Q&A: Scramble for vaccine as flu season heats up

WASHINGTON (AP) — Missed flu-shot day at the office last fall? And all those "get vaccinated" ads? A scramble for shots is under way as late-comers seek protection from a miserable flu strain already spreading through much of the country.

Federal health officials said Friday that there is still some flu vaccine available and it's not too late to benefit from it. But people may have to call around to find a clinic with shots still on the shelf, or wait a few days for a new shipment.

"We're hearing of spot shortages," said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.

Colorado offers an example. Kaiser Permanente, which has 535,000 members in the state, stopped giving flu shots this week. But it expected to resume vaccinations when new shipments arrive, expected this weekend.

Some questions and answers about flu vaccines:

Q: Are we running out of vaccine?

A: It's January — we shouldn't have a lot left. The traditional time to get vaccinated is in the fall, so that people are protected before influenza starts spreading.

Indeed, manufacturers already have shipped nearly 130 million doses to doctors' offices, drugstores and wholesalers, out of the 135 million doses they had planned to make for this year's flu season. At least 112 million have been used so far.

The nation's largest manufacturer, Sanofi Pasteur, said Friday that it still has supplies of two specialty vaccines, a high-dose shot for seniors, and an under-the-skin shot for certain adults, available for immediate shipment. But it also is working to eke out a limited supply of its traditional shots — some doses that it initially hadn't packaged into syringes, said spokesman Michael Szumera. They should be available late this month.

And MedImmune, the maker of the nasal spray vaccine FluMist, said it has 620,000 extra doses available.

Q: Can't they just make more?

A: No. Flu vaccine is complicated to brew, with supplies for each winter made months in advance and at the numbers expected to sell. Although health officials recommend a yearly flu vaccination for nearly everybody, last year 52 percent of children and just 39 percent of adults were immunized. Most years, leftover doses have to be thrown out.

Q: Should I still hunt for a vaccine?

A: It does take two weeks for full protection to kick in. Still, health officials say it's a good idea to be vaccinated even this late, especially for older people, young children and anyone with medical conditions such as heart or lung diseases that put them at high risk of dangerous flu complications. Flu season does tend to be worst in January and February, but it can run through March.

Q: I heard that a new flu strain is spreading. Does the vaccine really work?

A: Flu strains constantly evolve, the reason that people need an updated vaccine every year. But the CDC says this year's is a good match to the types that are circulating, including a new kind of the tough H3N2 strain. That family tends to be harsher than other flu types — and health officials warned last fall that it was coming, and meant this winter would likely be tougher than last year's flu season, the mildest on record.

Q: But don't some people get vaccinated and still get sick?

A: Flu vaccine never is 100 percent effective, and unfortunately it tends to protect younger people better than older ones. But the CDC released a study Friday showing that so far this year, the vaccine appears 62 percent effective, meaning it's working about as well as it has in past flu seasons.

While that may strike some people as low, Frieden said it's the best protection available. "It's a glass 62 percent full," he said. "It's well worth the effort."

Q: What else can I do?

A: Wash your hands often, and avoid touching your eyes, nose and mouth. Viruses can spread by hand, not just through the air. Also, cough in your elbow, not your hand. When you're sick, protect others by staying home.

And people who are in those high-risk groups should call a doctor if they develop symptoms, added CDC spokesman Tom Skinner. They might be prescribed antiviral medication, which works best if given within the first 48 hours of symptoms.

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AP Medical Writers Lindsey Tanner and Mike Stobbe contributed to this report.

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Poisoned Lottery Winner's Kin Were Suspicious

Urooj Khan had just brought home his $425,000 lottery check when he unexpectedly died the following day. Now, certain members of Khan's family are speaking publicly about the mystery -- and his nephew told ABC News they knew something was not right.

"He was a healthy guy, you know?" said the nephew, Minhaj Khan. "He worked so hard. He was always going about his business and, the thing is: After he won the lottery and the next day later he passes away -- it's awkward. It raises some eyebrows."

