It is positively anti-social to cough and sneeze these days.

Flu shots for 2020-2021?  We know that not everyone gets a flu shot, but we have begun to get notices that it is time to schedule an appointment to get the flu vaccine in late September.  Articles are suggesting that more people than usual will get flu shots this year because many are especially cautious about upper respiratory infections in a time of COVID-19.  Flu and coronavirus in the same season could be a ‘twin-demic’.  If a person is unlucky and gets the flu, there will be pressure to stay at home – it is positively anti-social to cough and sneeze in public these days.

We are not medical professionals – you should always discuss medical decisions with your own doctor – but here are some things to think about when considering flu shots.

When should we get the vaccine?

  • The flu season in the northern hemisphere generally runs from December to March, but it can vary year to year, and begin as early as September, and go as late as May.
  • It takes about two weeks after getting the vaccine for your body to build up immunity to the flu virus.
  • The immunity you create is most protective for about six months, so don’t start too early in the season.
  • Most flu vaccines are determined by a committee that meets twice a year to review global surveillance (from ~100 countries). They meet once for the northern hemisphere and once for the southern (essentially) and then start production of vaccinations. If you are traveling, it is important to get a new flu vaccine. We suspect 2020 will not be a big year for travel, but if you are relocating, particularly outside of the US, it is a good idea to get a local flu shot. Each country takes the recommendations of a WHO working group, and local and global flu surveillance data, and then creates the ‘optimal’ flu vaccine for the strains they believe will be present in their country. Occasionally countries can have very different strains of flu circulating even in the same year.

What kind of vaccine?

  • It is important to emphasize that we are talking about the seasonal flu vaccine. This is what is most commonly referred to as a ‘flu shot’, but it likely will not protect you against rarer strains of flu such as the swine or avian flu you may have read about. The ‘flu shot’ has the best chance of protecting you against the most common standard ‘flu’ in circulation each year. Always discuss options with your doctor if a new flu or disease is emerging in your area and you think you may need to be vaccinated.
  • Be thoughtful about which vaccine you get – not all are created equal. Flu vaccines typically cover three to four viruses and can come in many strengths and types of administration. In general, the standard ‘quadri-valent’ vaccine is appropriate for adults without serious underlying conditions. If you are nervous about the vaccine or feel you have reacted to it badly in the past, be sure to discuss your options with your doctor before getting the “standard” flu shot being offered at your office or pharmacy. There may be a different dose or type of vaccine that would be most appropriate for you.
  • There is a preservative-free flu vaccine that you can ask your health professional about without the usual preservative, mercury based Thimerosal which is used to prevent bacterial contamination when multiple doses of the vaccine come from a vial.  When your shot comes from a single-dose vial, it does not need to contain the preservative.
  • If you are allergic to eggs, there is a vaccine available which does not contain egg.
  • There may be a nasal spray vaccine option, ask your doctor about its efficacy. Nasal spray vaccines are made in a slightly different way than the other types of flu vaccines and are only appropriate for some people. The nasal spray is a live, attenuated virus vs dead viral particles – so it’s really not recommended for patients over 50, under 2 or who have underlying health conditions as there is a very small chance it could cause flu-like symptoms more strongly and/or a VERY SMALL chance it could actually mutate to become virulent flu.

Who should get the flu vaccine?

The CDC recommends everyone 6 months of age and older get vaccinated every flu season. Children 6 months through 8 years of age may need 2 doses during a single flu season.  Everyone else needs only 1 dose each flu season.

From the CDC: “Anyone can get the flu, but it is more dangerous for some people. Infants and young children, people 65 years of age and older, pregnant women, and people with certain health conditions or a weakened immune system are at greatest risk of flu complications.

Pneumonia, bronchitis, sinus infections and ear infections are examples of flu-related complications. If you have a medical condition, such as heart disease, cancer or diabetes, flu can make it worse.”

There are people who do not have access to flu vaccines, or who, in rare cases, cannot tolerate the vaccine. The best protection for these people is to reduce the total amount of virus present in society, what is referred to as the “viral reservoir”. The more people who are vaccinated, the fewer chances the flu has to infect people, create more copies of itself and potentially spread to others. People are typically most infectious the first three to four days they have the flu, and many don’t recognize the symptoms immediately and can continue to spread the disease.

Availability of the flu vaccine?

Nobody can predict how many people will get vaccinated this year, but it is likely to be a greater number than in non-COVID-19 years.  If you are planning to get vaccinated, don’t leave it too late.

Interview with Dr. Fauci on a possible ‘twin-demic’, COVID-19 and Flu

Dr. Anthony Fauci, MD, the country’s top infectious disease specialist, gave his perspective on the confluence of the Covid pandemic and the approaching seasonal flu season.  He describes several public health scenarios from a season with a very active strain of flu combined with ongoing Covid infections – to a season in which ongoing Covid respiratory infections ‘crowd out’ the seasonal flu virus and we have a mild flu season.  Interview with Dr. Fauci

In fact, in some countries in the southern hemisphere they have reported as much as a 90% drop in the number of seasonal flu cases reported this year versus last.   This is by no means a guarantee for the northern hemisphere, but between good hygiene, social distancing, and widespread adoption of the flu vaccine, we can all hope for that best-case scenario.

New York Times flu shot article

Find flu shot providers in your area.

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