This Year’s Flu Vaccines: What To Know, And Why Not To Punt

An ad for vaccines outside a Brookline, Mass., pharmacy on Sept. 20, 2013. (Carey Goldberg/WBUR)

An ad for flu vaccines outside a Brookline, Mass., pharmacy on Sept. 20, 2013. (Carey Goldberg/WBUR)

It feels premature, off-seasonally odd, a bit like all the Halloween candy already on store shelves in August.

Flu is a cold-weather plague, yet the pharmacy signs advertising flu vaccines are already out on the sidewalks now, beneath the benevolent sun of perfect 70-degree days and leaves just beginning to tinge their edges with red and yellow.

But flu vaccine experts say that it’s really not too early to get vaccinated, and there’s a bit more to know this year as you roll up your sleeve. There are new and myriad options in flu vaccines, including:

• A “quadrivalent” vaccine that protects against four strains of flu virus rather than the usual three.

• New egg-free flu vaccines for people with egg allergies.

• High-dose “super” vaccines for older people.

• Short-needle vaccines (I’m not sure if I got one of these last year, but I was pleasantly shocked at how tiny the needle was and how little it hurt.) For shot-haters, nasal vaccines remain available for many as well.

Health authorities emphasize that flu vaccine “shopping” shouldn’t get in the way of just getting it done. Flu is no joke, killing an average of 24,000 Americans a year, including dozens of children.  USA Today offers a nice rundown of the options here, and the CDC’s flu vaccine page is here. I also spoke with Dr. Michael Jhung, a flu vaccine expert at the CDC’s National Center for Immunizations and Respiratory Diseases. Our conversation, edited, is below, but first, my own personal favorite flu-vaccine tip: A 90-minute bout of exercise soon after a flu shot could help jump-start your antibody production, according to a recent study that suggests it might even double your antibodies

CG:  First of all, I’m seeing these ads for flu vaccines in pharmacies already now in September, and it seems ridiculously early; flu season doesn’t even peak until January, and also, doesn’t the vaccine wear off after a while? So I’m thinking, maybe I’ll get it, but not now . . . How would you respond to that?

MJ: That’s a great question. I think a lot of people entertain the idea of getting an influenza vaccine, but then they put it off and they say, ‘Well, the season hasn’t started, I have plenty of time.’ But the fact of the matter is, the best time to get an influenza vaccine is before the season starts, not during the season.

And influenza seasons are very unpredictable from year to year. Typically, they do peak in January or February, and they start a few months prior to peaking, but last year, we saw a season that started a month earlier than it typically starts. So we don’t know when the season’s going to start, that’s why we’re encouraging folks to go out and get vaccinated as soon as they can.

And what about the wearing-off thing?

The influenza vaccine does provide excellent protection against influenza. That protection does wane over the course of a year, and that’s one of the reasons why we recommend folks get vaccinated every year. But the protection that it offers should last throughout one entire influenza season, even if someone gets vaccinated in early October.

Or even September?

Or even September.

What if I were to say ‘Well, I already got one last year, and I know that the vaccines come out every year because they change the strains of the virus that are in them, but there has to be a big overlap in viruses from year to year. So do I really need to get another one?’

That’s a very interesting question. There is some overlap from year-to-year in the virus strains that are in the vaccine, but it’s really important to recognize that the vaccine will only protect you against the influenza viruses that it contains. So, if you got influenza last year, and you think that protects you against influenza this year, that may not be true. You could very well be exposed to a different influenza this year, and be protected by this year’s vaccine if the vaccine contains that virus in it to provide that protection.

Even during the flu season, if you’re one of those people who puts off vaccination and you happen to get the flu early in the season, you can still get the flu, just a different virus later in the season. So we’d still recommend folks get vaccinated, even if they think they’ve had the flu this year.

So how about this? This year is just too confusing! There’s that nasal vaccine, there’s this new quadrivalent vaccine, there’s some kind of super-vaccine for old people, so there are too many choices, and what if my clinic doesn’t have the exact vaccine that I should get?

There are a lot of choices out there, as far as the influenza vaccine goes. Let me just make it very simple: get vaccinated, and get vaccinated early.

Okay….

We don’t have a recommendation as far as what vaccine you should get. As long as you get vaccinated, you’re going to be protected. And I’d say that the number of options out there really is a nice opportunity for folks to get vaccinated if they otherwise might not get vaccinated.

There’s an option for folks who don’t like needles, they can get a nasal spray. There’s now an option for folks who really have had bad allergic reactions to egg proteins and egg-containing items in the past. There’s a completely egg-free option that those folks could elect. And as you said, there’s an option for older people, the high-dose option, that may be a great fit for them, because they need a little bit more protection due to their natural protective immunity waning a little bit as they age

But as a good comparison shopper, doesn’t it make sense for me to try to get a quadrivalent vaccine, with four strains in it, instead of just three? Shouldn’t I look around for that?

You know, we really want you to get vaccinated as soon as possible. So, the recommendation we have is: go to your healthcare provider. If they have quadrivalent, and you’re interested in that, go ahead and get it. If they don’t, if they just have a trivalent shot, that’s good protection too, and we’d recommend that you’d get the vaccine on that first visit. The quadrivalent, four-strain vaccine is intended to provide a broader protection; it protects against an additional influenza B. But the trivalent offers great protection as well. It includes protection against one influenza B and two influenza As. And if that’s all that your provider has when you’re going in to get vaccinated, we would recommend that you take that vaccine when you’re there.

