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The Real Poop on the Flu Shot
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The Real Poop on the Flu Shot

As many of you know I feel strongly about this, especially in light of the huge amount of ignorant or malicious misinformation out the on the net about it.  My background is pediatrics with post-doc fellowship in Immunology.  I speak from a standpoint of real knowledge and having made the choice to dedicate my career to improving the lives of children.

I am going to formulate this sort of like an FAQ.

1)  SHOULD A PERSON WITH MS GET THE FLU SHOT CONTAINING INACTIVATED VIRUS?

With very few exceptions, YES, YES, AND YES.  As most of you know, one of the greatest threats to us are infections.  Infections cause a stimulation of the immune system and, thus, can cause relapses of our disease.  Not all infections are equal in their tendency to stimulate the immune system.  Simple colds, mild skin infections, mild UTIs may or may not result in a relapse for us.  However, there are some infections that can lay us low, cause the Mother of all relapses and result in suddenly and permanently worsened disability.  A few examples of these more severe infections are Influenza, deep tissue bacterial infections like pneumonia, Hepatitis B, and Epstein Barr virus.

The real influenza is a massive overrun of the body with billions of copies of a potent virus.  It is spread through the respiratory system and is incredibly contagious.  A lot of people refer to an illness involving vomiting and diarrhea as the flu or the tummy flu.  This is inaccurate, but common.  The real seasonal influenza has a short 3 day incubation period and typically causes a severe sore throat, cough (from deep invasion of the lungs), head and body aches and high fever.  Interestingly enough a great deal of the aches, myalgias, fever, and chills are due to the strong stimulation of the body's immune system and the subsequent release of very large amounts of Interferon (yes, the same chemical in Avonex, Rebif, and Betaseron.  This is the exact reason why we often have "flu-like" side effects from those DMDs)

HOW MANY PEOPLE REALLY GET THE FLU EACH YEAR?

It is hard to estimate because many people never even see their doctor, but the best estimates for the 2009-2010 year were 43 MILLION to 83 MILLION.  The midrange estimate was 61 MILLION.  This was 1/5th of the population of the United States (pop. About 305 million).   Some years it is much less.

Influenza is the largest cause of infection-related hospitalizations and deaths in the United States.  Because of the frequently massive damage it causes to the lungs a secondary bacterial infection is common.  Typically the groups at greatest risk at the very young (under 5), the elderly (over 65, sorry to many of you who do not feel elderly, it's a medical grouping and naming system), and the immune-suppressed.  I need to stray here a bit and remind ALL of us the MS does NOT suppress your immune system and NEITHER do the four first line MS drugs.  The other groups identified as being at high risk for death or complications are:

People who have medical conditions including:
•Asthma (even if it’s controlled or mild)
•Neurological and neurodevelopmental conditions [including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, multiple sclerosis, epilepsy (seizure disorders), stroke, intellectual disability (mental retardation), moderate to severe developmental delay, muscular dystrophy, or spinal cord injury]
•Chronic lung disease (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis)
•Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)
•Blood disorders (such as sickle cell disease)
•Endocrine disorders (such as diabetes mellitus)
•Kidney disorders
•Liver disorders
•Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)
•Weakened immune system due to disease or medication (such as people with HIV or AIDS, or cancer, or those on “chronic” steroids)
•People younger than 19 years of age who are receiving long-term aspirin therapy
•People who are morbidly obese (Body Mass Index [BMI] of 40 or greater)

However, with the appearance of H1N1 in 2009 the groups at risk changed as did the severity of the flu for the last three years.  H1N1, for still unknown reasons, had its greatest severe disease in the group 18 to 64.  I'm sure you all remember the horrific stories in the winter of 2009 - 2010 of young athletes, robust healthy adults dying within a few days from the flu.  

WHAT VIRUSES DO THIS YEAR'S FLU VACCINE PROTECT AGAINST AND HOW DO THEY DETERMINE IT?

The major epidemiology groups around the world - but specifically from the US, France, Japan, Australia and China constantly survey which viral stains (cousins) are popping up and showing a quick tendency to spread.  From these they pick the three that statistically will cause  greater than 99% of all the seasonal disease for the next season.  These are then given to the vaccine manufacturers to formulate the vaccines that will be produced.

This year's shot will contain the following:  an influenza A (H1N1) virus, an influenza A (H3N2) virus and an influenza B virus.  This is identical to the vaccine used last year and experience showed that it did, indeed, cover more than 99% of all cases.


BUT, I THOUGHT VACCINES GIVE LIFE-LONG IMMUNITY.

Some do and some don't.  Over the decades we have seen that the flu vaccine immunity does wear off gradually.  Some people's titers are much lower the next year and other peoples' not.  The safest way to avoid influenza is to get the yearly shot.  Also some people just don't form great immunity to some shots.  (I never was able to get antibodies to Rubella even though I had the wild virus and have had three shots.  Go figure.  Other vaccines and diseases didn't show that problem in me).

