For those that don’t know me as an individual, there’s nothing that bothers me more than people being misinformed. Lately, there’s this growing trend of “Vaccines = BAD.” People seem to think that vaccinating their child, or themselves, will cause some sort of plethora of plagued toads that will spread disease like wildfire, causing a million kittens to die and your limbs to fall off. The shocking aspect, to me, is that people don’t check their references: Sally’s neighbor’s cousin’s cat’s owner’s best-friend’s farmer’s nephew could have spewed some ignorant, misinformed “fact” and people take it to heart like it was Jesus’ last will and testament. Let alone, no one knows if that’s a credible source. Or even better, people read some article on some super reliable site *cough*not*cough* like http://www.theworldisflat.whyareyoureadingthisseriously and everyone believes this stuff. It’s insane. So how does this tie into the flu vaccine you might ask? Well, I’m not advocating either way regarding getting vaccinated or not. My purpose is to give you more information about it and hopefully you make your own, well-informed decision as to whether or not you’d like to contribute to kitten sacrifice….errr getting vaccinated. Below is a very detailed and — what I hope you would find — helpful article I wrote back in March of ’13, about the Flu Vaccine, provided from extensive amounts of research I did from scholarly/academic articles and peer review journals. It is important to be informed as best as you possibly can, about all issues in life, but this one — people fearing the flu vaccine for all sorts of crazy reasons — really gets me. So please, grab yourself a cup of tea and a Biscotti, it’s time for some learning to be done!
Flu Vaccination — Is it safe?
The end of the year is approaching and flu season has begun rearing its ugly head — we take precautionary measures, and yet it seems we still end up getting sick. The U.S. Department of Health and Human Services (HHS) notes that each year 5-20% of Americans contract the flu, and 200,000 people fall victim to complications from this vicious virus (“How Long Am I”). With illness looming around the corner as every autumn nears, how are people supposed to avoid what seems like the inevitable? Hand sanitizer, probiotics, and vitamins may help support your immune system, but they may not be effective for everyone. So what are some other options? How about that controversial flu vaccine?
The Centers for Disease Control and Prevention (CDC) reports the flu vaccine is 62% effective (“Vaccine Effectiveness”) in protecting against the current season’s most prevalent flu strains. And yet, according to surveys published on the Clinical Infectious Diseases (CID) website, half the U.S. population opts-out of receiving the flu vaccine, and roughly 2/3s of Americans think it would be better to build natural immunity to the virus (“Half of U.S. Adults”). So why are people less inclined to get vaccinated? The answer primarily lies in popular myths surrounding the flu vaccine and its safety on the general public. Although there are many anxieties and misconceptions surrounding the flu vaccine, there is no scientific evidence that one can contract the flu virus from the flu vaccine or that receiving the flu vaccine damages one’s immune system.
The CDC notes flu season can begin as early as October, peaking typically in January/February, and then tapering off around May (“What You Should Know”). Contrary to popular belief, once you’ve contracted the flu virus, you are actually contagious before you even start feeling sick. According to HHS, the contagious period starts 1 day before symptoms develop, can last up to 7 days after symptoms disappear, and can remain longer in children (“How Long Am I”). The recovery rate in the United States is typically between 1-2 weeks (“How Long Does” and “Seasonal Complications”). This means that people can be contagious for more than 14 days — that’s quite a risk exposure to the flu virus, even for healthy individuals.
Symptoms of the flu develop anywhere between 1-4 days after the virus enters the body. As the strain of the flu varies each season, so does the severity of the symptoms. Primarily, aches, pains, fever, and respiratory complications are the most common symptoms people experience from the flu; however, children, more so than adults, can also suffer from nausea, vomiting, and diarrhea. The flu more commonly develops in the form of a “respiratory disease and not [typically a] stomach or intestinal disease” (CDC “Is the Stomach Flu”). In addition to common symptoms, many people develop complications which can fall into a wide range from ear/sinus infections, to dehydration, to bacterial pneumonia, to even death. As the CDC notes, “People 65 [years] and older account for… about 90% of flu-related deaths” (“Do Flu Vaccines”).
