Friday, September 2, 2016

Welcome to Flu Season 2016-17

Flu Season is upon us as such I felt it important to discuss the flu vaccine when talking about adult vaccination.

Influenza is an acute febrile respiratory disease. In an average year influenza can account for 3,300 – 48,000 deaths per year in the US alone (yes, deaths), 100,000-800,000 hospital admissions, 25 million physician visits, and 50-50 million infections and illnesses. The majority of the deaths occur in people aged 65 and over. Individuals most vulnerable to complications of influenza are children age 2 and under, adults age 65 and over, people with suppressed immune systems (patient’s on chemo, on immunosuppressive drugs, HIV), and people with other underlying conditions (asthma, COPD, chronic renal failure, diabetes, etc). Last year's flu season resulted in 85 pediatric deaths, a vast majority of them unvaccinated or too young to vaccinate.

An inactivated influenza vaccine has been in use since the 1960’s to help prevent influenza infection. The current recommendation in the US is that every individual age 6 months and older get the flu vaccine yet many people do not get it. Why?

Common Reasons Nurses Hear from Patients Who Are Hesitant to Get Their Influenza Vaccines
"I never get the flu” or “I had it and it wasn’t that bad” – That’s great that you haven’t gotten the flu – yet. If you thought you had the flu but felt it wasn’t that bad – it wasn’t the flu, it was probably a bad cold or other influenza like illness. Flu hits hard and fast. Your whole body aches, and your head wants to explode. A large percentage of people who get it, report not being able to get out of bed, and it is serious (see above numbers from the CDC’s Mortality and Morbidity Weekly Report). Even after the flu has run its course, most people report fatigue that lasts for several weeks afterward. Becoming infected with the flu may be as simple as being in the same room with someone who coughs. The incubation period for influenza is 1-4 days. An infected person can shed virus to others from 1 day before, to 5 days after becoming symptomatic. So it is possible to not even know if you are around people who are sick (can you say plane ride?) No amount of “immune boosting” concoctions will prevent the influenza virus from protecting you if you are exposed. (that is all I will say about that. It is a topic for another post). I have seen healthy, athletic, well-nourished young people come down with it and have to be hospitalized.

“The flu shot makes me sick” – This one may be my favorite. The current injected flu vaccine is an inactivated vaccine. It is a dead virus. (insert Monty Python Dead Parrot Sketch here). IT CANNOT GIVE YOU THE FLU! Keep in mind though, it takes the body up to two full weeks to develop an immune response to the vaccine that will protect you from getting sick from the flu. If you did get sick after the flu shot, it was for one of two reasons. Either you were exposed to it before you got the shot or before your body developed immunity via the vaccine OR you got one of the other 99 or so recognized rhinoviruses in existence, and you would have gotten sick whether you were vaccinated or not. As an aside, there is a live virus vaccine called Flumist, but I will discuss that in another point. The shot does not make people sick. Period.

“The flu shot is not very effective, the virus mutates so they never know if it will work or not.” There is some truth to this though not enough to avoid getting the shot. The formula for the flu shot varies from year to year based on surveillance systems from various agencies (Centers for Disease Control-CDC, World Health Organization-WHO, National respiratory and Enteric Virus Surveillance System -NREVSS and about 5 more that I won’t mention unless someone asks as I have been told I am verbose enough). The vaccine takes about a year to develop. Researchers and scientists all over the world use data from previous years and mountains of epidemiological data to predict which 3 or 4 strains will be most prevalent and formulate the vaccine accordingly. It was all over the news during the 2014-2015 flu season how low the effectiveness of the vaccine was that year (about 23%). Last year’s vaccine was better at about 59%. Does this mean the shot is no good? I don’t know about you but I’ll take a 23-59% reduction in the chance of getting flu over 0% reduction. Also in the news was the lack of effectiveness of the quadrivalent nasal Flumist, and the CDC’s recommendation against using it this year. Is this a failing on the part of vaccine research and development? Actually no, it is good medicine at work. It is proof that those who make it their life’s work to develop these vaccines want to make sure they are effective. Interesting enough a Canadian study of the intranasal flu vaccine is reporting different results with effectiveness on par with the shot. This again is demonstrates how no one study can be used to make health care recommendations. All evidence must be compiled and a consensus is then reached. Will this change the CDC’s recommendation? Not likely for this year, but it may have an impact on the recommended use of the intranasal vaccine in the future.

