Choosing Whether to Get the Flu Shot This Year: RA, Rituxan, and Vaccines

Patient Expert

Have you seen the commercials for flu shots offered at your local grocery store?   Or have you seen the signs outside the large chain pharmacies advertising that flu shots are available already?

Some businesses are offering clever incentives for getting vaccinated this year.   There is one grocery chain which is offering 10 percent off your grocery bill if you get your flu shot while shopping.   It's an interesting way to motivate people to get themselves vaccinated.   Quite a move to influence public health.

I remember the first year that I got my own influenza vaccine at a local grocery store.   Shots were only offered during narrow hours and locations were running out of vaccines quickly.   I stood in a line which spanned from the pharmacy area, past the meat area, and into the bakery area.   That was the year I decided while standing in line to get the pneumonia shot in addition to the flu shot.

At that time, I had been rather motivated to get the vaccines because of having had a nasty case of pneumonia a few years prior and a humbling case of flu earlier that year.   I really couldn't afford to be out of commission for as along as I had been when I was sick.   Being an active performer and teacher (and being self-employed without any sick leave), I couldn't afford to cancel too many lessons or performances.   Doing either would eventually kill my growing career.   (Ironically, developing chronic disease put a damper on that rising career anyway in following years.)

Since developing multiple sclerosis and rheumatoid arthritis, I have been getting my annual flu shot upon the recommendations of my doctors.   It is not something which seems to be a big deal to me personally.   I feel that I'm doing my job in protecting myself against the germs which are shared through being in close proximity to many different children during private music lessons.

Sharing a piano keyboard with more than 15 pairs of hands each week is a rather intimate endeavor, one which you don't really think about until someone is coughing and sneezing right onto those same keys.   It is in my own best interest to protect myself against colds and flus which could easily be spread.

One of the things that my rheumatologist wanted me to do before starting Rituxan in 2009 was to receive the annual flu vaccine and the separate H1N1 vaccine which was available.   She even wrote a prescription which stated that I was "high priority" for the H1N1 vaccine which was not offered to everybody that year.   I went to the local CVS store and received both easily.   This was in October and I started Rituxan in November.

So when it was time to get the annual flu vaccine last year, I did so without question.   Then when I developed the flu in January, I wondered what had happened.   I had been protected from the flu each year.   Why was this year different?

What I learned upon researching the issue is that the desired immune response following an influenza vaccine is reduced in patients who receive Rituxan infusions.   In a small study, a large percentage of patients who received vaccines two months or less following Rituxan infusions developed no antibodies to the virus.   Patients who were vaccinated 6-10 months following Rituxan infusions produced a much lower level of antibodies as compared to patients on methotrexate alone or healthy controls.   This study confirmed the results of previous even smaller studies.

In 2010, I received Rituxan infusions in late May/early June.   I got the flu shot in October (four months later).   Likely, I did not develop the desired antibodies to the vaccine and that is what contributed to my getting the flu in January 2011.

This year, I received Rituxan infusions in March which is already 6 months ago.   Now the decision I have is: 1) Do I get the vaccine now as early vaccines are recommended this year?, 2) Do I wait until October or November so that I have a better chance of developing more antiobodies?, 3) Do I skip the vaccine because it might not be as effective for me?

I am leaning toward choice B.   I think I will wait until October to get the shot.   That way my immune system may have a better shot at protecting me against any nasty viruses the piano students might share with me.   And, it should be early enough to be protected in January and February when the flu tends to travel through our area.

What about you?   Do you decide whether or when to get your flu shot based on other drugs you take?