Don’t wait any longer to get that flu shot

The News Tribune - - Front Page - BY JANE E. BRODY New York Times

If you’ve waited un­til now to get your flu shot, your pro­cras­ti­na­tion may ac­tu­ally pay off, though you’d be un­wise to de­lay get­ting the vac­cine any longer.

Although there are some cases of flu in Oc­to­ber and No­vem­ber in the United States, flu sea­son here doesn’t usu­ally get go­ing full speed un­til De­cem­ber, peak­ing in most years in Fe­bru­ary and usu­ally end­ing by April.

I’ve just learned from Dr. Michael T. Oster­holm, direc­tor of the Cen­ter for In­fec­tious Dis­ease Re­search and Pol­icy at the Uni­ver­sity of Min­nesota, that im­mu­nity in­duced by the flu vac­cine, which is rarely greater than 60 per­cent to be­gin with, tends to wane by 20 per­cent a month, leav­ing those who got their shot in Au­gust or Septem­ber with less than de­sir­able pro­tec­tion by the time they’re ex­posed to a vari­ant of flu virus their body doesn’t rec­og­nize.

Oster­holm sug­gested that “since 95 per­cent of flu out­breaks start in midDe­cem­ber, it’s best to get the flu shot in early to mid-No­vem­ber.”

Of course, if you, like me, were plan­ning to travel abroad mid-fall, you should have got­ten the vac­cine be­fore­hand be­cause you never know what you’re likely to be ex­posed to en route or wher­ever you land, and no one wants a trip ru­ined by the de­bil­i­tat­ing fever, aches, fa­tigue and nau­sea that typ­i­cally ac­com­pany the flu.

The Cen­ters for Dis­ease Con­trol and Pre­ven­tion, the na­tion’s in­fec­tious dis­ease watch­dog, rec­om­mends that ev­ery­one, start­ing at age 6 months, get a sea­sonal flu shot ev­ery year. Chil­dren younger than 6 months can be pro­tected if their mothers get a flu shot dur­ing preg­nancy. An­nual vac­ci­na­tion is es­pe­cially im­por­tant for peo­ple 65 and older, those with a chronic ill­ness, preg­nant women and any­one with com­pro­mised im­mu­nity, all of whom are most sus­cep­ti­ble to se­ri­ous and pos­si­bly fa­tal com­pli­ca­tions should they get the flu.

It’s very im­por­tant that chil­dren, too, get vac­ci­nated with the cur­rent year’s vac­cine, since chil­dren are less likely to have any resid­ual pro­tec­tion from prior ex­po­sure to the flu and are the lead­ing vec­tors for in­fect­ing oth­ers should they get sick.

Fur­ther­more, the flu virus is read­ily trans­mit­ted to oth­ers start­ing the day be­fore you de­velop any tell­tale signs of the in­fec­tion, which comes on sud­denly. You may be fine in the morn­ing and feel like you’ve been hit by a truck by af­ter­noon. A seem­ingly healthy child who is in­cu­bat­ing the virus can eas­ily trans­mit it to a dozen oth­ers, in­clud­ing teacher and par­ents, be­fore they know they are sick.

Af­ter peo­ple who con­tract the flu think they’re well enough to re­sume their nor­mal ac­tiv­i­ties, they may con­tinue to spread the virus for up to a week af­ter they first be­came ill.

I’ve of­ten heard peo­ple de­cline the vac­cine be­cause they once got flu­like symp­toms af­ter the in­jec­tion, or they came down with the flu de­spite it.


1. The vac­cine does not, and can­not, cause the flu. Ei­ther they were in­fected be­fore they were im­mu­nized or be­fore im­mu­nity took hold, or the fever and aches they ex­pe­ri­enced were side ef­fects of the vac­ci­na­tion, not the flu it­self.

2. As cur­rently for­mu­lated, the vac­cine is far from per­fect. In some years, it has been as lit­tle as 20 per­cent ef­fec­tive in pre­vent­ing the flu, although it may still lessen the sever­ity of the ill­ness and like­li­hood of com­pli­ca­tions.