WHAT STRAIN IS EXPECTED TO CAUSE THE GREATEST DISEASE IN THE NORTHERN HEMISPHERE?

H1N1 is still expected to be the major strain for the entire world.  Also, the make up of the vaccine is the same for the Southern Hemisphere.


Con't

Quix
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YOU HEAR SUCH BAD THINGS ABOUT THE FLU SHOT - OR VACCINES IN GENERAL.

I will try to be restrained here.  People, these things have been studied by non-Pharma-funded groups all over the world for the last 40 years.  They are safe - especially compared to the diseases they prevent they are marvels.  I have personally seen people die (usually children) from most of the things we vaccinated against.  There was a HUGE, HUGE!!!! misinformation campaign launched in 2009 against the H1N1 crying out that the CDC stated that they expected 30,000 people to die or be maimed by the H1N1 virus.  This was a lie.  What the CDC said was that, at worst, 1 person for every 100,000 who received the vaccine "might" be maimed or killed in the US.  Since yearly they only give out about 130 million to 160 million doses, the worst case scenario would have been 1300 to 1600 harmed by the vaccine.  Nothing even close to that occurred.

The flu kills on average about 36,000 people in the US.  The number is only an estimate using the best reporting, statistical tools and is a average of several different ways to estimate these deaths.  Doctors and hospitals do NOT have to report flu-related deaths, only pediatric flu-related deaths.  The lowest estimate last year was about 18,000 deaths, the highest was 60,000.  To me all of those numbers are scary.

WHAT IS THE GENERAL RECOMMENDATION FOR PEOPLE WITH MS AND MY NEURO SAID NOT TO TAKE IT

All of the formal MS groups and the VAST majority of MS experts and neurologists recommend that we receive the inactivated flu shot (NOT the Live-Attenuated Virus).  A smattering of neurologists apparently recommend against it.  I have only heard one rationale for this advice and that was, "The flu shot can cause relapses."

Personally, all I can imagine is that these neuros do not understand the risk of having someone go through flu season unprotected.  Yes, the shot can cause a relapse.  However, the likelihood is that the real disease (aside from the threat of death) is FAR more likely to cause a humongous relapse.  This is why.  The shot gives a person a finite (limited) amount of antigen (proteins that stimulate antibodies) to the body.  The immune response is stimulated and the body clears the antigens out of the body.  One the other hand, the real disease, involves the virus spending days making billions of copies of itself that cause an on-going and severe stimulation to the immune system.  The relapse is likely to be much, MUCH worse.

However, if your Neuro doesn’t want you to have the flu shot you must then decide whose advice you will follow.  I would recommend, though that you ask for the explanation before you decide.  It is ultimately your decision.

WHY CAN’T WE GET THE LIVE-ATTENUATED VIRUS VACCINE?

In general it is true that the live virus vaccines are better at giving immunity, but the reason we should NOT get them is one of the same reasons we don’t want to get influenza.  The live virus vaccines are altered genetically so that they cannot cause the flu, the they look just like influenza to the immune system.  After vaccinated one gets a true “infection” but it doesn’t cause much in the way of symptoms, at least not compared with the real disease.  We don’t want the big time relapse.

CAN I GET THE FLU FROM THE SHOT?

Absolutely not.  In the Inactivated Virus vaccine, it is put through a process that no virus can withstand.  Even though we may feel “fluish”, as explained above, we do not get the flu.

Yet, some people have developed the flu right after they got the shot.  This is a coincidence.  Those people were exposed to the real flu and it took hold, causing infection with influenza BEFORE the vaccine could mount any protection.

WHAT IF I DON’T GET A SHOT?

You owe it to yourself to do everything possible to keep from getting the flu.  Measures include avoiding groups of people, fastidious hand washing, making sure those around you get the shot, talking to your doctor about taking antiviral (which have their own set of side effects) prophylactically, or taking antiviral AS SOON AS YOU HAVE THE FIRST SYMPTOMS of the flu to try to prevent its development.  Then you owe it to the others around you to take extraordinary measures to prevent the spread of the virus if you end up getting sick.  This means STAYING HOME for the duration of the illness - not that you would feel like school or working anyway.  And absolutely you must stay away from people in the high risk groups!  Giving the flu to a high risk person can kill them.

DO THE VACCINES CONTAIN THIMEROSAL?

Most of them do not.  All of the vaccines which come in one-dose, prefilled syringes do not, but some of the multi-dose do.  Here is a reference by maker and name of the vaccine.

http://www.cdc.gov/flu/protect/vaccine/vaccines.htm

The vaccines available may vary by region or provider.  Large, public clinics are more likely to carry the multi-dose vials which may have thimerosal in them.  

