My Thoughts On The Flu Vaccine

I have been getting a ton of inquiries about the flu vaccine.  Below you will find my thoughts.  As an integrative pediatrician, I try to look at both sides of this argument and present a balanced view. 

Here is how this blog will take you through the decision to Flu Vax or not to Flu Vax.

  • The Effectiveness of the Flu Vaccine
  • The Side Effects of Influenza Illness and Influenza Shot
  • Risk factors to be considered
  • Flu Vaccine ingredients and Flu Illness remedy ingredients
  • My take on the whole thing
  • Summary

Getting the Flu Shot for you and your family is a choice.

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How effective is the Flu Vaccine (2017-2018 Update)?

Generally, most seasons its 40'ish% effective, depending on how well matched the circulating strains are to the vaccine and how rapidly the influenza virus mutates (changes).  Vaccine makers have to predict one year in advance which circulating strain will be causing trouble.  

During the 2015-16 season, vaccine effectiveness was 47%, but for the 2017-2018 season, effectiveness is just 10% against the influenza A strain (H3N2) , according to the New England Journal of Medicine

The Pro Vaccine Arguments:

Of note, in past seasons when the flu shot was only 13% effective, it still prevented nearly 30% of hospitalizations that might have resulted, according to CDC calculations. For older adults, that rate was even higher, at 37%. Plus, the vaccine reduced outpatient visits by 42% that season.

 Studies reviewed found vaccination was associated with reduced oral steroid use and reduced severity in those with asthma exacerbations. 

Several studies show that vaccination of health-care workers prevents transmission of influenza in long term care facilities and in hospital settings.

In 2017 Journal of Pediatrics found that influenza vaccination was associated with reduced risk of pediatric death from the flu.  

The In-between Argument:

A 2014 Cochrane Database Review concluded that there was no clear benefit of influenza vaccination in patients with asthma.  But out of 26 studies, only one included a randomized, controlled trial, which did not show benefit from vaccination.  It demonstrated improvement in asthma-related quality of life.   No studies investigated preventing influenza-related asthma hospitalization. 

The Anti-Vaccine Arguments:

A 2010 Cochrane Database Review  suggested that in adults "Influenza vaccines have a modest effect in reducing influenza symptoms and working days lost. There is no evidence that they affect complications, such as pneumonia, or transmission."

To confuse matters more, we have this Article from Canada suggesting that there is an immune issue after the Influenza vaccine.  According to the study there was an increase in H1N1 Influenza confirmed cases in those who got the flu shot that season, which did not contain H1N1 strain.  This study shows an association and states that it cannot publish an actual conclusion.

I can go on and on with arguments from both sides and bore you to death.  We must move on.  

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Influenza Virus Effects

  • Pneumonia - 14%  (stats)
  • Asthma Exacerbations - 32% (stats)
  • Ear Infections, Sinus Infections (antibiotics, fever reducers)
  • Dehydration, Cough, Congestion, Body Aches - (rehydration fluids, cough meds, pain meds)
  • Hospitalization - (lots of medications, stress, and exposure to hospital bacteria/viruses).  A total of 17,101 influenza-associated hospitalizations ( October 1, 2017 and February 3, 2018).  The highest rate of hospitalization was among adults aged ≥65 years and children aged 0-4 years 
  • Death.  Out of 124,316 documented flu cases nation wide, there have been 63 pediatric Deaths and 2,989 total influenza related deaths

Fluzone and Flulaval (flu shots) Side Effects:

  • Pain (57%)
  • Redness (37%)
  • Swelling (22%) 
  • Irritability (54%),
  • Abnormal crying (41%),
  • Drowsiness (38%),
  • Appetite loss (32%),
  • Myalgia (27%),
  • Vomiting (15%), 
  • Headache (23%)
  • Arthralgia (13%)
  • Guillain-Barré syndrome (GBS) estimated the risk for GBS after vaccination is 1 or 2 cases of per one million of people vaccinated
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Risk factors to be considered

  1. Kids under 4 years and adults over 65 yrs old have the highest risk for hospitalization and complications from the flu
  2. Kids with chronic disease such as asthma, diabetes, heart disease, neurological disease are at the highest risk for complications and death.   Viral Surveillance
  3. Kids who are sick, are on antibiotics, or have poor gut health may mount a lower response to the flu vaccine then their counterparts.  Gut Health has been implicated in the effectiveness of the flu vaccine by the NIH
  4. Family history of severe adverse reaction to the flu shot needs to be taken into account
  5. Previous adverse reactions to vaccines needs to be considered
  6. Your occupation and the health of those around you is important.
  7. The reality:  people don't wash their hands frequently, don't cover their cough/sneezes, and they go to day care/school/work while ill and contagious. 
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THE FLU VACCINE INGREDIENTS. 

