Mrs. O. brought her 17-month-old son to the office for a sick call because he had a runny nose, cough and congestion for about a week. The day before he developed a fever, was fussy and was pulling at his ear. My exam confirmed that he had an ear infection. I told her I was going to prescribe an antibiotic.
She was very frustrated. This was his second ear infection in the past several months. Folding her arms and shaking her head she said, “You know, we all got the flu shot in October to prevent this kind of thing. My husband and I are both schoolteachers. We were both terribly sick at Thanksgiving with a stomach flu. We had to cancel Thanksgiving dinner at our house because we were both vomiting and had diarrhea, fevers, aches and chills. It was awful. Thank God the kids didn’t get it, but now Alex has another ear infection. I think the flu shot is bogus!”
Mrs. O’s depiction illustrates a common misperception about “the flu” and the flu shot that is understood by many. First of all, “the flu”, or more accurately influenza, is a specific viral infection that is prevalent during the winter months. There are three main types of influenza; A.B and C. The flu that brings about seasonal outbreaks is usually caused by types A and B. Each type has many different strains, and the strains that circulate the globe change from year to year. While influenza is always present, some years the flu-season is mild, and other years it can reach pandemic proportions. It tends to cycle.
Generally influenza A is a respiratory virus that causes fever, chills, body aches, fatigues, sinus and nasal congestion, and a bad cough or a bronchitis. Influenza B causes similar symptoms but may also be the result of a localized myositis, or inflammation of a specific muscle group such as the calf, making it painful to walk. The flu typically lasts at least a week, and it can be most debilitating.
The flu shot is prepared each year after scientists look at data from around the world. They then determine which strains are circulating the globe and are most likely to be the key players that season. While there is some guess work involved, after studying surveillance cultures and following certain patterns, they are quite good at predicting which strains are needed to contend with that given winter. With this information, they then make the vaccine for that winter. The vaccine contains the three different strains that are likely to be present. The vaccine usually has two influenza A strains and one influenza B. Each year the vaccine is different.
The vaccine contains an inactivated form of the virus (killed). As a result, contrary to popular belief, one does NOT get the flu from the shot. It is essentially impossible. The major side effect from the vaccine is a sore arm for a day or two, or less likely a low-grade fever. It is felt that the soreness is either from the needle puncture or possibly from the antibodies that are being formed in response to the vaccine. It takes about a week or two for the antibodies to reach a protective level.
The seasonal flu vaccine should protect one from that specific type of influenza and ONLY that type of flu. It offers no protection against the myriad of other viruses that are so common during the winter months.
I would also like to comment on Mrs. O’s illness during Thanksgiving; her “stomach flu”. This term has worked its way into our common vernacular and is understood by everyone as vomiting, diarrhea and fever. If one wants to be accurate, there is no such thing as a “stomach flu”--not as it relates to actual influenza. What she is referring to is a viral gastro-enteritis which is common and is caused by other viruses or bacteria. Influenza is primarily a respiratory infection. Her son Alex had a virus that he most likely picked up at day care and, unfortunately, it caused another ear infection. This is not uncommon for a toddler during the fall/winter months but it had nothing to do with influenza. The seasonal flu vaccine could in no way have prevented any of these illnesses.
The seasonal flu vaccine is very effective and very safe. It is a good idea for anyone over the age of six months to get it unless they are egg allergic, (the virus is harvested in egg embryos) or have had Guillain-Barre Syndrome in the past. The flu vaccine can be given as an injection or as a nasal spray. There is no predicting which winter will be a bad flu season. We are long overdue for a pandemic, as history has shown that global pandemics do cycle. We do know that the extremes of life, the very young and the elderly, are more seriously affected by the flu and get much sicker. They definitely are at risk and SHOULD get the vaccine.
Mrs. O. seemed pleased with my discussion about flu and the flu vaccine but was frustrated with the fact that Alex had another ear infection. “I guess I’m glad that we did get the flu shot, but I wish they had a vaccine for ear infections,” she said with resignation. I shared with her frustration and told her that that was a whole different discussion!