There have been studies that came out recently that seem to imply that the effectiveness of the flu vaccine can be somewhat underwhelming. In fact, the CDC’s own weekly Morbidity and Mortality report seemed to say that last year’s vaccine was only 56% effective against the virus for people who were over 6 months old, and virtually ineffective for people over 65. So, that sounds kind of ‘eh.’ Should I really go ahead and get it anyway?

First of all, I need to say that regardless of the vaccine effectiveness numbers, the vaccine is still the best way to prevent you from getting the, getting influenza.

Better than hand-washing, better than being careful about contact — it’s the best?

Absolutely. So even though the numbers aren’t as high as we’d like them, it’s still the best way to protect yourself from influenza. And I think we need to take a close look at the vaccine effectiveness numbers to make sure that folks understand what they mean. If the effectiveness number is, let’s just say, 50% for example, it doesn’t mean that if you take the vaccine, you have a 50/50 chance of getting the flu that year, because then the argument wouldn’t really hold any water. If you have an equal chance of getting the flu whether or not you get the vaccine, it doesn’t make a whole lot of sense.

What it does mean, though, is, if you take two people, and you give one person the vaccine and the other person says ‘I don’t need the vaccine, I don’t want to get it,’ the person who’s vaccinated has a 50% less chance of getting the flu and having to go to the doctor for their influenza, and that’s a pretty big reduction in risk.

What if I say, ‘Oh, I don’t need the vaccine, I never get the flu”?

Well, we hear a lot of people say that they never get the flu, so they don’t need the vaccine. And I don’t want to force anybody to get a vaccine if they don’t elect that. But we also need to recognize the protection that getting a vaccine will provide others. Particularly those who are at high risk of bad outcomes from flu: this group includes folks with underlying medical conditions like asthma, or heart disease, people over 65, and people under 5 years of age.

If you think you’re not going to get the flu or you’re okay getting the flu because you’re a young, healthy person, but you live with somebody who’s a young child, or maybe has an underlying medical condition, you can help protect them from influenza by getting vaccinated so you can’t pass it on to people who are at increased risk of being hospitalized or dying from flu. So that’s one very good reason to get vaccinated, even if you don’t think that flu will harm you too much.

Is it possible to transmit flu without having symptoms yourself?

It’s very unlikely. We know that you can transmit influenza before you start to show symptoms, though, so on the first day or so of being infected, you may not have a fever or cough or sore throat, but you’re still infectious, and you can still pass it on to someone else before you know you have the flu.

Last one: I hear people say, ‘Oh, I’m not getting the flu vaccine. I got it one time and then I got the flu, and I think the vaccine gave it to me.’

That’s a great question, and it’s one we hear every year. And I think there’s a couple ways to answer that question. I’ll start by saying, the flu vaccine cannot give you the flu. The vaccine includes either a killed version of the virus, or a component that’s been altered in a way such that it’s not infectious. Some of the new vaccines have just a small component of the virus, one single protein, and not the virus at all, so they cannot be infectious. There’s one vaccine formulation that’s brand new this year, that’s a purified protein vaccine, and it contains a small part of the influenza virus, just a protein essentially, and that helps provide immunity from influenza. So, it’s non-infectious. It cannot give you influenza, and in fact, none of the vaccines can give you influenza.

But I believe I’ve seen on the nasal vaccine, it does say that it has ‘live vaccine,” doesn’t it?

Yes, and the acronym is L.A.I.V. for “live attenuated influenza vaccine,” and the “attenuated” means it’s been changed in a way so it’s not infectious. However, we recommend that folks who have poor immune systems, folks who are maybe immuno-compromised, we recommend that they still get vaccinated, but not take any chances at all, and get a different formulation of the vaccine, one that’s killed instead of attenuated.

It is still possible to get influenza after you’ve been vaccinated. And there are several reasons for that. It’s also very possible to think that you have influenza after you’ve received the vaccine. So, what happens is, we know that it takes about two weeks after the vaccine to become fully protected. And if somebody waits a little bit, until the season has started, gets their vaccine, but then gets exposed to somebody who has the flu before two weeks passes, they could get infected because they didn’t give themselves enough time.

We also know there are lots of respiratory viruses that circulate in the fall and winter, and folks who get the vaccine and come down with a fever and cough may think that they have the flu when they really just have a cold.

And remember, whatever vaccine you get, we know it’s not 100% effective, and we know that it provides protection only against three or four viruses.

Out of how many?

Out of many that are circulating. And you could be exposed to a slightly different form, a different virus, than what’s in the vaccine. Or, you may be in a group of people who doesn’t respond as well to the vaccine, and you still may get influenza after you’ve been vaccinated. Even though that vaccine’s given you the best protection we can give at this point, you can still get the flu, even if you’ve been vaccinated. But you can’t get the flu from the vaccine.

Readers, any lingering questions? Would you like to share your own reasons for skipping the flu vaccine in the comments below? We’ll ask health authorities and vaccine experts for their responses.

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