The medical examiner initially ruled Urooj Khan, 46, an immigrant from India who owned dry-cleaning businesses in Chicago, died July 20, 2012, of natural causes. But after a family member demanded more tests, authorities in November found a lethal amount of cyanide in his blood, turning the case into a homicide investigation.

"When we found out there was cyanide in his blood after the extensive toxicology reports, we had to believe that ... somebody had to kill him," Minhaj Khan said. "It had to happen, because where can you get cyanide?"

In Photos: Biggest Lotto Jackpot Winners

Authorities could be one step closer to learning what happened to Urooj Khan. A judge Friday approved an order to exhume his body at Rosehill Cemetery in Chicago as early as Thursday to perform further tests.

Lottery Winner Murdered: Widow Questioned By Police Watch Video

Moments after the court hearing, Urooj Khan's sister, Meraj Khan, remembered her brother as the kind of person who would've shared his jackpot with anyone. Speaking at the Cook County Courthouse, she hoped the exhumation would help the investigation.

"It's very hard because I wanted my brother to rest in peace, but then we have to have justice served," she said, according to ABC News station WLS in Chicago. "So if that's what it takes for him to bring justice and peace, then that's what needs to be done."

Khan reportedly did not have a will. With the investigation moving forward, his family is waging a legal fight against his widow, Shabana Ansari, 32, over more than $1 million, including Urooj Khan's lottery winnings, as well as his business and real estate holdings.

Khan's brother filed a petition Wednesday to a judge asking Citibank to release information about Khan's assets to "ultimately ensure" that [Khan's] minor daughter from a prior marriage "receives her proper share."

Ansari may have tried to cash the jackpot check after Khan's death, according to court documents, which also showed Urooj Khan's family is questioning if the couple was ever even legally married.

Ansari, Urooj Khan's second wife, who still works at the couple's dry cleaning business, has insisted they were married legally.

She has told reporters the night before her husband died, she cooked a traditional Indian meal for him and their family, including Khan's daughter and Ansari's father. Not feeling well, Khan retired early, Ansari told the Chicago Sun-Times, falling asleep in a chair, waking up in agony, then collapsing in the middle of the night. She said she called 911.

"It has been an incredibly hard time," she told ABC News earlier this week. "We went from being the happiest the day we got the check. It was the best sleep I've had. And then the next day, everything was gone.

"I am cooperating with the investigation," Ansari told ABC News. "I want the truth to come out."

Ansari has not been named a suspect, but her attorney, Steven Kozicki, said investigators did question her for more than four hours.

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Obama, Karzai agree to speed up Afghan military transition

WASHINGTON (Reuters) - President Barack Obama and Afghan President Hamid Karzai agreed on Friday to speed up the handover of combat operations in Afghanistan to Afghan forces this year, underscoring Obama's determination to move decisively to wind down the long, unpopular war.

Signaling a narrowing of differences, Karzai appeared to give ground in White House talks on U.S. demands for immunity from prosecution for any U.S. troops who stay in Afghanistan beyond 2014, a concession that could allow Obama to keep at least a small residual force there.

Both leaders also threw their support behind tentative Afghan reconciliation efforts with Taliban insurgents. They each voiced support for the establishment of a Taliban political office in the Gulf state of Qatar in hopes of bringing insurgents to inter-Afghan talks.

Karzai's visit, which follows a year of growing strains in U.S.-Afghan ties, comes amid stepped-up deliberations in Washington over the size and scope of the U.S. military role in Afghanistan once the NATO-led combat mission concludes at the end of next year.

The Obama administration has been considering a residual force of between 3,000 and 9,000 troops in Afghanistan to conduct counterterrorism operations while providing training and assistance for Afghan forces.

But a top Obama aide said this week that the administration does not rule out a complete withdrawal after 2014, a move that some experts say would be disastrous for the still-fragile Afghan government and its fledgling security apparatus.

Saying that Afghan forces were being trained and were "stepping up" faster than expected, Obama said Afghan troops would take over the lead in combat missions across the country this spring, rather than waiting until the summer, as was originally planned.