Over the past 100 years, the instances of people dying from influenza has decreased significantly. With large numbers of flu-related deaths merely clinging to the pages of history books, it is hard to remember a time where the flu virus took no mercy on its victims. Some may recall one of the nation’s greatest epidemics — the 1918-19 Spanish Flu — which claimed an upwards of 675,000 lives in the United States alone (Koszarski). This particularly unique strain of influenza swept the world with three consecutive waves, targeting healthy individuals mainly between 20-35 years old, killing roughly 5% of the world’s population within a year (Rosenberg). Thankfully, the world has not seen such a virulent strain of influenza since 1919; however, the recent emergence of the H1N1 virus (see next section) is a reminder that an impending threat of another potentially disastrous pandemic will happen again, as it is only a matter of time.
Although there are some who claim to have never caught the flu, the answer still remains — anyone is vulnerable to the flu virus. Because the virus changes seasonally, people who may have been immune to another strain in the past may not be immune to a newer strain of the virus in the future. There are two groups of people who should take extra precaution with the flu virus: those with high exposure rates and those who are naturally more vulnerable. The first group consists of people who have high exposure to those who are more naturally vulnerable to the flu: healthcare workers, caretakers of the young and old, and anyone in an environment surrounded by large crowds where viruses spread rapidly (hospitals, prisons, schools, cruise ships, nursing homes, etc). The second group consists of those who are more susceptible to contracting the virus, usually due to having a weak or compromised immune system: children and infants, pregnant women, travelers and people living abroad, people with disabilities, and seniors. Among the second group, even more vulnerable are those with chronic health conditions ranging from arthritis, asthma, cancer, diabetes, heart disease, and HIV/AIDS, due to poor health or medications that lower the body’s defenses (HHS “People with Health Conditions” and “Who is at Risk”). It’s also important to note that although it is highly unlikely to catch the same strain of the flu more than once, it is quite possible to catch a different strain of the flu within the same year, as there are multiple strains that circulate on an annual basis.
The Science Behind the Flu Virus
When analyzing claims about the flu vaccinations and assessing the risks of viruses versus their vaccines, it is critical to have an extensive understanding of the various structures and strains of the influenza virus and the vaccines used to prevent those viruses. The influenza virus is divided into three main categories: 1. Human Influenza Type A: This flu type is one of two strains that causes a seasonal epidemic every year in the United States. Type A can be broken down into “subtypes based on two proteins on the surface of the virus: the hemagglutinin (H) and the neuraminidase (N). There are 17 different hemagglutinin subtypes and 10 different neuraminidase subtypes.” Hemagglutinin acts as the agent that binds the virus to the cell, whereas Neuraminidase ensures the virus is able to leave the cell once the virus has multiplied.” Together, these two molecules control the infectivity of the virus” (Goodsell). Type A can be divided into different strains, such as the H1N1 virus (Swine Flu) and the H3N2 virus. Influenza Type A can undergo both the “Antigenic Shift” and “Antigenic Drift” mutation (see next section). 2. Human Influenza Type B: This is the second of two strains that causes seasonal epidemics every year in the United States. Although Type B does not have different subtypes, it can still be broken down into different strains. Type B can only undergo the “Antigenic Drift.” 3. Influenza Type C: Type C only “causes a mild respiratory illness and [is] not thought to cause epidemics” (CDC “Types of Influenza Virus”). Both Type A and Type B are included in the seasonal flu vaccine; however, the vaccine does not include Type C. The vaccines also do not prevent against other viruses that cause influenza-like illnesses (ILI).
