Flu season will soon be upon us. Joseph Lipinski, MD answers questions about the flu vaccine and discusses other steps you can take to keep you and your family safe.
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– This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgements when advising their patients. Patients in need of medical care should consult their personal care provider.
– It’s that time of year again, flu season. So what can you do to keep you and your family safe? Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat podcast. And joining us right now is Dr. Joseph Lipinski. He’s an internal medicine physician with UPMC. Thank you so much for joining us.
– Thanks for inviting me.
– Okay, flu season, typically, when does it begin and when does it end?
– It varies from area to area, but around here, we typically see cases start late November and then it can wrap up any time between February and even into April of the following year.
– And so when we talk about flu, is it a virus or is it a bacteria? How does it typically originate?
– So it’s a virus and, interestingly, it’s circulating continuously throughout the year. During our summer months, it’s usually present in the Southern Hemisphere, South Africa, South America, and it’s undergoing multiple mutations and changes as that’s occurring. And then come our wintertime, when we’re indoors, is usually when it’s getting spread in the Northern Hemisphere. So December, January are often peak months for us.
– What are some of the symptoms and can flu be extremely dangerous to some people?
– Absolutely it can be dangerous, particularly those with immune compromise, the elderly who have weaker immune systems in general, pregnant women is a group that was struck particularly hard sometimes in certain years, people on immuno-compromising medications, such as those for transplants, and also people with diabetes, kidney disease, and other conditions, chronic lung conditions or heart conditions are particularly at risk.
– And so what does it do in the body? What are some of the symptoms?
– It typically starts with a dry, non-productive cough, high fever, muscle aches. People often feel like they’re coming down with something. They feel sick all of a sudden. And it can get pretty bad pretty quickly. Interestingly, though, they’re often contagious for a day or so before they have those symptoms. And that’s the problem. Much as with COVID, they can infect a lot of other people before they even know they’re sick and go lay down in bed.
– And so once you have the flu, I would imagine it’s different for every person. Is there a typical length of time? And is there anything that can cure the flu?
– We do have some medication that can attenuate the symptoms. Tamiflu is probably the one that most people have heard of, and it can make symptoms better a little quicker. It certainly doesn’t cure the flu, but it can make you feel better faster. And so it’s probably worth taking, especially, again, if you’re in one of these immunocompromised groups or you’re elderly. The young are generally going to do okay with or without Tamiflu. Typical duration of symptoms range, again, very much from three to seven days, some people even two or three weeks ’til they feel fully well.
– Wow, so in the middle of the pandemic, initially, people were saying, “We’re going to have a twindemic. We’re going to have COVID and we’re going to have flu.” And then the cases of flu were remarkably low. And tell me why and what that means.
– I think there were two reasons. One was we were all wearing masks, which we’re no longer doing. So I do think we have more concern this year that flu will be back with a vengeance. But the other thing that people don’t mention much is we had a dearth of testing supplies during the first year of the pandemic. We were using them to test for COVID. And so we weren’t testing as much for influenza. We were making a presumption, well, if it wasn’t COVID, it might be flu, but quite honestly, we just weren’t testing as much as we would normally do in a typical year. And so I think there were probably some flu cases unaccounted for during that first year of COVID.
– The whole idea, though, of wearing masks. What does that tell us about how flu is spread and what can you do in your household when your kids go to school to try to prevent it?
– Great question. Well, it does tell us that flu is spread via respiratory means, small droplets, which are both suspended in the air for a short period of time, generally requiring close contact with somebody, such as at school with children or in a household. But it also can spread on surfaces. Influenza can be viable on a surface for hours, maybe up to 24 hours on a surface. And so the classic advice of wash your hands well, try not to touch your face and nose, as we were all reminded during the pandemic early days. Those things count for influenza as well.
– Okay, so what would you say to your patients is the best prevention for the flu?
– Get a flu shot. And yes, it’s not perfect. Much like the COVID vaccines, there are gonna be breakthrough cases of influenza even when you get your flu shot. And we always hear these numbers and we get disappointed when we hear 50% protective. “Well, why should I bother?” Well, the reason you should bother is first of all, reducing it by 50%’s pretty good. But also, if you get it, you’re much less likely to have a severe case or a protracted case, one that lands you in the hospital, or for that matter, could land you in the morgue. So it’s definitely worthwhile to get a flu shot every year.
