By: Heather Williams

Aaaachhooo!  You wake up with that tell-tale sore throat. Oh no! Aches and joint pain, headache, dry cough, runny nose and watery eyes.  It’s the flu…  But how?  You instantly start thinking about the co-worker coughing down the hall, or the sneezing sales associate at the store.  Regardless of the cause, it’s time to take care of yourself and help to prevent others from getting sick from you.  “I guess I should have gotten the flu vaccine,” you think to yourself. Then pause…  “Wait.  I did get the flu vaccine!” It was offered at work.  In fact, most of your co-workers probably also got vaccinated.  Then, how does the flu keep spreading?

There are two answers to that question.  First, not everyone can or has been vaccinated for the flu. Second, the flu vaccine (even on a good year) does not guarantee immunity.  In fact, the vaccine is often less than 50% affective.  This flu season is shaping up to be the worst we have seen in a long time.

Flu Statistics

According to the Center for Disease Control and Prevention (CDC) the flu virus has taken an early start, reaching 46 states in the last week of 2017.  While statistics move up or down from year to year, the CDC reports cases of influenza range anywhere from 9 million to 35 million cases each year since 2010.  This leads to 140,000 to 710,000 hospitalizations and between 12,000 and 56,000 deaths in the United States each year.  This year the flu virus is evading the vaccine, pushing statistics toward the high end.  According to the CDC, the majority of patients tested have been infected with a different strain of flu virus than the vaccine protects against.  The nasty H3N2 flu is linked to increased hospitalizations and deaths in young children and those over 65 years old.

Flu Vaccine Effectiveness

How effective is the flu vaccine anyway?  Believe it or not there are published statistics on this.  The information is gathered based on flu vaccination data, laboratory test data, and patient information.  As the virus begins to move from person to person, it begins to mutate and change, sometimes exceeding the protection of the vaccine.  Other times the projected strains are not even the ones that end up circulating in the population.  More on that in a bit.

For now, let’s look at what the statistics say.  The flu season generally spans from October through May, often peaking between December and February.  For this reason, you will see flu data include 2 years.  Check out the table below for previous year’s statistics:

2004 to 2005 Season 10% effective
2005 to 2006 Season 21% effective
2006 to 2007 Season 52% effective
2007 to 2008 Season 37% effective
2008 to 2009 Season 41% effective
2009 to 2010 Season 56% effective
2010 to 2011 Season 60% effective
2011 to 2012 Season 47% effective
2012 to 2013 Season 49% effective
2013 to 2014 Season 52% effective
2014 to 2015 Season 19% effective
2015 to 2016 Season 48% effective
2016 to 2017 Season 39% effective

While we won’t have all of the data in until the flu season is over, the current rate of effectiveness is only about 10%.  With an average effectiveness from year to year of 40.8%, 10% is a terrible rate.  You may ask, “why can’t the vaccine be 100% effective?”  The answer to that question stems from how the vaccine is made and the nature of the virus.

Making a Flu Vaccine

Unlike measles, mumps, or any of the other vaccines you get as a child, the flu virus is a highly mutable virus.  That means that while there may be just a few types of flu (Type A and Type B for example), the virus doesn’t reproduce itself very well, causing minor changes here and there as it spreads.  This generates many different strains of flu that will be floating around throughout the flu season.

The flu vaccine attempts to take these factors into consideration.  Each season a new vaccine is produced in anticipation of what it expected to circulate that season.  That’s right.  They take this years data, make an educated decision on what trends could happen the following year, then produce a flu vaccine for the three most likely strains.  While it might seem blind, some protections might be possible.

The process begins with data collected from patients presenting flu symptoms.  If you have ever been tested positive for the flu, you helped make the decision for the following years vaccine.  Maybe something positive came from your chapped nose after all.  Data is collected and genetically identified.  New mutations are indicated and all of this surveillance data is passed on to the World Health Organization.  This organization is responsible for selecting the three strains most likely to match the next winter flu season.  This could lead to new strains in the vaccine or sometimes the same strain is expected to persist so it stays in the vaccine.

Within 4 to 5 months of vaccine strain identification (around summertime), the three vaccine strains undergo testing.  Researchers are verifying potency and purity.  When all three passes, they are combined into a single vaccine.

Why can’t they make the vaccine as they go?  Producing a vaccine isn’t something that can be easily done overnight.  It can take up to eight months from selecting the strains to final product availability.  Occasionally, a need arises for a faster turn-around-time.  In 2009 H1N1, better known as Swine Flu, became a pandemic.  In cases where a strain is identified to be especially virulent or widespread, the vaccine for that virus can be created.  A separate vaccine was created and disseminated to help mitigate the spread of the virus.  I’m not sure if this season’s H3N2 will prompt such a reaction, though the severity leads me to watch this issue very closely.

Spread of Flu Virus

The flu virus is spread through infected respiratory droplets.  Someone who is sick finds themselves coughing or sneezing, sending this assailant airborne.  These microscopic drops of doom get breathed in by an unknowing victim, land on surfaces around unsuspecting people who then put their hands in or around their mouths or eat without washing their hands.  And now the virus has a new host to torment.

Unfortunately, the illness coaxes the host to further spread the virus.  When a person gets knocked down with muscle aches and fever, a caregiver finds themselves easy prey for the virus.  The illness makes you cough, releasing the virus into the air to those closest to you.  Sometimes people are lucky enough to be infected and not show symptoms.  Sadly, this does not mean the unhappy chain letter ends with you.  An asymptomatic person can still be contagious.

What to Do If You Have the Flu

If you have the typical symptoms, muscle and joint pain, headache, cough, sore throat, runny nose, etc., you might find yourself suffering through and just treating the symptoms.  Identifying the illness early can allow you to seek antivirals from your doctor that will help you recover more quickly, but this must be done very early.  The best way to treat yourself is getting plenty of fluids and rest, fever and pain reducing medications such as acetaminophen or ibuprofen, and cough medicines can help ease your symptoms until the virus runs its course.

You might not need to seek any medical attention unless you begin having trouble breathing or shortness of breath, pain or pressure in your chest or belly, confusion, sudden dizziness, or severe vomiting.  If you are in the higher risk category of the very young, over 65, or have a compromised immune system, you should seek medical treatment to reduce the risk of additional complications.  Pneumonia is a common complication of the flu virus and can be serious or life threatening.  Additionally, the environment the flu thrives in can also leave you susceptible to bacterial infections which can lead to sinus infections, ear infections, and even chronic pulmonary diseases and inflammation of the heart.

Do I Vaccinate or Not?!

The flu vaccine was added to the United States childhood immunization schedule in 2004, so chances are you have been asked several times if you wish to be vaccinated and if you wish for your child to be vaccinated.  Some workplaces and childcare institutions may even make this a mandatory vaccine.  It is recommended that the vaccine be administered each year after six months of age and annually after that.

If given a choice, should you vaccinate?  That is a very personal question that should be answered based on your own risk factors and personal choice.  Each exposure to a strain of the virus could protect you from future infection of that particular strain, so there is a benefit.  But the choice is ultimately yours.

 

Sources:

https://www.webmd.com/cold-and-flu/adult-flu-symptoms

https://www.cdc.gov/flu/professionals/vaccination/effectiveness-studies.htm

https://www.cdc.gov/media/releases/2017/p1213-flu-death-estimate.html

https://www.historyofvaccines.org/content/articles/influenza

https://www.usatoday.com/story/news/2018/01/09/deaths-and-hospitalizations-rise-flu-season-hits-full-swing/1017898001/

https://qz.com/1143420/the-2017-2018-flu-vaccine-is-less-effective-than-usual/