The big­gest prob­lem with flu vac­cine is the need to de­ter­mine months in ad­vance of flu sea­son which of the virus vari­ants to in­clude. The flu virus is a mov­ing tar­get, highly sub­ject to mu­ta­tions; even the way the vac­cine is made – of­ten in­volv­ing grow­ing the virus vari­ants in eggs – can cause them to mu­tate.

If the vari­ants in­cluded in the vac­cine dif­fer from those that are ul­ti­mately re­spon­si­ble for sea­sonal out­breaks, pro­tec­tion is likely to be greatly re­duced, which is what hap­pened in the 2004-05 and 2014-15 flu sea­sons, when vac­cine ef­fec­tive­ness was only 10 per­cent and 19 per­cent, re­spec­tively. Last sea­son’s vac­cine was about 36 per­cent ef­fec­tive.

There is also a dif­fer­ence in the pro­tec­tion af­forded by the same vac­cine given to peo­ple in dif­fer­ent age cat­e­gories. For ex­am­ple, the vac­cine used against flu in 2012-13 had an over­all ef­fec­tive­ness of 49 per­cent, but was only 11 per­cent ef­fec­tive for peo­ple 65 and older. A higher-po­tency vac­cine is now avail­able for older men and women.

There is now a con­certed ef­fort to cre­ate a new “uni­ver­sal” flu vac­cine that would pro­tect against all man­ner of vari­ants and not re­quire an an­nual shot. The goal, Oster­holm said, is “a vac­cine that can han­dle many new changes in the virus and that needs to be given only once ev­ery five or 10 years.”

The ba­sic re­search needed to de­velop such a vac­cine could cost $1 bil­lion a year for the next five to seven years, he es­ti­mated. How­ever, Con­gress al­lo­cated a mere $100 mil­lion for the com­ing fis­cal year.

Un­til a safe, ef­fec­tive, broad-based vac­cine be­comes a re­al­ity, we all have to work with the im­per­fect vac­cine we’ve now got. In ad­di­tion to get­ting im­mu­nized (keep in mind that it takes about two weeks for the vac­cine to be fully pro­tec­tive), any­one with flu­like symp­toms should stay home.

The virus is be­lieved to spread mainly by droplets when in­fected peo­ple cough, sneeze or talk from as much as 6 feet away and the virus-laden droplets land in the mouths or noses of oth­ers. Al­ways cover coughs and sneezes with a tis­sue that is im­me­di­ately dis­carded, or cover your mouth with the crook of your el­bow. Avoid touch­ing your eyes, nose and mouth un­less you have just washed your hands.

Clean hands, washed with soap and warm wa­ter for at least 20 sec­onds, are al­ways im­por­tant. The flu virus can sur­vive for up to eight hours on hard sur­faces, so it can be picked up from a door­knob, handrail or even a light switch.

There are two pre­scrip­tion drugs avail­able for out­pa­tients, os­eltamivir, sold as Tam­i­flu, and zanamivir, sold as Re­lenza, that can help pro­tect peo­ple in high-risk groups who are in close con­tact with oth­ers who are in­fected. If taken within two days of on­set, these drugs may also re­duce the sever­ity and shorten the du­ra­tion of the flu.

We are now a cen­tury away from the worst flu pan­demic in his­tory, the 1918 Span­ish flu that in­fected 500 mil­lion peo­ple world­wide, killing as many as 50 mil­lion, in­clud­ing 675,000 Amer­i­cans.

Snake oil, later known as Ra-Ta-La Oil, was all there was to of­fer for pre­ven­tion.

To­day’s vac­cines, though im­per­fect, are far more ef­fec­tive, but only if you get them be­fore flu sea­son is in full swing.

GRA­CIA LAM New York Times

Im­mu­nity tends to wane by 20 per­cent a month, leav­ing those who got their shot in Au­gust or Septem­ber with less than de­sir­able pro­tec­tion by the time they’re ex­posed in the fall and win­ter.

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