The flu season may be winding down, but it’s not too soon to start thinking about the next one — and what all of us must do differently if we are to avoid a repeat of the epidemic of the past few months.
Up to 20 percent of Americans get the flu each year, according to the Centers for Disease Control and Prevention. More than 200,000 are hospitalized, and on average, 36,000 die as a result. These victims are not just the chronically ill or elderly: About 100 children die from the infection annually, and 20,000 are hospitalized. Most of these youngsters were perfectly healthy before this unpredictable virus struck.
Although most flu victims recover within a few days to two weeks, some develop debilitating, even life-threatening, complications: pneumonia, bronchitis, sinus infections or ear infections. Even after recovery, the flu can cause lingering postviral fatigue and weakness.
Despite all this, only a minority of U.S. adults, and fewer than 1 child in 5, receives an annual vaccination, the best protection against the flu.
Perhaps more people would get immunized if they knew all their options, especially the various kinds of flu vaccines now available and how to find local, low-cost or free sources.
It takes about two weeks for the flu vaccine to be fully protective, and the best time to get it is in September or early October, before flu season begins in the United States. But even after the flu becomes widespread or is on the wane (it can continue to make people sick until sometime in May), the vaccine can be protective.
Four types of flu vaccine protect against the three variants of the flu virus — two versions of Type A and one of Type B — that experts expected to be the predominant culprits in the current flu season.
A fifth vaccine, which protects against four variants — two Type A’s and two Type B’s — has recently been approved and should be available later this year. An unexpected surge in a Type B variant that was not in this year’s vaccine caused many cases of flu this season and infected some people who had been immunized.
The traditional flu shot is an injection into the muscle, usually in the arm. It consists of killed viral particles that stimulate an antibody response in the body. Typical side effects are soreness or swelling in the injected arm and, in some people, symptoms that resemble the common cold: runny nose, headache, sore throat, cough or achiness.
A high-dose version of the traditional shot is available for people 65 and older, who typically have a less robust response to immunization than younger adults. The higher dose of antigens it contains can produce a more protective response from an aging immune system.
An intradermal vaccine given under the skin with a smaller needle is available for adults ages 18-64. It contains the same viral particles as the traditional shot and is preferable for people who avoid immunization because they hate shots.
A nasal-spray vaccine, called FluMist, is licensed for people ages 2-49 who are healthy, not pregnant and not in close contact with people with compromised immunity. Unlike the shots, it contains live, weakened flu viruses that cannot cause the flu because they can’t reproduce in the human body. The nasal spray is ideal for children as well as young adults who are phobic about shots, although it may cause more flulike side effects, like runny nose, headache, fever, sore throat and muscle aches.
Children younger than 9 who are receiving flu vaccine for the first time should get two doses administered at least 28 days apart, preferably starting as soon as the vaccine becomes available in the fall. The first dose primes the immune system; the second stimulates an immune response. Either dose can be administered as a nasal spray or a shot.
Some young children who were immunized in previous years may also need two doses this year or next because a particularly virulent variant, the 2009 H1N1 virus, was not in vaccines produced before the 2010-11 flu season.
The potential value of flu vaccine for women who are pregnant or planning to become pregnant was emphasized by a recent report from Norway, where researchers found a near doubling of the risk of fetal death among women who got the flu during pregnancy.
But some people should not be vaccinated: those with a severe allergy to eggs or who previously had a severe reaction to a flu shot; people with a history of Guillain-Barre syndrome that occurred after getting the flu vaccine (unless the flu itself poses a serious health risk to them); and babies younger than 6 months.
In addition, if you are moderately or seriously ill with a fever, you should wait until you recover before getting a flu shot.
For help in finding a vaccine provider, use the vaccine locator and enter your ZIP code.
Experts agree that better flu vaccines are needed, and several possibilities are under development or awaiting government approval.
But even with the less-than-perfect versions now available, the benefits of immunization clearly outweigh any risks, Dr. Thomas R. Talbot, an infectious disease specialist at Vanderbilt University School of Medicine, said in an interview.
Inevitably, some who are vaccinated will fall victim to the flu anyway. At the first hint of illness, go home and stay home. Avoid other people as much as possible, especially those who would be at high risk of serious illness if they were to catch the flu.
Consider asking your doctor to prescribe one of the two approved anti-viral medications that can help reduce the flu’s severity and duration.
One is Tamiflu (generically, oseltamivir), available as a pill or liquid, and the other is Relenza (zanamivir), sold as a powder that is inhaled (it is not appropriate for people with respiratory disease). Both are taken for five days, and both can safely be used by children and pregnant women.
The medications work best if started within two days of the onset of flu symptoms and should be given as early as possible to people who become very sick with the flu or face the possibility of serious complications from it.