Flu Shots – Influenza 2018

As a general pediatrician practicing in the suburbs of Sacramento I diagnose a lot of cases of influenza or flu.  I treat these patients with antiviral medication to help decrease the severity and the length of time of their illnesses.

Unfortunately, the medication, Tamiflu, is only really effective in the first 48 hours of illness, so in many cases all I have to offer these patients is sympathy and education about the signs and symptoms which suggest more severe illness or complications that warrant a return visit or a trip to the hospital. 

Of course, I would rather prevent disease than treat it.  In fact, that is at the heart of pediatric practice.  I see my patients for their routine well checks trying to catch problems early enough to intervene and prevent little problems from becoming big ones.

One of the most important things that I do at well child visits is vaccinating my patients.  Vaccines are probably the single greatest accomplishment of medical science. Because of vaccines, I have never seen a case of smallpox, measles, or polio in my career.  I have not seen a case of chicken pox in the last 4 years.  I have not seen a case of meningitis in the last 9 years.

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I do have parents who choose not to vaccinate their children.  I could probably spend hours writing on this subject, but this article is about flu so I will leave that for another day.  I am writing this article more for the parents who vaccinate their child with all the routine vaccinations of childhood, but for whatever reason they choose not to vaccinate for influenza.

I get behind during my day at work a lot during flu season.  Sometimes it is because I have a challenging patient problem to work through like a depressed or anxious teenager, but more often than not it is because I am doing my best to convince a parent to vaccinate for influenza.

The reason I am so passionate about vaccinating my patients from influenza is that influenza is the most deadly infection in the United States.  We are all terrified of flesh-eating bacteria and meningitis and staph infections and scarlet fever, but influenza kills way more people than all of these infections combined.

We humans are just terrible at risk assessment.  We are more scared of getting killed by terrorists than we are of getting killed by influenza, but more than 30,000 of us die from influenza every year.  Even accounting for 9/11 about 74 Americans on average die from terrorism yearly.  On average 100-200 children die yearly from influenza.  At the time I am writing this article, so far 63 children have died from influenza this flu season.

This may not seem like a lot to some folks, but to those parents it is a devastating number.   I am not saying that all of these deaths are preventable.  They are not.  However, probably at least half of them were preventable.

Parents come up with lots of reasons to not vaccinate against influenza.  Probably the three most common reasons I hear are “I just have never done it and I have been fine”, “Whenever I get the flu vaccine, I get very sick” and “The vaccine is not very effective.”

I would like to address these reasons briefly.

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“I have never done it…”

The first one, “I have never done it…” uses inductive reasoning which is inherently flawed.  Just because something worked in the past does not necessarily mean it will continue to work in the future.

This is why people lose their shirt betting on red when there were 10 blacks in a row on the roulette table. An analogy I like to use is about seatbelts and car seats.  Most of us use car seats and seatbelts every time we ride in a car.

This is a good idea because we never know when another car will hit us.  However, if we employed the same reasoning we do with flu shots, we wouldn’t bother with seat belts or car seats if we have never previously had a car accident.

“Whenever I get the flu vaccine, I get sick”

The next one, “Whenever I get the flu vaccine, I get sick” is another example of flawed reasoning because we are mistaking correlation and causality.  In other words, if two things happen close together in time, then we reason that one thing caused the other.  This is not a bad thing to do sometimes, because some things do cause other things.  But sometimes, it causes us to make serious mistakes.

However, the fact is that people get sick a lot all year long and even more so during “cold and flu” season.  Rhinovirus, Coronavirus, Picornavirus, and Enteroviruses, Adenovirus, and Human Metapneumovirus are just a few examples of other viruses that make us sick during this time of year for which we have no vaccine.

So when people get a flu shot and they happen to catch one of these viruses, they wrongly assume that the flu vaccine made them sick.

Also, it should be noted that flu vaccine does not work instantaneously.  It actually takes 2 weeks to protect people from influenza.  So it is possible to catch a vaccine preventable case of the flu within that time period.  Flu vaccine is not a live virus, at least not the injectable version.  So all the flu vaccine usually does is give you a fever or make you feel a little crummy for a day or two.

Anything else is likely due to another virus.  Now that is not to say that there are no risks with getting a flu vaccine.  Of course, anything we do poses a risk to us.  Rare side effects are possible from anything we do.  But the risk of getting a flu vaccine is dwarfed by the risks of not getting a flu vaccine.

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“The flu vaccine is not very effective”

The third reason I hear is “the flu vaccine is not very effective.”  The truth is that the flu vaccine has never been as good as we all wish it was.  I wish that I could prevent every case of flu with it, but the reality is that medical science has not come quite far enough to do so.

The flu virus is an RNA virus so it is very sloppy when it copies itself and that makes our immune system and our vaccines often a step behind in killing it.  Generally speaking flu vaccine efficacy varies from year to year based on how lucky we are at guessing the predominant strains that will attack us in the year to come.  Efficacy ranges from 40-80%.  Last year it was about 50% effective.

This year it is too early to say how effective it is because we can only make that assessment accurately in hindsight.  But, if I were a parent of a child who had died unvaccinated from influenza, I think a 50% chance of still having my child would be way better than nothing.

We cannot change the past and I have nothing but sympathy for parents of children who have died from influenza.  But I urge all you parents out there to maximize your living children’s chance at living a full life by protecting them as much as you can.

We all feel the burden of responsibility of keeping our children safe.  I wish I could protect my daughter from all the hurts she is bound to have as she goes through life.  But I know that is not possible.  So all I can do is my best and that includes giving her all the vaccines I can, especially the flu vaccine. Even though she hates shots and I hate to see her upset, my daughter gets her flu vaccine every year as do I.

Andy Katz, M.D.
Pediatrician
Dignity Health
Mercy Medical Group

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