We know what you may be thinking. "Here it comes — information about flu — again. They're going to tell me I need to get a flu shot."
You're absolutely right. In fact, flu season is here again, but don't be so sure it's going to be predictable, because it never is. "If you've seen one flu season, you've seen one flu season," experts like to quip.
The clear message for everyone 6 months or older: Get your flu shot and do it before the end of October. It is safe and it is the very best way to protect yourself and others. Because it's true: This isn't just about you and you do have the power of prevention. That's why you'll hear the terms "herd immunity" or "community immunity." They matter.
Expert panel talked flu
Prevention was the official word from William Schaffner, M.D., medical director at the National Foundation for Infectious Diseases, as he moderated a news panel about flu from Washington, D.C. on Sept. 27, 2018.
He shared these national statistics from the Centers for Disease Control & Prevention (CDC) about last year's high-severity flu season, the worst since the 2009 pandemic:
- 80,000 people died; 900,000 Americans visited the hospital
- 180 children died: 80 percent of all children did not get vaccinated
The blame can be shared. All of those people contracted the flu from someone else, said Surgeon General Jerome Adams, M.D., M.P.H., during the press conference.
This year, as in past years, the vaccine is especially important for older people, young children, pregnant women and those who have chronic or long-term health problems. No excuses now: Your doctor can give the shot, as can clinics, pharmacies and even your place of employment.
More flu knowledge
Dr. Schaffner said there's a "new view of flu." Experts acknowledge that older people, and persons with chronic illnesses, have a higher level of low systemic inflammation, which is exacerbated by influenza infection. Damage from flu causes continues after you've recovered from the acute respiratory illness — for as long as two to four weeks — because that initiates systemic inflammation that continues beyond resolution of the illness. This response can involve blood vessels in the heart and the brain that increases risk of heart attack and stroke.
Second, older and frail people may not recover "completely," he said. They may never return to pre-flu functional level. The flu can knock down the first domino of what becomes progressive decline and vaccine-preventable disability. Dr. Adams shared that he had first-hand experience with a family member who died.
Shot or nasal spray
You may hear about viruses of flu, such as A or B, H1 or H3, and that last year, A(H3N2) was predominant. You don't really need to concern yourself with that, instead, just trust scientists who research each impending season and update recommendations about what should comprise this year's flu vaccine. As the CDC reminds us, "The composition of U.S. flu vaccines is reviewed annually and updated as needed to match circulating flu viruses."
The agency also says that during seasons when the vaccine viruses matched circulating viruses, a flu shot reduced risk of having to see a doctor with flu by 40 percent to 60 percent.
One of the challenges is that it takes approximately 6 months to prepare a vaccine, said Litjen (L.J) Tan, M.S., Ph.D., and the Immunization Action Coalition's chief strategy officer, during a telephone interview with HealthCentral. "Viruses can continue to change, and some do while some don't."
Manufacturers shipped 155.3 million doses of flu vaccine, a record number, last season. Remember flu activity starts to increase in October and November, peaks in December and February, and can last as late as May. This year, you will receive one of five vaccines — your health care provider will choose which one — or a nasal spray.
Test or not?
"The rapid flu test can be very effective when flu is circulating," says Dr. Tan. "During that time, tests are what we call more 'specific' so results are more valuable than when there is little influenza circulating."
Tests can help determine whether a person should go on antiviral medication, he says, but he reiterates that tests are not necessary to start antiviral treatment. "If someone has flu symptoms, they should consider a prescription antiviral. Antivirals are most effective when a person starts them within 48 hours of having symptoms. Remember this is not a substitute for the flu vaccine."
Three antiviral drugs are FDA-approved: generic oseltamivir or the brand name Tamiflu, the most prescribed; zanamivir or Relenza; and peramivir or Rapivab.
Now, you may ask yourself, how else do I know if I really have flu?
"Flu is very abrupt onset, like 'I was feeling good this morning but this afternoon, I crashed,'" says Dr. Tan. "'I have aches, a chest cough and a bad headache.' Conversely, a cold builds up, maybe starting with that tickle in the throat in the morning, and by afternoon, you're you think that you may be catching something."
What did I have?
Last year, I got my flu shot in November — yes, that was probably too late — and three weeks later I had "something" which I "guess" was the flu. Did I test for flu? No — another unwise decision, perhaps. I coughed for almost three months, and asked my primary care doctor what I could do.
"You may cough for three months," he said. I had a chest x-ray and it was clear. I took an antibiotic and it did nothing. I’m still not sure what I "had," but the coughing was unmanageable much of the time, leading to gagging and a very red face.
If what I had was a version of the flu, in spite of my shot, so be it. I was lucky, a fact seconded by Dr. Schaffner. "Partial protection is good. Even if you get the flu, a flu shot may prevent you from getting pneumonia or dying — both of which are real benefits. I like to say, 'I'm so glad you're here to complain!'"
Flu isn't the only bad actor when it comes to annoying, long-lasting illness. "Influenza virus is responsible for only 30 to 40 percent of respiratory tract infections," says Dr. Tan. He points to the adenoviruses that "act like the common cold and cause a fever, also causing gastrointestinal problems like diarrhea. Rhinovirus causes the common cold, which doesn't include fever. Respiratory syncytial virus also causes flu-like symptoms."
The bigger picture
"We do so well with kids in terms of their vaccinations," Dr. Tan says. "They're recognized as a preventive health tool, but for us adults, we don't do so well because we think they're a 'convenience.'"
In fact a 2017 study found that the flu vaccine can significantly reduce a child's chance of dying from the flu as well as flu-associated hospitalizations. Wendy Swanson, M.D., better known on social media as Seattle Mama Doc, said matter-of-factly during the webcast that kids have a lot of "snot and drool," and when they go to school, they share those secretions. At least 10 to 40 percent of children are exposed, then get and spread the flu."
If you do get sick, Dr. Tan reminds you to follow the "Three Cs," even if you've heard them before, because they work:
- Cover your cough with a tissue or the crook of your elbow.
- Contain germs by staying away from people who are sick. And if that's you, do your friends and co-workers a favor by staying home.
- Clean your hands, 20 seconds with soap and water or use an alcohol-based hand cleaner.
Vaccinating for two
During the news conference, obstetrician and gynecologist Laura E. Riley, M.D. of Weill Cornell Medicine, said lung volume decreases during pregnancy and that pregnant women who get flu fare very poorly. The likelihood of more severe illness gets worse during the second and third trimester — they're more likely to die or be hospitalized with severe respiratory illness. Women who get really high fevers for an extended period of time are at risk of birth defects. Women who get flu at 20 weeks to 29 weeks are more likely to deliver prematurely.
A mother's flu shot provides protection to newborns for the first 6 months of life before a baby can get its own vaccine. She said that last year, only 49 percent of pregnant women got a flu vaccination.
She and the other panel members, along with Dr. Tan, urge you and everyone you care about to get vaccinated — it's just not worth taking a chance.