Flu Shots

Ask the DOC

2018 was the 100th anniversary of the 1918 influenza pandemic, (when an epidemic is worldwide, it is called a pandemic). That pandemic is estimated to have killed 50 million people. There were other flu pandemics in 1957, 1968, and 2009, but thankfully they were not as deadly as 1918. The influenza epidemic of 2017-2018 was a bad one with illness and mortality rates approaching that of a pandemic. It lasted 19 weeks, and killed more people than any other epidemic since 2010, particularly children, and was associated with 30,453 hospitalizations – almost double the previous season, high in some areas of the U.S. Regrettably, 171 unvaccinated children died during 2017-2018, accounting for almost 80 percent of deaths. The mean age of the children who died was 7.1 years, and half of them had underlying medical conditions which placed them at risk for influenza-related complications. Fifty-seven percent of them died despite being hospitalized.

The influenza virus was first isolated in 1933 and a vaccine was developed shortly thereafter. There are three strains of the virus, namely A, B, and the very rare C. The first non-egg vaccine was introduced in 2013. Currently, research is ongoing to develop a universal vaccine that would cover all strains and last for multiple seasons. At present, the vaccine for each season is formulated on a best-guess scenario based on what strains were prevalent the prior year and what strains are expected the next year. This usually results in an effective vaccine rate of 60 to 65 percent, however, for the 2017-2018 season, the guess was wrong and resulted in an effectivity rate of only 30 to 35 percent. It takes about three weeks for an immunity to develop post-vaccination and, for the flu, the immunity lasts about six months.

As flu season peaks during cold weather, when people congregate in indoor areas, in this part of the country that means flu season is usually from about November 1 to April 1. If you get the vaccine in August, you may not be covered by February or so and a second dose may be required. Some experts already recommend two doses per season. There is a stronger vaccine for seniors, but a second dose would work just as well. This year’s vaccine is quadrivalent, meaning it covers four strains of the flu – two A type and two B type.

Despite public educational efforts, vaccination rates remain low. The national goal is to immunize 80 percent of the population and 90 percent of those at-risk populations (those with diseases that effect the immune system like diabetes and cancers). Unfortunately, actual vaccination rates are far lower (37 percent in 2016). This is partly due to “antivaxxers,” those who wrongly believe, despite hundreds of studies to the contrary, that vaccines are harmful, and those with religious objections. All states except California, Mississippi, and West Virginia allow non-medical vaccine exemptions based on personal or religious beliefs. Despite the best efforts of the medical community and public health services, the numbers of those refusing to be vaccinated are rising. If only they realized the danger they are putting themselves and their children in. Convincing them that they are wrong might be harder than getting Republicans and Democrats to work together constructively.

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