Fall is here!! Did you get your flu shot yet? First read all about it from Dr. Elizabeth Nesmith, MD

10/5/2015

Doc Blog It’s that time of year again! Fall weather is here which means cooler temperatures, football, bonfires, and…….wait for it…..flu season! You might think it’s a little early for flu season and what is all the fuss about getting your flu shot so early anyway? More on that to come later!

I remember it like it was yesterday. I was a budding 2nd year resident starting my ER night rotation. I looked on the board to see who my first patient would be. Room 3 was a young man who was brought in by his mother with fever, cough, and lethargy. Seems easy. I entered his room to begin my assessment. That poor kid looked miserable! I sure was glad I was not him!! As I leaned my healthy flu free body over him to listen to his heart, that sweet child let out the world’s largest sneeze. Right into my face. As multiple viral laden respiratory particles landed on my unprotected face, one thought quickly crossed my mind….”Did I get my flu vaccine this year?” Unfortunately for me, I had failed to get my vaccine that year. Insert several possible excuses….I am too busy to go to the convenient vaccine clinic located IN the hospital, I am young and healthy, in 29 years I have never had the flu…..blah, blah, blah. 36 blissful hours after that precious child shared his respiratory droplets with me, I woke up feeling like I had been hit by a bus. Literally. I was febrile and every muscle/bone/cell in my body ached. My hair even ached! Not only was my entire being aching but I was more tired than I could ever imagine I could be. I was so sick that I couldn’t even walk my poor dog and was unable to work for 5 straight days. Now, just to be clear, I am not one who misses work easily. Prior to that glorious day, I had never missed a day of work and since that day, I have never missed another. Why? Because you can work with a cold. You cannot work with the flu. It was during that time that I realized how dangerous the flu can be. Here I am in the prime of my life, young, healthy, and I thought I was going to die! From that day on I have never missed an annual flu vaccine. Now that I have children, I am that annoying mother, who starting in late August, starts calling her pediatrician to find out if they have the vaccine yet and schedules an appointment immediately upon its arrival. The flu virus is no joke and once you have had it, you never want to feel that way again, and you certainly don’t want your children to ever go through that pain. So how do you know you have the flu? I promise you that once you have it, there is no mistaking it. If you can get dressed, put on makeup, or go to work, you probably don’t have the flu. I often have patients come in and say, “I think I have a mild case of the flu.” That’s like having a mild case of pregnancy. You either have it or you don’t, and if you are questioning whether you have it, you more than likely have the common cold. There are a couple of things that can distinguish the flu from the common cold. The flu is often accompanied by fever, severe body aches, and…oh…wishing you were dead.

So, why is the flu virus such a problem every year? The flu virus is very contagious. I mean VERY contagious. Why is it so contagious? Not only does it have a 1-3 day incubation period, but a person is usually contagious 24 hours prior to the onset of symptoms and remains contagious for about 5 days. It is also spread from respiratory droplets that are emitted during a cough, sneeze, or even just talking. Do you know how far droplets from a sneeze can travel? I didn’t, so I did what all good Americans do and googled it. Some guys in Hong Kong decided to figure it out and determined that during a good sneeze, about 40,000 droplets can be expelled at over 60,000 km/hour. WHAT?!?! They found that even if you are standing on the other side of the room during a sneeze, you are probably not safe. For arguments sake, let’s say you were lucky enough to dodge those 60,000 km/hour viral missals. Are you in the clear? No, my friend. You are still smack dab in ground zero. That nasty virus can live on nonporous surfaces for 24-48 hours and porous for 8-12 hours. Can someone please pass the Lysol?!? Not only is the flu virus super contagious, but the only currently available treatment for the flu must be started within 48 hours of symptom onset to get the maximum benefit. Even if you are lucky enough to get treatment started during that magic time window, studies show it will probably lessen your misery by about 1 day. 1 day! That doesn’t seem worth the $75 I just paid for that prescription! Now let’s say you got the flu and you miserably survived those 5 days and think, “I did it! I survived the dreaded flu!” Is it over? Oh no! Since your immune system just fought a World War I sized battle, it is weakened and down in numbers. It is during this time that you are at risk for one of the dreaded post-flu complications such as….bacterial pneumonia! The flu sucks. As someone who takes care of multiple flu patients each year, you may wonder why I do not decide to wear a hazmat suit from October to May. The reason? I have a secret weapon. Okay, it’s not so secret but it does work. It’s the flu vaccine!!

