Sunday, September 21, 2014

NPM14: Giving Preparedness A Shot In The Arm


Photo Credit PHIL


Note: September is National Preparedness Month, and this is one of a series of new or updated preparedness articles I will be running for the occasion.


# 9098


While it is hard to quantify the absolute risks from any of them, in the nearly 9 years that I’ve been doing this blog, I don’t ever recall seeing as many infectious disease threats on the horizon as I do this fall and winter. 


In addition to the standard onslaught of seasonal flu (which can vary greatly in intensity each year) and our usual host of winter respiratory viruses (RSV, Adenoviruses, Rhinoviruses), we’ve got a rogue enterovirus sweeping across the nation called EV-D68, affecting mostly (but not solely) kids (see CDC EV-D68 Update & FAQ).




Another cause of `flu like’ symptoms, but less common than the winter respiratory viruses, are infection via one the vector borne diseases like West Nile Virus, Dengue and Chikungunya. 

What all of these have in common is that they can initially present as do most viral infections  – like a mild cold or the flu; Fever, malaise, body aches . . . sometimes accompanied by a cough or other respiratory symptoms.

All of which not only makes getting a firm diagnosis from your doctor (other than you’ve picked up `a virus’ ) problematic, it increases your chances of picking up `something’. 


Much, much further down the list of things to be worried about (at least in North America) are imported exotics like H7N9, H5N1, and MERS-CoV. 


Still, they cannot be ruled out completely, as 2 of the 3 have already happened this year (see CDC Statement On 1st H5N1 Case In North America & CDC : 2nd Imported MERS Case Confirmed In Florida), and public health officials continue to watch for additional cases.


With heightened scrutiny over these imported threats (not to mention Ebola), traveling while symptomatic (fever, cough, vomiting) may prove exceedingly difficult this fall.  Many international airports are screening passengers for fever, and showing up at the terminal with `flu-like symptoms’  just might get you bumped from your flight . . . or worse.


Making this year – perhaps more than ever before – a good year to go ahead and get that flu shot early.  


No, the shot won’t protect against any of these exotics.. The vaccine only offers protection against 3 or 4 pre-selected stains of seasonal influenza. Sill, flu is a relatively common severe winter respiratory virus – and claims tens of thousands of lives every year – making it well worth avoiding if at all possible.  


As we’ve discussed before, flu vaccines – while considered very safe – most years only offer a moderate level of protection against influenza. Their VE (vaccine effectiveness) can vary widely between flu shot recipients, and is often substantially reduced among those older than 65 or with immune problems.


In 2011, NFID - the National Foundation for Infectious Diseases - convened a group of experts to address the issues of influenza and the elderly. From that panel a 5-page brief has emerged, called: Understanding the Challenges and Opportunities in Protecting Older Adults from Influenza.


While the elderly generally see less protection from the flu vaccine, they state that older individuals may still mount a robust immune response. Even if the vaccine doesn’t always prevent infection in the elderly, studies suggest that the vaccine may blunt the seriousness of the illness in those over 65.


You might not have thought about it, but getting your seasonal flu shot each year should be part of your overall preparedness plan. During a disaster or prolonged emergency you are likely to be tired, stressed, and your immune systems could be weakened.


The last thing you need during a crisis is to be sick with the flu on top of it.


Which is why I’ve already paid a visit to my local CVS pharmacy and got my yearly seasonal flu shot.  The process (and the shot – nice job, Carol) were painless.


According to the CDC, more than 50 million doses of this year’s flu vaccine have already been distributed, so finding a shot should be no trouble.



September might seem a little early to be getting the flu shot, but we are already seeing scattered reports of influenza around the country, and it takes a couple of weeks after getting the shot for immunity to kick in. 


While the vaccine can’t promise 100% protection, it – along with practicing good flu hygiene (washing hands, covering coughs, & staying home if sick) – remains your best strategy for avoiding the flu (and other viruses) this winter. urges all Americans to follow these 3 steps to better preparedness:





Sage advice. But if you want to be truly prepared, I would add an important 4th step.

Get a shot


Anonymous said...

I am not so sure that giving a flu shot early is the best recommendation: I have read that protection from the shot is already substantially lower 6 months later, and with flu often experiencing a secondary peak in the spring, like it did this past season...might be worthwhile to investigate in your blog?

Michael Coston said...

The CDC's recommendation on this is on their What You Should Know for the 2014-2015 Influenza Season webpage

When should I get vaccinated?

CDC recommends that people get vaccinated against flu soon after vaccine becomes available, preferably by October.

It takes about two weeks after vaccination for antibodies to develop in the body and provide protection against the flu.

Doctors and nurses are encouraged to begin vaccinating their patients soon after vaccine becomes available, preferably by October so as not to miss out on opportunities to vaccinate.

Those children 6 months through 8 years of age who need two doses of vaccine should receive the first dose as soon as possible to allow time to get the second dose before the start of flu season.

The two doses should be given at least 4 weeks apart.

Anonymous said...

An an example of the literature I am referring to, see here:
It can really hurt in a flu season like last year, where there was a huge and very late second wave of flu illness. It certainly makes the optimal timing of vaccination much more complicated. I think September is likely too early - you are most protected for a month or two without any, or barely any, circulating flu...The CDC has to worry about more than "optimal" timing - they also want to ensure that people get the vaccine at all. And I certainly do wish everybody got their flushot! And many thanks for your excellent blog!!

Michael Coston said...

Thank you, yes.

I wrote about that study at the time in:

The effects were most prominent in the elderly, and that year was believed a sub-optimal vaccine match AND saw a late start to the flu season.

A `perfect storm' for vaccine failure.

The authors called the waning immunity a plausible explanation for the late-season decline in VE, but said other factors may have been at work as well.

Given that this phenomenon has only been well-documented (thus far) in the one flu season, and there are other factors involved, the CDC has not changed their advice.

They addressed these issues also in:

Should I wait to get vaccinated so that my immunity lasts through the end of the season?


Although immunity obtained from flu vaccination can vary by person, previously published studies suggest that immunity lasts through a full flu season for most people.

There is some evidence, however, that immunity may decline more quickly in older people. For older adults, another flu vaccine option is available called the “high-dose” vaccine, which is designed specifically for people 65 and older.

So, yes . . . I do understand your concerns, and why you may legitimately feel getting a later shot is better for you.

But I think we need to see more evidence - and have a better understanding of `why' the VE dropped - before the CDC can contemplate making a change in their recommendations.