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| The Flu Shot |
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DrugStudy writes, "Influenza, commonly called "the flu," is caused by the influenza virus, which infects the respiratory tract (nose, throat, and lungs). "
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DSI Newsletters, Issue 14:
The Flu Shot
What is the flu?
Influenza, commonly called "the flu," is caused by the influenza virus, which infects the respiratory tract (nose, throat, and lungs). The flu usually spreads (contagious) from person to person when an infected person coughs, sneezes, or talks. This sends the virus flying through the air. Unlike many other viral respiratory infections such as the common cold (rhinovirus), the flu can cause severe illness and life threatening complications in many people which are preventable with getting a yearly flu shot.
What are the symptoms of the flu?
The flu is a febrile (fever) contagious disease that comes on abruptly during the flu season, which in the USA is between December and March. Patients often describe the moment they get sick as if they were "hit by a train." It attacks the respiratory tract causing: fever; headache; tiredness; dry cough; sore throat; nasal congestion; and body aches. Complications include: bacterial pneumonia; dehydration; and worsening of underlying chronic medical conditions like CHF, asthma, or diabetes. Children more commonly get sinus and ear infections complications. The sick and the elderly are at the highest rick for serious complications, but the healthy young still transmit the virus to everyone, even if they are hardly sick themselves. If you are exposed to influenza, you might get sick within a few days. You will be contagious from a day before you feel sick to about a week later. The new antiviral drugs can shorten this time.
I don't usually get very sick from the flu. Should I still get it?
Yes! The flu is a major cause of a preventable illness. Some years, when the virus mutates (shifts or changes), pandemics occur with many excess deaths compared with the year before. In the USA, it leads to about 20,000 extra deaths and about 114,000 extra hospitalizations each year. The ICUs of our nation's hospitals fill up each winter with people injured by the flu. Thousands of people in the US die each year as the result of the flu or its complications. And to think, grandma's influenza was probably caught from her own grandchild, who was infected with the flu virus and hardly got sick and didn't think it was worth getting the flu shot. We can create healthier local neighborhoods by getting everyone vaccinated each fall. This way, when you are in a public place, there will be less influenza circulating around in the environment. Immunization of high risk people decreases many potential deaths from influenza. Immunization of those caring for high risk people decreases the potential of spreading the flu from otherwise healthy people to those at higher risks. Immunization of everyone will benefit our whole society at large.
I got the flu shot, then I got the flu?
No! Absolutely not. The flu shot contains only killed inactivated viruses: two influenza A strains (H1N1 and H3N2) and an influenza B strain. This trivalent vaccine typically contains preservatives like thimerosal, although other preservatives are in clinical trials. It can not cause the flu. It has never been shown to cause the flu, not even in a single person. So why do so many people think they got the flu from the shot? They may have been incubating influenza before they received the shot. Also, the shot only works about 80% of the time. It does have a higher chance of working if you also received last year's shot. When the killed viruses placed in this year's shot are similar to those circulating in our environment, the efficacy goes up to about 90%. Whereas, when they diverge a lot, efficacy goes down to about 70%. In addition, it takes about two weeks for the vaccine to work.
I got the flu shot last year. Is that good enough? I'm tired. There are long lines this year.
The influenza virus is around somewhere on our planet all the time. People traveling to other countries should be aware that influenza occurs throughout the year in tropical countries and that the "flu season" for temperate countries in the Southern Hemisphere is April to September. Wherever it's winter, there's a flu season. Birds can harbor the virus in them and fly around and spread the virus to different nations. The flu viruses are constantly mutating (changing). As the virus that causes influenza slowly drifts its immunogenicity, it gradually turns into a new and different viral strain. Sometimes it abruptly shifts into a new and different strain. Influenza vaccines are developed each year to protect people from the three strains expected to be most prevalent for that coming season. If you received the shot last year, you will have more protection this year than if this was your first shot. Generally, new influenza virus strains circulate every flu season, so the vaccine is customized (changed) each year to what we expect the current strain might be. The trivalent vaccine contains three strains of the killed virus, two from influenza type A and one from influenza type B. The CDC has characterized 393 influenza A (H3N2) and 30 influenza A H1, and 267 influenza B viruses. They follow how the viruses drift away over the year and slowly become antigenetically new viruses. The years that they abruptly shift to a markedly new virus are the years the flu shot doesn't work as well. Those are also the years characterized by the pandemics with the greatest loss of life.
Is it safe in pregnancy?
Yes. But, all women are nervous about birth defects. You should try not to vaccinate in the first trimester. Of if you do, you have to make sure the risk is justified. There is no hard evidence that the flu shot is bad in any stage of pregnancy.
AIDS?
Yes. Even though concerns have been raised regarding human immunodeficiency virus (HIV) infected individuals, it's still worth it. Persons with severe immunocompromise do not respond well, and some studies have shown a transient increase in HIV-1 in the plasma in the two to four weeks after vaccination, which has been associated with clinical deterioration. Because many patients may still benefit from the vaccine, influenza vaccine should be considered for HIV-infected persons.
