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You and the flu
Last year’s flu vaccine proved disappointing in its overall effectiveness because of a last-minute mutation in the virus that circulated. For the new 2015-16 flu vaccine, scientists have chosen two new strains to update coverage, according to Cornelia L. Dekker, MD, professor (research) of pediatrics (infectious diseases) at Stanford School of Medicine. BeWell spoke with Dr. Dekker to learn more about why, once again, getting vaccinated against the flu this fall is so highly encouraged.
Why is the flu of such concern to me as an individual and to the nation as a whole?
Influenza is one of the most important respiratory pathogens, causing from 55,000 to 431,000 hospitalizations yearly in the U.S., and between 17,000 and 51,000 excess deaths with each epidemic. Influenza can affect all age groups, but causes most severe disease in the elderly, young children, pregnant women and adults with predisposing conditions. This RNA virus is prone to high rates of mutation as it circulates; a significant mutation can mean that no one has immunity to that strain — which is when we see pandemics occur, such as the one in 2009 that infected 20-40% of the world’s population.
What should I do to protect myself from the flu?
The best protection against the flu is getting an annual flu vaccination.
The media ripped on the flu vaccine last year for failing to cover several strains of virulent flu. Was this truly the case, and if so, will there be improvements this year?
Last year, the circulating virus mutated just around the time that the new vaccine strains for that year were being chosen by WHO and FDA for manufacture. This meant that there was a mismatch between the circulating A/H3N2 virus and the one that had been chosen for the vaccine. Unfortunately, the result was that the effectiveness of the vaccine in preventing influenza was disappointingly low, at 23% overall. The other viruses in the vaccine were a good match, but they were responsible for very little disease last year. In this year’s vaccine, the mutated version of that A/H3N2 virus has been substituted, as well as a new B strain; we hope this will provide better protection in the coming flu season.
If you had to identify one sub-group of people who may not know they should seriously consider getting a flu shot, what group would that be?
Pregnant women need protection, too, because flu is 5 times more likely to cause severe illness (including premature labor and delivery) in pregnant than in non-pregnant women. If women are or will be pregnant during influenza season, they should receive inactivated influenza vaccine (IIV). Live attenuated influenza vaccine (LAIV) is not recommended during pregnancy. Postpartum women can receive either LAIV or IIV; pregnant and postpartum women do not need to avoid contact with persons recently vaccinated with LAIV. Immunization helps not only the pregnant woman, but also benefits the unborn baby, who can’t otherwise be immunized until 6 months of age.
Who is eligible for free seasonal flu vaccination at Stanford?
Flu vaccination is free to all students, active university faculty and staff, retirees and post-doctoral scholars/fellows. Spouses/domestic partners of graduate or undergraduate students are eligible to receive the vaccine for a fee. (Children will need to obtain the vaccination from an outside care provider.) Last year, Vaden and SUOHC, in combination with the Flu Crew, vaccinated over 8,000 Stanford personnel.
Is it the same vaccination I would get at my doctor’s office, local clinic or pharmacy?
There are many versions of the trivalent and quadrivalent flu vaccines available, including live-virus nasal spray quadrivalent vaccine that is licensed for use in healthy children and adults 2-49 years of age, high-dose trivalent vaccine as an option for those over 65 years of age, and trivalent egg-free vaccines for those with egg sensitivity or allergy. Both the Occupational Health Center and Vaden Health Center are providing the inactivated (not live) quadrivalent flu vaccine that is given as an injection into the upper arm muscle.
When and where will they be available?
The annual influenza vaccination clinics begin on campus in October and continue through January. Please see flu.stanford.edu for additional details, including this campus calendar of vaccination times and locations.
If I get vaccinated, can I still get the flu?
Yes, that is possible. The flu vaccine usually provides 50-60% protection, but there’s room for improvement. We already mentioned last year’s mismatch, as an example; and it’s also possible that if you get the vaccine during the time when influenza is circulating in the community, you may get infected during the two-week period that it takes to respond with an effective immune response to the vaccine. All that said, there is no better way to protect against influenza disease than by getting an annual flu vaccination.
Is there treatment for the flu?
There are antiviral drugs that work against influenza A and B: oral oseltamivir (Tamiflu®), inhaled zanamivir (Relenza®), and intravenous peramivir (Rapivab®). These drugs have been shown to shorten duration of fever and illness if given early after symptoms begin, ideally within 48 hours. They also reduce death and duration of hospitalization in patients. Two older drugs are no longer recommended because circulating viruses have developed resistance to them.