This time of year, several times per day I ask patients if they would like to receive a flu vaccine. This elicits a variety of responses. I am often impressed by the passion that some patients display against the flu vaccine. There are also some people who are indifferent and others who want to get the flu shot as early as possible. Patients of advanced age are usually first in line to get the flu vaccine and may even get anxious if we are temporarily out of vaccine. Aging does often come with some wisdom of self preservation. But the people who seem to trigger a little countertransference are patients who immediately say, “No, I don’t do flu shots.” I will then respond, “What do you do? Flu?” When I ask why patients choose not to get the vaccine, a common response is, “Because I don’t want to get the flu.” My response to that is, “Neither do I, and that’s why I get a flu vaccine.” Another common response is, “I don’t get the flu.”. You mean you haven’t gotten the flu yet. When those people eventually do get the flu, they often express interest early the next season in vaccination. When a patient feels the flu shot gave them influenza, it is often a patient who received the vaccine too late in the season and who then was exposed to influenza.
Several years ago there was a major shortage of flu vaccine that coincided with a particularly aggressive flu season. That year many of my patients wanted the vaccine. I even had friends ask if I could get them flu shots. The demand resolved the next year when the flu vaccine was readily available. Human nature is certainly interesting. Tell someone they can’t have something and they want it. Tell them they need it and they reject it.
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A large portion of the public does not necessarily understand what the flu is. They often will say that when they got the flu vaccine they were sick all winter; however, none of that was due to influenza. Many people think gastroenteritis is “the flu.” The main symptoms of influenza are fever, headache, sore throat, cough, and myalgia. Not 1 or 2 of the symptoms but usually all at the same time. This makes you feel like you have been hit by a truck. Although the flu may last for a couple of days, it is usually significantly longer. I often see patients with symptoms for 7 to 10 days. Then there are those who sustain a serious complication of influenza such as pneumonia, which can be severe and life threatening.
The flu vaccine of 2014-2015 was less effective than other years. It was a less-than-optimal match for the strains that were prevalent, partly due to antigenic drift. Even if the vaccine was less effective, it still could potentially prevent or reduce severity of illness. In its worst years the vaccine may only be 25% effective. In a typical year 75% effectiveness is good.
If a patient says they don’t want the flu vaccine because it isn’t that effective, I use the following analogy. If you are managing the Yankees and you have 2 outs, bases loaded in the bottom of the ninth inning, and your clean-up hitter is due up, yet he is only hitting .250 or 25%, you wouldn’t decide to send up no one instead, right? You take your chance with the 25%. Just like you should do with the flu vaccine. At least it gives you a chance at protecting yourself, your loved ones, and even the community.
Ultimately , the flu kills, but the shot doesn’t.
