Influenza Vaccination 2011-2012

Though it's still 90 degrees outside, flu season is actually not to far off.  In fact, Flu shots are coming, if not already here.  Many local pharmacies have already started receiving the flu shot supplies and beginning administration.

I agree with CDC recommendations that everyone 6 months and older receive a yearly flu shot.   It is especially important for those at high risk of influenza complications to receive vaccination.  Such high risk features are below.   Even for those at low risk of influenza and its complications, being vaccinated can reduce the overall burden of the flu in the community and in important for public health.

High Priority Patients for Flu Vaccination

• Pregnant women
• Children younger than 5, but especially children younger than 2 years old
• Health care workers
• Household contacts of persons at high risk for complications from the flu
• Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)
• People 50 years of age and older
• People of any age with certain chronic medical conditions such as cancer, HIV, diabetes, auto-immune disease, heart and lung disease or any reason for immune supression
• People who live in nursing homes and other long-term care facilities
• People who live with or care for those at high risk for complications from flu, including:
  • Health care workers
  • Household contacts of persons at high risk for complications from the flu
  • Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)

The flu season can start as early as October and the vaccine takes 2 weeks to become effective.   The CDC states vaccination in late Summer will be protective for the entire season, which can often last until May.  I do not carry vaccines at the office though it is readily available at essentially all pharmacies as well as multiple other locations throughout the city.   Currently there are no expectations of vaccine shortage and availability should be widespread within the next month.

Most people do not have side effects from flu vaccines; when they do occur, common reactions include pain and redness at the injection site and 2-3 days of flu like symptoms (aches, low-grade fever, and malaise).  Some patients do report more pronounced side effects though overall this is very rare.

For this season, there are multiple options for flu shots: the regular shot into muscle, a newer shot just under the skin, a high dose version for those over 65, and a nasal spray version.  The CDC does not recommend one version over another.

• The shot under the skin (intradermal) uses a smaller needle and requires less material for injection.  This is the first year it is available. Studies show equal antibody response to the regular shot.
• As people age, their response to vaccination can be diminished.  The high dose vaccine is approved for patients 65 and over, uses more material for injection, and causes a higher antibody response.  Studies are ongoing whether this truly results in greater protection but results will not be available for 2-3 more years.   Side effects are slightly more common with the high-dose version but overall remain low in studies.   I think the high-dose shot is reasonable for those over 65 at high risk of flu complications, who have had the flu in prior seasons, and who have tolerated regular shots without problems and want the potential of greater protection.  I do not recommend the high-dose version for any that has had significant side effects to prior flu shots.
• The nasal version is only approved for patients 2-49.  It should only be used for healthy patients without any of the high-risk conditions listed above.

Remember, flu vaccination only protects against the most common strains of influenza, a very specific viral illness.   It does offer protection against the common cold, bacterial infections, or other common winter illnesses.

I will put updates on my blog during the season should unique situations regarding influenza and flu vaccination arise.

I also recommend the CDC Website for more information: www.cdc.gov/flu