How does the flu virus change, and why do you need to get vaccinated year to year? The CDC refers to the “Drift” and “Shift” technique in which the virus can mutate in one of two directions. The first method of mutation, “Antigenic Drift,” occurs when the virus slowly changes over time. The human immune system builds up antibodies to certain strains, but with the “Antigenic Drift,” the immune system does not recognize the foreign strain that has slowly mutated — this is the reason people contract the flu more than once in their lifetime. Seasonal flu vaccines focus on staying updated with the current “Antigenic Drift” flu strain. The second method of mutation, “Antigenic Shift,” is an extreme change in the flu strain that occurs abruptly, and does not allow the immune system enough time to build up resistance to that particular flu virus. This type of strain creates new Type A subtypes, but it also is the product of the animal-to-human jump in influenza, such as the H1N1 virus. Because this mutation occurs too rapidly, the seasonal flu vaccine does not typically prevent against this type of mutation (“How the Flu Virus”).
Are viruses a living agent? The answer, put in simplest terms, is no. Luis P. Villarreal describes the living component of a virus in “Are Viruses Alive?”. Viruses are immensely complex structures, acting like a chemistry compound composed of nucleic acids (DNA and RNA), surrounded by a protective protein coat. However, once the virus has entered the cell, it uses the cell’s reproductive constituents to reproduce its own DNA and RNA. According to Dr. Ananya Mandal, “An infected cell will produce viral particles instead of its usual products.” Viruses are 100 times smaller than a bacteria cell, and even possess the capability of infecting bacterial cells, animal cells, human cells, and plant cells.
The Science of the Flu Vaccine
As stated above, the molecular variety in flu vaccines varies as the manufacturing of the vaccines attempts to keep up with the mutating strains of the influenza virus. In addition to each targeted strain produced in the flu vaccine, there are also different forms in which those vaccines can be distributed; furthermore, within those forms resides a slightly different distinguishing component of each vaccine type. Anita Manning, author of “Flu Vaccine Myths, Misconceptions,” elaborates on the differences between the flu shots and nasal sprays. Viruses used in the flu shots are “dead” whereas viruses in the nasal sprays are “weakened” — neither of which can grow in the lungs. The flu shot is considered an “inactive virus,” one that has been killed and is completely incapable of entering a cell to perform its dirty work. In general, the flu shot is given with a needle, typically in the arm, and is safe for people 6 months and older, healthy or with chronic health conditions. It works by injecting antigens into the body to stimulate antibodies (CDC “Key Facts”).
There are three different kinds of flu shots people can receive: 1. The “Seasonal” Flu Shot: This flu shot is injected into the muscle (intramuscular). It consists of the three flu viruses that are predicted to be prevalent that particular flu season. This flu shot is safe for pregnant women and anyone 6 months or older, healthy or with chronic health conditions. 2. The “High-Dose” Flu Shot: The high-dose flu shot is also comprised of the three seasonal flu viruses but in contrast to the seasonal flu shot, it contains 4 times the amount of antigens found in the seasonal shot, to produce a strong immune system response. This vaccination is ideal for those who are 65 years or older as it provides the strongest protection of all three flu shots. 3. The “Intradermal” Flu Shot: The intradermal shot contains the three seasonal flu viruses; however, it is injected into the skin (intradermal) via a small needle rather than the muscle with a larger needle. It requires a much smaller dose of antigens and produces very similar effects of immune system response; therefore, it is safe for anyone between the ages of 18-64. Being a relatively new vaccine, it first became available to the public in 2012-2013. This flu shot is ideal for people who also have a fear of needles — it requires a needle 90% smaller than the typical flu shot needle because it only needs to pierce the skin (CDC “Key Facts”).
Aside from the flu shot, the vaccination can also be distributed through a nasal spray. Compared to the “inactive” flu virus in the shot form, the nasal spray contains a live yet weakened virus (LAIV for “Live Attenuated Influenza Vaccine”). Given that it is “live” versus dead, does it make the vaccine any more of a risk factor for adverse reactions compared to the shot? The answer is yes, but only by a small percentage, and has been proven to be 92% effective when distributed to the proper vaccine recipient group. The benefit to this vaccine is that it is far less invasive than a flu shot and is much easier to distribute to children. Unsafe for children under the age of 2, adults 50 years or older, pregnant women, people with chronic health conditions, those who have compromised immune systems, or people with a history of Guillain-Barré Syndrome, it is safe for healthy people between the ages of 2 and 49 (CDC “The Nasal-Spray”).
