The old news is that each year thousands of Americans die, and many more miss valuable days of work or school, due to a preventable illness — influenza. Each year healthcare providers are challenged to convince people that they should get a flu shot. Why is this? We’ve learned that “scare tactics” don’t work, although I don’t understand this completely. Each year 20,000-50,000 people die in the United States from seasonal flu, and last year 149 children died of the flu (348 in 2009). That scares me. Since numbers don’t seem to motivate people, we try education. You can’t get the flu from a flu shot — it contains parts of dead viruses. However, have you ever heard someone say, “I don’t get the flu shot because the last time it gave me the flu”? Of course you have, but don’t believe it. The most common scenario is that someone was exposed to the flu virus a few days before they got the shot or during the first two weeks after they got the shot, then came down with influenza or an influenza-like illness (ILI) and blamed the immunization. Wrong.
Current recommendations are unchanged — Everyone aged 6 months and over should be immunized unless there are specific contraindications. If you have concerns about whether you should be immunized, please discuss your specific case with your primary care physician or other health professional rather than just avoiding immunization. There are quite a few influenza products available this year, and only a healthcare professional can help you navigate the options. Pregnant? You can probably be immunized and should. Allergic to eggs? You can probably still be immunized.
This year there are at least seven different types of flu vaccines available, so it is very likely that one or more of these is appropriate for you. You may hear the words “trivalent” and “quadrivalent” mentioned this year. The trivalent vaccine contains two strains of influenza A (H1N1 and H3N2) and one strain of influenza B. The quadrivalent vaccine contains these three plus another strain of influenza B. The quadrivalent vaccine may be available a little later in the season this year, but the CDC recommends not waiting for the quadrivalent vaccine. If you have an opportunity to get the trivalent vaccine now, go ahead if you qualify. Ideally everyone who qualifies would be vaccinated by October, but anytime this fall and winter is better than never.
It takes about two weeks for the flu vaccine to become effective. Due to weaker immune systems, people over age 65 may want to get the “high-dose” trivalent vaccine, although again, the most important thing to do is get immunized. So if you are over 65 and have a chance to get a “standard-dose” trivalent vaccine, don’t wait for the quadrivalent or high-dose vaccine to be available — go ahead and get immunized as soon as possible.
Does it work? Every year we hear people comment that their flu shot didn’t work because they got a flu-like illness with runny nose, fever, and body aches. However, without a specific test, we don’t know if they really had the flu or an ILI. The flu vaccines are very effective against the strains of influenza A and B that they are designed to prevent. However, this doesn’t mean that you won’t still get an ILI illness (including the common cold).
If you think you might have the flu, please see your PCP as early as possible. Available medications that might lessen the symptoms and shorten the course are only effective if started at the earliest onset of symptoms. These include olsetamivir (Tamiflu) and zanamivir (Relenza). In certain situations, anti-viral medications may be recommended for limiting the spread of the flu virus in families and other settings. This “post-exposure” chemoprophylaxis might be recommended, for example, for unvaccinated family members of a diagnosed contact.
The flu season is a dangerous time and should be respected. Large healthcare networks are determined to protect both current and potential patients and healthcare workers. Many, including Community Health Network, are making influenza immunization mandatory for employees. The vaccines and medications are complicated, but can be life-saving. Please see your PCP this fall and make flu immunization part of your fall checkup conversation.
Dr. Fleming is the Medical Director of The Jane Pauley Community Health Center (part of Community Health Network). Ideas for this column can be e-mailed to Dr. Fleming at AskDrFleming@gmail.com