What if there was a major scientific breakthrough that could dramatically decrease an individual’s chances for severe and even life-threatening respiratory illness complicated by stomach cramps, diarrhea, nausea, vomiting, body aches and fatigue? Furthermore, by taking advantage of this breakthrough one would be protecting loved ones with weaker immunity from lethal infection — young children, the elderly and immunocompromised patients? What is more, the scientists that developed the technology make it available at low cost or even no cost for people who cannot afford it on their own. Such a boon to society would be difficult to differentiate from magic.
Even more impressive is that this is not some far-fetched imaginary technology on Star Trek, or fairy dust from an alternate universe. It is the annual flu vaccine, available now at pharmacies and clinics everywhere. What is the catch? No catch. In fact, that may be the problem. The flu shot works so well most years that people think, “Why get the flu shot, it was no big deal last season.” Or alternatively, a patient gets sick with an unrelated virus and thinks, “Why get the flu shot if I get sick anyway?” Or, even more commonly, erroneously supposes the flu shot caused an illness and thinks, “I always get sick when I get the flu shot.” Anyone can have an opinion regardless of medical training, and with the proliferation of social media and the internet, those opinions can be shared and published without regard for factual basis, or peer reviewed impartial research and development. The impact of these statements can be even more profound when the person offering the opinion is a celebrity or otherwise well-respected community or society figure.
Vaccines rely in part on what is called “herd immunity,” which means that the more people in a population are vaccinated, the better it works. When people electively decide not to vaccinate it places not just those individuals, but the whole population at increased risk. There is a resurgence in the Pacific Northwest in viruses largely extinct in recent memory such as measles and whooping cough: viral diseases that can be prevented with routine vaccination. For most people these viruses result in a self-limiting infection, but for patients with existing respiratory dysfunction or underlying lung disease they can prove life-threatening.
Another wrinkle in the story is that viruses sometimes undergo something called “drift” or “shift.” This can be a small change in their genetics, resulting in a less effective vaccine (drift), or a large rapid change in genetic structure, resulting in a strikingly more virulent disease (shift). Those who remember the Swine Flu (also known as H1N1) in 2009 may recall how much more severe the symptoms could be than a traditional influenza infection. In this case, the vaccine may be even less effective, but may serve to decrease the scope or severity of disease.
So, who should get their flu shot? According to the Centers for Disease Control, Adult Immunization Schedule for 2018, “Adults with egg allergy other than hives (e.g., angioedema or respiratory distress): Administer IIV or RIV (influenza vaccine) in a medical setting under supervision of a health care provider who can recognize and manage severe allergic conditions.” It is also recommended for everyone else, including expecting mothers.
Damon Armitage, MD
Medical Director, Camas Swale Medical Clinic