Education is Key
In “Reasons For Not Having Received Influenza Vaccination And Its Predictors In Canadians,” Thomas Wong and his associates found that in addition to the majority of Americans choosing to not get vaccinated from the flu, only 1/3 of Canadians receive the flu vaccine. The primary reason Americans and Canadians chose not to get vaccinated was because they feared having adverse effects.
So where does all the fear come from surrounding the flu vaccination? The most likely answer: The general public lacks important education about the flu vaccine and its benefits compared to its risks. In “Do Parents Understand Immunizations? A National Telephone Survey,” Bruce G. Gellin, Edward W. Maibach, and Edgar K. Marcuse research the significance behind educating people about common misconceptions regarding the flu vaccine. Their findings showed that 87% of parents support immunizations; however, a considerable minority of parents believed that children are receiving more immunizations than necessary, or that children’s immune systems could lower after receiving too many immunizations. Lack of education about immunizations has led to the “erosion of public confidence in vaccine safety,” which could lower immunization rates and could reintroduce vaccine-preventable diseases back into the general population. The issue is not necessarily that the information isn’t easily accessible; instead, it seems to be that some people feel little need for information regarding certain matters and are therefore less inclined to seek out that information. The solution to the lack in vaccination education may rely upon the strong influence of nurses, physicians, and primary care givers.
Ambiguous Facts Create False Impressions
Information, conveyed in an ambiguous way, can create misperceptions about subjects whose clarity is crucial to the comprehension of that material. Because of this, it is important to read critically, analyzing the deliverance of facts and reading between the lines. In “A Cluster of Deaths Following Influenza Vaccination, Israel, 2006,” Emilia Anis and her peers investigated the deaths of four flu vaccine recipients, which occurred within the same week. After extensive tests, the Health Ministry’s findings “concluded there was no reason to suspect a causal relationship between the vaccine and the four deaths.”
As the article notes, there is a correlation– that needn’t go unrecognized– between elderly people having the highest vaccination coverage and also having the highest mortality rate. Without recognizing the relationship between those who typically are covered for the vaccine and those who already have compromised/weak immune systems, the news about deaths (and furthermore illnesses) in recipients of the flu vaccine can give false impressions that the flu vaccine was the cause of those deaths (or illnesses).
Debunking the Myths
There are a handful of reasons why people choose to not receive the flu vaccine. I’m going to delve further into some of the more common phobias and misconceptions surrounding the vaccinations, in hopes of debunking the myths or at least providing some clarity behind the safety and risk factors involved when getting vaccinated against the flu. Fact or fiction:
1. Flu vaccines give you the flu: As noted earlier in this text, the flu itself infects hosts when the live virus enters the body, attaches itself to a host cell, makes its way to the nucleus, and tricks the cell into reproducing the virus’ genetic material. Since the flu shot only contains an inactive (dead) virus, it is scientifically impossible for the virus to do anything beyond exist and be recognized by the body’s immune system. The nasal spray, containing an attenuated (weakened) virus, still cannot cause the flu. In addition to the spray being weak, it is also “cold-adapted,” which means during manufacturing, it can “only cause mild infection at the cooler temperatures in the nose.” It is virtually impossible for this virus to infect the lungs or any warmer areas of the body (CDC “Can the Nasal Spray”).
2. Flu vaccines can harm pregnant women: As explained above, there are risks to pregnant women, and people with compromised immune systems, when getting vaccinated, but only if they receive a vaccine type that isn’t recommended for them. It is recommended that pregnant women and breast-feeding mothers get vaccinated against the flu, as they, and their children, are at higher risk for contracting and developing complications from the flu virus. Numerous studies conducted by the FDA (Food and Drug Administration) and CDC have not shown any evidence that the flu vaccine poses a health risk to pregnant women (CDC “Seasonal Flu Vaccine”).