"Starting this spring, our troops will have a different mission: training, advising, assisting Afghan forces," Obama said. "It will be a historic moment and another step toward full Afghan sovereignty."

There are some 66,000 U.S. troops currently in Afghanistan. NATO allies have also been steadily reducing their troop numbers there with the aim of ending the foreign combat role in 2014, despite doubts about the ability of Afghan forces to shoulder full responsibility for security.

Obama said final decisions on this year's troop reductions and the post-2014 U.S. military role were still months away, but his comments raised the prospects of an accelerated withdrawal timetable as the security transition proceeds.

Precisely how much of an acceleration was unclear.

For his part, Karzai voiced satisfaction over Obama's agreement to turn over control of detention centers to Afghan authorities, a source of dispute between their countries.

The two leaders, who have had a tense relationship in the past, stood side by side in the White House East Room, nodding occasionally as the other spoke.

Obama once called Afghanistan a "war of necessity," but he is heading into a second term looking for an orderly way out of the conflict, which was sparked by the September 11, 2001 attacks by al Qaeda on the United States.

(Additional reporting by David Alexander; Editing by Warren Strobel and David Brunnstrom)

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Rockefeller to retire from US Senate

WASHINGTON: Veteran Democrat Jay Rockefeller of West Virginia announced Friday that he will not seek re-election to the US Senate next year, providing Republicans a prime opportunity to pick up a seat.

The lawmaker has been a longtime defender of the rights of laborers and the poor, and was an initial supporter of using US military force against the regime of Iraq's Saddam Hussein before becoming a fierce critic of US president George W. Bush and his war policies.

"As I approach 50 years of public service in West Virginia, I've decided that 2014 will be the right moment for me to find new ways to fight for the causes I believe in," Rockefeller said in a statement released as he spoke to supporters and media in state capital, Charleston.

"Championing those most in need has been my life's calling, and I will never stop fighting to make a difference for the people who mean so much to me."

Rockefeller, 75, a two-term West Virginia governor, was first elected to the Senate in 1984.

He is a great-grandson of oil tycoon John Rockefeller, and the only Democrat in the Republican family dynasty to serve in national politics.

Rockefeller is chairman of the Senate Committee on Commerce, Science and Transportation, where he said he has led "exhilarating fights... to make our cars more efficient, our phone bills more truthful, our Coast Guard more agile, and the Internet more safe."

He also served as chairman of the powerful Senate Intelligence Committee in the wake of the terror attacks of September 11, 2001 and helped implement reform of the intelligence community.

President Barack Obama lauded Rockefeller's "lifetime of service" and said his fellow Democrat would be missed on Capitol Hill.

"From his time in the state legislature to the governor's office to the Senate floor, Jay has built an impressive legacy, one that can be found in the children who have better schools, the miners who have safer working conditions (and) the seniors who have retired with greater dignity," Obama said in a statement.

Rockefeller stressed that he would not shy away from the challenges facing lawmakers in the next two years, notably a looming series of fiscal battles.

"We've got a really rough debt ceiling in several weeks coming up," he said, referring to the debate over extending US borrowing authority. "I want to be part of that fight."

Rockefeller's departure sets up a succession scramble, with Republicans eager to chip away at the Democrats' 55-45 hold of the 100-seat Senate.

House Republican Shelley Capito has announced in November that she would run for Rockefeller's seat in 2014.

Since his first Senate victory Rockefeller has mostly coasted to re-election, but with Obama deeply unpopular in West Virginia, no one doubts the difficulty the senator would have faced in winning a sixth term.

West Virginia, among the poorest states in the nation, voted Democratic in presidential elections from 1988 to 1996, but from 2000 onward it has been reliably Republican.

Although a West Virginia Republican has not served in the Senate since 1958, Capito has cited the recent political shift as a sign that Republicans now have a strong shot.

