We’re coming up on back-to-school season, which means the start of flu season so the biggest question I’m hearing at the office is “do I need the flu shot?” It’s a great question, and I can’t answer it for you specifically, but I can give you some facts about the flu vaccine, the FluMist® nasal spray and also some natural alternatives to the flu shot so that you can make the best decision possible for you. Just make sure you read down to the part about dog proteins (eek!!!)
What is the Flu Vaccine? The Basics
The flu vaccine or nasal mist is typically tiny doses of the actual flu virus that has been weakened or “killed,” depending on the vaccine type, so that your immune system can respond without you actually having to get the flu. There are several forms from several manufacturers. These are mostly “trivalent” which means there are three different strains of flu, and “quatrivalent” meaning four strains. According to the CDC the 2014-2015 trivalent vaccine will have:
- an A/California/7/2009 (H1N1)pdm09-like virus
- an A/Texas/50/2012 (H3N2)-like virus
- a B/Massachusetts/2/2012-like virus.
The quadrivalent form will add B virus (B/Brisbane/60/2008-like virus). There are three broad categories of Influenza vaccines, depending on the way they are produced. Each form has it’s own strengths and weaknesses. According to the Centers for Disease Control (CDC) website, these types are:
IIV or Inactivated Influenza Vaccine:
As the name suggests, these vaccinations contain an inactivated form of the virus so they can not give you influenza. These are all injected only. The trivalent form has been used clinically before, but this is the first year for the quadrivalent form, so there isn’t as much safety data on that one. This does contain egg ingredients so watch for egg allergies and it is not safe for infants under 6 months. This is the oldest type of influenza vaccine and so has the most safety and clinical data.
RIV or Recombinant Influenza Vaccine:
This vaccine is extremely new technology and has not been on the market until this flu season. It does not use eggs anywhere in it’s production and so is safe for those with egg allergy. Uniquely, it also does not use the actual influenza virus, but is rather a lab-altered insect virus called baculovirus. Because this is new technology it has only been approved for those between the ages of 18 to 49 years old and not enough data is available to pregnant women, nursing mothers, children or adults over 50 years of age. This new technology is marketed as Flublok®
Live, Attenuated Influenza Vaccine or LAIV:
This is administered as a nasal mist, called FluMist® and is actually the live virus, that has been weakened so that it is extremely unlikely to cause the flu, but can generate a strong immune response. Because this actually contains live virus is shouldn’t be given to anyone with family members who are immune-supressed or immune deficient, or people with medical conditions that make them more at risk for serious complications of the flu. This form also isn’t suitable for pregnant women. This is approved for people over the age of 2 and under the age of 50. The most common side effect of this vaccine is runny or congested nose, and in kiddos age 2 through 6 years old there can be a fever after the vaccine. This also shouldn’t be given to children or adolescents who are taking aspirin or other salicylates because there is a risk of a condition called Reyes Syndrome.
Any vaccine, whether it’s delivered as an injection or not, can cause symptoms or adverse events. There is a hotline to report any adverse events to the appropriately named Vaccine Adverse Events Reporting Service (VAERS) 1-800-822-7967or you can visit their website to report an event. There is also a National Vaccine Injury Compensation Program (VICP) you can get more information at 1-800-338-2382.
What is the Success Rate of the Flu Vaccine?
First off, every year the vaccine is different so we don’t know for the 2014 flu shot, but we can get a ballpark idea from previous years vaccines. An important fact to remember is that the flu vaccine only protects from the actual influenza virus (and only if they get the right strains in the shot), but there are many other viruses that can create “influenza-like-illnesses” that it’s still entirely possible to get something that looks and feels like the flu, it just isn’t. There are two factors that determine how well the flu shot works every year and one of them is how well the vaccine matches the actual strains that people get. The other is how healthy you are as a whole person (we’ll talk about that in just a minute). The CDC says:
“At least two factors play an important role in determining the likelihood that flu vaccine will protect a person from flu illness: 1) characteristics of the person being vaccinated (such as their age and health), and 2) the similarity or “match” between the flu viruses the flu vaccine is designed to protect against and the flu viruses spreading in the community.”
