welfare Ministry predicting that the number of reported cases will hit a peak in early February.

As always in outbreaks of this kind, those most at risk are the very young and the very old. The elderly in particular face the danger of developing pneumonia from what they at first assume is only a common cold. Children face the danger that infection with the influenza virus can trigger a fatal bout of meningitis or encephalitis — inflammation of the brain. Although specialists in infectious diseases believe that well over three-fourths of the nation’s children between the ages of 5 and 9 should have a high degree of immunity this year, close to 65,000 students at kindergartens, elementary schools, junior high and senior high schools have already been affected. That is still fewer than last year, but the worst could be yet to come.

Many of the daily calls for emergency ambulance service being placed this season come from family members of elderly people living alone who are suffering from high temperatures and other serious symptoms of influenza. Understandably, the epidemic has unleashed a rush to obtain flu shots at hospitals, clinics and public health centers nationwide. Yet some doctors at welfare facilities for the aged that have been especially hard-hit report they did not automatically prescribe influenza vaccine inoculations for all the elderly under their care because of fears that some might have severe reactions to the shots.

Specialists question that judgment, suggesting that the risk is worth taking. Flu shots are not a guarantee against the illness, but doctors recommend that vaccine shots should be dispensed as a general rule to the most likely victims early in the season, before influenza begins to strike. The Health and Welfare Ministry reportedly is now asking local government officials to take the threat to their older populations seriously and to make special efforts to alert nursing homes to take all necessary steps to reduce the risks of an outbreak. Better late than never, as the saying goes, but earlier steps might have saved the lives of those who have already fallen victim to the disease in such facilities this year.

When nearly 50 elderly residents of a single nursing home are struck down by influenza, and five of them die, it is not extreme to say that the necessary precautions do not seem to have been taken. Since many of the residents are unable to fully care for themselves, reminders to gargle frequently and regularly wash one’s hands not only fall on deaf ears, they will not achieve the desired results. It is necessary for all those working in such institutions, as well as everyone who visits them, to exercise more than the usual care.

Among the public at large, advice from medical experts to lead a generally healthful lifestyle and avoid crowds will not go far toward reducing the influenza toll in a nation of overcrowded cities. The Health and Welfare Ministry, and individual members of the health-care establishment, should promote the flu vaccine more forcefully. They should also warn the public that, as helpful as the old standbys of gauze masks, gargling and hand washing may be, they are not the panaceas that some assume — at least not in a nation where openly coughing, sneezing and spitting, with no thought given to those nearby, remains everyday behavior.

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