I’ve never had flu — do I really need the jab?
Q I AM aged 85 and was married for 58 years, until my wife died four years ago. I have three children and five grandchildren. I spent 13 years at school, four at university, two in the Army and 38 as a teacher and must have been exposed to various strains of the flu virus — hundreds — and yet I’ve never had flu.
Would the flu vaccine interfere with my obvious natural immunity? Am I being irresponsible by refusing the vaccine when it’s offered in September? D. S. Robson, Middlesbrough.
A INFLueNzA is an acute respiratory tract illness caused mainly by influenza A or B viruses. The virus has a high rate of mutation — and it’s this tendency to change that limits our ability to become permanently immune to it.
This is why flu vaccines have to be reformulated every year.
As you’ve noted, throughout your life you have had regular and frequent exposure to the virus, but have never caught it, so you appear to have a highly effective natural immunity that has served you well — I’ve occasionally come across other patients like you during my working career.
But this is no guarantee that you will continue to be protected. even the robust good health of growing children does not necessarily prevent the potentially lethal complications of the flu virus — viral pneumonia, viral muscle damage or heart damage and toxic shock syndrome.
I was at boarding school in Lancashire during the influenza outbreak of January/ February 1962 — more than half of the 200 boys were bedridden and we were all sent home for an early easter break. I recall that two teenagers at a boarding school in Sussex died during that outbreak.
Since then, like you, I have never again had influenza, despite working on the front line in healthcare since 1968 — although I have always taken the precaution of an annual influenza vaccination.
It’s known that the efficiency of the immune system lessens with age and, while you have a built-in library of anti-influenza antibodies after a lifetime of exposure, these may not continue to protect you.
I wish you well as an example of admirable resilience, but do obtain protection nevertheless; have the vaccine.
Q I’VE taken 75mg aspirin daily for many years, after it was prescribed with statins for my high cholesterol.
But I know that if someone takes aspirin, there might be problems if you take certain other drugs — and, recently, I’ve been prescribed naproxen for a knee problem. Is it advisable to take this as well as the aspirin? J. C. Lindsay, Sevenoaks, Kent.
A LIke you, many patients are prescribed low-dose (75mg) of daily aspirin, not for pain, but because it reduces the stickiness of blood cells called platelets.
These cells play an important role in the blood-clotting process, becoming sticky and clumping together if there is a breach in a blood vessel. essentially, they form a ‘scaffold’ for the clot.
The problem is that platelets can also stick in clumps to roughened — or ulcerated — patches in arteries, such as those that supply the heart muscle, causing a blood clot.
It’s thought that these patches are the result of inflammation in the artery lining, either as a result of physical damage or the build-up of cholesterol plaque (or atheroma).
For that reason, many patients who have atheroma are not only prescribed statins to lower cholesterol and prevent further build-up, but are also advised to take a small dose of aspirin to reduce platelet stickiness and the potential consequences, such as a heart attack or stroke.
As for your question about other drugs interacting with aspirin, there are more than 500 drugs that are reported to do this, with about 70 causing major complications, such as the drug not working or making dangerous side-effects more likely.
Importantly, aspirin should absolutely not be taken by a patient who’s on an anticoagulant (blood-thinner), such as warfarin, as this could stop the blood clotting altogether, which could be catastrophic.
It should be noted that even when aspirin is taken alone, it is not a trouble-free drug.
At the dose of one 75mg tablet daily (an adult aspirin is 300mg), it can have a potentially lethal side-effect — a haemorrhage of the stomach lining (there are also other, less worrying side-effects, such as allergy). This may be because aspirin reduces the stomach’s natural protective barrier (bear in mind that aspirin is acetylsalicylic acid).
This effect is random and idiosyncratic — it can occur when people take it over a long time or after a single tablet in those who are particularly at risk of haemorrhage, and may or may not cause obvious symptoms such as pain and nausea.
I had a patient who thought he was doing himself good by taking one small-dose aspirin each day but, within a week, he developed terrible black diarrhoea — the sign of massive blood loss.
He underwent immediate surgery and, during the operation, received more than 24 pints of blood while efforts were made to control the haemorrhage.
He’d heard that a daily aspirin was a ‘good idea’ to protect his heart and perhaps protect against a stroke, and had taken it upon himself to self-medicate.
Aspirin is an important and effective drug, but one to be taken on the basis of informed advice from your doctor.
To address your specific question, naproxen is a nonsteroidal antiinflammatory drug (NSAID). Like aspirin, these work by inhibiting the prostaglandins, hormones released when cells are damaged. They have an inflammatory effect and can potentially cause gastritis (stomach inflammation) and bleeding from the stomach lining, just as aspirin can.
Accordingly, there is a greater risk when taking the two at the same time, so they should probably never be prescribed together, though, on occasion, it is a balanced risk that is accepted by some clinicians.
So the message is to proceed with caution and do not take the anti-inflammatory, naproxen, for longer than necessary — hopefully limiting your use of this medicine to a few weeks at most. If it is a long-term prescription, then raise this concern with your GP.