No reason West Nile patient should skip flu vaccine

DEAR DR. ROACH: I am a paraplegic due to complications from the West Nile virus. I am getting conflicting information from my health care providers concerning flu shots. My primary care doctor says that the flu shots are contraindicated for West Nile victims; my pharmacist says the vaccinations are OK; and my hematologist is unsure. I would like to get a flu shot and a vaccination for COVID-19 when available. Please give me a definite answer.

— P.H.L. ANSWER: West Nile virus was relatively unknown in the U.S. until 1999, when an outbreak occurred in New York, but WNV now has been found in all the continental states and Canadian provinces. It is an arbovirus, related to the Japanese encephalitis virus. As such, it can cause neurological symptoms, including meningitis and encephalitis. It may also cause an acute flaccid paralysis, similar to poliomyelitis. Only polio virus causes poliomyelitis, and polio only exists in the wild in Afghanistan and Pakistan now, but several viruses can cause symptoms that act similarly. Although many people recover partially or fully, a third of people with acute flaccid paralysis do not recover.

There is no definitive answer on flu shots, because it’s an unusual situation and there are little data. However, I found no published information that would lead me to recommend against a flu vaccine in people with neurological compromise due to West Nile virus. I suspect your primary doctor is concerned because there is a syndrome from West Nile similar to Guillain-Barre, about which there is controversy about flu vaccines. It is very unlikely that you have paraplegia from a Guillain-Barre syndrome from West Nile. Even if you did, the benefits of influenza vaccine outweigh the risk, according to multiple studies.

I cannot comment on any COVID-19 vaccine until efficacy and safety data from large studies are available, which is not the case as of this writing.

DEAR DR. ROACH: Is there a way to do a noninvasive, easily reversible vasectomy?

— K.M.B.

ANSWER: Vasectomy is a safe and highly effective procedure to assure permanent male sterility. Although the preferred technique in the U.S. is a noscalpel vasectomy, in my opinion, it cannot be considered noninvasive. Minimally invasive is a more correct term.

Complications are uncommon, and include infection and post-vasectomy pain syndrome (both less than 1% with the no-scalpel method). The overall rate of pregnancy after vasectomy is approximately 1 in 2,000.

Vasectomy is for men who want permanent sterility: They are sure they never want children again. Men should not think of a vasectomy as a reversible procedure. Nevertheless, reversal of vasectomy is still sometimes attempted. In the best of hands, the success rate is 50% to 70%. Consequently, careful counseling is mandatory prior to vasectomy. Also, men need to know that although a successful vasectomy protects against pregnancy, it does not protect against sexually transmitted infections.

Most men tolerate the procedure quite well. Some of my patients have noted post-procedure pain, but a few days of light activity and pain relievers is generally adequate. One or two have had unexpectedly high amounts of pain requiring more potent pain relievers for a few days.