Getting the flu shot isn’t about you

Flu season has begun, which means that it’s flu shot time.

I see lots of different responses when I talk to families at our clinic about the flu shot. Some are happy to get it. Others are unsure, worried about side effects. Others plain old refuse.

Plain old refusal isn’t an option for me — as a doctor and an employee of Boston Children’s. I need to get it — and I did, last week (they were out of red lollipops, so I had to settle for purple). But even without being told to get it I would have. Because not only do I not want to get the flu (I got it once, and it was no fun), this isn’t just about me.

It’s not that I don’t know that there might be side effects, or that it might not work. I know that. But the side effects are usually mild (like some muscle soreness or feeling a bit icky for a day or two), and given that the flu can’t be counted on to be mild, I’ll take whatever protection I can get. Especially because this isn’t just about me.

This year, there are some new options when it comes to the flu shot. There is a quadrivalent version, meaning that it protects against four strains of the influenza virus instead of three. All of the nasal spray versions, or LAIV (live attenuated influenza virus) are quadrivalent, and there are injectable versions too.  There is also a version made without any eggs at all (for those with severe egg allergies) and one that gets injected into the skin with a smaller needle (for those who really don’t like needles), although both at this point are only for adults, ages 18 and older. And for those 65 and older, who are more likely to end up hospitalized with flu, there is a high-dose version of the trivalent shot.

There are remarkably few people over the age of 6 months who shouldn’t get a flu shot. People with a history of an allergic reaction to the flu shot itself, or with a history of Guillain-Barre Syndrome (if you haven’t heard of it, you likely haven’t had it) shouldn’t get it. Some children with severe egg allergies shouldn’t get it, but many can — check with your doctor. The nasal spray is only recommended for healthy people ages 2 to 49, who aren’t pregnant and don’t have close contact with someone with serious problems with their immune systems — but most people who can’t get the spray can get the shot.

It’s important for everyone who can to get something — because it’s not just about you.

I can’t remember why I didn’t get the flu shot the year I got the flu, many years ago. I was busy when it was offered, and then I didn’t get around to it, although I kept meaning to. I got a miserable case of the flu, but the bigger problem was that I gave it to everyone around me. My youngest child at the time had a fever for 10 days. My sister came to visit, and ended up in an emergency room a few days later — as did her husband a few days after that. It took quite a while before we were all well. I’ve never missed a shot since.

And the thing was, we were lucky. All of us were basically healthy people, which helped. We were lucky enough not to get any complications of flu, which can happen even to healthy people. But we might not have been so lucky — and it scares me to think of all the people we might have infected, or did infect.

See, that’s the thing: every year, some people get really sick or even die from the flu. The people most at risk are the very young, the very old and people with underlying diseases like asthma or problems with their immune systems. Some of those people, like newborns, can’t get the flu shot — and even when they do, it doesn’t always work. When everyone around them gets a flu shot, it helps keep them safe. When someone around them gets the flu, it can put their life in danger.

That’s why it’s really important to get vaccinated. If you have questions or concerns about the flu shot, check out the flu website of the Centers for Disease Control and Prevention, and talk to your doctor. But please, if you are thinking about not getting it, remember:

It’s not just about you.

Claire McCarthy is a primary care physician and the medical director of Boston Children’s Hospital’s Martha Eliot Health Center.  She blogs at Thriving, the Boston Children’s Hospital blog, Vector, the Boston Children’s Hospital science and clinical innovation blog.

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  • Ron Smith

    Good post, Claire.

    I wish there was the same motivation about offering Tdap. I recommend it for parents of all of our new babies.

    I recommended HPV for boys before it was an official vaccine policy. I explain that taking the HPV vaccine is something you do for someone that will someday love very much.

    Selfless love it seems is often a pretty convincing argument for reticent parents. Sometimes adolescent boys themselves are convinced before their parents and ask to get the HPV vaccine.

    Warmest regards,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

  • Chiked

    Another physician pushing that we all get vaccinated but not giving any facts. Show me the numbers proving the vaccine is even moderately effective. Actually, don’t even bother. You keep pushing vaccinations and I will spend my time getting my family and I to eat well and get plenty of rest.

