Get Your Flu Shot, Before the Flu Gets You Simple prevention for a potentially serious illness

On a bone-chilling, wintery Friday evening you have a horrible sore throat. It has turned your commute home from a mindless routine into a trek that feels like it might never end. You took ibuprofen around lunch, but it’s starting to wear off and every swallow feels like tiny razorblades slicing their way through your throat. You start feeling clammy under your winter jacket and work clothes. Your eyelids feel hot and heavy. The front door of your home is in view but passing that threshold feels harder than summiting Mt. Everest.

Finally, you get inside, put on comfy clothes and settle in on the couch. You spend the next few days feeling like you’ll never leave the couch again. Your nose is clogged, your throat feels raw and your body temperature fluctuates faster than you can cover up or kick off your blankets. You haven’t moved from that spot in days, as you lay in an ever-growing pile of tissues.

As the weekend turns into the work week you make your way to the doctor’s office. The waiting room is packed with people spewing germs, just like you. The doctor takes a swab and sticks it up your nose. After 15 minutes the test confirms what you already knew. It’s the flu. As you miserably make your way back home, death feels closer than returning to work.

But, as the days blend into a haze of sleep, soup and tissues, you start to feel better. You return to work and within a few days you barely remember the nasty bout of illness. However, not everyone that falls ill with the flu is lucky enough get better. The flu, even in this era, can be fatal.

Same Symptoms, New Strains

Every fall, Americans begin to prepare for the upcoming flu season. People stock classrooms and offices with hand sanitizer, add vitamin C supplements to their diet and hope they do not fall ill. Despite best efforts, the flu predictably comes around every October and lingers until May. However, the severity and strain of flu is unpredictable. Some seasons, like the 2010-2011 season, are mild and see under 10 million infections when others, like the 2017-2018 season, 49 million fall ill.

The CDC uses mathematical modeling to get these estimates. These estimates include deaths linked to influenza from the virus, complications and secondary infections.

The flu is a respiratory infection caused by the influenza virus. It commonly results in fever or feeling feverish/chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches and fatigue. These symptoms usually last a week or two. However, people can be contagious up to 24 hours before they start showing symptoms and can still pass it to others for up to a week. It is spread through respiratory droplets. These are released into the air or left of surfaces each time someone infected coughs, sneezes, talks or breathes.

Patients with flu-like symptoms typically have their nose or throat swabbed. These tests look for the flu virus and what type it is. Flu infections can be difficult to detect because someone can have the flu with no symptoms, but these carriers are still contagious and can get other people sick.

The flu is a virus, so it cannot be treated with antibiotics, which means prevention is the best way to reduce flu frequency and severity, according to the CDC. Vaccines are the best prevention, according to the United States Surgeon General, Dr. Jerome Adams MD, MPH.

There are four types of influenza. Influenza A, B, and C occur in humans and influenza D is known to infect animals. Influenza A and B are responsible for the seasonal flu, with influenza A being the cause of a vast majority of those infections. Influenza A, which can appear in humans and animals, is classified by its hemagglutinin (HA) and neuraminidase (NA) protein’s classification. There are 18 versions of HA and 10 versions of NA. Once the HA and NA protein are identified and that becomes the strain name, like H1N1 (swine flu) or H1N5 (avian flu).

Vaccine Myths

Less than 50% of adults and 63% of children get a flu vaccine in the United States, according to the CDC. Many people refrain from getting a flu shot because they think it is not effective. However, as a result of year-round trend tracking microbiologists, epidemiologists, physicians and other public health experts create a vaccine that is typically 60% effective in preventing the flu.

There are seasons, like the 2017-2018 season, when rumors spread that the vaccine was ineffective, because it did not prevent against the strain circulating in Australia. Australia and the southern hemisphere's flu season happens before the northern's flu season so it is one part of what is looked at to predict the United State's flu strain. Despite claims of ineffectiveness, health officials encourage people to get their flu shots by stating, “some effectiveness is better than no effectiveness.” Even if the vaccine is not perfect it can still help prevent the flu or reduce the severity.

Another misconception that stops people from getting the vaccine is that it can make people sick. Flu vaccines are created using an egg or cell cultures to grow flu viruses, according to the U.S. Food and Drug Administration (FDA). The virus is then killed or weakened, depending on the vaccine type, and added to the vaccine. Because a killed form or single strain version of the virus is used in the shot it is impossible to get sick from that form of the vaccine. However, the nasal flu vaccine only has a weakened version of the virus, so it is possible for someone to get sick from it, which is why it is not suggested for young children, adults over 65 or anyone that is immunocompromised.

