National Influenza Vaccination Week was from Dec. 6 to Dec. 12. However, getting your flu vaccination is not confined to this one week. In fact, the peak season for the flu has only just begun, and it doesn’t end until February. The flu can even hang around in the United States until May. Considering this, I thought that if it’s going to be here a while, why not get myself vaccinated?
The Centers for Disease Control and Prevention (CDC) began National Influenza Vaccination Week in 2005 to inform the public that the flu season extends beyond the holidays, and that a ten-second wipe and prick could save someone a week’s worth of the flu and potential flu-related complications.
In order to explain the importance of influenza vaccination, I thought it was essential that I first get vaccinated myself. So on Dec. 6, I strolled into a Safeway, walked to the pharmacy in the back of the store, and finally, after months of my mother’s begging, got the flu shot. In addition to getting a vaccination that would elicit an immune response in my body to make antibodies to recognize and prevent different viral strains of influenza from attacking my body’s defenses, I also got one complementary interview, one free Simpsons Band Aid, and a 10% off coupon for my next grocery purchase at Safeway that’s up to $200. Talk about good service!
In a conversation with the Safeway pharmacist, who administers the flu vaccine, I learned about the politics and price of the flu shot, the best times to get vaccinated, and the truth about the “I got sick from the flu shot” myth.
According to the pharmacist, Dr. Jason Kuan, the influenza vaccine “is incubated in [duck] eggs, so it takes a while to mass produce all of this vaccine.” People are turning to pharmacies for matters of flu vaccination “because of convenience, and because doctor’s offices don’t receive the vaccines till later, but here [at Safeway] we got ours in August. Also, for a big corporation, you have more people working to procure more of the vaccine, whereas a doctor’s office is probably doing it in smaller amounts, and they might not have the buying power to get first shot at the vaccine.”
If you don’t have insurance, “$29.99 is the cash price [for the shot], and for the higher dose it is $59.99.” But if you do have insurance, not only is the shot free, but “you receive a 10% off coupon at Safeway, which makes getting the shot have more of an incentive.”
Kuan mentioned that “someone can’t get vaccinated too early.” He also suggested that, unlike myself, others should strive to get vaccinated before December “so that they’re protected earlier,” and before the peak season begins, because “once you’ve gotten the shot, it takes about 10 to 14 days” for the vaccination to become effective. In addition to good timing, it is even more important that one simply remembers to get their vaccination each year. This is because “every year [the influenza virus] mutates so that there are different strains that are not covered by the previous year’s vaccine. This means that your body may not already have the antibodies to defend against the strains of flu this year, unless you get the vaccine.
“I’ve heard people say,” noted Kuan, “‘I got the flu shot last year, and I got sick.’ The flu vaccine is a dead virus in a protein coat, so you can’t actually get sick from it.” If a person gets sick after getting the vaccine, it could be due to a concurrent illness, or they could have been infected by a different strain that wasn’t in the vaccine. Scientists predict ahead of time which strains they think will pop up in the coming year, but sometimes new strains emerge.
Dec. 6 was the first time in a decade that I have gotten the flu shot, but this is not due to irresponsibility on my parents part. For the past 10 years I have taken the flu mist.
The flu mist is an alternative to the flu shot, but unlike the flu shot, it contains a “live” virus. It is an influenza virus that has been cultured on human cells at room temperature until it becomes cold-adapted, and able to replicate effectively at room temperature. The flu mist is an intranasal flu vaccine, and the virus can colonize the nose and set up a very mild, nasal infection because that area is much cooler than the rest of our body. But the virus cannot spread to the rest of the body because the rest of the body is too warm of an environment for its replication.
In order to learn more about the reasons for the seasonal pattern of influenza, who is at risk, flu-related complications, and some other fun flu facts, I talked to Jim Laidler. He is an adjunct professor at Portland State University who specializes in virology, but he is also an M.D., and has a PHD in biology (does that make him Doctor Doctor?).
First, I wanted to learn why the flu comes around during the winter months. Dr. Laidler responded that “the flu follows the same pattern as a lot of other respiratory illnesses, from measles to adenoviruses and rhinoviruses” (the common cold). These viruses typically peak sometime in the winter, which has been hypothesized to be because more people tend to spend more time inside, thus increasing the potential for viral transmission via coughing and sneezing. Dr. Laidler then explained that, “influenza follows patterns of waterfowl migration between the Northern and Southern hemispheres, and the virus itself is of waterfowl, so one of geese, ducks, and swans.”