    • Martha55

      There are no studies that show eating a healthy diet and sleeping well prevent the flu. Pushing diet and sleep without giving any facts…not very scientific.

      • Chiked

        No amount of evidence will be good for the vaccine pushing crowd. So you go ahead and vaccinate yourself every year. We will be the dumb ones that focused on nutritious foods, sleep and dressing appropriately. It has worked for two decades.

        • Martha55

          It’s fine you chose not to get a flu shot. Don’t claim you do it because of scientific evidence. If you want to feel good about your anecdote, fine. No amount of evidence will be good enough for the anti-vaccine crowd.

          • Chiked

            Never said I do it because of scientific evidence. I do it because it works….and again I beg you or anyone to show me this evidence you speak of. You will find that it is almost useless in the high risk groups (kids under two years and the elderly) and barely 50% effective for those in-between depending on the study. No thanks. I will stick with a natural preventative regimen. You go ahead and keep filling the pockets of big pharma.

          • J.L. Creighton

            “You go ahead and keep filling the pockets of big pharma.”

            Physicians don’t recommend vaccines because of some unholy alliance with “big pharma”. They do it because they would prefer to give their patients every chance of staying well, rather than letting them get sick and then having to treat them.

            In a fee for service model, I would make far more money treating flu-ridden patients than simply giving them a jab. If all we’re out for is money, why on earth would we recommend vaccines?

          • Chiked

            If you are in the healthcare field, I am sure you realize that you are HEAVILY courted by big pharma. From conferences to lunches and drug samples, you are the gateway for big pharma. If you think that it does not influence what you do, then maybe you can explain why they continually spend hundreds of millions of dollars supporting you. They do so because it works. Now you may feel it does not impact your recommendations but the money says it does.

        • J.L. Creighton

          “No amount of evidence will be good for the vaccine pushing crowd.”

          No amount of evidence will be good enough for the anti-vaxxers.

          Vaccine deniers live in a world of anecdote. Physicians live in a world of science.

          • Chiked

            Science, the always infallible foundation of medicine. Wasn’t it science that told us that women over a certain age needed hormonal replacement. How many changes in diabetes care have we gone through? Does a drug called Vioxx ring a bell?
            This was all science based. Right? Lol…

          • FEDUP MD

            Without science, we would still be burning witches when the crops failed.

            Unlike dogma and magical thinking, science evolves. You make the best decision at the time based on the data you have. If the data changes with further study, then you change your decision making. The goal is to eliminate as much bias as possible, because we humans are very prone to it, even the most rational among us. There are multiple studies indicating that with strongly held beliefs, even contrary data is often not enough to make us change our minds (in fact it often does the reverse!) Science is the continually ongoing process of trying to mitigate this effect.

            The difference between me and you is that if you could do a study proving lower flu rates with your lifestyle changes compared with controls without, I would sing it from the rooftops and completely change my thinking about how to prevent flu. But nothing I say will change your mind.

          • Chiked

            Look science is great when you want to understand why water boils at 212 degrees fahrenheit at sea level.

            But outside of basic anatomy, science has a miserable track record in understanding how and why the human body functions.

            So if you trust science to provide all your answers, be my guest. I first look at the trail the human body has left and then pattern my life after that. It has revolutionized my health.

            As for a study, I will say the same. Show me a flu vaccine study with better than 50% effectiveness not requiring yearly shots and I will be all over it.

          • FEDUP MD

            Wow, I guess I was popping bonsbons for 14 years of my life. Here I am thinking I was learning how the human body works and how to treat it.

            Funny, in my field, I have seen over the years kids saved by medicine and scientific breakthroughs who would have died even thirty years ago. My son is one of them. He would have died of something which killd my aunt 80 years ago. Now he is fine. Go to a cemetary even from the early part of the 20th century and note all the tiny little graves. Do you really think kids are living healthier lifestyles to account for a dramatic drop in child mortality? Now, when obesity is endemic, breastfeeding has been replaced by formula, processed food is everywhere, and kids vegetate in front of the TV instead of playing outside?

