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Stienecker: Thoughts on the flu vaccine

Editor's note: This is an email written Thursday by Dr. Scott Stienecker, Medical Director For Epidemiology and Infection Prevention for Parkview Health, in response to a Journal Gazette inquiry.

Thoughts on Flu Vaccine:

This year, we have not seen a dramatic increase in flu cases – we have only about 40 cases in house of flu-like illness and not all of them will be flu. But what is remarkable are the cases of flu in healthy people between the ages of 22 and 55. We have about 6 patients in the ICU right now (and another 2 that are getting tested), healthy people that are devastated. Others have been sent to Ann Arbor and other teaching hospitals for treatment not available here. They end up on the ventilator for weeks to a month, and then have to learn how to walk again. Can you imagine (being) out of work for 8 weeks just because you did want to get a shot? Or just because you are too busy? Flu typically starts at the end of December, peaks in February and starts to fizzle out in March. Most of what we are seeing is H1N1pan09 (pandemic H1N1 flu). Last year, our season went well into April and we had a B strain not covered by our vaccine that caused flu among vaccinated people.

We have more options than ever this year for flu vaccination. The standard trivalent vaccine has 3 different strains of flu, 2 A strains including H1N1, and 1 B strain. The newer quadrivalent vaccine has the same 2 A strains but also has 2 B strains. The newest vaccine, is egg-free, and can safely be given to people with egg allergy. All 3 of these vaccines contained only pieces parts of the flu virus and cannot cause influenza. Also available is the nasal mist form which does contain a mild form of a live virus. My experience is that it tends to cause even less side effects than the flu shot despite the fact that it is a live virus. My kids did great with no after effects at all.

Vaccines are not 100% effective but are typically around 70-80% effective, but varies by group (the elderly don't immunize as well as adolescents, for example). Those that develop infection, either do so prior to full immunity (which takes about 2-4 weeks), (don't) have the flu at all, or are infected with a strain not covered by the vaccine. If vaccinated, but still get the flu, we note that the disease tends to be much more mild and of shorter duration.

All flu can be blunted by the use of anti-flu medications, and anyone who has signs or symptoms of the flu (runny nose, itchy eyes, cough, shortness of breath, fever, chills, muscle aches) should see their doctor to be started on anti-flu medication. Note that those people who primarily have diarrhea and other GI symptoms, likely don't have the flu. Norovirus has been fairly bad this year.

Recommendations:

1. Everyone needs to be vaccinated against the flu, especially those between the ages of 20-55.

2. Pregnant women are especially at risk for severe flu. Those reluctant to take a vaccine during pregnancy ignore the very high risk of severe illness or death from the flu.

3. If sick, see your doctor for Tamiflu.

4. Unless some other contraindication, take an anti-inflammatory such as ibuprofen or naproxen on the day of vaccination and the day after vaccination.

5. It is not too late to be vaccinated!

Scott Stienecker MD FACP FSHEA

Medical Director For Epidemiology and Infection Prevention

Parkview Health

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