Dr. Patricia Yarberry Allen is a collaborative physician. This week, she addresses the concerns of a woman who is lucky enough never to have had the flu, and is wary of getting a flu shot.
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Dear Dr. Pat:
I have never had a flu shot, but my primary care nurse practitioner is insistent that I get it this year. I am 66, never smoked, and have never had any lung problems. I have two young grandchildren and do volunteer work at a nursing home, yet I have never had the flu. I don’t understand this push to get a flu shot. They were even giving them out at my church. What do you think?
Dr. Pat Responds:
Many people are afraid of the influenza vaccine. They may claim that they had a “flu shot” once and then got the flu the next day. Or they may associate the influenza vaccine with other diseases. Some illnesses that are not caused by the influenza virus are often mistaken for the flu. Flu vaccine will not prevent these illnesses. It can prevent only influenza. The frail and elderly people you work with in a nursing home are at greater risk of acquiring an influenza infection. The immune system in the elderly is slower to respond, and this increases their risk of getting sick in general. In addition, flu shots or other vaccines may not work as well in the elderly residents of of health-care facilities. For this reason, in many health care settings, all staff members are required to be vaccinated against the flu.
I have asked Dr. Jason S. Kendler, Clinical Associate Professor of Medicine at the Weill Medical College of Cornell University—an infectious disease specialist who is a member of the Medical Advisory Board of Women’s Voices for Change—to discuss this timely question.
Dr. Kendler Responds:
The leaves are changing, school has started, and now it is time to think about . . . avoiding the flu! And the best way to avoid the flu is to receive an influenza vaccine.
For the 2013-2014 influenza season, there are more vaccine options available than there have been in the past. The Centers for Disease Control (CDC) does not preferentially recommend any specific vaccine over the others, but does recommend that everyone 6 months of age and older (including pregnant women) receive a flu vaccination unless there are medical reasons for not doing so.
Influenza causes an illness that can be experienced as the sudden onset of malaise, high fever, headache, cough, sore throat, runny nose, and severe muscle aches. Although most patients with the flu will recover within a week, it should not be forgotten that approximately 30,000 people in the United States die each year from the flu. Young children, pregnant women, the elderly, patients with weakened immunity, and patients with certain underlying medical diseases are more susceptible to complications from influenza.
Although side effects from influenza vaccination can occur, these effects are generally quite mild, and it is a myth that patients can get the flu from the injectable form of the vaccine. The flu vaccine is most effective when the circulating strain(s) of influenza match the strain(s) in the vaccine; however, some degree of protection is usually achieved even if there is a mismatch.
A brief description of the different vaccines follows.
• The standard trivalent vaccine contains two strains of Influenza A and one strain of Influenza B. This vaccine has been approved for persons 6 months of age or older.
• A quadrivalent vaccine adds a fourth strain, an additional strain of influenza B, to the three strains in the trivalent vaccine
• A high dose vaccine may be more effective than standard vaccines in persons 65 years of age and older.
• An intradermal flu vaccine is administered under the skin instead of deep into the muscle, and may therefore be preferred by some patients.
• An egg-free vaccine is now available, so that persons who are allergic to eggs (the other vaccines are produced in eggs) can now safely receive the influenza vaccine.
• An intranasal vaccine (this is a quadrivalent vaccine) is administered by a mist that is inhaled. This vaccine contains weakened, live virus and can be given to patients aged 2 to 49 years old (but not to pregnant women, asthmatics, or patients with weakened immunity).
Now that you know about the different vaccines available, you can see your doctor or go to your pharmacy to get your flu vaccine. It is far more important that you receive any influenza vaccine than it is that you receive a specific vaccine mentioned above. In particular, vaccination should not be avoided or delayed because of unavailability of one of the newer vaccines. In my opinion, the quadrivalent vaccine is not so far superior to the trivalent vaccine that the trivalent vaccine should be avoided. Indeed, I myself received the standard trivalent vaccine this season.
Whether you have had the vaccine or not, if you are exposed to someone with the flu you should call your doctor, because there is a medication you can take to lower your risk of developing flu.
The flu vaccine generally results in maximal protection approximately two weeks after immunization, and this protective effect lasts for six to eight months. So get your flu shot today!
Dr. Jason S. Kendler
Jason S. Kendler, M.D., is a Clinical Associate Professor of Medicine at the Weill Medical College of Cornell University. He is a graduate of Yale University and the University of Pennsylvania School of Medicine. He completed his postgraduate training at the New York Presbyterian Hospital–Weill Cornell Medical Center, where he served as Chief Medical Resident, including a Fellowship in Infectious Disease. Dr. Kendler is now Course Director for Medicine, Patients and Society 2, a course for second-year medical students at the Weill Cornell Medical College. He maintains an active practice in Internal Medicine in Manhattan and has a special interest in travel medicine.