"We've been consistently higher than the state average and consistently higher than the U.S. average," Washington County Health Officer Dr. Robert Parker said.
Between 1988 and 1995 Washington County's death rates from influenza and pneumonia among the elderly were about 35 percent higher than the state's average, Parker said.
In the most recent years for which data is available - 1993 to 1995 - there were 243 influenza-related deaths per 100,000 elderly in the county, compared to 191.1 deaths per 100,000 elderly statewide, he said.
The state and county rates only differ among the older population. In those same years there was no significant difference in the influenza and pneumonia death rates among younger people, he said.
Parker said there are several theories why the county's elderly population is more vulnerable to the flu.
The county may have more high-risk elderly because "we do have a lot of nursing homes," Parker said.
High risk factors include being elderly and having a chronic illness which would require nursing home care, he said.
Also, the county's immunization rate for influenza could be lower than the state's rate and "that's the one we can really do something about," Parker said.
However, reliable information on vaccination rates is not available because there are no reporting requirements for adult flu and pneumonia shots, he said.
Parker estimated that only about 50 percent of the county's elderly get flu shots and even fewer, probably about 30 percent, get pneumonia shots.
Unfortunately, the vaccine for the flu is not as effective as vaccines for diseases such as polio and measles because there are so many different strains of flu and the antibodies have to be changed every year, according to Dr. George W. Comstock, director of Johns Hopkins University's Training Center for Public Research at the Washington County Health Department.
At best, it is about 70 percent protective and is most effective in preventing the flu altogether in younger people, he said.
While older people can still get mild forms of the flu after vaccination, "it is very protective against the disease killing them or requiring hospitalization," Comstock said.
The vaccine doesn't cause the flu. People "cannot get the flu from the shot. It's a killed virus," Parker said.
However, some people may experience side effects, such as achiness and a low-grade fever for up to 48 hours after the vaccination, he said.
Martha Wilkinson, a resident of Potomac Towers, said she has gotten the flu shot every year from her doctor for as long as it has been available.
One year Wilkinson, 70, got blisters in her mouth after the shot but she said she still believes in the vaccination because "if you happen to get the flu, you don't get it as bad."
Jean McHenry, 75, another resident of Potomac Towers, said she has gotten the flu shot every fall for about the last 10 years and has never had any side effects.
It is equally important for the elderly to be immunized against pneumonia, which unlike the flu vaccination is a one shot deal, requiring a booster after six years in only a few high risk cases, Parker said.
An estimated 40,000 people a year in the United States die from the type of bacteria that the pneumonia shot protects against, he said.
Healthy Communities 2000, a group of volunteers from local social service and health organizations which has been studying the health of the county, formed an influenza subcommittee to encourage immunization, according to member Linda Humbert, director of community health nursing at the health department.
In an effort to reach more senior citizens, the health department will be offering flu and pneumonia vaccinations at some new sites this fall, including the Smithsburg Fire Hall, Brownsville Church of the Brethren and at senior housing complexes in Hagerstown for the residents there, Humbert said.
In addition, letters will be sent to private physicians asking them to track the number of flu and pneumonia shots they give and to nursing homes recommending that caregivers also get vaccinated, she said.
Recent studies have indicated that it is important for those who care for the elderly to also get flu shots to prevent its spread, Parker said.
Washington County has a tragic history when it comes to influenza.
In the epidemic of 1918 more than 300 people, or about 1 percent of the county's population of approximately 30,000 people at the time, succumbed to influenza or pneumonia, Comstock said.
There were 250 epidemic-related deaths in the month of October, 1918, alone, he said.
One unusual aspect of that epidemic was that very young children and adults between the ages of 25 and 40 were as hard hit as the elderly, Comstock said.