The Annual Influenza Gamble: Who Should Give It A Shot?

By Nancy K. Crevier

It is that time of year when millions of people across the United States roll up their sleeves, grit their teeth, and take a shot in the arm — against flu.

 For many who have suffered the headache, fatigue, fever, muscle aches, and bone-wracking cough that comes with influenza, or who have heard family horror stories about the flu pandemic of 1918, getting a flu shot is a welcome opportunity to head off one of winter’s nastiest illnesses. For others, though, there remains doubt as to the efficacy and safety of vaccines, the flu vaccine in particular.

Influenza, a respiratory infection, and the complications that arise from the illness, such as pneumonia, can be deadly to those with compromised immune systems. Nearly 36,000 Americans in the high-risk group die from influenza-related complications every year, according to the Centers for Disease Control and Prevention (CDC).

The flu vaccine has been available since its first approval during World War II, but uneven and slow distribution of the vaccines, a 1976 setback when a large number of people inoculated with the flu vaccine showed an increased incidence of an autoimmune reaction, and an uneven success rate from year to year, has affected the ability of the CDC to convince people as to the necessity of the flu vaccine.

Reports that the flu vaccine actually causes flu, rumors of the safety of ingredients added to the vaccine, and concerns about side effects have further created questions in the minds of many Americans as to the need for flu vaccination. Recently, the CDC has pushed to broaden the recommendations to include younger children and all school-age children, in hopes that the “herd effect” of immunization will decrease the spread of influenza within that age group and those with whom they come in contact.

“There is no overwhelming reason for a healthy person between 3 and 50 years old to get [a flu shot], unless they just don’t want to get sick,” said Dr Peter Anderson, president of the medical staff at New Milford Hospital. On the other hand, the protection rate is extremely high for those adults between 50 and 65 years of age who do get it, he added. That of course is if the flu strain going around is one of the three strains contained in the flu shot.

“Unlike other vaccines, the flu vaccine is customized each year,” said Dr Anderson. “Flu strains are constantly evolving.”

The CDC and World Health Organization play a guessing game of sorts every year, using information from the southern hemisphere to determine which three flu strains are most likely to move into the northern hemisphere the following flu season, he explained. At any time, there may be ten to 20 strains, some common, some not so common, said Dr Anderson. “I think [the CDC] does a pretty good job of estimating. It is an educated guess,” he said.

There have been years when nature decided to take a different path than that predicted by the CDC and rendered the flu vaccine worthless for that season. It is that unpredictability that opponents of flu vaccines point out, as well as the low efficacy rates among the targeted population.

A CDC report from September of 2006 indicates that the influenza vaccination among the elderly, that group most commonly urged to receive the flu vaccine, is effective in only 30 to 40 percent of the cases in preventing the flu. That rate increases to between 70 and 90 percent for healthy adults under the age of 65, mainly said Dr Anderson, because younger adults have a stronger immune system than do the elderly. “In the elderly, the immune system doesn’t work as well, so the vaccine doesn’t work as well,” he explained.

Despite the low rate of success in preventing flu in the elderly, Dr Anderson said that the flu shot is a useful tool in that any elderly person who gets the flu is subject to further complications, and it is from complications that an older patient is most at risk. “I think a 30 percent, or a 50 percent, effective rate is better than 0 percent,” he said, adding, “A study a few years back showed that patients with a history of heart disease had a notable drop in hospitalization if they had received the flu shot.

“You are constantly bombarded your whole life with bacteria and viruses and all kinds of things. It is unlikely you would get sick from the flu vaccine,” he said.

The net of the flu vaccine, in Dr Anderson’s opinion, is “tremendously positive.”

But there are those who argue that possible allergic reactions and the introduction of foreign substances into the body place people at unnecessary risk. The flu vaccine is created from the fluid of chick embryos inoculated with the strains of flu designated for that year. It is inactivated with formaldehyde, and unlike many childhood vaccines, is preserved with a mercury solution.

Dr Harold Ofgang is a naturopathic doctor with offices in Manhattan and at 57 North Street in Danbury. He believes that people need to take a proactive position when considering the flu shot.