Traditionally it is thought that only the very young, the very old, and the immunocompromised are at risk of being affected by the flu, but that is another misconception. It is true that normally influenza brings on a u-shaped mortality curve, and the young and old face the greatest risk, but the 1918 influenza had a w-shaped curve, meaning there was a big peak in the middle that represented the portion of the population in their late-teens and twenties. And more recently, in 2009, an outbreak of H1N1 (swine flu) popped up in May, and like the 1918 influenza, it too presented a w-shaped mortality curve.
Complications related to the flu shot are most often allergic reactions. Or, people think that they have the flu because they have “muscle pains at the site of injection and they feel achy and feverish and fatigued. But that’s because almost all of the symptoms of a viral infection are caused by your immune system. These symptoms show that is your immune system responding to the dead vaccine of the influenza.” As I mentioned earlier, the vaccine is still cultivated in duck eggs (since FDA approval for a new process would take years and billions of dollars, which they don’t want to spend on a vaccine that makes so little money). This is important because some people with really severe chicken egg allergies may react poorly to a vaccine cultivated in duck eggs, because the eggs are pretty similar.
In response to a question about flu-related complications, Dr. Laidler explained: “Serious reactions to the vaccine, meaning serious enough that someone has to go the hospital or seek medical attention, is [between] about 1/100,000, and about 1/100,000,000 end up needing to be hospitalized for some reason, and the fatality rate for the influenza vaccine is about 1/10,000,000.”
Dr. Laidler then went on to clarify these statistics: “To put that in perspective, if everyone in the U.S. got the influenza vaccine, fewer than 30 people would die from the vaccine. Don’t forget, these deaths are often not actually caused by the vaccine, because any death within 14 days of vaccination is counted as a vaccine-related death. I actually read that a fella was vaccinated and then hit by a car, and somehow that got counted as a vaccine related death.”
Before the flu treatment called Tamiflu was introduced, the first influenza drug was an antipsychotic, but now almost 100% of the strains are resistant to those drugs. Most influenza strains are still susceptible to tamiflu, but some have become resistant.
Pandemics are fairly random events, where two different strains infect the same organism, usually a human or a pig, and then recombine in that organism and spread. One exception to this normally random event was the Russian influenza pandemic in 1977. This was the first year that two major strains circulated, one strain was expected, but suddenly an old H1N1 strain also began circulating. Many years later, it was found out that the H1N1 was an escaped Russian bioweapon, because the Russians had tried to recreate the H1N1 influenza, but they merely reintroduced a less virulent H1N1 into the world.
Herd immunity, in which enough of a population has been immunized that those who haven’t are protected, is not something that you should depend on with influenza. Since influenza mutates, and requires a yearly vaccine, people are not motivated to do it yearly. But, in order for influenza to have caused herd immunity, this would require that (1) the vaccine is effective, and (2) 95% of people get the vaccine (of course this is all assuming that a unpredicted strain doesn’t show up).
The influenza virus from the 1919 pandemic left 50 million people in the Western world dead. “Five or six years ago, some people who had died from influenza in 1919 were dug up close to Alaska, and they were buried, but buried in permafrost,” explained Dr. Laidler. “Scientists were able to isolate enough of the RNA from the virus to reconstruct the 1919 influenza virus, infect mice with it, and then isolate the virus. It was a hybrid” virus with some avian and human-like characteristics. Now scientists can compare the genome of newer strains of influenza to the 1919 virus, to help predict the virulence of the virus that year.
Dr. Laidler also mentioned that there used to be mercury in the vaccines “because mercury has preservative capabilities, and because it is very effective at prohibiting bacterial and fungal growth. The fungal aspect was a big issue because bacteria can be controlled with refrigeration, but fungi can grow even under refrigeration.” But don’t worry, there is no longer mercury in your vaccines. There is still aluminum in them, but “it’s less aluminum than you get from drinking an aluminum can of pop.”
Getting the flu makes for a miserable week (or more), so just get yourself vaccinated so that you can have a happy immune system and a happy Winter Break.