Public Health Announcement

Tuesday, November 24, 2015


Well folks, it's the middle of November... somehow. I'm not sure how that happened, but here we are. November means lots of things. Cooler temperatures (at least in the northeast), boots get pulled out of the closet, pumpkin spice lattes abound (or in my case, caramel apple spices!), and Thanksgiving is right around the corner. However, a dangerous and much scarier event is also lurking right around the corner. In fact, it might already be here.

(Insert ominous music here!)

Imagine there is a disease that you can contract from someone sneezing at another end of the subway car that you're on. Imagine that this disease can occur throughout the year, throughout the world, and that the attack rate (or the biostatistical measurement of how fast a disease can spread in a population), is 10-15% for adults and 20-30% for kids. Imagine that this disease was expected to result in 3-5 million cases of severe illness (that can land even healthy people in the hospital, but is especially bad for the very young and very old), and that it will cause between 250,000 and 500,000 deaths. Imagine that this disease shows up, every year, without fail. Then imagine that there is a vaccine. Would you get it?

I would hope so.

Surprising probably no one, I'm talking about influenza. Influenza (or the "flu") has its peak incidence between December and February, but can occur as early as October and as late as May. It can also randomly pop up not during the "flu season," because influenza is a virus and it does not give a crap about your seasons. As a future physician, current public health degree-holder and enthusiast, and person generally in favor of people not being deathly ill, here are a few helpful tips, some busted myths, and some interesting facts about the flu.

No, You Can't Get the Flu from the Shot

You would think that by now, this myth would have died. You would be wrong. Last December, an article was published about a 2012 online survey in which 1,000 people were surveyed about their concern about the flu shot. Nearly 40 percent of the people surveyed believed that you could get the flu from the flu shot. Even when half of the group was given information from the CDC about the safety and efficacy about the flu vaccine, a bunch of people (statistical term, obviously) still were concerned, and a third of those surveyed said they wouldn't be getting the flu vaccine. 

WHAT? I would think information is power! Make better, more informed choices! Turns out that the more information you give people about vaccines and their safety, the less likely they are to get the vaccine. Figure that one out. As you probably know, trying to change someone's mind is intensely difficult, and the best tool we have, information, doesn't seem to work. 

The truth is, it is biologically impossible to get the flu from the shot, as what is in the vaccine is dead virus particles. Yes, you might feel crappy and your arm might hurt, but that's because even with dead virus pieces, we're activating your immune system, and we also just stuck a needle in your arm, so that might be sore. The good news is that you won't actually get the flu, and now that you got the vaccine, you're far less likely to contract the flu. All good things. (And I promise, your arm will stop hurting soon. Try some ice.)

If you opt for the nasal vaccine, FluMist, you will be receiving live-attenuated virus (which means we took some live flu virus and beat it up a bit, to make it less virulent), but you still can't get the flu from that. You might get stuffy, or even a bit of a cold, but you won't get the flu. I know that giving people this information is unlikely to change anyone's mind, but here it is. 

There is No Such Thing as the "Stomach Flu"

Lots of people will say that they have the stomach flu. They are lying, although probably unintentionally. I don't know how the phrase "stomach flu" got started, but the flu is a respiratory virus. Yes, some strains (H1N1, for example) can cause nausea and vomiting. Also, kids are usually more likely to experience nausea and vomiting with the flu. Symptoms of the flu include fever/feeling feverish/chills, cough, sore throat, muscle and body aches, runny or stuffy nose, headaches, and fatigue. Not everyone who contracts the flu will get a fever, however.

So, if you're puking up your guts, chances are, you don't have the flu. You probably have gastritis, and it's probably viral.

Semi-related: You probably don't have food poisoning. At least, probably not from food you JUST ate. Depending on the bug, it can take anywhere from an hour (if you've picked up Staphylococcus aureus, yes, the same organism responsible for MRSA) to 28 days (if you have Hepatitis A). So, wash your hands, make sure you cook meat until the internal temperature is high enough, and don't contaminate your work surfaces with raw meats. Oh, and while I was working on my MPH, our epidemiology professor told us one very important thing: don't eat the potato salad. It's always the potato salad.

Every Year is Different

Mazel tov, you have beaten the odds and have yet to get the flu. However, just because you haven't gotten the flu doesn't mean you won't ever get the flu. And yes, you do have to get the flu shot every year. Viruses, despite not being technically alive, are pretty smart, and they mutate. This is why sometimes, the flu shot "doesn't work". Scientists start building next year's vaccine a year ahead of time, because it takes that long to develop the vaccine. A network of labs all over the world analyze data and patterns, do a lot of math, cross their fingers, and hope that what gets spit out on the other end will be a vaccine for the major strains of the flu circulating in the coming year.