"I don’t get the flu shot because it’s full of toxins and heavy metals”. Ok, so I lied. This one is my favorite. First let me start out by saying that the people who screech about that, typically have no understanding of basic chemistry and the fact that everything is a chemical. The air we breathe, the water we drink, every molecule in our body is a chemical. Also, the poison is in the dose. Anything can be toxic at the right dose – water, oxygen, anything. The properties of any element on the periodic table are dependent upon the other elements to which they are bound. Sodium is a metal that is volatile if it comes in contact with water, but when bound to the element chloride it becomes table salt. Not only safe, but fairly essential for life. I’ll start with the big gun in vaccines. Mercury. Not all mercury is created equal. There is elemental mercury, the stuff in thermometers. That stuff is really bad for you, can do a lot of damage if ingested, inhaled, whatever. There is methyl mercury - a dangerous compound often found in polluted water. Then there is thimerosal a vaccine preservative, used only in multidose flu vaccine vials, that breaks down into ethyl mercury. Ethyl mercury does not bio-accumulate. The body excretes it, unlike methyl mercury which can build up in the body and cause harm. Think of ethyl alcohol (wine) vs. methyl alcohol (rubbing alcohol). Drinking 8 oz of ethyl may give you a buzz. Drinking 8 oz of methyl alcohol can kill you. Aluminum is another popular culprit. But the catch here is that the aluminum in a vaccine is not ground up bits of aluminum foil. It is a compound in the form of aluminum salt. The aluminum salt acts as an adjuvant enhancing the immune response of the active ingredient in the vaccine. Aluminum salts are found in many things, particularly oral antacids like Mylanta and Maalox. There is more aluminum in a feeding of breastmilk for a baby than there is in a vaccine. Formaldehyde is another scary sounding chemical in a vaccine. The formaldehyde is used to kill or inactivate the virus used in a vaccine. The human body manufactures its own formaldehyde, and there is more naturally occurring formaldehyde in an organic pear than in a vaccine. There is not enough formaldehyde in a vaccine to even register a change in serum levels in the blood. So, scary chemicals, not so scary after all. By the way have you ever looked at the chemical composition of a strawberry? That shit’ll kill you. 
Ingredients of an All-Natural Strawberry
In closing, everyone 6 months and older is recommended for annual flu vaccination with rare exception. For the 2016-2017 season, CDC recommends use of injectable flu vaccines--inactivated influenza vaccine (or IIV) or the recombinant influenza vaccine (RIV). The nasal spray flu vaccine (live attenuated influena vaccine or LAIV) should not be used during 2016-2017. 

You can use this widget Flu Vaccine Finder, to locate flu vaccine clinics near you. Simply enter your zip code or city and state to find mapped locations of flu vaccine clinics.

You can also visit to find out what other vaccines are available in your area. Talk to your doctor or nurse if you have any questions regarding which flu vaccine is best for you and your family.

And when you get your vaccine... send us your selfie! Like past flu seasons, we'll be collecting and sharing your #Vaxselfie. Send it to us on our Facebook page, email it to us (, or tag us on Instagram and Twitter at @NursesWhoVax. We look forward to sharing everyone's efforts to protect themselves and others from influenza. Be safe this season!

Lori B. has been in nursing for 20 years. She began advocating for vaccine awareness and working toward dispelling myths and misinformation about vaccines in 2013 as she was finishing her advance practice degree. Since then she has become a member of Nurses Who Vaccinate, Voices For Vaccines and the New Jersey Immunization Network.