WHAT ABOUT GETTING GUILLAIN-BARRE FROM THE SHOT?
Most of the cases of Guillain-Barre Syndrome are caused by infections and NOT vaccines.  GBS is caused by a few infections especially often.  The primary one of these is a bacterial, diarrhea called camphylobactor jejeunii, but other infections include influenza. An infection with actual influenza is more likely to cause Guillain-Barre than the vaccine.   Every year, irrespective of flu shots, about 1 in 100,000 people develop GBS in the US, so about 3,000 cases per year.  In the swine flu vaccine of 1976 the number of increased cases of GBS was an additional 1 per 100,000 per dose of vaccine, so that there was approximately 1,500 additional cases.  Nothing even approaching that has been seen since, including the H1N1 vaccine.  There is a tendency for anti-vaccine groups to try to blame all GBS during flu season on the flu vaccine, but this is not valid.  GBS was occurring in the hundreds of years before there was even such a thing as flu vaccine.  


Con't

Quix
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HOW DO I TIME THE FLU SHOT WITH MY MS MEDICATION?

∙ Steroids - talk to your neurologist, but as a rule, a minimum of 2 weeks after the course of steroids.  Three or four weeks is better.  And it should bed at least 10 days before steroids are given again. .  This is because steroids suppress the immune response and you wouldn’t be able to form antibodies to the shot.  If you can’t do it within these guidelines, talk to your neuro about getting it when you can and getting a booster dose later

∙ Avonex - It is “best” to wait until three days after your shot and at least three days before your next one.  Some neuros recommend that you skip one dose of Avonex in order to get the greatest benefit from the vaccine.  Talk to your doctor.

∙ Betaseron - Timing doesn’t matter.

∙ Copaxone - Timing doesn’t matter.

∙ Rebif - Timing doesn’t matter

∙ Tysabri - If possible, get the flu vaccine midway between infusions.

∙ Gilenya -Timing doesn’t matter

∙ Cytoxan (cyclophosphamide) - It is important that the vaccine be given at least 14 days after and no less than 10 days before the next Cytoxan dose.

∙ Novantrone (mitoxantrone_ - It is important that the vaccine be given at least 14 days after and no less than 10 days before the next Cytoxan dose.

∙ Cellcept (mycophenalate) - Timing doesn’t matter.



I got this info from my own MS Center.

Quix
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Well said Quix, well said!  Thanks for sharing your knowledge.  I worked in a family pratice office for over 13 years.  Most don't realize how important immunizations are, both childhood and adult!  I've had my flu shot this year and pneumococcal vaccine a few years back :)  
Debbie
~live as if all your dreams came true~
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Should a person currently in a relapse get the flu shot?
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Wow.  You explained everything so thoroughly and I understood all of it!  I wish you were my neurologist!  Thanks for the information.

Tammy
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Thank you for your time and effort in writing this - I am now fully aware of the benefits of having the Flu shot.

I think that this should be added to the Health Pages?

What does every one else think?  DR Q put a lot of time and effort into this, and I don't think that it should be lost!!

Debs.
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Thank you so much for this, Quixy. So important, and so many people with the very questions you answered.
Mucho Thanks to you,
-Shell
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I noticed that you included my medication which I haven't seen anyone else on here taking. Thanks. I got my shots ( flu & Pneumonia ) just last Tuesday,

Dennis
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Thank you, Quix.  I always learn when you post.  There are many on this forum from which I have learned, but it was still a bit of a drought of the indepth during those months you were gone.  I appreciate the time and expertise you pour into your posts.

I will be getting my flu shot when I see my doctor.

Most sincerely,
Beth
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Quix...so glad you are back on the boards!

This is a wonderful explanation on the flu vaccine.  I think it should be a health page as well.

I had the flu about 14 years ago, and have NEVER missed the vaccine since!
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Thanks so much for this information.  I have a few friends who have bombarded me with emails about why I should NOT have my 3 year old vaccinated.  I have always went with my gut feeling (and the feeling of my childrens pediatrician) and my children have had all the vaccinations.  I will continue to do so, as well as making sure me and my husband have the flu shot!

Maureen

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My belief is, after watching my son suffer with every round of vaccines until I said no more, vaccines are safe. Mercury (thimerosal) in any form or amount, at any time, isn't safe. His reactions most resembled those of the pertussis description, and so he will have another one of those over my dead body. And until they can come up with a DT without thimerosal for kids, we will have to let that one pass unless absolutely necessary.

I have no problems with vaccines, other than the pertussis for my son because of the reactions I witnessed first hand. I have issues with thimerosal as an ingredient, and actively seek out supplies without it.