– Okay, explain to folks why there just isn’t one flu vaccine and we use the same vaccine every single year.
– Great question. So the reason is influenza is a tricky little virus. Its strategy, really, is make a lot of offspring with a lot of mutations, even if a lot of those mutations are gonna result in dead offspring. It accepts that. It takes over your cellular machinery and pumps out millions of copies of itself and literally half may be non-infectious or non-viable. But the upside of that is that there are slight changes being generated with every new generation of influenza. And some of those changes give it an advantage to be able to escape our immune system. And so we are always fighting the last war when it comes to influenza. We look and see what’s been circulating in the Southern Hemisphere to draw upon what we’re going to do with our vaccinations. So we make a vaccine based upon what’s circulating in Australia or South Africa, hoping that it doesn’t mutate or change too much by the time it gets to us because it takes months to make 180 million doses of a flu vaccine, which is what we’re going to hopefully have here this winter for the United States.
– What is in a vaccine? There are always so many myths when it comes to vaccines, including the flu vaccine. So what is in the flu vaccine?
– You know, people often say, “Well, I can’t take one because I have an egg allergy.” That’s been really shown not to be the case. There is some gelatin and there are a few people who may have a true allergy to the vaccination, but they are very, very few and infrequent. Most people, even if, again, they have egg allergies, can take a vaccine every year. You’re going to be having basically some proteins from the virus that will allow you to make an antibody against its surface to be able to fight the actual flu. But you’re not really going to be worried about getting any other significant contaminants in there. Other than, as I mentioned, some gelatin. There’s really no reason for the vast majority of people to avoid a flu shot. But the only ones might be people who have a history of Guillain-Barre, but otherwise, we have very few restrictions on who shouldn’t get a flu shot.
– And that’s really a conversation to have with your doctor if you’ve had a bad reaction in the past or if you have a condition that may make you not the best candidate. What do you say to people who say, “If I get the flu shot, I’m going to get the flu and I’m going to be sick. They’re injecting the flu into me”?
– Right, no, that’s not true. Not with a shot. Now, interestingly, the nasal flu is an attenuated, weakened strain of the virus. And it does give you a little bit of a local symptom because you squirt that into your nose and it replicates in just the tip of your nose. So you can get some nasal congestion or very low grade flu symptoms. You have the advantage of not having to have a shot, but the disadvantage is you actually are mildly infecting yourself. And there are certain people who shouldn’t get that one. The nasal flu is contraindicated in people, again, immunocompromised, or who have cochlear implants.
– Is there any difference for others in the effectiveness of one or the other?
– That’s also debated. For a few years, the nasal flu vaccine was actually off the market. For some reason or other, it didn’t seem to provide immunity. When that was discovered, it was pulled from the market, they went back to the drawing board, and they’ve re-engineered it. It’s back again and it’s indicated for people 50 and under. So we tend to not give it to older individuals, in part because there’s still the belief that you get a better immune response to the shot than you do from the nasal flu.
– And so really, then why even have it? It’s just people that are petrified to get shots?
– That’s the primary reason. Yeah, there was also a year when we didn’t have enough shots, if you remember that, and we were using some of the nasal flu for people that were at lower risk. We said, “Well, save the shots for the older people and let the younger folks take the nasal flu that year.”
– So when, ideally, should someone get a shot and should you get a flu shot in conjunction with a COVID shot, with the latest COVID booster? What does that all look like?
– Great question. Personally, I like October as a month to get my flu shot. And the reason is I do have some concern about getting them earlier in the year for fear that if it’s a long flu season, that your immunity may begin to wane by March or April. And we’ve seen cases in April, certainly, around here. However, if you happen to be at your doctor’s office and they have it today, it’ll be fine to get a flu shot according to the CDC. I’m not a fan of getting them, again, in August. As far as getting it together with the COVID booster, you can. It’s been shown that the rate of side effects is a little higher if you get two shots on the same day. And if you do get a fever, for example, you’re not gonna know was it the flu shot or the COVID booster that gave it to me. So while, again, it’s perfectly fine to do both, it’s also fine to get one and go back a week later and get another one if it’s convenient.
– What do you wanna say about the side effects? Because I’m listening to this and I’m like, “He just said I could get the flu shot and then I’m going to get a fever.” What does that mean?