The Flu Shot Ingredients

Flulaval Vaccine 0.5-ml vial Inactive Ingredients (2017 manufacturers insert) :

  • ovalbumin (≤0.3 mcg),
  • formaldehyde (≤25 mcg),
  • sodium deoxycholate (≤50 mcg),
  • α-tocopheryl hydrogen succinate (≤320 mcg),
  • polysorbate 80 (≤887 mcg) 
  • Thimerosal or Mercury - NONE in single dose vials.  Multi dose vial still contain Thimerosal of 12.5micrograms per 0.25ml.  Make sure you ask your provider about this detail.

Antibiotics are not used in the manufacture of this vaccine.

Influenza (Fluzone) Quadrivalent Inactive Ingredients (2017 Manufacturer's Insert):

  • 0.5 mL dose: ≤100 μg formaldehyde,
  • 0.5 mL sodium phosphate buffered isotonic sodium chloride solution
  • and ≤250 µg octylphenol ethoxylate (Triton X-100)
  • thimerosal (multi-dose vials only)

Antibiotics and gelatin are not used in the manufacture of this vaccine.

THE FLU REMEDIES INGREDIENT LISTS: 

 

My take on the whole thing:

The flu shot provides some protection depending on the season.  For this season, 2017-2018, the protection is not great for Flu A, it is ok for Flu B.  There is some reduction in transmission of influenza virus in those vaccinated, especially for those working in nursing homes, medical settings, day care settings, and schools.  It's not perfect, but it helps. 

According to the Centers for Disease Control and Prevention, the flu virus can travel six feet on droplets from coughs, sneezes or talk.  A cough contains 200 million viral particles.  Those infected can spread the virus 24-48hr before symptoms develop and for a week or more after getting sick. Less often, flu is spread by touching a contaminated surface, then touching one’s eyes, nose or mouth.  Viral particles last for hours on paper, and days on plastic and metal.

Flu shots have side effects as do flu remedies.  For example acetaminophen has been linked to increased rates of asthma (AAP).  There is a strong connection between antibiotics and asthma (AAP) and eczema (British J of Derm).

Reducing the risk of getting The Flu reduces:

  1. the risk of pneumonia, asthma, ear infections, hospitalizations, and death. 
  2. the use of flu remedies such as Tamiflu, Amoxil, Steroids, Acetominophen (Panadol/Tylenol), Ibuprofen, Dimetapp, Gatorade

The immune system is a complicated process.  It depends on the person's nutrition, sleep, stress, fitness, life style habits, living situation, school/work situation, previous illnesses, family history, chronic medications, skin care products, cleaning products, mold exposures, and so on.

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When considering the Flu Shot, consider the entire picture.  

  • My Family: after reviewing the data annually, we get the flu shot.  We have cleaned up our nutrition, skin care, cleaning products, boosted our gut health and immune system as well.  I choose less ingredients.
  • Risk of death
  • Risk of hospitalization
  • Age of children and family members
  • Health condition of children and family members
  • Nutrition habits
  • Life style habits
  • Gut Health
  • Compare all ingredients.  The vaccine has ingredients that make it a viable vaccine.  Is it a spectacular list? No.  Can it be better?  Yes, says the person who does not manufacture vaccines and prefers essential oils and nutritious food.  But consider and compare all the ingredients in medications,  supplements, and fluids used to treat the flu.  If you refuse the Flu Vaccine due to "ingredients" that is your choice, but will you chug Tamiflu and ignore those ingredients?  What about acetaminophen?  Will you give that to the kids every 4 hours to reduce fever while knowing that there is a strong association between acetaminophen and asthma?  Will you continue using products containing formaldehyde? 
  • The Flu Shot is a choice. Make it wisely!