Congressman Nick Rahall, a 19-term Democrat, hailed Rockefeller as a lawmaker who "pledged his heart, mind and strength" to West Virginians ever since he first went to the state as an anti-poverty worker in the early 1960s.

-AFP/ac

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Three northeast states to go to polls in mid-Feburary

NEW DELHI: The Election Commission announced assembly polls in Tripura, Meghalaya and Nagaland on Friday, giving Tripura chief minister Manik Sarkar the chance to join the exclusive club of long-serving chief ministers led by Jyoti Basu and for former Lok Sabha Speaker PA Sangma to prove his relevance in Meghalaya politics.

While Tripura will vote on February 14, Meghalaya and Nagaland will poll together on February 23. The model code of conduct will apply in all three states as well as to the Union government with immediate effect.

Counting is scheduled in all the three states on February 28.

For the Congress, a win in Nagaland and Meghalaya would help to fill up its rather bare cupboard of recent electoral wins and assert its credentials as the only mainstream party with a pan-Indian presence.

The EC on Friday also announced by-polls to nine assembly seats spread across seven states. While polls to one assembly seat each in Mizoram, Punjab and Uttar Pradesh as well as to three assembly seats in West Bengal are scheduled for February 23, an assembly seat each in Assam, Bihar and Maharashtra will go to polls a day later on February 24.

Counting for the bypolls will also be held on February 28, the day when the Union budget is likely to be presented.

While the poll notification for Tripura will be issued on January 21, the notifications for Meghalaya and Nagaland shall be out on January 30.

The assembly polls and bypolls are to be completed by March 3.

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Poisoned Lottery Winner's Exhumation Approved

A judge has approved the exhumation of the Chicago lottery winner who died of cyanide poisoning.

Judge Susan Coleman of the Probate Division of the Cook County Circuit Court in Illinois today approved the county medical examiner's request to exhume the body of Urooj Khan at Rosehill Cemetery in Chicago.

Khan, 46, died July 20, 2012, from what was initially believed to be natural causes. But a family member whose identity has yet to be revealed asked the medical examiner's office to re-examine the cause of death, which was subsequently determined to be cyanide poisoning.

The office did so by retesting fluid samples that had been taken from Khan's body, including tests for cyanide and strychnine.

In explaining the request for exhumation, Chief Medical Examiner Stephen Cina has said, "If or when this goes to court, it would be nice to have all the data possible."

The Chicago businessman had won a $1 million lottery jackpot -- before taxes -- the month before he died.

In Photos: Biggest Lotto Winners

In the latest legal twist, Khan's brother filed a petition Wednesday to a judge asking Citibank to release information about Khan's assets to "ultimately ensure" that [Khan's] minor daughter "receives her proper share." Khan reportedly did not have a will.

He left behind a widow, Shabana Ansari, 32, and a teenage daughter from his first marriage. Ansari and Khan reportedly married 12 years ago in India.

Authorities questioned Ansari in November and searched the home she shared with Khan. She and her attorney, Al Haroon Husain, say she had nothing to do with his death.

"It's sad that I lost my husband," she told ABC News. "I love him and I miss him. That's all I can say."

The siblings of the poisoned lottery winner have pursued legal action to protect their niece's share of her late father's estate. They also questioned whether he and Ansari were legally married, but Ansari's attorney said she has a marriage certificate from India that is valid in the United States.

ImTiaz Khan, 56, Khan's brother, and Meraj Khan, 37, their sister, had won a court order to freeze the lottery winnings after Ansari cashed the check.

Husain said Ansari cashed the lottery check after it was mailed to the home, which she did not request.

The lottery check, about $425,000 in cash, was issued July 19 by the Illinois Comptroller's Office, then mailed, according to Brad Hahn, spokesman for the Comptroller's Office. Hahn said it was cashed Aug. 15, nearly a month after Khan's death, but he did not know who cashed it.

The judge later approved Ansari's competing claim as an administrator of the estate.

"I don't care what they talk [sic]," Ansari told ABC News of what her in-laws are saying.

