I am finding it hard to believe it is that time of year again. Yes, the kids are back in school and the homework has started in earnest, fall sports are kicking in and it’s getting chillier in the evenings. But… I still find myself surprised that it is time for flu shots! Flu shots seem to herald the arrival of fall as clearly as Pumpkin Spice Lattes!

Flu shots are available now for the 2017 – 2018 season!

It seems the debate over when pumpkin spice flavoring and scent has gone too far is as vehement as the debate over the need for your annual flu shot. I can’t claim to be an expert on the Pumpkin Spice Latte, but I do know something about the influenza vaccine, so let’s explore the controversy. Please note, the general controversy surrounding vaccines is a completely separate issue that I we can talk about in a future post.

Arguments Against the Influenza Vaccine

It would be easy to look at the data from last year, which showed the vaccine was 23% effective against influenza A and 60% effective against influenza B, and suggest there’s minimal utility in even having this discussion. However, that only tells part of the story! There are two strains of influenza and the major difference is how they are classified and their potential to cause epidemics. Influenza B can cause outbreaks of seasonal influenza, but they occur less frequently than outbreaks of influenza A which can undergo big changes from year to year and is typically the cause of large epidemics. Both can make you equally as ill. The available vaccines are active against 2 strains of A and 1 strain of B (trivalent) or 2 strains of A and 2 strains of B (quadrivalent). The CDC recommends either vaccine. That’s the science-y part of this post!

Even if you look at last year’s pattern of effectiveness I don’t think that’s a great argument to skip your flu shot this year, because things change. As Dr. Anothony Fauci, director of the United States’ National Institute of Allergy and Infectious Disease says, “All the flu-oologists, myself included, say the only thing you can predict about influenza is that it is going to be unpredicable.” Influenza A has the ability to change and sometimes our committees don’t get the strains exactly right! In this CNN article they note that Australia is experiencing influenza numbers 2.5 times higher than were seen at this time last year. Fauci adds, in regards to this that our season tends to follow what the Southern Hemisphere sees. Again, the flu is unpredictable, but, the current rates of influenza in our Southern Hemisphere neighbors should get our attention.

Other flu shot myths and facts:

The flu shot can cause neurologic problems such as Guillain-Barre. Actually, influenza causes more cases of Guillain-Barre than the vaccine.

The flu shot cannot give you the flu. The CDC states emphatically: “No, the flu vaccine cannot cause flu.” The vaccines either contain inactivated virus, meaning the viruses are no longer infectious, or a particle designed to look like a flu virus to your immune system. While the nasal spray flu vaccine (not recommended this year) does contain a live virus, the viruses are changed so that they cannot give you the flu.

So, if it is not the flu, why do I get a headache, muscle aches and feel tired for 24 – 48 hours after getting a flu shot? These symptoms are from your body mounting a response to the inactivated virus (ie, dead) or particles that act like a virus, so when you are exposed to the flu your body is fully ramped up to fight it! Two days of mild symptoms are a far cry from 1-2 weeks of severe symptoms, possible hospitalization or, in extreme cases, death. The flu shot doesn’t weaken your immune system, it prepares your body to fight the flu!

Flu shots do not cause Alzheimer’s disease. They save lives in elderly people who are at high risk for complications from influenza.

Influenza is responsible for 104 pediatric deaths in the 2016 – 2017 flu season. Adult deaths from influenza are not reportable, but the range is 3,349 in the 1986-7 season to as high as 48,614 in the 2003-4 season per the CDC.

Pregnant women can get flu shots that contain inactivated virus. They do not need clearance from their obstetrician.

Flu shots reduce the risk of flu in adults and children.

There are no reported deaths from the flu shot.

What Symptoms Will I Get With the Flu?

Generally, the flu will cause fairly rapid onset of fever and chills, cough, sore throat, runny nose/congestion, muscle aches, headaches and severe fatigue. Occasionally vomiting and diarrhea may be associated symptoms, but this is usually in children. DO not mistake this with the common cold, folks. This will make you miserable. For days. On end.

Complications of the Flu.

Adults over 65, young children, especially those with neuromuscular or cardiac disorders, pregnant women and those up to 2 weeks postpartum, residents of nursing homes and longterm care facilities, and Native Americans, including Alaskan Natives are at higher risk for complications of the flu. As well, people with chronic medical conditions or on medications that weaken the immune system can also be at heightened risk for complications of influenza.

Even though these groups are most likely to get the sickest if they contract the flu, healthy people are susceptible to complications which include: minor problems such as ear infections or, more significant problems such as pneumonia, inflammation of the heart (myocarditis), brain (encephalitis) or muscle (myositis, rhabdomyolysis), and sepsis with multi-organ failure which is an overwhelming inflammatory process which causes organ stems to fail.

Just for Kids:

The most important thing you can do to protect your kids from influenza is to get them immunized. Although antiviral medications may help once you are suffering from the flu, they are not a substitute for the vaccine. In the 2010 – 2011 Influenza season 49% of pediatric flu deaths were in healthy children.

The American Academy of Pediatrics just released new recommendations for the 2017- 2018 season (link: http://pediatrics.aappublications.org/content/early/2017/09/01/peds.2017-2550). These recommendations include:
1. Annual immunization with the trivalent or quadrivalent vaccine for all kids over 6 months of age.
2. Immunization in children with egg allergies regardless of the severity of the allergy without any precautions beyond those recommended for any vaccine.
3. Receipt of vaccine as soon as possible once it becomes available, preferably before the end of October.
4. A child’s age and immunization history will determine the number of recommended doses.

When Should I Seek Care?

Care for flu includes symptomatic relief and, at times, treatment with an antiviral medication. If you develop complications related to the Influenza virus you may require more extensive treatment. You should be seen if you have uncontrolled pain, have difficulty breathing, cannot drink enough fluids to stay hydrated or have any other concerns. Symptomatic relief for the treatment of influenza (which we can test for in the office) often includes IV hydration, pain medications, and breathing treatments. As these symptoms can also indicate complications of influenza, you may need further evaluation with lab tests or radiology studies.

Flu shots are available now for the 2017 – 2018 season at ER Specialists Urgency Center.