It is that time of year again: From September to January, your healthcare providers will remind you to get a flu shot. There seems to be ambivalence in many regarding flu shots, as not everyone is willing to receive one even if they are readily available. The American Diabetes Association (ADA) recommends flu shots for every person with diabetes. Currently, there are two forms of influenza vaccine available: the injectable (killed flu) and the nasal spray FluMist (for those younger than 50 and older than 2 years). As such, I have adhered to ADA guidelines and encouraged my child and adolescent patients to get the shot. However, after the H1N1 epidemic several years ago in which the injectable form became scarce, leaving more doses of FluMist, I encouraged my families to go ahead and get the spray in order to decrease the risk of the flu in any way possible. In my practice, there were no adverse reactions to the intranasal preparation. So, why does the ADA recommend flu shots instead of nasal spray for diabetic patients?
My interpretation is, given that the majority of people with type 2 diabetes are older, they also have comorbid conditions that may lead to potential problems with an attenuated vaccine, especially if there is any possibility of immunosuppression. My patient population rarely has other major underlying issues, aside from diabetes, and is not considered to be immune-compromised. Therefore, I have no objection to the FluMist preparation in most situations except if there is an individual family member living in the household that is immune-compromised and at risk, or for those children between ages 2-8. The age limitation is based on a recent article that was published in the Washington Post (Health section 11.11.14) that noted that the FluMist nasal spray “did not protect young children against the H1N1 strain last winter and might not work again this year.” This information obtained by the Washington Post was based on an AstraZeneca study that included over 1,000 children and found that protection was not as good for children between ages 2-8, but normal for older children. The article also stated that the spray should be acceptable this year based on the fact that other strains are expected to a major threat, other than H1N1. Last year, the flu vaccine was about 60% based on CDC statistics (apparently this is considered acceptable).
Why is it a good idea to be immunized against the flu?
Aside from avoiding the obvious annoying symptoms of the flu, including muscle aches, fever, cough, vomiting, diarrhea, etc., people with insulin-dependent diabetes, particularly type 1, are especially at-risk for developing ketones and dehydration with the illness. Therefore, we could perhaps avoid a trip to the emergency department for IV fluid rehydration or treatment for diabetic ketoacidosis. In addition, there also is the risk of developing viral pneumonia that can then lead to bacterial pneumonia with serious consequences, especially in the older type 2 diabetes population.
The major objection to flu shots has been the fear of coming down with minor, flu-like symptoms or developing the Guillain-Barre Syndrome (reversible paralysis, in most cases). This major complication did occur many years back with a different formulation and preparation of flu vaccine. The current vaccines are prepared differently and have been demonstrated to have very few side effects other than local muscle pain after the injection. Still, many decline the vaccination.
In many hospital settings, including my own at Children’s National Health System, we are required to receive the flu shot in order to remain healthy and available to care for our patients. To facilitate flu vaccine administration for our patients and families, our diabetes team at Children’s National System has instituted a pilot program by which children over 7 years of age and their parents may be vaccinated on site by the pharmacists at the Walgreen’s Pharmacy that is housed on the first floor of the hospital.
Lastly, in terms of perspective, more people are at risk of becoming ill with the influenza—which is extremely contagious due to secretions that have been aerosolized through coughing, sneezing or talking—than with Ebola, which is spread by direct exposure to bodily fluids.
Therefore, please strongly consider getting vaccinated against the flu. Please speak to your pediatrician or diabetes care team if you have any further questions or concerns.
Published On: November 12, 2014