Frank Bures: What to do about the flu? Get your shot, ASAP

September 16, 2018

Dr. Frank Bures

Summer is over, fall is in the air, and signs are popping up in front of big box drug stores for flu vaccinations, like campaign signs, which this year are populating many yards. The main questions now are what influenza vaccine is recommended, what is available, and how effective is it? The variations of 2018 vaccines are like a smorgasbord of viruses and preparations.

The time for influenza to strike is quite variable from community to community. Usually fall is typical, say by the end of October or November. Think Halloween to make it spooky. It takes about 2 weeks for the vaccine to produce a full response. Getting vaccinated later is still better than not at all.

Who should get vaccinated? Simply put, everyone. This tends to produce what is called herd immunity, which means the more people in a group that have some immunity to a contagious organism, the less it gets passed around. This year most recommendations are for all folks older than 6 months (age-wise, not mentally) to be vaccinated. Vaccines are supposed to be safe for pregnant people, women, that is. (Not sure about pregnant guys.) Some protection from mom’s shot is passed on to her newborn for about 6 months.

Many of the versions are cultivated in eggs. People with egg allergies which only create hives are supposed to be able to get any vaccine. People with more complicated prior reactions should have the vaccination given under medical supervision.

Flu viruses come in two categories for humans, A and B. The viral strains used this year include two A types, an H1N1/Michigan, a H3N2/Singapore, which is supposed to be more effective than last year’s model, and a B/Colorado. These are in the trivalent (three strain) shots. Another B strain/Phuket is added to some to make a quadrivalent recipe.

The menu of formulations is remarkably diverse. Most contain the inactivated (killed) virus or a portion reproduced without whole microbe. One type is live and weakened or attenuated, which is only available in the nasal spray mist. There are the standard shots, either tri- or quadrivalent; high dose for older citizens, because it takes more to prod their immune systems to kick in (like so many other things); shots called adjuvant, made with a substance called squalene oil, again with the goal of cranking up the responses of fogies; the partial virus recombinant version; a kind with viruses grown in mammalian cells instead of eggs; and the live attenuated nasal squirt spray.

The nasal formulation was not thought to be effective the last couple seasons. Some new data indicate the new virus in the mix will enhance immunity, although there is no real world experience yet to test it.

The American Academy of Pediatrics, however, is not yet recommending it unless it is a last resort.

So, which one should you get out of this potpourri of possibilities? The CDC’s Advisory Council on Immunization Practices (ACIP) has no specific recommendations. Checking with your doctor is likely the best idea. How protective any formulation will be is to be seen and tested by this season’s actual wild viruses (viruses in the wild?) and our reaction to them. Last year the H3N2 strain that dominated infections in many areas had become different enough from the one in vaccines by what is called antigenic drift, that the human immune response was not adequate (or didn’t get the drift?).

Prevention advice is the same old common sense, hand washing, avoiding people coughing or sneezing on you, etc. The latter is kind of hard if you’re cuddling a sick grandkid. But it is worth it to take a shot at the vaccine because it may at least lessen how sick you become, even if it doesn’t completely prevent it. And you can’t say hand washing enough. But I think I’m going to wash my hands of the topic for now.

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