John L. Pfenninger, MD
Influenza is a serious illness which can result in death for people of any age. It also causes significant days of just plain feeling bad, leading to lost work and school time. The most effective way to prevent true influenza is by getting your flu shot every year. There are very few changes to last year’s recommendations regarding the vaccine.
Last year, for the first time, the Center for Disease Control (CDC) recommended all persons age six months and older obtain the vaccine. They are once again encouraging this.
You may have noticed that pharmacies and drug stores have signs offering the flu shots and they usually start very early. The CDC recommends that the vaccine be given as soon as it is available. This allows time for protective antibodies to develop which takes about two weeks. They also recommend that the vaccine be given throughout the entire flu season until the end of March. Early vaccination before mid November not only protects against influenza but also reduces heart attack rates by 21%. Receiving the vaccine after mid November reduces the heart attack rates by 12% compared to those who do not receive the vaccine at all. I find this fascinating and there is good medical evidence to support the findings.
Each year, the CDC plays a guessing game as to which viruses will cause the flu. They have to predict a year in advance which viruses they think will be present to give the manufacturers time to prepare the vaccine. This year’s flu vaccine will be identical to last year’s and provide protection against three separate viruses including H1N1 (swine flu). Even though the viruses will be the same, the CDC has emphasized that everyone should obtain the flu vaccine this year whether or not they got it last year. Apparently, protective levels can decline over the course of a year.
For children age six months through eight years (if it is the first time that they have received the flu vaccine), two doses of the flu vaccine are recommended with a minimum of four weeks between them. If children received only one dose of the vaccine last year, since the vaccines are the same, it is recommended that they only receive one dose this year.
There is now an inactivated type of vaccine (versus the usual “attenuated” vaccine that is usually given). It is recommended that this be used for individuals who report an egg allergy including hives. These individuals should receive their vaccines from a physician who can observe them for at least 30 minutes rather than getting the vaccine at a nonmedical facility. Skin testing is no longer necessary for people with egg allergy. Those who have experienced more significant reactions to eggs, such as respiratory distress or recurrent vomiting, should be referred to an allergist.
Two groups have been especially targeted by the CDC to receive the flu vaccine. They include health care providers and pregnant women. There is special emphasis that all health care personnel be vaccinated annually to protect their patients. Only half of pregnant women in the United States were vaccinated in the last two flu seasons. Pregnant women and children younger than six months of age are at higher risk of severe illness. Vaccination during pregnancy has been shown to decrease the risk for illness in the mother as well as the risk of influenza and influenza hospitalizations in their infants during the first six months of life.
A high-dose influenza vaccine has become available for adults 65 years of age and older, but the CDC does not necessarily recommend this vaccine over the standard one. For those who have a phobia for needles, there is also an intranasal vaccine that remains an option for healthy people between 2 and 49 years of age.
Remember, influenza (the flu) is a specific contagious respiratory illness caused by specific flu viruses. Although we all have the tendency to call every viral illness “the flu”, the flu vaccine will only prevent influenza. Symptoms of the true flu include fever and chills, cough, sore throat, runny nose, headaches and especially muscle and body aches. In the last 30 years, flu-related deaths in the United States have averaged 36,000 per year. This is a shame, when influenza and resulting deaths are so preventable.
As always, consult your personal physician before making any health care decisions.
John L. Pfenninger, MD. President and Director, The Medical Procedures Center, PC, Midland Michigan. Clinical Professor of Family Medicine, Michigan State College of Human Medicine.