Despite low vaccination rates, Alachua County has dodged an influenza outbreak. Marion County hasn’t been so lucky.

Alachua County School District Supervisor of Health Services Patricia Hughes remembers a time before intranasal flu vaccines, when so many students missed the FCAT because of the flu that the governor had to pardon the county’s exam scores.

Given the number of students and nurses out with the flu so far this year, she fears a repeat of that nightmare.

The FDA signed off on the development of an intranasal flu vaccine in 2003. In 2007, the CDC approved its use for the 2007-08 flu season. The incorporation of a needleless vaccine improved vaccination rates , lowering flu outbreaks and flu-related deaths.

But in 2013 , a particularly potent strain of the H1N1 flu virus threw a wrench in that progress. FluMist, the brand-name intranasal vaccine at the time, proved less effective against this strain (officially named H1N1pdm09) for three consecutive years, leading the CDC in 2016 to stop recommending its use. This meant that schools and other government entities could no longer give intranasal vaccinations.

In the years since, vaccination rates in Alachua County have plummeted, from around 70 percent in 2015 to as low as 30 percent today, according to Paul Myers, director of the Alachua County Health Department.

Myers, too, fears catastrophe, but unlike Hughes, he believes the data so far bode well for Alachua County residents.

“Even though we’re down to about 25-30 percent [vaccinated], we just don’t see the influenza activity in our community that we’re seeing in other North Central Florida and other Florida counties,” he said.

Myers suggested that it may have something to do with Alachua County’s school vaccination program. Run every year since 2009, the program has earned national recognition for achieving high vaccination rates, and even after rates halved post-mist, they stabilized at a rate higher than most North Central Florida counties.

The program aims to vaccinate children, who Myers deems “super spreaders” for their understandably poor hygiene practices, to achieve what some call “herd immunity”: resistance to the spread of disease resulting from sufficiently high rates of immunization within a population.

Marion County, by contrast, has no such program. Instead it contracts with a private company called Healthy Schools LLC.

Healthy Schools provides flu vaccination services free of charge to students and school districts, recouping costs through pre-existing contracts it has with Medicaid and private insurance companies.

In week one of the 2018 flu season, however, Marion County has already seen an uptick in influenza activity, recording an average of 19 positive flu tests a day, compared to eight a day in December, according to Marion County Health Department representative Christy Jergens. The state health department as of Jan. 6 has already reported 1-2 flu outbreaks in the county, defined as a sudden increase in the occurrence of the infection.

They recorded no outbreaks for Alachua in the same time period.

Hughes, Alachua County’s school health services supervisor, sounded less buoyed by this data.

I don’t know,” she said. “[Without the intranasal spray,] this year could be the year where it’s really bad.”

Where Hughes and Myers agree: the need to get vaccinated.

“Influenza is the only illness for which there is a vaccine that circles the globe annually, sickens millions and millions of people, kills hundreds and hundreds of thousands worldwide for which we have a vaccine,” Myers said.

A vaccination, while not perfect, can make the difference between life and death.