A case for the flu shot, even with the flu

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Elizabeth Newman
Elizabeth Newman

The time has come, dear readers, to confess a secret.

I caught the flu after Christmas. And I had received the flu shot in September.

I tell you this knowing how many of our dedicated readers feel incredibly strongly about not receiving flu shots. Feel free to leave your comments about how I've been brainwashed by Big Pharma. But for the rest of you, I wanted to share why I don't regret having the shot and, secondly, why we should pay attention to the FDA's statement this week on the current flu season

It's not a secret the flu shot this year wasn't very effective. Yet I'm still baffled how I caught it, given no one else in my family was sick, I didn't travel around the holidays and I am fairly religious about washing my hands. But one night there was no denying the fever, chills and congestion that meant, for the first time in my life, I had caught the big F.

While my doctor put me straight onto Tamiflu without testing, statistically I (along with, inevitably, my husband a few days later) had H3N2, as the vaccine is generally less effective against that strain. To put the strains into context, one researcher has found that combined vaccine effectiveness during H3N2 seasons is about 33%, compared to 54% during influenza type B seasons and 67% during H1N1 seasons.

The flu shot was about 36% effective this year, meaning it reduced the risk of getting sick with the flu by more than a third. But its effectiveness against H3N2 was around 25%, according to the Centers for Disease Control and Prevention.

It certainly sounds unimpressive. Certainly having the flu was miserable, and I was not really healthy again for about a month. But I'm still alive. And lest you think that's being melodramatic, that's not true for roughly 56,000 people in the United States.

That number includes almost 100 children, pregnant women and healthy adults, including a woman who didn't buy Tamiflu due to the cost. (I have a new appreciation for the out-of-pocket costs related to medication with insurance, a topic for another time). There's conflicting evidence around whether repeated flu vaccinations may help or hurt effectiveness, but in this particular year, there's reason to believe my September shot created a less aggressive flu, allowing me to stay out of the hospital, especially given I have an immunocompromised system.

In the case of children, one study found that 4 out of 5 children who died of the flu hadn't received the vaccine, leading researchers to believe that the shot may allow less severe symptoms.  

But as much as we might fight over these studies, we can all agree clearly there's room to do better. That's why I cheer the lengthy memo from FDA Commissioner Scott Gottlieb, M.D. to the public on the seasonal vaccine.

“We would particularly like to understand why vaccine effectiveness against H3N2 influenza year-to-year tends to be lower than effectiveness against other influenza viruses,” he wrote.

Well, you and me both. But I was pleased to see that the FDA is working with Centers for Medicare & Medicaid Services to study the flu vaccines given to four million people, to see whether they were treated at a hospital or with antivirals. Importantly for long-term care providers, these researchers are looking at the difference in effectiveness in people 65 years and older who were vaccinated with high-dose influenza vaccine and adjuvanted influenza vaccine.

That will allow them to compare effectiveness to those vaccinated with standard dose vaccines. The adjuvanted influenza vaccine contains an ingredient meant to boost the immune system's response to the vaccine, while high-dose vaccines contain four times as much of the influenza material or antigen as standard vaccines.

What they are trying to discover is whether people need a higher amount of H3N2 antigen.

Ultimately, there's no way to convince hardcore anti-vaxxers about receiving a flu shot. For the rest of us, I'm sympathetic to those who feel like, “What's the point?” But I also know how many of us are around children, the elderly and the immunocompromised. There's lots of room for improvement with the flu shot, but I'll still stand by getting it each year.

Follow Senior Editor Elizabeth Newman @TigerELN.


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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.