Q: Shouldn’t I worry more about Ebola this year than the flu?
A: Ebola is due to infection with the RNA Ebola virus. The almost 15,000 people infected and more 5,000 deaths in West Africa, as well as the small number of cases here in the United States, have brought concern from the American public.
If this concern leads to better knowledge and understanding of the disease and action to combat its spread, this is a positive thing. Ebola is spread by contact with body fluids from a patient after they have become symptomatic. Although there is as yet no Ebola vaccine, work is being done to develop one. When it is available, people at risk will be encouraged to get immunized.
The flu is also due to an RNA virus, but from the influenza virus. Worldwide the World Health Organization estimates that 3 million to 5 million people are infected with the flu every year, leading to 250,000 to 500,000 deaths. In the United States, there are, on average, 200,000 people hospitalized and 20,000 to 35,000 deaths every year.
The flu is transmitted by droplets from an infected person (from coughing, sneezing, etc.), or when the infected person has droplets on their hands and touches something that is then touched by someone who infects themselves by touching their own mouth or nose. Flu patients can be infectious a day or so before they develop symptoms and up to a week after they become symptomatic.
There is a flu vaccine, and the Centers for Disease Control and Prevention recommends it for everyone over age 6 months old, yet less than half of eligible Americans get it.
Symptoms of the flu can include fever, sore throat, cough, body aches, congestion/runny nose, fatigue, headaches and/or even vomiting and diarrhea. However, some people, such as older people, the very young, pregnant women and people with certain other conditions such as lung disease (for example, asthma or COPD), heart disease, diabetes or immune compromise may be at a higher risk of complications, such as exacerbation of underlying health problems, pneumonia, sinus infections, and other conditions.
Influenza viruses rapidly mutate, minimizing the ability of people’s immune systems to fight them off. In order to “prime” the immune system, a yearly vaccination is developed which is aimed at the type of virus predicted to “go around.” Since it takes nine months to manufacture a sufficient supply, the predicted flu strains for the annual vaccine is based on worldwide monitoring and tracking by the CDC and the WHO. When the match is very good, vaccination prevents 50 to 90 percent of people from developing infection. When the match is poor, the efficacy can be 30 percent or less.
There are two major ways to make flu vaccine. One is by using inactivated “predicted” flu strains; this is the type that is given by injection, and is called trivalent or quadrivalent inactivated vaccine. The other method relies on live virus, which is manipulated so as not to be able to multiply, as with the live attenuated influenza vaccine; this is the type of vaccine that is squirted into the nose.
LAIV is approved for people 2 to 49 years old. TIV/QIV should be used in the other age groups, with intradermal vaccination a possibility in those 18 to 64. Kids 6 months to 8 years old should get two doses separated by a month unless they had two doses in a previous year, in which case one dose is sufficient; everyone else typically requires only one dose.
People with a history of a severe allergic reaction to flu vaccination or those who developed Guillain-Barre syndrome within six weeks of a previous flu shot should not receive vaccination. Eggs are used to prepare flu vaccines, however research has shown that egg allergy is not a contraindication. People with a history of egg allergy should receive the flu vaccine only after consultation with their physician and under close observation.
LAIV should not be given to anyone with a compromised immune system, lung disease, cardiovascular disease, diabetes, kidney insufficiency, pregnant women, kids less than 2 years old or close household contacts of these patients: TIV of QIV should be used instead.
Arm soreness in those getting an intramuscular vaccination or runny nose for those getting intranasal administration and/or minor flu-like symptoms commonly occur after flu vaccination, but should not dissuade people from getting vaccinated. The flu season is upon us, and everyone eligible should get their flu shot as soon as possible since it takes about two weeks for the protective antibodies to manifest.
Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.