But like I said, viruses are smart, and sometimes, they outsmart us. Last year, lots of people were up in arms because "the flu shot didn't work". It did, just... not as well as we thought it would or would have liked it to work. That being said, just because a virus mutates doesn't mean that it completely changes its identity. Parts of the virus stay the same, and so the vaccine can confer some immunity, because our immune system is really good at picking up patterns. Even if you got the flu last year, chances are, if you were immunized, your illness was less severe and you weren't sick as long as you would have been without the vaccine. If you want to try and create a vaccine, check out this website. It's pretty fun, and it shows you just how complicated vaccine design can be!

You're Not Getting the Flu Shot for You

It's pretty great that you can get a vaccine and protect yourself from the flu, but it's even MORE awesome that you can protect lots of other people by getting yourself vaccinated. If you are over the age of 6 months, you should get a flu vaccine. (Also, to the 6 month old babies reading this blog, I commend your advanced skills, but you should probably work on like, rolling over or something. There's plenty of time for public health later.)

Here are the people who shouldn't get a flu shot:

- Kids younger than 6 months of age
- People who are allergic to the vaccine (this means eggs, gelatin, or any other vaccine ingredient)
... and that's about it. Here are the people who should REALLY get a flu shot:

- Kids between the ages of 6 months through 4 years

- People over the age of 50

- People with chronic illnesses like asthma, cardiovascular disease (except if you have high blood pressure), kidney disease, liver disease, neurologic conditions, blood disorders, and metabolic disorders (including diabetes!)

- Immunosuppressed people (like people who have had organ transplants, who have autoimmune disease, and those who have HIV or AIDS)
- Women who are pregnant, or who will be pregnant during the flu season

- People between the ages of 6 months and 18 years who are on long-term aspirin therapy (This is because being on aspirin and getting the flu can give you this other condition called Reye syndrome. No bueno.)

- People who live in nursing homes or other assisted living and chronic-care facilities

- American Indians and Alaskan Natives
- People who are morbidly obese (this means that your BMI > 40)

- People who work in health care

- People who live with or take care of or hang out with kids younger than 5 or people over than 50

- People who live with or take care of or hang out with people who have chronic medical conditions (like those listed above) who are more likely to have chronic complications from getting the flu

That list is a lot longer. And even if you don't think you fit into any of those categories, just think about all of the people with whom you come into contact every day. On the bus, in the grocery store, getting your coffee at Starbucks, touching doorknobs and keyboards and faucet handles all day... and there's no way to know if a little kid or an immunocompromised person or an elderly person (or really, anyone who is around any of those people) is also touching those things or sitting next to you on the bus or is behind you in line at the grocery store. 

By getting vaccinated, you're helping yourself, but you're also helping all of those people who need to be more protected. The reason vaccines work is due to herd immunity. This means that by getting vaccinated, you're helping ensure that people who can't get vaccinated, or who are at a higher risk of contracting an illness even if they are vaccinated, don't get sick. So get vaccinated, and you could save a life!

Here are a few more fast facts about influenza for you. You know, to share at cocktail parties and such. Trust me, you'll be super popular.

- You can't get the flu from going outside in the cold without a coat.
- The flu is not "just a really bad cold".
- You can still transmit the flu if you feel okay.
- For the love of God, don't take antibiotics if you have the flu. The flu is a virus.**
- Only certain people should get the FluMist nasal vaccine.
- Just washing your hands a lot is not enough to prevent the flu. (But still, wash your hands.)
- If you got the vaccine and still got the flu, it doesn't mean the vaccine didn't work.
- There is no link between the flu shot and Bell's Palsy.
- There is no link between the flu shot and Alzheimer's disease.
- There are egg-free, preservative-free, low-dose, and high-dose vaccine options.
- People die from influenza EVERY year.
- Getting the vaccine at ANY point during flu season helps reduce your risk. But earlier is better!

And if you want even MORE information, check out NPR's list of concerns and flu facts

I hope this post helped you learn about the flu, and I really hope that if you haven't gotten vaccinated yet, that you will at least think about it. If you don't have a primary care physician, the clinics at CVS and Walgreen's have the flu shot, and you can stop in on the way to work, on your lunch break, or when you're out running errands without making an appointment. (Note: I do not work for CVS or Walgreens, I just want people to not get the flu.)

tl;dr - The flu sucks. There is lots of misinformation out there. Read the CDC's website. Get vaccinated.

With much love,

Your friendly, neighborhood, public health advocate (and future physician)


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