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with Rod Moser, PA, PhD

Stories from behind the examining room door, as told by Rod Moser, PA, a primary care physician assistant with more than 35 years of clinical experience.

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Monday, February 4, 2013

Flu and Apathy

By Rod Moser, PA, PhD

flu shot

I hear the excuses every day:

  • “I never get the flu”
  • “We don’t believe in flu vaccine”
  • “I got the flu vaccine years ago and it made me sick. I still got the flu.”

And my all-time favorite:

  • “Flu is no big deal. If I get it, I get it.”

Ever since someone tried to link autism with the measles-mumps-rubella vaccine (MMR), it seems to jump-start the still-flourishing, vaccine-refusal movement. Influenza is a big deal. It certainly has been in the past, and most certainly will be a big deal every year until we get an epidemiological handle on it.

In a few more years, we will reach the 100th Anniversary of the 1918 Influenza Pandemic – a worldwide plague that killed more people than all of the deaths in World War I. No one really knows the exact number, but the original estimates were 21.5 million people died, but now, researchers feel that than number could have been as high as 30-50 million. About 675,000 Americans died during this influenza pandemic. For them and their families, influenza was a very big deal.

They called it the Spanish Flu, but in reality, this deadly strain originated in the heartland of the United States: Kansas. There have been other pandemics, but 1918 was the Mother Lode of all of them. It even killed more people than the Black Plague in the middle ages.

Hardly the first vaccine to hit the market, the first influenza vaccine was not approved and marketed until 1945, nearly thirty years later. As it is with painful memories of past epidemics, people did not eagerly line up for vaccines either. It wasn’t until the 1950s that the popularity of vaccines rose was long lines formed to get children immunized against polio, diphtheria, and a wide-array of kid-killers and kid-cripplers. The public health service provided the vaccines and people demanded them. A year after I was born in 1951, the U.S. experienced the worse polio epidemic (over 57,000 cases). Before my third birthday, the first polio vaccine was being administered. Vaccines were modern miracles for Baby Boomers, but as the decades clicked by and those killer diseases became fewer and fewer, new parents didn’t see the need anymore.

Medical providers are more-or-less required to get the flu vaccine. If not, their companies can make their lives a living hell; requiring that they wear masks and/or gloves at all times when they are seeing patients. Believe me; the flu vaccine is much easier.  For this flu season, nearly 86% of all doctors in the United States have taken the vaccine. Why? We know that influenza is a killer. We do not want to get it ourselves, and we do not want to pass it on to one of our patients and put them at risk. We also want to set a good example for our patients and staff.

When you factor in all health care workers (nurses, medical assistants, etc.), the vaccine rate is only 67%; far less than public health goals. According to Medscape, Americans over the age of six months are only 41.8% immunized this year; a bit less than last year. Are we suffering from vaccine ambivalence (again)?

Flu vaccine gets a lot of guff because it isn’t perfect. This year’s vaccine is only about 65% effective against preventing influenza, so one out of three vaccinated people can still get the flu. Personally, I would rather have 65% effectiveness than zero, but many people do not see it that way. Next flu season should give us the new quadrivalent vaccine, covering four strains instead of the traditional trivalent (three strain) vaccine. The FDA has also approved a new novel recombinant DNA vaccine that is manufactured without using eggs. This new vaccine can be produced quickly and less-expensively, and will not need any controversial preservatives like thimerosal.

The FluMist vaccine contains a live virus. Even though this live virus cannot cause disease, the ideas of “something alive” going into our bodies is somehow more troubling to people. (Incidentally, the MMR vaccine and varicella/chicken pox vaccine is also live.). This vaccine is no more risky than the traditional shot, offers good protection (some say even better), and the best part: no needles!

Influenza is rampant right now. In California, influenza tends to peak right after the holidays. So far, several dozen children alone have died nationwide of influenza this season. The elderly are hit hard; tens of thousands may die as a result of the innocent flu. We have had the vaccine available since October, but these scary reports tend to motivate people to seek the vaccine. I remind them that the vaccine takes at least two weeks to be effective, so they will remain vulnerable until that time.

Think of the flu vaccine as a seatbelt. Drivers wear the seatbelt all of the time; not just when they think they are going to have an accident. Getting your flu vaccine early in the season will limit its ability to spread and mutate. When the flu finally hits, you will be ready. If it doesn’t, at least you had your immunological seatbelt on.

Be protected all of the time; not just when you think you may get the flu.

Posted by: Rod Moser, PA, PhD at 9:15 am

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