Effectiveness is difficult to determine from the research, or at least difficult to decode if you’re not a researcher or a statistician. In terms of general effectiveness the best study I found was published in the Lancet Infectious Diseases in 2012. This study says that the flu shot is 59% effective in preventing the flu, which sounds amazing. Except that when you do the math, it’s less amazing and more just meh. In a normal population about 2.7 out of every 100 people will get the flu in any given year. This study shows that if those 100 people get vaccinated then only 1.2 out of those 100 people will get the flu (and going from 2.7% to 1.2% is 59% risk reduction). So… It’s not actually tricky math, it’s just that 59% sounds WAY better than saving 1.5 people out of every 100 people vaccinated from the flu. That just sounds mediocre at best.
This study published by Vanderbilt University Medical Center about the 2010 – 2011 flu season inspected adults who were hospitalized for influenza-like illness. All of those people were tested to see if it was actually the flu, or another virus and also tested to see if they had evidence of the flu shot. Out of 169 cases admitted to the hospital who had their vaccine status confirmed there were 17 actual flu cases, the other 152 cases were other viruses with the same symptoms. Of the 17 flu cases 11 were not vaccinated and 6 were vaccinated, making the flu shot 71% effective at preventing hospitalizations. This is because in the vaccinated group there were less than half the number of cases than in the non-vaccinated group (but notably still a fair number of cases). It seems reasonable to point out that this study was funded by the Center for Disease Control.
Obviously the flu shot reduces risk, but doesn’t prevent the flu entirely and doesn’t even prevent hospitalization entirely. Of course, nothing works 100% of the time, but given the amount of hype there is every year about flu shots I would love for this information to be more exciting than lukewarm.
Are there Allergy Risks with the Various Types of Flu Shot or FluMist® Nasal Spray?
Yes. Vaccines in general contain many ingredients. The most up to date list I was able to find on the CDC website was for the 2013 flu shot and included a number of potentially allergenic ingredients including:
- Thimersol (mercury)
- Egg protein
- Antibiotics including neomycin sulphate, polymyxin-B, gentamycin sulphate, polymyxin,
- Polysorbate 20, polysorbate 80,
- Gelatin or hydrolized porcine gelatin (sorry if you’re kosher or halal) and most distressing, the Madin Darby Canine Kidney (MDCK) cell protein and DNA. I’m presuming that’s exactly what it sounds like – dog kidney. This probably isn’t a big deal health-wise, it’s really just high up on my creepy factor.
Please note that not every vaccine contains all of these ingredients. The ingredient list for the 2013 vaccines is here. The Institute for Vaccine Safety at Johns Hopkins School of Public Health has a complete breakdown of what each additional ingredient is used for here. Here is the complete breakdown of mercury and egg protein for the 2014-2015 vaccinations from the CDC. In general the package insert should have the complete ingredient list for the exact vaccine you’re getting so always ask to see it to verify the ingredients before you get the injection.
In addition to distressing chemical ingredients including thimersol (mercury), aluminum, phenol and MSG, your flu vaccine may also contain animal ingredients from egg, pork or more alarmingly from dog.
What Is the Truth About Mercury and Chemicals in the Flu Shot?
In 2001 the use of the mercury-based preservative thimersol was discouraged from childhood vaccines because generally injecting mercury into children seems a bad idea, but it can still be used in multi-dose vials of the influenza vaccine. For the 2014-2015 influenza vaccine there are single-dose vials available that are thimersol free and also the FluMist nasal spray is thimersol free. Thimersol is highly controversial and a more complete history of it’s use, safety and recent prohibition can be found here. According to the CDC vaccines also often contain a number of somewhat alarming ingredients including aluminum, phenol, antibiotics, egg protein, MSG and formaldehyde in small amounts. Honestly, I’m still stuck at dog protein, but given that I’m allergic to MSG and no huge fan of aluminum or formaldehyde it’s possible that those should be bothering me more right now. But dog proteins. Really?!?
