When pigs fly … or get the flu

Disclaimer

It’s fall! … and flu season. Blah, blah, boring! Perhaps, but understanding why you (and your family) cannot afford to forgo the flu vaccine is the goal here. This is an enjoyable time of year and traditionally very busy. You don’t have time to be in bed with I-just-got-hit-by-a-truck body aches and fever of 103 for four days.

The flu costs Americans an estimated $10 billion annually. What does that add up to for you? Aside from the misery of the flu and subsequent lost days of your life, the flu can have more serious implications. Admittedly, most people who get the flu recover without incident; however, each year the flu hospitalizes 200,000 people, many of those are children. While the severity of the flu fluctuates from year to year, it is estimated to kill between 3,000 and 49,000 people annually. To put that in perspective, that’s close to the number of women killed by breast cancer (close to 40,000) each year, and twice the number of people killed by AIDS.

The CDC is recommending everyone over the age of 6 months be vaccinated every year. Why every year? Unlike other viruses and bacteria, “the flu” is, quite literally, different every year. The influenza virus is notorious for its ability to change (mutate) and essentially recreate itself. Thus, there are many different strains of the flu, to include several different animal species (avian and swine flu ring a bell?). The United States Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have a reporting network that tracks influenza viruses throughout the world. This tracking enables the global health community to monitor disease activity and predict the appropriate components for the annual influenza vaccine. For the 2013-2014 flu season, there are three recommended strains for the flu vaccine, which is fairly standard. However, this year, there is as an additional fourth strain included in the recommendation which is expected to be available as a quadrivalent influenza vaccine. If you have the choice, opt for the quadrivalent to get the most protection this flu season.

So what’s with the pig? Remember, the influenza viruses affect animals, too. As the flu virus adapts and changes, it can serendipitously mutate to infect other species (this mutation is known as an antigenic shift). It is particularly worrisome when the influenza virus mutates to cross species (birds to human, pigs to humans) because we, as humans, do not have an built-up immunity to these strains of the flu. This lack of immunity enables easy infection and thus transmission causing wide-spread, global disease (i.e. pandemic). The H1N1 pandemic of 2009, represented an antigenic shift in the influenza virus (from pigs to humans). Although death rates from the “seasonal” flu (human strains) are usually higher among the elderly and infants, a shift in the age distribution is seen during pandemics. And what is so terrifying with flu pandemics are the higher rates of mortality that occur not only at the extremes of age, but also in young adults (read: everyone, including pregnant women). As a medical community we cannot predict when these pandemics will occur. The research is showing our best defense is prevention: vaccinate everyone, monitor flu activity globally, and educate the public.

There are two options for being vaccinated against the flu: intramuscularly (needle in the arm) and nasally (spray in the nose). The intramuscular vaccine is composed of inactivated (killed) viruses, whereas the nasal vaccine are live attenuated viruses (only parts of the virus). If you are healthy, between the ages of two and 49, and not pregnant, you may opt for either. If you fall outside this category, then you should receive the intramuscular vaccine (the shot). Yes, especially you, mothers-to-be as stated by the CDC and ACOG. There are very few true reasons not to get the flu vaccine. Children are vaccinated starting at six months, but may require two doses to be fully protected. Have an egg allergy (the vaccine is manufactured using eggs)? If the allergy involves hives and not symptoms of anaphylaxis, then the flu vaccine is safe and should be given .

It is difficult to measure the efficacy of the flu vaccine for several reasons. Most notably, the sheer nature of the influenza virus makes it impossible to predict what strains to even vaccinate against. Not to mention the possibility of a novel antigenic shift creating a flu virus we’ve never even seen before. And, not everyone responds the same to the vaccine. So, no, you are not guaranteed to be protected against getting the flu if you get the vaccine. But, your chances are better if you get vaccinated than not at all. Furthermore, contrary to popular belief, the flu vaccine does not give you the flu (there are lots of viruses, including the “cold”, going around this time of year). The most common side effect is a sore arm. In fact, there are so many excuses and reasons people give for not getting the flu vaccine that the CDC, Harvard, WebMD, Mayo clinic, and others have complied resources debunking commonly held myths.

Almost all insurance companies cover the flu vaccine. One of the best places to get vaccinations is with your primary care physician. Often your provider’s office will have flu clinics or special hours for giving the flu vaccine that does not require an appointment. Don’t have a primary care provider or insurance? Many health departments and retail pharmacies are giving the flu vaccine at little or no cost. And the best time to get it? As soon as possible! The CDC recommends getting the flu vaccine as soon as it becomes available for the upcoming flu season (ideally by October).

As women, we are natural caretakers and protectors. Why would we not do everything we could to protect our children, ourselves, and those particularly at risk? Going to get the flu vaccine? The question is not “why?”, but “why not?”.

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