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The Flu, The Vaccine, and Grandma

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Created: Monday, 04 November 2013 02:58

Written by Dr. Bell

"Why should I get the flu shot? I never get the flu."

"The flu shot gets you sick!"

"Only sick people die from the flu."

I see a number of parents with children in the office who refuse to give their child a flu shot. The most common reason is "He's never had the shot before, and he never has had the flu."

Influenza, or the flu, comes around every year. It affects the youngest and oldest most severely, and it can be very difficult to treat. The best medical advice that I can recommend is to get the vaccine every year.

Still not convinced?

Here are a few points to remember regarding the flu, the vaccine, and doing your part for your community:

1. The "Flu" is not a "24 hour stomach bug" or "the stomach flu"

   The influenza virus causes an upper respiratory infection with cough, congestion, runny nose, sore throat. Sometimes people can have headache, muscle aches, fatigue and fever. Vomiting and diarrhea does occur sometimes, but this is mostly in children. Symptoms start usually in 1-4 days of exposure, with an average of 2 days. Symptoms can last from a few days to two weeks. (CDC)

2. "I never get the flu" is a false statement.

   Fact is, you probably have had the flu before but did not realize it (see #1). In the US, on average 5% to 20% of the population get the flu.

   Perhaps you had a "cold" with cough and sore throat for a week. Maybe you had a runny nose and felt tired in February last year. Everyone responds to the influenza virus differently with different symptoms, intensity and time course. Truth be told, almost everyone has had the flu at least one time in their lives. (CDC)

3. There are many influenza viruses.

   You may have heard of "bird flu" or "swine flu", specifically H1N1, which had a pandemic outbreak in 2009.

   Here is the CDC explanation for types of influenza viruses:

   "There are three types of influenza viruses: A, B and C. Human influenza A and B viruses cause seasonal epidemics of disease almost every winter in the United States. The emergence of a new and very different influenza virus to infect people can cause an influenza pandemic. Influenza type C infections cause a mild respiratory illness and are not thought to cause epidemics.

   Influenza A viruses are divided into subtypes based on two proteins on the surface of the virus: the hemagglutinin (H) and the neuraminidase (N). There are 17 different hemagglutinin subtypes and 10 different neuraminidase subtypes. Influenza A viruses can be further broken down into different strains. Current subtypes of influenza A viruses found in people are influenza A (H1N1) and influenza A (H3N2) viruses. In the spring of 2009, a new influenza A (H1N1) virus (CDC 2009 H1N1 Flu website) emerged to cause illness in people. This virus was very different from regular human influenza A (H1N1) viruses and the new virus caused the first influenza pandemic in more than 40 years. That virus (often called “2009 H1N1”) has now mostly replaced the H1N1 virus that was previously circulating in humans." (CDC)

   This is why you can get the flu every year. There are many different combinations of the H and N types, such as H1N1, H3N2, etc. Your immune system may have learned to fight H1N2, but not H2N3, etc.

   H1N1 cause the Spanish Flu. H3N2 caused the Hong Kong Flu in 1968. H2N2 caused the Asian Flu in 1957.

   You may have had the flu in the past, but you can get it again every year. You may have had the vaccine in the past, but that does not count for this year.

   Each year the CDC uses statistics and epidemiology studies to predict which strain is most likely to spread to nationwide infectivity. In the most recent years, the vaccine protects against 3 flu viruses: influenza A (H1N1), influenza A (H3N2), and an influenza B. This year, 2013, a vaccine against four viruses, (quadrivalent vaccine), includes an additional B virus.

4. The influenza infection can be deadly.

   The infection is especially deadly to the elderly, children, and asthmatics. But this does not mean healthy people are at no risk. Sadly, my son's best friend's father died of influenza last year. He was healthy, and in his late 40s.

   Viruses themselves do not usually cause death, but it is the complications from the disease that lead to death. The infection causes an increase in nasal mucus, which can drip into the lungs. The weakness and fatigue makes it difficult to cough out the mucus. This can lead to a bacteria pneumonia in the lungs. Vomiting and diarrhea can lead to dehydration which can lead to heart failure or kidney failure. If a child has underlying asthma, she may have more inflammation in her lungs. An elderly person may not have the strength to cough and may develop pneumonia this way.

5. The next Flu outbreak could be "The Big One."

   2009 was the outbreak of H1N1 "swine flu" and caused quite a scare. It is estimated that it caused up to 88 million cases of flu, and between 8,000-18,000 deaths that year.

   It was nothing compared to the 1918 H1N1 Spanish flu pandemic, which infected 1/3 of the world population, or 500 million people, and killed an estimated 50-100 million people.

   I do not want to be an alarmist, but the CDC cannot predict the future, and you cannot guess which year will have a more deadly flu strain. You cannot wait until there is a serious outbreak and expect to get your vaccine. (it takes at least 2 weeks to develop an immune response to the vaccine).

6. Maybe your daughter will not get very sick from the flu, and does not "need" the vaccine, but grandma does not need to catch it from her.

   Perhaps this is the best reason to get the vaccine. The virus needs a host to infect and spread the disease to another host. The vaccine stops the spread of the disease. If everyone in the country got the vaccine, conceivably we could prevent yearly pandemics.

   To put it bluntly, NOT getting the vaccine makes you and your child part of the problem and not the solution. For example, your teenager may get the flu, with simple congestion and sore throat for a week, but spread it to his classmates. One classmate who catches the flu gives it to his cousin on chemotherapy, or a newborn niece, or a young brother with asthma, or a elderly grandmother.

