Medical Examiner

Big Shot

Why you should get your flu vaccination.

Have you gotten your flu shot this year? If you haven’t, your excuse is most likely feeble. Influenza is a deadly infectious disease that returns every year, threatening young and old alike. According to the federal Centers for Disease Control, the virus kills on average 36,000 Americans annually, a terrible toll—almost as many as die from auto accidents.

There are indications that this year the influenza death toll will be far higher than average. The type of virus circulating this season causes more deaths and hospitalizations than other strains. Already this year it has killed thousands in other parts of the world. And in the United States, the flu season started with a lot more cases, and earlier in the year, than usual. So far, Texas and Colorado have been hit hardest, but cases are now appearing in almost every state and we will likely soon have a nationwide epidemic. To make matters worse, this dangerous strain has mutated slightly from the one used to prepare this year’s vaccine eight months ago, so the protection afforded by the vaccine may not be complete. Yet in the face of this potentially deadly threat, any protection is better than none. In other words: You should get your flu shot.

“I’m young and healthy,” you might say, “why do I need the shot?” True, 90 percent of those who die from the flu are 65 and older, and many—but by no means all —have underlying medical conditions that weaken the lungs or heart. It’s not as though any deaths are acceptable, but these people are not the only ones at risk. Last week, five children aged 6 months to 15 years died suddenly from influenza in Colorado and Oklahoma; two children in England and four in Scotland had already died from the same strain. No one knows why some healthy children suddenly succumb to influenza. But as the virus spreads further through this country, there will almost certainly be more deaths.

One of those who died in Colorado was 8-year-old Joseph Williams. He had been perfectly healthy before the sudden onset of a stomach ache and high fever. His parents took him to the emergency room, believing they would bring him home quickly, but a brain inflammation brought on by the influenza killed him in hours.

The day after Joseph’s death, his parents held a tearful news conference to beg everyone in the community to get flu shots. If more people had been vaccinated, they argued, their child might have never contracted the infection in this first place. That is the major reason you should get a flu shot. Even if spending a week violently sick and bedridden doesn’t worry you, by immunizing yourself you vastly lessen the chances you will spread the virus to some child or older person (family member, friend, or stranger) who might die from it.

In medicine, this concept is called “herd immunity”—that is, if enough members of a group of animals (including humans) are immunized against a disease, the entire group is more likely to escape infection. Despite the overwhelming logic for immunization against influenza, in America we have a terrible record. Last year, 66 percent of people 65 and older got flu shots; among those aged 50 to 64, the rate was only 34 percent, and for those 18 to 49, it was 16.3 percent. Most appalling of all, only 34 percent of health-care workers got flu shots. The very people who are most at risk themselves and most likely to spread the virus to others are for the most part not getting their shots.

Why aren’t people getting immunized? The reasons are many and various. Because a flu shot confers immunity for only one year, many people see it as an annual bother. Others are afraid of needles (although there is now a new nasal spray alternative, called FluMist, for them.) The major reasons people don’t get immunized, however, stem from a set of widely held myths about the flu (these are prevalent even among doctors and other health workers who should know better), as well as government policies that have been slow to confront the real danger and the economics of vaccine production.

Influenza is a specific virus that usually causes a high fever, cough, and sore throat. When people of any age actually get the real flu they usually know it because it makes them very sick. Yet we often use the word “flu” to mean a lot of things. There is no such thing as “stomach flu,” for example, although there are a lot of viruses that can lead to intestinal trouble. Or when people say they have a “touch of the flu,” they are usually suffering (if they are suffering at all) from one of hundreds of viruses, most of them circulating during the winter, that can cause respiratory infections.

One common misapprehension is that people believe that they (or they have heard that someone they know) got flu despite a flu shot—or they got flu from the flu shot, when they are probably only suffering from one of the common viruses mentioned above. Studies done on of millions of people have now shown conclusively that the influenza vaccine does not cause the flu. In fact, it is about as safe as a medical product can be, with minimal side effects. (The myth of the dangerous flu shot probably arose from a 1976 a campaign that vaccinated 35 million people against a potential new threat that never materialized, “swine flu.” There was careful surveillance for side effects, and seven cases of Guillan Barre syndrome, an autoimmune disease that can cause paralysis, were reported. In fact, there was never any proof of cause and effect, and in any case, today’s flu vaccine does not carry that danger.)

Another reason more people aren’t vaccinated is that efforts by the government and the medical profession to promote flu vaccination have, until recently, been half-hearted at best. Flu shots have been available to all since they were first invented in 1945, but the government recommended them only for people 65 and older, those with medical conditions that put them at risk, and health workers. In 2000, the recommended age was lowered to 50, and last year, in response to new studies revealing the danger to children, shots were recommended for kids 6 months to 2 years old. The next logical target would be school-age kids. Children, as noted above, can die suddenly from the flu, but even when they do not get so sick themselves, runny-nosed encounters in classrooms and playgrounds make up the major reservoir that spreads the virus to the entire community. An experiment in Japan proved that immunizing school-age children could cut deaths in the elderly by many thousands. Still, U.S. health officials are reluctant to recommend yearly shots for children. Many kids hate needles and a few vocal parents increasingly have irrational fears about vaccination in general. (A large group of these people fear that vaccines cause autism and other developmental disorders.) The new nasal spray vaccine, on the market this year for the first time, could help those kids (and adults) frightened of needles, but the antivaccine sentiment is not easily quelled.

Even without a campaign to vaccinate school-age children, the government, which has spent so much money on the theoretical dangers of smallpox and anthrax, could save thousands of lives now by urging more people to be vaccinated against influenza. As of now, the CDC urges everyone to “consider” a vaccination, whatever that means. The biggest obstacle to an all out campaign, however, is the economics of vaccine production. This year, private companies will produce only 85 million doses for the United States. If more people than usual demand vaccine, supplies will run out, and some of those who need it most might be denied. If demand falls short, on the other hand, the manufacturers will not sell out their stock, and next year, they will produce less vaccine. The government’s goal, then, is to nudge up demand and production slowly. You can do your part: Get a flu shot. You’ll help increase overall demand. You might save yourself a lot of misery. And you could even save someone else’s life.