It is common for people to experience low grade fevers, fatigue and muscle aches as a side effect of the flu shot. This is a response of the body’s immune system building resistance to the virus. It is also possible to get the flu within the two weeks of getting the vaccine because the body has not yet built immunity.

The typical flu season in the northern hemisphere begins in late fall and lasts until early spring, with peaks in January and February, according to the World Health Organization (WHO). The flu season runs from June through October in the southern hemisphere. In tropical regions the flu can appear at any time with no consistent increase at any time of year.

There are three main theories to explain why the flu falls in the winter in each hemisphere, according to a Harvard study. One theory is that people spend more time indoors with the windows shut so people are more likely to come in contact with the infection. The second is that humans have less exposure to vitamin D in the winter months which leads to a weaker immune system. The third theory is that the virus survives better in cold and dry climates.

Seasonal Impact

Flu shots are between 40-60% effective in preventing the flu. Because of the flu's unpredictable severity, there are a variety of flu vaccine options that aim at protecting as many people as possible.

There are two main types of flu vaccines; trivalent and quadrivalent. The trivalent vaccine protects against two strains of influenza A and one of influenza B and the quadrivalent vaccine contains two strains of influenza A and two of influenza B. Beyond those differences the quadrivalent vaccine has a non-egg option for individuals with egg allergies and a nasal version with an extremely weakened live version of the virus.

For most Americans the positive effects of the flu vaccine outweigh the risks. In 2017-2018, almost 80,000 people died as a result of the flu, according to the CDC. Children accounted for 180 flu fatalities; 80% of these children were not vaccinated.

The CDC does not require states to report flu deaths in adults over 18-years-old. Many flu and flu related death certificates do not have flu listed as the cause of death because many people seek treatment after a flu test is not viable or because they die from a secondary infection or flu related complication.

Adults 65 and older, infants and children, and pregnant women are the most critical groups to get vaccinated because infections can be more severe or cause complications. Older adults and young children tend to have weaker immune systems. This makes them more susceptible to the flu and also makes them more likely to have complications or secondary infections. The flu can also be dangerous for pregnant women because pregnancy already affects the immune system, heart and lungs. As a result, if pregnant women get the flu their infection is more likely to be severe. This can lead to hospitalization or death. It can also affect the fetus and cause miscarriages or preterm labor.

Even with these vulnerable populations being vaccinated more than the general population, there are still groups of people that cannot get a flu vaccine because of age, other illnesses and allergies. This is where community immunity becomes important.

Community immunity is when “a sufficient proportion of a population is immune to an infectious disease (through vaccination and/or prior illness) to make its spread from person to person unlikely. Even individuals not vaccinated are offered some protection because the disease has little opportunity to spread within the community,” according to the CDC.

The World Health Organization suggests that every person over six-months-old gets a flu vaccine, unless an individual has a serious allergy to a component of the vaccine. There are other rare cases where someone should not get a flu shot and the CDC recommends people with concerns about that work with their healthcare provider to address these issues.

This Flu Season

It is unclear how severe the 2019-2020 will be. However, pneumonia and flu were responsible for 5.8% of deaths for the final week of the decade, according to the CDC. There have also been 32 pediatric influenza-related deaths this season.

It is estimated that there have been 9.7 million flu illnesses, 87,000 hospitalizations and 4,800 deaths from flu this season, according to the CDC. The flu typically peaks in January or February, so it is not clear yet if flu activity has peaked this season. The CDC still recommends people continue getting their flu shot if they have not already done so.

Vaccinations eradicated smallpox and almost completed stopped the spread of measles, mumps, and rubella in the United States because almost everyone that could get a vaccine did. The flu shot cannot eradicate the flu because the influenza virus is always changing, but it can vastly reduce the spread and severity of flu.

Common misconceptions make the flu seem like an inconvenience that can be treated with sleep, fluids and ibuprofen. It is easy to think the flu hasn’t been severe since Swine-09 or lethal since the 1918 flu pandemic, but that is far from the truth. The flu has the capability to kill tens of thousands of people each year and the best way to prevent the spread of flu is for each eligible person to get the flu shot.

Millions of people will be able to return to school and work after a few days in bed, but for thousands of Americans, from infants to the elderly, will fall sick from the flu and die from their illness or a secondary infection.


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