Ansari said she was married to Khan but declined to comment to ABC News about cashing the check after his death, although The Associated Press has reported that she denied removing any of the assets.

Meraj Khan filed in September to become the legal guardian of her niece. After the judge asked the 17-year old daughter with whom she wished to live, she chose her aunt and has been there since November, Husain said.

Neither sibling has petitioned to obtain a share of the dead man's estate, which is estimated to be $1.2 million in lottery winnings, real estate, Khan's laundry business and automobiles.

Neither the attorney for ImTiaz Khan nor the two siblings has responded to requests for comment.

A status hearing on the future of the estate is scheduled for Jan. 24, according to the AP.

ABC News' Alex Perez and Matthew Jaffe contributed to this report.

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String of bombings kill 101, injure 200 in Pakistan

QUETTA, Pakistan (Reuters) - At least 101 people were killed in bombings in two Pakistani cities on Thursday in one of the country's bloodiest days in recent years, officials said, with most casualties caused by sectarian attacks in Quetta.

The bombings underscored the myriad threats Pakistani security forces face from homegrown Sunni extremist groups, the Taliban insurgency in the northwest and the less well-known Baloch insurgency in the southwest.

On Thursday evening, two coordinated explosions killed at least 69 people and injured more than 100 in Quetta, the provincial capital of Balochistan, said Deputy Inspector of Police Hamid Shakil.

The first attack, in a crowded snooker hall, was a suicide bombing, local residents said. About ten minutes later, a car bomb exploded, they said. Five policemen and a cameraman were among the dead from that blast.

The attacks happened in a predominately Shia neighborhood and banned sectarian group Lashkar-e-Jhangvi claimed responsibility. The extremist Sunni group targets Shias, who make up about 20 percent of Pakistani's population.

Targeted killings and bombings of Shia communities are common in Pakistan, and rights groups say hundreds of Shia were killed last year. Militant groups in Balochistan frequently bomb or shoot Shia passengers on buses travelling to neighboring Iran.

The killers are rarely caught and some Shia activists say militants work alongside elements of Pakistan's security forces, who see them as a potential bulwark against neighboring India.

Many Pakistanis fear their nation could become the site of a regional power struggle between Saudi Arabia, source of funding for Sunni extremist groups, and Iran, which is largely Shia.

But sectarian tensions are not the only source of violence.

The United Baloch Army claimed responsibility for a blast in Quetta's market earlier in the day. It killed 11 people and injured more than 40, mostly vegetable sellers and secondhand clothes dealers, police officer Zubair Mehmood said. A child was also killed.

The group is one of several fighting for independence for Balochistan, an arid, impoverished region with substantial gas, copper and gold reserves, which constitutes just under half of Pakistan's territory and is home to about 8 million of the country's population of 180 million.

SWAT BOMBING

In another incident Thursday, 21 were killed and more than 60 injured in a bombing when people gathered to hear a religious leader speak in Mingora, the largest city in the northwestern province of Swat, police and officials at the Saidu Sharif hospital said.

"The death toll may rise as some of the injured are in critical condition and we are receiving more and more injured people," said Dr. Niaz Mohammad.

It has been more than two years since a militant attack has claimed that many lives in Swat.

The mountainous region, formerly a tourist destination, has been administered by the Pakistani army since their 2009 offensive drove out Taliban militants who had taken control.

But Talibans retain the ability to attack in Swat and shot schoolgirl campaigner Malala Yousufzai in Mingora last October.

A Taliban spokesman said they were not responsible for Thursday's bombing.

(Additional reporting by Jibran Ahmad in Peshawar, Pakistan; Writing by Katharine Houreld; Editing by Mark Heinrich and Jason Webb)

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US focused on Syria's chemical arms after Assad: Panetta

WASHINGTON: The United States is increasingly focused on how to secure Syria's chemical weapons if President Bashar al-Assad falls from power but is not considering sending ground troops into the war-torn country, Defense Secretary Leon Panetta said Thursday.