Thanks so much for the info, Quix. I just got off the phone with my dad who said they are refusing to do the flu shots. My mom has lung cancer and is on chemo. She's at a very high risk. I did my best to explain to him that there are many strains of the flu that go around every year, and the shot covers several of them. Now I have even more weaponry to add to my sales arsenal in convincing him they can't afford to take a pass on the flu shot this year.

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way to go Quix, so nice to be back on here, and see you, this is a lOT of information, and so very valuable, especially at this time of year.   THANK YOU ....

Cheers,
Candy
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thanks for giving your time, knowledge and talents to write this one - I agree it should be an HP so we can refer people to it each time the question "Should I get a flu shot?" comes up here.  
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Good question about taking the shot during a relapse.  I have not seen the answer to this published, but here are my thoughts.

I would want to see the worsening phase of the relapse over before I got the shot.  If the new symptoms were still there but not getting steadily worse, it should be fine.

The above comment works best if the flu is not actively going around, like now.  There are very few cases being reported anywhere.  However, in full-blown flu season I would compare the this question with your question

Should a person currently in a relapse get the flu?  (answer - OMG, No!) and that is how I would decide.

Quix  :))
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I was chugging along with Wow, Wow, Wow.  This absolutely IS great DQ and a HP it should be.

I'm a little stumped by that last post though.  I'm having a hard time following at the end (it could easily be a problem unique to me).

I'm thinking a real flare earns lots of us a boost of roids.  That would be a disqualifier for vaccines and get us a caution again close contact with sickies and crowds anyway - especially at times when the flu is lurking everywhere.

Bravos to excellence in infomation sharing.  Thanks again DQ.
Mary
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I was making two points.  A new flare is signaled by a sudden worsening of old symptoms or the appearance of new symptoms.  It is a time of deterioration in how we feel.  And, yes, it may earn us a round of 'roids.  but, after the newness, we often sit with those bad symptoms for quite a while before they begin to improve.  My thought is that this later time is the best for the flu shot and it would be the time after the 'roids are pretty much out of our systems (more than 2 weeks).

If we can take the steroids out of the picture, then the question of whether or not to get the flu shot during a relapse - rather than waiting for a full remission - is easily decided by comparing the following questions:

I am well into a relapse - do I want the shot?  Yes, yes, yes,!

I am well into a relapse - do I want the flu?  OMG, NO!!!

This way the decision making is pretty simple.

Sorry if I was being obtuse and garbled my meaning.

Quix
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No apologies needed on your part at all!  That clears everything up for me, bumped this to the top for a re-read by those who already understood and gives visibility of great info to anyone who missed it the first time around :)

Mary
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Q? Does anyone the the correct "timing" for getting the flu shot?

What I mean by that is this, where I live, in KS, they have been giving flu shots since August, which seems way too early for me.

I was told, by a doctor, a few years ago, that the flu only helps you for about 3 months, so if you get it early, you could still get the flu, later.

I was told, at a local Wal-Mart, back in September, by the RN there giving flu shots, that this years shot is good for 4 months.

When my wife spoke with her PCP, he told her, it's actually 3 months, so take it as late as possible, but during normal flu season, so get the flu shot around November.

OK, so does anyone know, the truth???

-- Socrates2k1 (aka Stan)
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The CDC disagrees with what you've been told.  Their literature states that immunity lasts pretty much at least a year.  I have never heard of anything like immunity lasting only about 3 or 4 months.  

The only thing I can think of is that if you give someone actual antibodies - like the old gammaglobulin shots - 3 to 4 months is the length of protection you get. Because that is the length of time it takes the body to breakdown a doese of passive antibodies.   But, in a case of a vaccine, where you stimulate the production of antibodies, the protection is much much longer and sometimes lifelong.

Weird.

Quix

Quix
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Maybe while discussing how important the flu shots are for us, I think we should also address pneumonia vaccination.  According to my neuro it is just as important.  I thought I was protected because years ago (when I was very young) I had been told the shot would last my lifetime.  My understanding today is I need it yearly.  So I just take one in each arm on the same day and get it over for the year.

Any comments on this issue?
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I can not take flu shot becaue I am allergic to eggs (mostly the egg white).  My husband got the flu shot last year, but he still caught the flu and brought it home from work.  We were both sick over Christmas and new years.  What i don't understand is I seemed to get better a few days faster (and I have a compromised immune system) then him. (though he is a man and  IMO they are huge babies when sick and may act out the pateint role more) We must have had some weird strain not covered in last years shot. Or Since i get the flue too often I may have had that strain before. Not fun!  

My ashtma doc wants me to get the pneumonia shot becaue of my stem cell transplant, and because MM makes you susceptible to pneumonia.  Any idea if it is also grown in eggs?  
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