Can the Flu shot protect me from heart attack?
Surprisingly, it can. People with severe heart disease are more at risk of dying from influenza or its severe complications including pneumonia, respiratory failure and heart attack. According to the Mayo Clinic, getting the flu shot can help to prevent flu, which may help you to prevent a heart attack as well. Also, even if you do get the flu after having the vaccination, you are more likely to have a milder flu with less severe complications. A huge research study confirmed this, showing that the risk of major cardiac events in the unvaccinated high-risk population was 4.7% vs 2.9% in the vaccinated group. Essentially in this population being vaccinated against the flu cuts the risk of having a major cardiac event almost in half because major cardiac events can be triggered by the flu virus. Not having a heart attack is actually a really big deal and a great reason to get a flu shot.
Is the Flu Shot a Good Idea for Pregnant Women?
Pregnancy is certainly a riskier time to get the flu. Pregnant women are more likely to develop more severe symptoms if they do get the flu, and according to the CDC high fevers caused by the flu can actually lead to birth defects in the unborn child. Also getting a flu shot during pregnancy gives both the mother and the fetus protection against the flu, and the fetus can retain that protection for up to 6 months after birth. Since the flu can be fatal for newborns this may be a compelling reason for pregnant women to consider the vaccination in spite of the additional ingredients.
Is There a Natural Alternative to the Flu Shot?
There is a homeopathic preparation of influenza that has been used historically. Public records of the homeopathic influenzinum as a preventative were not kept, but there is historical information for other homeopathic vaccinations. According to an article by homeopath Patty Smith-Verspoor, in one case using homeopathic meningitis virus for 18,640 children during an outbreak only 4 cases of actual infection were reported (0.0002%). Also in the flu epidemic of 1818-1819 homeopathic MDs who treated using this form of medicine lost less than 1% of their patients, while the death rate for conventional medicine was 30%. Research evidence isn’t present for flu prevention, but a study published in 2013 gives evidence that homeopathic flu virus does induce cellular and immunological changes to cells in a lab. No matter the lack of modern research, the historic use is compelling. The homeopathic influenzinum may be a useful tool in flu prevention
So Do I Need The Flu Shot?
The accurate answer is that this is a question only you and your doctor can answer accurately. Clearly the benefits outweigh the risks if you are at risk for serious heart disease because not having a heart attack can be life-saving. Everything else is such a personal decision and depends so much on your medical history, your risk factors and your overall health as well as what risk you feel the additives will be to your body (if any). The best answer is get all the information you can and have a serious, informed talk with your physician about it. Learn everything you can and ask your physician, who knows your health history, “do I need the flu shot?”.
What Else Can I do to Protect Myself From the Flu?
Helping the health of your body as a whole not only helps protect you from the flu, but also makes the flu shot more effective if you do decide to get it. This means eating balanced meals regularly with fruits and veggies and lean proteins and good fats and not as much starch or sugar as you might typically get. It also means getting rest, drinking water, exercising and generally being a healthy human. I know, it’s not as glamorous as dog protein, but it’s also not made of DOG. Also good flu season habits are covering coughs, washing your hands often and especially before eating and trying to avoid sick people. Some natural supplements that can help to boost your protection against viruses specifically are colostrum and elderberry syrup.
Generally I have to apologize for all the links, but vaccines are a huge issue and it’s important to have reliable information so you can make the best decisions for you and your family. If you’re asking the question “do I need the flu shot?” maybe this will help you to feel better about your choices, and also give you some data to bring to your doctor’s office when you have the conversation with them. Also, I’m writing an article about vaccines for the awesome Austin Fit magazine so I’ll link to that here as soon as it’s available.