“The side effects of the flu vaccine are not high, but they are significant. Reactions including Guillain-Barre syndrome, egg allergies, fevers, aches, all of the flu symptoms, are possible,” said Dr Ofgang. “People need to be informed about the risks.”

Dr Ofgang is not an advocate against vaccines, he stressed. “I’m an advocate of informed patients. I’m against the panic, fear, and hype associated in recent years with the flu vaccine and I’m against uninformed uses of vaccines or the overuse of vaccines.”

Who Needs A Shot?

Even from a conventional point of view, said Dr Ofgang, there are questions about who should actually get the flu vaccine. “There are three types of flu strains,” explained Dr Ofgang, “There is the A strain, B strain, or the flu syndrome. Most people don’t get A or B. The majority of people get the flu syndrome.” The flu vaccine is least effective in preventing the flu syndrome, unfortunately, and most years, said Dr Ofgang, the flu shot is using poorly matched strains. “In some cases,” he said, “the shot does prevent the flu. But if you’re one who experiences side effects, it’s a different story.”

Even the CDC admits that the efficacy of the flu vaccine is not tremendous, said Dr Ofgang. “Statistics are often misleading. There is a difference between actual and relative percentages. If you think about it, only a small percentage of people actually get the flu each season.”

Elderly persons are most frequently encouraged to get the flu shot, but Dr Ofgang pointed out that as the elderly population grows, so does the number of elderly receiving flu shots. “But the percentage of elderly getting complications from the flu has not decreased accordingly,” said Dr Ofgang.

The big question, he said, is whether a person will be healthier long term by getting the disease or if they get a vaccine. “Philosophically, the fewer foreign substances [a person puts in his/her body], the better. But there are instances where modern medicine has had some miraculous results,” he said. “Vaccines throughout the world have been immensely helpful. But can we make them better? I think we need more research to make them completely safe.”

In a statement to The Committee on Government Reform in 2005, Dr Jesse Goodman, MD, MPH, and director of the Center of Biologics Evaluation and Research, stated that the FDA continually works “to support progress toward more modern, dependable methods of production.” In addition, he stated, the FDA in conjunction with the National Institutes of Health “will try to develop vaccines that could lead to longer lived immunity and to vaccines that help protect against multiple strains of influenza.” Currently, flu vaccines provide limited immunity for a limited number of flu strains, and thus require a yearly booster.

In that same statement, Dr Goodman noted that the FDA and Health and Human Services agencies believe that “More widespread vaccination during periods between pandemics not only has direct health benefits but also will increase vaccine production capacity and help America and the global community better prepare for an influenza pandemic.”

In some respects, it would seem that the desire of the CDC to broaden the scope of those for whom the flu vaccine is recommended would be linked to the FDA’s concern about flu of epidemic proportions and the ability to cope with such an emergency. In fact, Dr Goodman’s statement says that the “FDA’s goal is to establish a process to produce pandemic influenza vaccine in the shortest amount of time possible and protect the largest number of people, using a vaccine that is safe, effective and easy to deliver.” By increasing the government’s ability to produce, access, and deliver flu vaccines under normal conditions, gearing up for a pandemic flu would be less of a stretch. Still, like so many other medical solutions, there is no definitive answer as to the safety and usefulness of the flu vaccine for the general population at this time.

Dr Ofgang promotes a preventative approach to the flu season. “Eat right, get fresh air, and wash your hands. The stronger and healthier you are, the less likely you are to get the flu.”

There are homeopathic remedies, in which minute doses of particular natural substances are suspended, that relieve flu symptoms and natural remedies that can ease the symptoms of the flu without dangerous side effects, should a person succumb to the disease, said Dr Ofgang, as well as the adages of resting in bed and drinking plenty of fluids. Several over-the-counter homeopathic and natural remedies are available, as well, although they may not be as helpful as a remedy tailored to the individual.

“People should discuss the need for a flu shot with their physician and not just assume they should get it. Certainly, the amount of panic the last few years is way out of proportion to the effectiveness of the flu shot,” said Dr Ofgang.