Flu-ish Foolishness

A reminder: Do not use this blog post (or anything else on the internets) as your sole source of info with regard to flu shots. Consult your health care provider with any questions you have, and use him/her as your primary resource while trying to make decisions regarding your health.

If you hang around any group of people, like coworkers, for any period of time, you are likely to hear all manner of opinion with regard to getting flu shots. You will hear some good information, very accurate, and you will hear some complete and utter horse shit. You will hear personal experience that is presented as fact. You will hear rumors of conspiracy and evil doings.

Please take it all with a grain of salt. Or two grains. Oh, heck, bring the whole salt shaker.

I have never heard so much misplaced knowledge, ignorance and just general garbage then on this topic. It's a perfect storm of half-knowledge and no knowledge; of rumor, junk science, and conspiracy. Now, I am no fan of the medical-industrial complex, but immunizations are one of the things we have done well, and have markedly increased the quality of life in our country. Find someone in their 80s. Ask about polio, measles, and small pox. Ask them about typhoid fever and diphtheria. Ask what it was like to nurse a child with whooping cough. Ask them about when an infectious illness would rip through a community. You know what happens when chicken pox gets loose in a group of children, like a school or day care. Imagine debilitating and fatal illnesses running amok like that involving the entire population, including those who do all the vital things we take for granted every day. Let's get started with some basic science. This is by no means a comprehensive review; if you need more, ask your health care provider and/or go to the library and do some research.

Vaccines work by exposing the body to a weakened or dead form of the infectious agent, thus causing antibodies to that agent to form in the body, which will fight the disease if you are exposed after you get vaccinated. Vaccines are made by growing the infectious agent, then modifying it or killing it. Flu vaccines, among others, are made using eggs as a medium to culture the flu viruses in. (That's why you are asked about egg allergies when you go get a flu shot; there may be stray egg proteins in the vaccine, which would provoke an allergic reaction if you are allergic.) When you take a vaccine, you may experience some very mild symptoms of illness, but nothing that is as severe or lasts as long as the illness itself. Your arm may be sore at the injection site. You may have absolutely no change in how you feel whatsoever; this is the experience of the majority of people. A very few people have some bad reactions. 1 out of 1,000,000 of people getting a flu shot might get a neurological condition called Guillian-Barre Syndrome. Some people discover allergies they didn't know they had the hard way, with a nasty anaphylactic reaction, that will occur within 15 minutes of receiving the shot. A very, very few people will experience some weird adverse reaction that is even more than a one in a million shot, like the cheerleader in Washington .

When you decide to get a vaccine, you are balancing these possibilities against the risk of a full-blown case of the illness, which may cause disability and/or death. In addition, you protect other people, in two ways: one, by preventing yourself from being sick and spreading the illness to others, and two, by boosting the "herd immunity" of the community, decreasing the number of people in a given community who can get sick.

Right now, there is a substantial anti-vaccine movement among parents. This post is not about that topic per se, but if enough kids are not vaccinated against common childhood illnesses, we may see those illnesses again, as our communities lose their "herd immunity". Most of the fear has centered around vaccines causing autism. However, strong scientific studies have shown that there is no connection between vaccines and the development of autism. Despite this, some have continued to insist that vaccines are harmful, and the studies are rigged by "Big Pharma". This is known as a "catch 22" or "can't please these people no how." If I had kids, they'd get their shots, both for their protection and the community's.

So. let's drill down to flu shots in particular, and the situation currently, with both seasonal flu shots and H1N1 (Swine) flu shots. Flu shots, like all vaccines, carry the side effect profile outlined above. Most will experience no side effects. A few will have very mild side effects. A very few will have allergic or adverse effects. The virus in injectable flu immunizations is dead, and cannot give you the flu. The nasal form of vaccine is a highly modified virus that will not make you sick. Now, the vaccine takes a week or two to give full immunity, depending on your immune system. If you are exposed in that time, before full immunity, you will get sick. If your immune system is not working as it should, you may not respond to the vaccine in a normal way, and have a full immunity. In this situation, you will get sick with the flu if exposed to the virus.

H1N1 is a particular flu virus that created epidemic to pandemic conditions in the northern hemisphere during the spring of 2009 and has continued to spread throughout the world during the summer and early fall. Reports from the southern hemisphere, which is just coming out of their winter flu season, indicate continued spread, and no change in the virus or illness profile. It emerged too late to be included in the seasonal flu shot. Vaccines, made in the same manner as the seasonal flu shots, have been fast tracked into production. Clinical trials were done with 10,000 to 12,000 participants without any marked problems emerging. The H1N1 vaccine carries the same side effect and risk profile as the seasonal flu shot.

So, should you get a flu shot? An H1N1 flu shot? It's a very personal decision. It involves a lot of issues ranging from the scientific issues and facts discussed above to the fact that some people will decide based on psychological factors such as disliking being told what to do. Scientifically, it's a balance between the risks of the vaccine and the risks of getting the illness, with a little consideration of the health of the community thrown in. Some people are viewing the H1N1 shot as a little bit riskier than the seasonal flu shot, due to the rapidity of its development and testing. Some just view all flu shots as bad, since they swore they got sick because of the flu shot back five years ago. A few people have decided that all vaccines are bad, causing all manner of problems. And the risk of the flu? Death rates can be hard to pin down but a number closed to 36,000 has been developed. An episode of the flu, especially in those with risk factors and preexisting health problems, can lead to other illness that may ultimately cause death. As the linked article notes, influenza related deaths may be somewhat underestimated. H1N1 has been hard on people under 25, and pregnant ladies, causing bad illnesses and occasionally death.

If you have questions, ask your health care provider. Do research on the internet, but stick to sources of information that are well known and/or are documented with reliable sources. Read skeptically, with a questioning mind. There's a lot of junk out there, don't let it scare you. Your decision needs to come from a rational mind, satisfied that it understands. Not a mind full of fear, hearing rumors, not fully understanding, just running from something unknown or poorly understood.

And whatever you decide: to get the seasonal flu immunization and the H1N1, to get just one or the other, or none at all, practice good hygiene. Wash your hands before eating or touching the eyes, nose or mouth. Wash your hands after touching your eyes, nose, mouth, or coughing/sneezing. Wash after using the restroom. Wash hands after using a public surface, like a communal computer keyboard. Cover the cough or sneeze with the inside of your elbow. Stay home, out of public circulation, if you are sick with fever, chills, and having a lot of secretions. No vaccine is 100% protective; these simple measures will protect you and others from illness where the vaccine falls short. As well, take good care of yourself during the flu season. Get the sleep you need. Eat good food. Watch your stress level. Work on keeping your body and immune system strong.

You expected that I was going to give you a definitive answer: yes, no, maybe--did you expect that? Sorry, nope. This is one aspect of health care that has changed a lot: providers will advise, educate, maybe even encourage or cajole. But when it comes down to the nitty-gritty, health decisions are the patient's to make, not the provider on behalf of the patient. I'm not even going to tell you what I'm doing; that's between me and my doctor.