          • Chiked

            I encourage you to read about some of these “scientific breakthroughs”. You will be surprised at how much keen observation and serendipity has played a role.

            So I am not against vaccines. The drop in childhood mortality is due in large part to the impact vaccines have had on communicable diseases.

            However you cannot vaccinate yourself out of every disease. This is the hubris of science and medicine and why this generation of kids will be the unhealthiest ever. All you see from pediatricians are more drugs, more vaccinations, statins for kids and ridiculous food recommendations. I even read the other day that researchers are looking at an obesity vaccine for animals. Now that obesity is a “disease”, how long do you think it will take for doctors to start recommending them for humans.

            So I remain fixed. Show me better numbers than 50% and I will commit my children to yearly shots. Meanwhile, we will feed the body what it is really needs to function: good organic nutrition, exercise and sleep.

          • http://www.pediatricinsider.com/ Roy Benaroch MD

            Here’s one from last month, showing a 77% reduction in severe illness among vaccinated children: http://www.pediatricnews.com/specialty-focus/infectious-diseases/single-article-page/flu-vaccine-reduces-risk-of-severe-illness.

            Studies supporting the effectiveness of influenza vaccine abound, but as others have said these will be summarily ignored by the hardcore antivaccine cultists. So it goes.

          • Chiked

            Sir, this study shows that if you have contracted the flu, the vaccine was effective in preventing severe complications. That is not what I am referring to. Show me studies that demonstrate the primary effectiveness of the vaccine.

          • http://www.pediatricinsider.com/ Roy Benaroch MD

            Preventing serious complications and death isn’t a good enough goal? Typical, move the goalposts.

            Look, it’s obvious you don’t care what the studies show, you’ve made up your mind. But for those of you who might have some honest interest, here’s links to dozens of good-quality studies spanning over several decades that show that the influenza vaccine is effective: http://www.cdc.gov/flu/about/qa/publications.htm

          • Chiked

            It is clearly obvious you wish to push your vaccine agenda but please have the intellectual honesty to compare apples and apples.

          • http://www.pediatricinsider.com/ Roy Benaroch MD

            I’m not talking about apples. I’m talking about saving lives and preventing misery. You asked for a study which showed > 50% effectiveness, I quickly posted one. Then you wanted more; I posted a link to hundreds of studies supporting the safety and effectiveness of influenza vaccines.
            Your contention that all you wanted was a single study was obviously false. “intellectual honesty”? Please.

          • Chiked

            I asked for a study showing greater than 50% effectiveness in preventing me or anyone from contracting the flu. That is not what you sent and I made that very clear as soon as you posted it.

            Look for whatever it is worth, I am not against all vaccines. But I am sick of big pharma and doctors pushing pills and vaccines that have marginal benefits…..while at the same time watching a generation that will not live as long as their parents.

            Our healthcare system does not need ANOTHER pill or vaccine. We need a return to the basics: good nutrition, exercise and sleep.

          • http://www.pediatricinsider.com/ Roy Benaroch MD

            What you posted was: “Show me a flu vaccine study with better than 50% effectiveness not requiring yearly shots and I will be all over it.”

            Certainly good sleep, nutrition, and exercise are very important for good health. That doesn’t mean that we ought to step developing vaccines and medications (and surgical techniques, and chemotherapy and whatever else we can also use to prevent and treat illness.)

  • Chiked

    Lol…..following your reasoning smoking has nothing to do with lung cancer since there are people who have smoked a pack a day for decades and have no traces of cancer.

    • Martha55

      No… according to your reasoning, people who don’t smoke don’t get lung cancer.

      • Chiked

        As is typical on the internet, your sole purpose is to misrepresent everything I have said.
        So like I said earlier, feel free to subject yourself to vaccine shots every year. I and millions of others are doing quite well with a nutrition based approach to most diseases. You will come around sooner or later. There was once a time it was heresy to suggest smoking caused cancer.

        • J.L. Creighton

          Of all the people made seriously ill by the flu, more are unvaccinated than are vaccinated.

