For the Monitor
Published: 2/9/2018 10:59:56 PM

Once again flu season hits New Hampshire and the issue of flu vaccination becomes important. For doctors and other medical providers the issue also becomes even more frustrating as some high-risk patients and their parents listen to the “fake medical news” and decline vaccination.

As providers we spend many hours of our time explaining how the flu vaccine works and what it does or doesn’t do and why it’s important to get vaccinated. Nothing is more frustrating than spending half an hour or more in an appointment slot explaining the need (especially for very young children and the elderly) and then having the patient or parent still be concerned that the vaccine will harm them or their child, despite our reassurances.

I consistently hear that the flu vaccine “causes the flu” and that the flu vaccine offers “no protection from the flu,” which are both patently false. So I’d like to explain some of the questions out there to hopefully help people make an informed decision.

First, let’s discuss how the vaccine works. To many people it is a mystery that borders on sorcery and therefore is anxiety provoking. It works by science. The vaccine contains killed viral antigen and is injected into our body. There, the body’s white cells react to the killed antigen and recognize it as flu virus. Since it isn’t live, the white cells soon realize that there is no virus to attack and don’t mount an all out inflammatory response. However some white cells are like “memory cells” and they encounter the antigen and remember that it is something to attack if the live virus gets into our body. So the white blood cells are prepared to fight the actual virus when it does infect us and that’s how the vaccine helps our body fight the flu. It isn’t mysterious at all.

The myths

I’ll get the flu from the vaccine. Totally false! The vaccine is made from a killed virus and can in no way cause you to get the flu. What can happen is that you were exposed to the flu virus before you received your vaccine and were already infected. The flu vaccine will not prevent the flu if you were already infected and already becoming ill. Also it takes two weeks for the flu vaccine to provide you with full coverage so you can still be at risk of getting the flu during those two weeks.

The flu vaccine isn’t effective. This is partially true for some strains as it is for the H2N3 this year, where the vaccine is only 10 percent effective. However, it seems to be around 40 to 60 percent effective for the flu strains included in this year’s vaccine, which is better than the 0 percent you get if you aren’t vaccinated.

Why isn’t the vaccine 100 percent effective? One problem is that each year’s flu vaccine strain choices are determined by what flues are affecting the world in Asia where it usually shows up earliest. By the time the flu reaches our side of the world it could have mutated or another strain could have joined the party. It takes awhile to make the flu vaccine and we need large supplies so the pharmaceutical companies can’t wait to make flu vaccine when the disease hits as they couldn’t produce it quickly enough. Also, no vaccine is ever 100 percent effective. Most vaccines are between 95 to 98 percent effective so that’s why we get boosters of routine vaccines to get the effectiveness as high as possible. Since the flu virus strains change from year to year, each year is a different vaccine with different strains in the final product.

If the vaccine isn’t very effective it’s not worth getting at all as I’ll still get the flu. Not true. While the vaccine may not be effective against a particular strain, it still confers some protection. This is important because even if you get the flu your illness won’t be as severe if you were vaccinated as it would if you were not vaccinated.

I got the flu even though I was vaccinated so I’m not getting it this year. Again, you can get the flu even if vaccinated due to variable efficacy but you still get some protection from the vaccine. This could make the difference between being moderately ill, admitted to the hospital or ICU with severe flu symptoms or even dying from the flu.

I’ve never gotten the flu before so I don’t need it. Either you have been lucky or you had that flu strain when you were young, don’t remember having it, and have immunity to one strain. Also, children under 2 years old and the elderly have a much greater chance of getting the flu due to decreased or absent immunity and a much greater chance of dying of the flu. So far this year 50-plus children have died of the flu. Of those children, around 85 percent had not received the flu vaccine. Perhaps their deaths would have been prevented had they been vaccinated and had less severe illness. Why take this chance with your young children or elderly grandparent?

I’m not in the age group that gets severe flu. There are no guarantees for anyone but just because you are not a young child or elderly doesn’t mean you can’t get the flu and transmit it to these two groups. If you have young children or elderly family members you could wind up being responsible for giving them the flu. How would that feel if they do poorly? So my advice to everyone is that they get the vaccine as soon as possible. Also it’s not too late to get vaccinated this year as New Hampshire was slow in getting to widespread flu status but we have reached it this past week. We could have a flu season that lasts into April so there is still time to go to your doctor’s office or local pharmacy and get this year’s flu vaccine. As a doctor I want my patients to be protected so I never have to give bad news to a parent about their young child who was not vaccinated!

(Dr. Patricia Edwards is a pediatrician in Concord.)


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