While the US government has issued stern warnings to Damascus against resorting to such arms in its war with rebel forces, Panetta said that a more likely scenario might be a chaotic vacuum if Assad is toppled, with uncertainty over who controls the lethal weapons.

"I think the greater concern right now is what steps does the international community take to make sure that when Assad comes down, that there is a process and procedure to make sure we get our hands on securing those sites," Panetta told a news conference. "That I think is the greater challenge right now."

The US government was discussing the issue with Israel and other countries in the region, he said, but ruled out deploying American ground forces in a "hostile" setting.

"We're not talking about ground troops," Panetta added.

The US military's top officer, General Martin Dempsey, told the same news conference that if Assad chose to use his chemical stockpiles against opposition forces, it would be virtually impossible to stop him.

Preventing the launch of chemical weapons "would be almost unachievable... because you would have to have such clarity of intelligence, you know, persistent surveillance, you would have to actually see it before it happened," he said. "And that's unlikely, to be sure."

He said that clearly worded warnings to Assad from President Barack Obama have served as a deterrent.

Even if the regime chooses not to employ the weapons, the Obama administration worries that Islamist militants allied with rebel forces might gain control of some chemical sites.

Syria's chemical weapons stockpile, which dates back to the 1970s, is the biggest in the Middle East, but its precise scope remains unclear, according to analysts.

The country has hundreds of tons of various chemical agents, including sarin and VX nerve agents, as well as older blistering agents such as mustard gas, dispersed in dozens of manufacturing and storage sites, experts say.

But it remains unclear if the chemical weapons are mounted and ready to be launched on Scud missiles, if the chemical agents are maintained effectively, and whether the regime is able to replenish its chemical stocks.

Damascus has said it might use its chemical weapons if attacked by outsiders, although not against its own people.

Panetta's comments came as prospects for international diplomacy to halt the violence in Syria appeared bleak.

The regime blasted the UN-Arab League envoy, Lakhdar Brahimi, a day before he was due to hold talks with US and Russian officials, accusing him of "flagrant bias."

The 21-month civil war has claimed more than 60,000 lives, according to the United Nations.

- AFP/jc

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Govt raises financial aid for rural housing

NEW DELHI: The Centre has increased the amount for construction of houses for rural poor from Rs 45,000 to Rs 70,000 in plains and Rs 75,000 for those in hilly and difficult areas.

The landless would get Rs 20,000 in place of the present Rs 10,000 for buying homestead land.

The hike in Indira Awas Yojana came after Cabinet members on Thursday prevailed upon finance minister P Chidambaram who wanted to restrict the proposal from rural development ministry to Rs 65,000 per unit and opposed the hike for buying homestead land.

The issue brought to the fore the difference between the two arms of UPA, with rural development minister Jairam Ramesh telling reporters that finance ministry was overruled by the Cabinet. "The Union Cabinet in its overall collective wisdom decided to increase the amount," he said.

Ramesh cited the agreement signed with Ekta Parishad that stopped marching tribals in Agra in October last year. The protestors were seeking land for the landless and the Centre agreed to bear 75% of the cost for buying homestead land in place of present 50%.

There was overwhelming support in the Cabinet for increase in IAY unit cost with Ghulam Nabi Azad, Harish Rawat and Pavan Bansal pitching on other aspects of the debate.

Water resources minister Rawat said Rs 75,000 was inadequate for IAY houses in the hills since land was scarce. He demanded that construction cost be decided according to the cost of land.

Members also complained that while the Centre was funding liberally, the states changed the names of schemes to suit their political ends. The ambulance-on-demand scheme was cited as an example — it has been renamed by states though it is a centrally funded scheme under NRHM.

Briefing reporters, Chidambaram urged states to furnish lists of beneficiaries to banks to enable them to avail loans up to Rs 20,000 at 4% interest. He said loans were not being availed despite the provision for IAY.

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Flu season strikes early and, in some places, hard

NEW YORK (AP) — From the Rocky Mountains to New England, hospitals are swamped with people with flu symptoms. Some medical centers are turning away visitors or making them wear face masks, and one Pennsylvania hospital set up a tent outside its ER to deal with the feverish patients.