          Just like of all the people who develop lung cancer, more are smokers than are non-smokers.

          These are actual facts, not opinions.

          There are no 100% guarantees, but your best chance of avoiding serious illness from an influenza virus is to get the vaccine, just as your best chance of avoiding lung cancer is to not smoke.

          • Chiked

            “Of all the people made seriously ill by the flu, more are unvaccinated than are vaccinated.”

            Alright facts guy or gal, tell me what percentage of those unvaccinated people actually eat nutritious (organic) foods and live a healthy lifestyle (ie sleep well, exercise and dress appropriately). Show me that study. Don’t bother. There is probably none. Because the facts will refute everything you and the drug industry wants you to believe.

          • FEDUP MD

            Dressing warmly?! Grandma, is that you?

            In all seriousness, we call this wishful thinking. I say this as I have seen kids die from the flu, kids who were healthy and active. Kids who were just fine, athletes and scholars and now they’re gone. It’s a horrible death. It’s nice to think that you can exercise some control over these things, and they only happen to others, who somehow aren’t doing things right the way you are. The sad truth is, there is only so much you can do. The flu vaccine is not 100% but it does reduce the risk. You may not have gotten the flu in 2 decades, but I would caution you about thinking you are somehow invincible. Even with the vaccine you would not be.

            Oh, and the reason behind the article? It’s well known the shot does not work well in the very young and elderly. We still give it because it’s better than nothing. That’s why everyone around them needs the shot, especially for that time where one is contagious without symptoms. It’s risking the most vulnerable among us. It’s called herd immunity, look it up.

          • Chiked

            Why does everyone keep saying “the flu vaccine is is not 100%”, try 56%, 9% in elderly. Look it is ok to disagree with me but at least be honest about the numbers.

            And with all due respect to your clinical experience, the herd immunity theory has been debunked more than a number of times. I won’t start a conversation on this but google it for yourself.

            Lastly and for the umpteenth time for those who choose to listen. The body needs proper nutrition, sleep and simple daily activity (some call it exercise) to function properly. There is no way, drug or vaccine around it. You may call it wishful thinking but your hubris is why you see medicine grinding in place unable to solve many modern diseases.

  • http://www.zdoggmd.com ZDoggMD

    Word. We teamed up with Zappos.com to do a little musical ditty about this important topic: http://www.zdoggmd.com/one-injection-flu-shot/

    • May Wright

      Hahaha, that’s brilliant!

      And now I feel a little bit better about my Zappos addiction as well ;)

  • adh1729

    But Dr McCarthy, you are assuming that I should care about other people. Why should I care about other people? Did you get that from the teachings of Jesus? or Buddha? Are you saying that flu vaccination is a religious kind of thing?

  • adh1729

    But, now in the great and advanced 21st century — is it time for us to liberate ourselves from “evolutionary traits that helped us survive”?
    We are now outgrowing old-fashioned ideas such as heterosexuality and traditional marriage. We now abort our progeny before they are born. All sorts of deadbeat dads donate sperm and then run.
    Is it time to reexamine this idea of self-sacrifice for the supposed common good? (Echoes of Ayn Rand.)
    Why does Claire McCarthy just assume that I *should* care about other people? “Should” by whose definition?

  • adh1729

    I agree with your ideals of community cooperation, etc. I was being a devil’s advocate.
    My point: why, when the establishment wants to crow that science has demolished religion, do they then turn around and argue for some form of morality? “We owe it to coming generations not to emit CO2″; “it is morally wrong to have so many uninsured patients”; etc. Morality cannot be derived from science; there is nothing moral/immoral about survival of the fittest, or big fishes eating little fishes, or cats eating mice. If science is the source of our values, and we are just primates that evolved down a different evolutionary pathway, then murder or child molestation (or merely spreading the flu) cannot be condemned as wrong or immoral.

  • heather

    I would love to know who your mito doc is. Because both my youngests sons mito docs and my mito/ms doc highly recommend the flu vaccine. If we get the flu at full strength it would put us in the hospital if not kill us. So a shot that decreases the strength of the flu is way worth it.

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