Why do we health care professionals want you to get vaccinated? Let me start by clearing something up. We, as physicians, do not get kickbacks from “Big Pharma” when you get vaccinated. We have no other agenda other than trying to keep you healthy and possibly save your life. In 2014-2015 there were 17,900 hospitalizations in the U.S. secondary to influenza. The estimated mortality was 6.4%. An even more sobering statistic is that 145 of those deaths were children. Let me make it clear…..the flu kills!!! Flashback to last year’s dreaded Ebola virus scare that received more press time than 9/11. 8 people in the US tested positive for Ebola and 2 people died. 2! Did any of you hear about the 145 children who died from the flu? Despite the staggering differences between cases of Ebola and Influenza, if I had an Ebola vaccine last year, people would be lining outside my door to get it. Yet, every year, I have to try to convince my patients to get the flu vaccine. Why is that? I wanted to find out, so I started asking my patients who refused vaccination. There were a lot of different reasons, and for some of them I couldn’t argue with it. Most of them, however, were rooted in misinformation.

My job as a health care provider is not to persuade you to get the flu vaccine, but to give you as much information as I can about it, and then let you come up with your own conclusions. So, let’s start with what the flu vaccine is. The flu vaccine is either a trivalent or quadravalent vaccine against the influenza virus. There are 3 types of influenza viruses: A, B, and C. A and B are typically responsible for the winter flu epidemic. These 2 viruses can further be categorized into various subtypes and strains based on different proteins that are found on their surface. To put it simply, there are a lot of different strains of the flu. Each year the influenza vaccine contains protection against 2 strains of influenza A and 1 or 2 against influenza B.

If there are so many different strains, how do they decide which strains to include in the vaccine? Good question! There are 141 national influenza centers in 111 countries that conduct year round surveillance and study influenza trends. They look at which virus strains are circulating, how they are spreading, and how well current vaccine strains protect against newly identified strains. New strains?!?! Yes folks. That resilient little flu virus has an amazing ability to change. Each time that virus replicates in your body, it is making small changes to its surface to try to prevent your immune system from being able to destroy it. The good news is, that most of the time these changes are small and our superior immune system is able to still recognize that sneaky flu virus and destroy it. Score for the human body! This is called antigenic drift, and is why even if the flu vaccine does not contain immunity to the exact virus of the season, you will still get some protection. The other type of change is the dreaded antigenic shift. This is when the virus makes new proteins from an animal subtype that now can infect humans. This doesn’t happen very often, but when it does, our immune systems are overrun and a pandemic occurs. This is what happened in 2009 with the H1N1 pandemic.

One of the most frequently sighted reasons for not getting the vaccine was that they themselves or someone they know, got the shot and then got the flu. I would like to finally put to this misconception to bed. I don’t care if your sister’s boyfriend’s brother’s best friend said he did. I can say with 100% certainty that he did not get the flu from the flu shot. The 2 flu shots that are currently available do not contain any live virus. Therefore, you CANNOT get the flu from the flu shot. Yay!!! You can, however, have a mild reaction from the vaccine with low grade fever and aches. Take it from me though, that is NOTHING compared to the real deal. We are finally circling back to why we are talking about getting the flu vaccine as early as possible. After you receive the flu vaccine, it can take 2-4 weeks before immunity will develop. Therefore, it is possible to still become infected with the flu virus during the time that your body is trying to make those beautiful antibodies. Flu season officially starts in October! It’s here! So when should everyone start thinking about getting their vaccine? Yesterday! Seriously the time is upon us, so you should consider getting your flu vaccine right away so that you are fully protected.

So how can you protect you and your family this flu season? First of all, get your flu vaccine and get it early. Give your amazing body enough time to make its warriors against that dreaded virus. Secondly, practice good hand hygiene. If you cough or sneeze, “Protect Don’t Infect. Use you sleeve when you sneeze!” Finally, keep your immune system in tip top shape. Our immune systems need vitamins and minerals such as vitamin C and zinc to do their jobs. If you can’t get these essential vitamins from your diet, you can get them from supplements. One great supplement is our Immune Wonder which is filled with those nutrients that our immune system needs to go to war for us.

Whew! That was probably more about the flu than you ever wanted to know! I hope I have put to bed some misconceptions about the flu vaccine. Even if I haven’t convinced you to get vaccinated this year, I hope you will at least talk to your doctor about it.

As the flu season descends upon us, I wish you all the best of luck and a flu-free season!

~Dr. Elizabeth Nesmith, MD