I really don’t like the term “flu” or “flu shot” because the term flu should not be used interchangeably with “viral illness.” Influenza is a specific, often very severe and even deadly viral illness and influenza vaccine is a very specific vaccine. Still the term flu shot is so integral to our everyday language that I’ll us the term, and encourage all of you to GET YOUR FLU SHOT. I hear excuses every day during the fall and early winter when I offer influenza vaccine to my patients. Here are some of the most common excuses (explanations?) I hear and my explanation (argument?) of the folly in that line of reasoning.
“I never get the flu. I don’t need a flu shot.” – Most people only get influenza once every several years. It is not unusual for any given individual to go 10-15 years without contacting influenza. Influenza is a severe illness much of the time and it is worth getting a flu shot every year to prevent one case of influenza every 10-20 years.
“The last time I got a flu shot I got the flu.” – This is just not true. An influenza vaccine simply does not cause influenza. Since the influenza vaccine contains a killed virus, it is not possible for it to cause influenza.During the season when we give flu shots minor illnesses are common. It is not unusual to become ill during the time shortly after getting a flu shot. Also a small percentage of people who get a flu shot may have some minor aching, low grade fever or malaise. This is not even close to as severe a problem as a real case of influenza, and is no reason not to get a flu shot.
“I just don’t like shots,” or “I hate needles,” or “Shots hurt.” – Nobody likes getting shots, or being stuck with a needle. The benefits of influenza vaccine, both for yourself and for those you care about are important enough to suffer through an injection. Just get it over with.
“I heard the flu shot this year is just the same as last year so I don’t need another shot.” – I heard this today from a medical student at the office. They should know better, and I tried to set them straight. It is true, that in 2011 the components of the influenza vaccine are the same as they were in 2010. I suspect that this student was just trying to find an excuse not to get a shot. It is good news that the vaccine has not changed this year. First it means that no new and very different influenza virus lurking and ready to cause a severe influenza pandemic was discovered. Getting a second vaccine will be the equivalent of a booster shot, making you even more immune to these strains of influenza, whereas the remaining immunization from last year’s flu vaccine are not adequate to provide immunity sufficient to prevent contacting influenza this year.
“I’m healthy and if I get the flu I won’t get all that sick.” — I’m happy that you are a healthy person who takes good care of yourself. Now get a flu shot and stay healthy, because influenza can be very severe or even lethal for even the strongest and healthiest of us. In addition if you catch influenza you will be putting others at risk. You’ll be sick enough that someone will need to take care of you, and they will be at risk needlessly because you chose not to be immunized. This is especially true if you are around the elderly, the very young, pregnant women, or persons with chronic disease. Respect yourself and those around you and get a flu shot.
“I want to leave my immune system alone so I will develop good immunity naturally. If I get a flu shot I weaken my immune system.” – - This is just faulty reasoning. There is no evidence to suggest that getting an influenza vaccination reduces your immunity against other germs. It simply provides antibodies against certain strains of influenza A and B. This immunity likely is increased by annual flu shots, so that by getting a flu shot annually you develop better influenza immunity each year.
Last year I posted on The Social and Moral Responsibility of Immunizations for health care workers, teachers and others in positions where others at high risk may be exposed to them if they contact influenza. I wrote earlier this year on the Flu Season. This health blog also links to an AFP article on The 12 Basic Rules of Influenza and I wrote on how to Avoid Getting Sick. I hopt that all of these are informative, but if I could accomplish one thing with this blogging effort, I’d convince every one of my patients and readers (except the uncommon patients with severe egg allergy or other valid reason to need to rely on the herd immunity that could occur if the rest of us got immunized) to get an influenza vaccination every year. If I could do that I’d feel that I’d have made a real difference in the tiny part of the world that I touch.
The flu season, or better the influenza season, generally runs from late fall to early spring of each year in northern temperate regions. Why this is the case is somewhat unclear, but consensus of opinion is that this is the season where people move indoors and there is more opportunity for person-to-person droplet spread of the influenza virus by coughing and sneezing.
I really dislike the term flu as slang for influenza because I feel it takes away from the uniqueness and seriousness of this disease, and lumps it with all the other viral illnesses we see in the office. Influenza is a specific set of viruses, influenza A and influenza B, that cause both seasonal and epidemic outbreaks of illness. In many people influenza can seem like a more severe but still minor illness with just fever, chills, headache, cough and runny nose. In others it can be devastatingly severe, with pneumonia, multiple organ system failure and death.
For the last two years, 2009 and 2010, the peak incidence of influenza in the US has been early, with the H1N1 swine influenza pandemic of 2010 starting exceptionally early in the late summer. Last year we as a nation have been immunized at a rate never seen before, and if our clinic’s experience this year is typical of the US, this year will be another banner year for immunization rates. Whether this “herd immunity” explains the slow start to this year’s flu season, or there is some other explanation this year has been an unusually light influenza season so far. That may be changing, as the CDC is showing more influenza cases over the last few weeks than were seen early in the season. One of our local infectious disease consultants just sent out a notice that there has been a big local upswing in influenza A cases, and told us that they are essentially all H1N1, and still sensitive to Tamiflu.
So if you still have not had your influenza vaccine this year, you should dash to your doctor or pharmacist to get it now. Check the CDC widget below to see the current status or influenza in your state.
Leave a comment if you have any thoughts on the late flu season this year.