Flu season in the U.S. has struck early and, in many places, hard.

While flu normally doesn't blanket the country until late January or February, it is already widespread in more than 40 states, with about 30 of them reporting some major hotspots. On Thursday, health officials blamed the flu for the deaths of 20 children so far.

Whether this will be considered a bad season by the time it has run its course in the spring remains to be seen.

"Those of us with gray hair have seen worse," said Dr. William Schaffner, a flu expert at Vanderbilt University in Nashville.

The evidence so far points to a moderate season, Schaffner and others say. It looks bad in part because last year was unusually mild and because the main strain of influenza circulating this year tends to make people sicker and really lay them low.

David Smythe of New York City saw it happen to his 50-year-old girlfriend, who has been knocked out for about two weeks. "She's been in bed. She can't even get up," he said.

Also, the flu's early arrival coincided with spikes in a variety of other viruses, including a childhood malady that mimics flu and a new norovirus that causes vomiting and diarrhea, or what is commonly known as "stomach flu." So what people are calling the flu may, in fact, be something else.

"There may be more of an overlap than we normally see," said Dr. Joseph Bresee, who tracks the flu for the Centers for Disease Control and Prevention.

Most people don't undergo lab tests to confirm flu, and the symptoms are so similar that it can be hard to distinguish flu from other viruses, or even a cold. Over the holidays, 250 people were sickened at a Mormon missionary training center in Utah, but the culprit turned out to be a norovirus, not the flu.

Flu is a major contributor, though, to what's going on.

"I'd say 75 percent," said Dr. Dan Surdam, head of the emergency department at Cheyenne Regional Medical Center, Wyoming's largest hospital. The 17-bed emergency room saw its busiest day ever last week, with 166 visitors.

The early onslaught has resulted in a spike in hospitalizations. To deal with the influx and protect other patients from getting sick, hospitals are restricting visits from children, requiring family members to wear masks and banning anyone with flu symptoms from maternity wards.

One hospital in Allentown, Pa., set up a tent this week for a steady stream of patients with flu symptoms. But so far "what we're seeing is a typical flu season," said Terry Burger, director of infection control and prevention for the hospital, Lehigh Valley Hospital-Cedar Crest.

On Wednesday, Boston declared a public health emergency, with the city's hospitals counting about 1,500 emergency room visits since December by people with flu-like symptoms.

All the flu activity has led some to question whether this year's flu shot is working. While health officials are still analyzing the vaccine, early indications are that it's about 60 percent effective, which is in line with what's been seen in other years.

The vaccine is reformulated each year, based on experts' best guess of which strains of the virus will predominate. This year's vaccine is well-matched to what's going around. The government estimates that between a third and half of Americans have gotten the vaccine.

In New York City, 57-year-old Judith Quinones suffered her worst case of flu-like illness in years and was laid up for nearly a month with fever and body aches. "I just couldn't function," she said.

She decided to skip getting a flu shot last fall. But her daughter got the shot. "And she got sick twice," Quinones said.

Europe is also suffering an early flu season, though a milder strain predominates there. Flu reports are up, too, in China, Japan, the West Bank, the Gaza Strip, Algeria and the Republic of Congo. Britain has seen a surge in cases of norovirus.

On average, about 24,000 Americans die each flu season, according to the CDC.

Flu usually peaks in midwinter. Symptoms can include fever, cough, runny nose, head and body aches and fatigue. Some people also suffer vomiting and diarrhea, and some develop pneumonia or other severe complications.

Most people with flu have a mild illness and can help themselves and protect others by staying home and resting. But people with severe symptoms should see a doctor. They may be given antiviral drugs or other medications to ease symptoms.

Flu vaccinations are recommended for everyone 6 months or older. Of the 20 children killed by the flu this season, only two were fully vaccinated.

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AP Medical Writer Maria Cheng in London contributed to this report.

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Online:

CDC flu: http://www.cdc.gov/flu/index.htm

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