– So what’s going on is you’re having an immune response to the flu vaccine, which is exactly what we want. Remember that when we feel ill, it’s usually our immune system that’s making us feel that way. So it’s our immune system flaring and producing all kinds of different inflammatory mediators and cytokines that cause the feeling of achiness or headache or stiff muscles, et cetera, after a vaccination. And so, when you feel that way, know that your immune system is doing what it’s supposed to do. It’s generally short-lived and responds nicely to some Tylenol, for example, if you do happen to get that reaction. But the biggest reaction that most people are going to get will be maybe a little bit of a sore arm.
– Does getting the flu shot help in terms of preventing transmissions to others or no? Like what do we know about that?
– I personally couldn’t answer that question. The hypothesis would be that yes, it probably does. First of all, it reduces cases, which is gonna reduce transmission, and tends to, again, result in less severe symptoms, which will generally mean less infectious particles, et cetera. But I honestly don’t have data to prove that hypothesis.
– Right, how young can a child be and still get a flu shot?
– Six months
– Six months.
– And so if you’re talking to parents right now, you know, that might seem, “Oh my goodness, six month old? They’re only with us at this point.” Why should a six month old get a flu shot?
– Great question, well, first of all, infants don’t have a completely constituted immune system, not until they’re about a year old. They are more prone to do poorly with certain things until they’re a year. So that’s one reason. And the other thing is it’s been shown that the most important people to vaccinate is actually people who have good immune systems. So you vaccinate the people that are going to introduce it to the baby. The parents should be relatively young, which is another reason why we suggest all healthcare workers get the vaccination so that they hopefully don’t give it to any of their frail patients. As an example, the residents in nursing homes, who still are, by definition, the most frail and immune compromised. And yes, it doesn’t work as well in them as we would like. We saw the same thing with the COVID vaccination. Those individuals also, by the way, this year, a new recommendation from the CDC is there are three vaccinations that are preferred for 65 and older. It’s hypothesized that these should provide better protection. We’ll see, after the year is over, whether they do or not. They also say, though, that if you can’t get one of these higher dose flu vaccines, get the regular dose if you’re at your doctor’s office and that’s all they have. It’s still better than getting nothing.
– So folks can get it at their doctor’s office, get it at their PCP, they can also go to pharmacies, stores. So there’s always going to be a segment of the population, they don’t believe in vaccines. And there’s perhaps enough of that that people who have had vaccines might begin to stop and think, “Oh, maybe I shouldn’t,” especially because, we mentioned earlier, they’re making a new one every year. Someone might say, “Um, well, if they just made this six months ago, how do we know?” What do you wanna say about the research and the methods of how these are produced?
– So the method generally does not change. And that method has been very well researched. It is true that the actual end product is slightly different to best match it, again, to what’s circulating. The technology’s been around. It’s been proven to be safe. And I would just like any person who’s around and disputing the wisdom of vaccinations to talk to some of my older patients or some of the folks that are around here that were part of the Salk trial. I mean, the people that lived through diseases like polio, they didn’t hesitate to get the COVID vaccination. They saw what vaccinations can do. And it’s a disease that, again, is making a comeback right now in New York City. We don’t need to see that. Vaccinations work. They’re really one of the most wondrous things that mankind has ever invented. Think about where the world was before the smallpox vaccine. Smallpox is a disease we haven’t seen in the world now in decades, thanks to that immunization. And we’ve been darn close to getting rid of polio entirely off the earth. We’ve failed, thanks to factors such as warfare and not being able to get into certain countries. And so there have been small pockets of polio that persist and continue to replicate throughout the world. And again, a lot of people now who don’t wanna have their children vaccinated, which, again, sets up a pool of individuals who are only one plane ride away from polio.
– Finally, what do you want to say to people out there about if they do have questions or concerns, having the conversation with their doctor?
– Your doctors should be well-informed. Hopefully well-informed and a proponent of getting your vaccination. They can explain those things that might give you hesitation. We understand. After all, you are putting something in your body. And I certainly don’t want to be dismissive. There are gonna be a few individuals who shouldn’t take a flu vaccine. But again, the vast majority of folks shouldn’t be hesitant.
– Right, well, Dr. Joseph Lipinski, thank you so much for coming in and spending time with us today. Some great information.
– Thank you very much, appreciate it.
– You’re welcome. I’m Tonia Caruso, thank you for joining us. This is UPMC HealthBeat.
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