It’s the illness season again. You can avoid getting sick, at least avoid getting sick as often, by doing a few simple things. People call it the “flu” season, and I dislike that term, because although it is the season where influenza is prevalent, what they really mean is that it’s the season where all the various respiratory and gastrointestinal viral illnesses are more common. Influenza is a specific illness, caused by two main classes of influenza viruses, influenza A and B. See a prior post, 12 Basic Rules of Influenza. All the other viruses are not influenza and so calling this the “flu” season, although true, is only part of the problem.
Most of the common fall and winter viral illnesses are spread by droplets, i.e. tiny aerosolized water sneezed or coughed into the air by a sick person. Many of these can also be spread indirectly by sneezing or coughing onto your hand, touching another person or object, and another person subsequently touching your hand or the object, then ingesting the germ. Either way avoiding illness involves not allowing the germ to gain access to your body, and having your body optimally prepared to fight the germs than do gain access. So here’s Dr. Pullen’s advice on staying well when all around you get sick:
Most important is to get the influenza vaccination. Every day I fail to convince patients to get this simple, effective, safe vaccine to prevent influenza. Every year about 1 in 5-10 of us gets influenza. Influenza is a serious illness, usually causes a week or more of missed work or school, and makes you feel terrible. Sometimes, especially in vulnerable patients like young children, pregnant women, and patients with underlying diseases like emphysema and diabetes can lead to hospitalization or death. You can reduce your chances of contacting influenza by >50% by getting the influenza vaccination. Just do it.
Wash your hands a lot, and use antimicrobial gels. After you cough, sneeze, touch other people like shake hands etc. wash your hands or use an antimicrobial gel. Some evidence suggests that the gels are better at killing viruses than hand washing, but both are much better than nothing. In addition, as my Mom always told me, keep your hands away from your face, especially your mouth, nose and eyes. These are the mucus membranes that germs can use to access your body.
A corollary to #2 is, “Don’t share eating or drinking utensils or foods.” This may seem obvious, but it’s easy to be lazy or sloppy with this one.
Get enough sleep. This falls under the general topic of take care of yourself. Sleep deprivation can lead to impaired immunity.
Exercise regularly. There is lots of evidence that exercise supports the immune system. Don’t forget to wash hands, use hand sanitizer, etc at the gym if you go, lots of face touching then equipment touching there.
Consider a vitamin. There is little evidence that high doses of any specific vitamin, including vitamin C, helps prevent illness, but a healthy diet, and a multiple vitamin daily may be helpful.
Especially when you travel in commercial airliners take good care to rest, use hand sanitizer, and stay hydrated. Although there is not much evidence that recirculated air in these situations leads to more respiratory illness, you should still do your best to at least avoid other ways to contact their germs.
Work from home or stay home if you are sick. Going to work sick increases everyone’s risk of getting your illness. If you are in management encourage this policy.
Consider avoiding handshaking during the illness season. At least minimize this germ sharing habit.
Don’t drink too much, stay out too late, and get yourself run down and exhausted. This reduces your immune system, in the same ways that most of the above positive behaviors improve your immunity.
Now that you are perfect, congratulate yourself, and enjoy a healthy fall and winter.
This is an interesting article comparing the flu virus of the deadly 1918 influenza epidemic with the 2009 H1N1 influenza virus, and a discussion of how this could have implications for future flu virus selection for immunizations. It discusses the way the virus may mutate to allow it to develop into a recurrent seasonal influenza virus. Originally published in MedPage Today.
Pandemic Flu Viruses of 1918, 2009 Reveal Similarities
By Michael Smith, North American Correspondent, MedPage Today
Published: March 24, 2010
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
The 2009 pandemic flu virus has marked structural similarities to its 1918 counterpart, two studies have shown — a finding that may help to devise new vaccines.
I get a lot of questions about influenza, especially this year of the H1N1 pandemic. In an AFP editorial Jonathan Temte, MD, PhD writes an excellent summary of the “12 Basic Rules of Influenza” written for physicians, but very appropriate for the informed patient to be understand.
To me the most impressive thing about the H1N1 pandemic was how fast it became a worldwide problem. In the 1919 Great Influenza the epidemic spread with unprecedented speed as soldiers moved around the world. Fortunately so far the virulence of the current H1N1 strain does not seem to rival the strain of 1918-19. If it had even close to as high a mortality rate, with the speed of spread it would have been an unprecedented disaster. In 2009, everyone moves around the world, on commercial airlines and by automobile. The initial reports from Mexico were followed in rapid succession by reports from all over North and South America, and around the world. Here is an animated map of case reports in the US early in the epidemic. If there is a lesson for public health officials, it is that we now have a small planet, and that any illness spread from person to person by droplets (coughing and sneezing) is probably not a problem that can be contained to a limited area. We as a healthcare system and as a nation will need to anticipate the rapid worldwide spread of any such epidemic.
The second thing that impressed me was the mobilization of the pharmaceutical capability to mass produce a new immunization. From the initial isolation of the H1N1 virus in April, to the production, testing and eventually distribution and administration of vaccine was just over 6 months. To me this seems remarkable. None-the-less to speed up the process that usually takes several months longer and to manufacture vast quantities of this vaccine was remarkable. I tip my hat to the rapid decision-making, the appropriation of funds, and the hard work of many who made this happen. Now I hope a focus of research will be to design a process for production of an immunization in a new process that will be even faster to mass produce, and ideally avoid the problem of immunization of people with egg allergy.
