To Flu Shot or Not to Flu Shot?

The Fall season is upon us and with comes the changing colors, start of rains, and of course, the flu.  Should you get the flu shot? – Short answer, yes.  The Centers for Disease Control (CDC) recommend every child over 6 months of age and older and all adults get the flu shot, including pregnant women.  The CDC strongly urges families with children in the home and people with chronic diseases to get vaccinated.  By getting vaccinated you can help yourself and those who are at highest risk of dying from getting the influenza virus.     

 

Seatbelts Save Lives

Most of us would agree with this statement and some venture as far as calling it obvious.  There exists countless research confirming this fact.  In some states, residents wear seat belts as required by law.  There still are a few states which do not require seat belts to be worn but data shows majority of residents still buckle up.  It’s straightforward – we know seat belts save lives. 

Why get a flu shot?  The same reason you wear a seat belt – it saves lives!    

How Vaccines Work

The first vaccine created was the smallpox vaccine in 1796.  Soon after, Louis Pasteur advanced the field of vaccination by working on the Rabies, Cholera, and Tetanus vaccines.    

Scientists created vaccines as a way for our body to be safely exposed to pathogens, thus creating an immunity against them.  That is, the immune system fights off the bad guy (germs) that enter our body, keeping us healthy.  As smart as the immune system is, it has to identify who the bad guys are and that can be tough.  For example, imagine you are a border guard in a peaceful nation such as Sweden.  If a foreigner wearing a polka dotted uniform entered your country how would you act?  If you had never seen or heard of this person or uniform before, you would have no reason to suspect this person as hostile. 

The person asks you for an audience with your president and you take him to your leader.  On the way there, you find out this individual is a foreign soldier and discover that his intention is to assassinate the president and take over the country.  Alarmed, you immediately turn the car around and kick the soldier out of your country.  From now on whenever you see a polka dot uniform you’ll be on alert.  That’s how the immune system works.  The first time an enemy cell or products of an enemy cell enter the body, it takes some time for the immune system to identify the intruder.  The next time the intruder is seen in the body, the immune system recognizes and swiftly neutralizes the bug before it can spread.      

From Pasteur’s knowledge we have evolved our current methodology of creating vaccines.  By giving a piece of the dead or alive but inactivated (unable to harm us) bug, we show our immune system who the enemy is.  The next time the bug comes into contact with our immune system our body fights it off, preventing illness.  Thus by giving our body a safe amount of the flu virus, the immune system is ready to fight off the real flu if it ever shows up. 

 Making the vaccination

Flu season begins in October and continues through spring.  Ideally we try to have the vaccine given to patients at the beginning of the season but we do continue to provide it throughout.  The vaccine is given via an injection into the arm or a spray in the nose and takes about two weeks to become active.  During these two weeks, the body is absorbing the vaccine products and building immunity to the virus. 

The method of building the virus is much like betting on a horse race in Vegas.  One places bets based on who the other racers are, their past history of wins and losses, age of horse, and conditions of the race track.  These variables help the one betting make an educated bet. 

Similar to horse racing, creating the flu shot is a bit of an educated bet.  Scientists and doctors take into account past surges in the different types of flu and current migration patterns of the virus.  Based on this and other factors they decide what strains they should be concerned for in the upcoming year.  That means this season’s vaccine was put together towards the end of last year/beginning of this year.  The epidemiologists and scientists are good at what they do and tend to be fairly accurate when building the flu vaccine. 

What’s on the menu for this year?  H2N2

The strains of flu are named by the uniforms they wear (called antigens).  One strain in particular, H2N2, has been a rather deadly strain.  Back in the 1960’s this strain caused a pandemic in the U.S.  As hundreds of people died the government rushed to make the vaccine available to everyone.  Many had already been vaccinated and those who weren’t were urged to vaccinate.  This mass vaccination drastically reduced the number of deaths which would have likely been in the thousands had there been no vaccine.    

