An ongoing dialogue on HIV/AIDS, infectious diseases,
January 28th, 2015
Quick Question: Should We Still Be Recommending This Year’s Flu Vaccine?
From a football-obsessed primary care provider, written to me on one very snowy day in New England:
I’ve been reading about this year’s flu vaccine, and how ineffective it is. Not surprisingly, my patients have been hearing this too, and it has only increased their reluctance to go through with it. Should I just cut my losses and stop recommending it this year? Seems we have much more important things to worry about, such as measles in Disney and deflated footballs.
p.s. I think the Pats are really geniuses. And they realized that if they pump the balls to 11.5 PSI right before the game, then heat them (microwave? hair dryer? ) to get up to 12.8 PSI, then hand to the refs who measure at at least 12.5 PSI, then let them cool down for a while. And, as with taxes, if it doesn’t say you can’t do it, then you can do it. Genius.
The quick answer is yes, we should still be recommending it, but I share your pain. (I mean about the flu vaccine, not about Deflategate.) My experience this year is that when I suggest a flu vaccine, my reluctant patients not only decline, but look at me as if I’ve recommended that they undergo a colonoscopy without sedation. You must be kidding me, everyone knows this year’s vaccine is a dog.
So why recommend it? First, it still works some of the time, even if the H3N2 match isn’t good (there are influenza B strains as well that are included in the vaccine). 23% effective is better than nothing, which means that these 23% not only won’t get sick with flu themselves, but they won’t spread it to the people who are the most vulnerable (the very young, the elderly, and pregnant women).
Second, there’s really nothing else out there that works, unless you want to take oseltamivir continuously, all flu season — this is not recommended, and would be very expensive. I suppose our patients could seal themselves off in a polyurethane bubble until Spring — which would be particularly difficult if they like to ski.
Third, there’s at least a little evidence that even if the flu vaccine doesn’t work, it might attenuate the severity of clinical influenza, reducing the risk of pneumonia and hospitalization. As an optimist, I plan to believe this last item until someone proves it’s not true.
Your email also gives me a chance to link a truly outstanding review over on Medscape called, Why is Influenza So Difficult to Prevent and Treat? It’s an interview with two experts in the field, Drs. Andrew Pavia and Gregory Poland, and really the title should have been expanded to “Why is Influenza So Difficult to Predict, Prevent, and Treat?” I always get asked about the upcoming flu season by my friends, and the honest answer is — WE HAVE NO CLUE.
The Medscape piece is top-notch, a very readable update on these issues. I learned a lot about this tricky infection, including the key fact that if we delayed choosing the strain for next year’s vaccine for a few months, we’d probably have a better vaccine match from year-to-year. Plus I was introduced to the seat belts analogy, which goes like this: “Seat belts may not protect from high-speed crashes all the time, but some protection is better than none.” Exactly!
So go ahead and continue to recommend it. I find that if my patients balk, I don’t push it, but better to have a uniform medical position on flu vaccine than to waffle.
And about that game on Sunday — 20 days until pitchers and catchers report for Spring Training.