Guillian-Barre Syndrome?
No! Probably for political and legal reasons. There is no hard evidence that the current flu shot is in any way linked, associated with, or harmful to sufferers of GBS. This is also known as GBS, Landry-Guillain-Barre Syndrome, acute idiopathic polyneuritis, infectious polyneuritis, and acute inflammatory polyneuropathy. Anyway you define it, it all sounds bad. Fortunately, it's very rare, being reported one in one million vaccinations in the past decade (none recently). GBS is an acute type of nerve inflammation. The inflammation damages portions of the nerve cell, resulting in muscle weakness or paralysis. The damage usually includes loss of the myelin sheath around the nerve (demyelination), which slows conduction of impulses through the nerve. The exact cause of this disorder is not known. It usually follows a minor infection, usually from a respiratory (like the flu) or a gastrointestinal source. The signs of the infection usually have disappeared before the signs of GBS begin. It most often occurs between ages 30 and 50. GBS may occur in association with AIDS, Mycoplasma infection, measles, herpes simplex, or other viral infection (the flu), or six weeks after major surgery, SLE, Hodgkin's Disease, other malignancies, and vaccines such as the antirabies vaccine and the swine flu vaccine. If GBS is associated with the current flu shot (there is no evidence that it is), it is very rare, in contrast to all the preventable hospitalizations and death from influenza.
In conclusion, there is no data to say the flu shot (influenza vaccine) has anything to do with GBS, but since we don't know a lot about this autoimmune disease, and back in 1975 there was an elevated incidence of GBS in recipients of the swine flu vaccine, it's safer to avoid it in anyone concerned about GBS.
Who do we not give the flu shot to?
Anyone allergic to chickens, eggs, or egg proteins.
People with a fever or illness that is more than "just a cold."
Anyone who has exhibited a moderate to severe reaction after a previous influenza shot.
Anyone who has ever been paralyzed due to Guillaine-Barre Syndrome.
Try to avoid women pregnant in first trimester (relative contraindication).
Most common adverse events (side effects)
Minor tenderness/induration at the injection site for a few days.
Low grade fever or muscle aches in those never immunized before or had the flu.
Allergic reaction/anaphylaxis in people allergic to eggs, egg proteins, or chickens.
Preservative free?
No! Preservatives are included in the flu shot to prevent the vaccine from being contaminated by bacteria. If you place urine in a sterile container, a few hours later there's bacteria as if the patient had an infection. Preservatives help keep the vaccines clean and safe from infection because bacteria cannot grow in their presence. Bacteria could be accidentally injected in the stock bottle of vaccine if it's a multi-dose vial.
One of the preservatives is called Thimerosal. The current flu shot, Fluzone, contains 0.01% Thimerosal as a preservative. It contains mercury. Several studies have shown that when pregnant women ingest large quantities of mercury that are found in heavily contaminated fish, the developing fetus may be affected and later found to have neurological disturbances.
What are the facts about Thimerosal/mercury containing vaccines?
The trace amounts of mercury contained in vaccines have not been found to cause any health problems, not even in infants or children.
Recent studies by the National Institutes of Health (NIH) showed that the levels of mercury contained in the blood of immunized patients are similar to that of the non-immunized.
The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics were concerned that, although there was no evidence that Thiomerosal caused harm, vaccines might be "perceived" as unsafe. So they recommended vaccines should be free of Thimerosal in the future.
There will be a drug study with the next generation Thiomersal-free influenza vaccine.
When is the best time to get the flu shot?
The Advisory Committee on Immunization Practices (ACIP) for the Prevention and Control of Influenza state the optimal time to receive influenza vaccine is during October through November. However, because of vaccine distribution delays during the previous two years and uncertainty about vaccine supply in future seasons, ACIP recommends that vaccination efforts during early October focus on persons at greatest risk for influenza-related complications (i.e., persons older than 65; persons aged 6 months through 64 years with certain medical conditions), household contacts of these high risk persons, children aged 6 months to 9 years receiving their first dose, and healthcare workers. Vaccination of the rest of the people should begin in November after the high risk group has been targeted, and continue until the supply of vaccine is run out. Because young, healthy children are at increased risk for influenza-related hospitalization, vaccination of healthy children aged 6 through 23 months and close contacts of children aged 0 through 23 months is encouraged when feasible and should begin in October. Vaccination of children aged greater than 6 months who have certain high risk medical conditions continues to be recommended strongly.
So, if you want to stay healthy and decrease the chance that your friends and family get influenza from you, it's a good idea for everyone to try to get the flu shot this season as early as possible.
And if you should get the flu, remember the two neuraminidase inhibitors available:
If the flu bug has been bugging you, ask your doctor for Tamiflu.
If your doctor says influenza, ask for Relenza. If you have any questions or concerns feel free to contact Dr. Saponaro at: www.DrugStudy.MD or Pi@DrugStudy.MD or 866-575-1212.
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Posted on Aug 17, 2005 12:15pm.
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