Scientists predict H2N2 will make a comeback this season.  We already know two things about this strain of flu: 1) that it is very dangerous and 2) when vaccinated against it, it works!  Many people over the age of 50 have already been vaccinated against this strain when they were younger but immunity wanes over time so they would still need to be vaccinated. 

Herd Immunity

The ultimate public health nightmare is the dreaded pandemic.  A pandemic is an outbreak of illness across the general population.  The most recent pandemic we can recall is the H1N1 pandemic which affected millions worldwide and where thousands of people died.  This is why scientists bundled H1N1 and the seasonal flu shot in one package last year.  The more people we vaccinate (even low risk people), the less the virus can spread and infect others (including those not vaccinated).  This is the concept behind what we call herd immunity.  If we vaccinate 95 out of 100 people we reduce the transmission of the virus to only the 5 who can get sick.  Even the 5 who did not get immunized are safer since the majority of the group was vaccinated and can’t carry the virus.  By vaccinating the general population we protect everyone, especially the vulnerable. 

The most vulnerable populations tend to be those whose immune system is compromised.  Diabetics, cancer patients, those with HIV, pregnant women, children, the elderly, and patients with cardiac or lung diseases such as asthma or emphysema are considered high risk.  These patients should be vaccinated yearly and anyone living in close proximity to these patients should also be vaccinated to decrease the rate of transmission.    

 

Urban legends

“I never get sick, I don’t need the flu shot”

The entire point of vaccinations is to prevent us from getting sick.  The flu is not just the cold or sniffles.  The reason the flu kills people is because it is a serious illness.  Odds are you won’t get the flu anyways, but if it should cross your path, the vaccine will help your body fight it off right away. 

“When I get the flu, I do fine.” 

Most of us use the term ‘flu’ interchangeably with any viral upper respiratory illness (cold).  ‘Flu’ is not the same as the cold.  We all have had the cold: cough, fever, and fatigue/pain.  This, however, is not the flu (influenza virus).  The real flu causes severe symptoms: high fever (often over 102 ̊F), cough, chills, rigors (violent shaking), weakness, electrolyte imbalances, pneumonia, severe muscle pains, and even death. 

When I ask my patients I see in the E.R. with confirmed flu (by a lab test) what it feels like, their unanimous response is “I feel like I’ve been hit by a truck; I feel like I’m dying.”  The majority of us have NEVER had the flu, but rather other viral illnesses (the cold). 

In 1918 a true pandemic hit the world, The Spanish Influenza.  It infected almost 500 million people, 27% of the world’s population.  Close to 50 million died, 3% of the world’s population.  This virulent form of influenza showed no mercy – it killed the weak and young and healthy alike. 

The flu kills, and that’s why we vaccinate against it.  And no, you most likely have NOT had the flu before.        

“Everytime I get the flu shot I get the flu in a couple of days”

The flu shot, and other vaccinations, are given in the muscle.  The products of the flu shot take weeks to get absorbed.  Numerous studies and pharmacokinetic data have shown us that the shot takes about two weeks to create an immune system response.  In the meantime, however, the body may mount a response to the foreign antigen and cause a mild fever.  This, however, takes a couple days to start and is NOT the flu.  This is the body’s response to any foreign antigen. 

Why else do people feel sick soon after getting the shot?    

Location, location, location.  Where do we go to get the flu shot?  We go to the pharmacy or doctor’s office.  Who else goes to both these places?  Sick people.  When at the office you may pick up a different virus from the door handle or faucet and take that little present home.  A day or two later, guess what…you’re sick!  That’s NOT from the shot and that’s NOT the flu.

Solved!  The mystery of ‘getting the flu after the flu shot.’ 

 

Bottom line? 

Most of us have never had the flu.  The flu is a very serious illness, like Smallpox or West Nile Virus and it kills.  Like Smallpox it can also be prevented.  Getting vaccinated protects not only you, but your herd (family and community) as well. 

The government (CDC), your doctor, and I recommend you get the flu shot.  

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