7. Antiviral medications are not very effective.

   There is no cure for the common cold, nor is there an cure for influenza. There are antiviral medications like Tamiflu (oseltamivir) or Relenza (zanamivir) are not as effective as the drug companies would like you believe. Antiviral medications do not pack the "punch" like antibiotics on bacteria. Also, viruses seem to develop resistance to medications faster than bacteria.

   Remember that drug resistance in viruses and bacteria works like Darwinian natural selection, where the susceptible viruses or bacteria are killed off, leaving behind only the resistant virus which grow and reproduce more drug resistant viruses and bacteria. The more we use antiviral medications the more we end up with resistant influenza viruses.

   Anti-viral flu medication helps only if started in the first 48 hrs of onset of symptoms, and it is difficult to distinguish between colds and influenza in those first few days.

   In most cases flu treatment is supportive - plenty of fluids and rest, giving the body and immune system the strength to fight it on its own.

8. The vaccine is safe as can be.

   The flu vaccine does not give "the flu." Your body may "think" it has the flu, and respond with as if it is sick, but it is not the real flu, and it is mild, if anything.

   There can be side effects from vaccines, that is true. Your body may react like the vaccine is an allergen. The body may turn on a fever response to "burn out" the infection. The worst side effect documented and attributed to the vaccine is Guillain-Barre syndrome (GBS), which is an auto immune attack on peripheral nerves, usually causing temporary weakness and potential paralysis of lower extremities. The syndrome can last for weeks, and is at greatest risk when it affects the diaphragm muscles for breathing. That being said, the rate of vaccine related Guillain-Barre syndrome is low. The association was noted during the outbreak of swine flu in 1976.

   A recent study in the Lancet journal demonstrated a low attributed risk from the vaccine:

   "The attributable risks were 1.03 Guillain-Barré syndrome admissions per million vaccinations, compared with 17.2 Guillain-Barré syndrome admissions per million influenza-coded health-care encounters."

   In other words, you are more than 17 more likely to get GBS from the infection, than from the vaccine.

   Again, everything we do has calculated risks. Driving in a car, trying new foods, crossing a bridge, etc. etc. But the vaccine is an insurance policy against the flu. The risks from side effects are very low, especially compared to the risk of getting the flu and its complications.

9. There is no controversy with flu vaccines.

   The flu shot does not cause autism. The flu shot does not cause Alzheimer's disease. There is no federal conspiracy regarding vaccines, and the pharmacutical companies are not just trying to make money on vaccines.

   Remember that there are scientific studies on vaccines that have reviewed side effects of vaccines. There is true science and it is published in medical journals such as Pediatrics, New England Journal of Medicine, and Journal of the American Medical Association (JAMA).

   Parents do not have to do research on their own other than checking with these verified journals, and the Center for Disease Control.

   Research on the internet, blogs (ha!), or facebook can be hearsay, ancedotes, lies or conjecture. People can make claims of associations of vaccines and unknown diagnoses like autism and Alzheimer's because the etiology of these disorders are not known.

   For example: You can make associative claim that whole milk, when started at 1 year causes autism, because almost all children are started on milk at a year. Therefore, you can say, "Look! This child started milk and then got autism at 18 months!" That is guilt by association, and it is not science.

   Another example: doing crossword puzzles cause Alzheimer's because of the association. My paternal grandmother did crossword puzzles every day up until she developed the unfortunate signs of Alzheimer's. A lot of elderly people do crossword puzzles. A lot of them develop Alzheimer's. By this association one could claim crossword puzzles cause Alzheimer's!

   Can you prove that it doesn't?

   It is the fear of the unknown that have fostered these claims. It is sad, because parents who want the best for their child are being scared by facebook blogs about how "unnatural" shots are, and it is better to get the disease naturally, or that we are trying to trick parents into harming their children.

   At some point you have to trust that the doctor has read the literature, and the CDC have done the studies to prove it. You must accept the safety of proven medication treatment and ignore the hysteria of conspiracy.

   The point is that the threat of influenza is real, and it is dangerous. For most people the infection is manageable. It can mean lost school time or work and has a financial impact. The real dangers of influenza are the complications from influenza that causes serious disease in infants, children, and the elderly. This is real science and is proven fact.

   The responsible parent protects their child from serious disease, and potential deadly disease. The responsible parent also protects their neighbors and extended family from disease by immunizing their children.

10. There are multiple ways of getting vaccinated from flu

    In our office at Fairview Pediatrics we order vaccine from the state and private supplies. We offer single dose vials (Thimerosal free), of the trivalent and some quadrivalent flu vaccine. We also offer the live attenuated influenza vaccine, FluMist, which is given as a nasal spray. This can only be given to our patients over 2 years old, without history of asthma, or other chronic lung or heart condition, or have immunosuppression.

    Children can receive their first flu vaccine at 6 months of age. During the child's first flu season receiving the vaccine, it is advisable to get a second shot in 1 month to insure proper immune response and protection from the infection.

So, in summary:

1. The flu is not a 24-hour stomach bug.
2. "I never get the flu" is false. Almost everyone has had it.
3. There are many types of flu, with different strains each year.
4. Influenza infection can be deadly, even to normal healthy people.
5. It is impossible to predict a bad season, so waiting to vaccinate may be too late.
6. Your child may be healthy, but unvaccinated children are a risk to the elderly and vulnerable individuals.
7. You cannot count on anti-viral medication to help if you are sick.
8. The vaccine is safe.
9. There is no controversy about the flu vaccine.
10. There are options for vaccination.

As you may have noticed, the Centers for Disease Control, the CDC, is my best resource for factual information regarding influenza and the vaccine.