3. Flu Vaccines Cause Mental Illness: After a 1976 swine-flu vaccine, in the United States, was associated with 5-9 cases per million of Guillain-Barré syndrome, scientists have been on the constant lookout for reoccurrences of this paralytic disorder with the distribution of newer flu vaccines. Studies of current vaccines have not shown a link between the disorder and flu vaccinations. Interestingly enough, 60 cases of narcolepsy appeared in 4-19 year olds in Finland, and more cases emerged in Sweden. Of these cases, many were recipients of an H1N1 flu vaccine called “Pandemrix,” which was made by a company, GlaxoSmithKline, in the UK. However, “Scientists have yet to confirm whether the vaccine caused the rise in incidence” (Kwok).
Laurence O. Gostin writes in “Swine Flu Vaccine: What Is Fair?” about the presence of strong social and political pressure on the FDA and CDC to quickly approve vaccinations before adequate research has been conducted regarding safety and side effects of the flu vaccine. More commonly, this is found with “exotic infections” and their vaccine types, such as H1N1. He indicates the motivation behind the government spending copious amounts of money on research and fast release of vaccine to protect against the H1N1 flu, is to prevent a lethal, catastrophic outbreak — similar to the 1918 Spanish Flu — of an otherwise initially benign virus.
As explained in the earlier text, the seasonal flu vaccine does not typically focus on “Antigenic Shift” viruses, since the mutation happens much faster than companies can anticipate — this may be the reason for a “rush” with rare flu vaccines. Of course, any adverse effects from vaccines are unideal, but it may be important to acknowledge the potential risks the government faces when releasing a new vaccine to the public in order to prevent a catastrophic pandemic, versus the risk the government faces when there is a serious “Antigenic Shift” virus that could potentially devastate the population when there hasn’t been a vaccine distributed to protect against that particular strain of the flu. Perhaps the issue isn’t negligence on vaccine safety, but rather the preparation for an unforeseen flu mutation.
4. Flu vaccines make you sick (but not with the flu): Though rare, there is always a chance of experiencing side effects with vaccinations, flu vaccine or otherwise. Both the shot and the nasal spray can generate different reactions. The most common symptom for those who receive the shot is redness and tenderness in the arm, although symptoms can also consist of aches or low grade fever and are much less severe than flu symptoms. The nasal spray can trigger a sore throat, runny nose, congestion, fatigue, cough, chills, or headache (CDC “Misconceptions”). Outside of these rare symptoms, some people also have an allergy to the vaccine. Those who have an egg allergy should not get the flu shot because it is grown in eggs (MacDonald, Weir, and Langley).
Conclusion: Fear the Flu or Fear the Vaccine?
Getting vaccinated against the flu is seen as a threat only by those who aren’t educated about the vaccine and its risks. It is important to understand which risk group and recipient category you fall into, to better identify the proper vaccine you should receive and which form it should be distributed in. The vaccination may cause some people discomfort or minor adverse effects, but a risk of negative side effects is no different with the flu vaccine than with any other preventative medicine. The important thing to recognize is the flu vaccine does not possess the molecular structure or capability to cause the flu in vaccine recipients. It is much more likely that vaccine recipients have either contracted the flu virus before their body built up immunity, contracted a strain of the flu virus not provided in the vaccine, or are sick from a virus, other than the flu, that causes flu-like symptoms.
The flu vaccine may not be for everyone; however, after evaluating the science and myths surrounding it, it appears to be a much safer option than many may have initially perceived. In addition to educating yourself on any substance you put in your body, it is important to weigh the risk factors between potential side effects of the vaccine, the likelihood you have of contracting the illness (in this case the flu), and the complications that could develop from the illness. Having a cold is one thing, but no one wants to get sick with the flu, and it seems getting the flu vaccine may be the best way in preventing that.
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 Antigen: “Any substance that can stimulate the production of antibodies and combine specifically with them.” (“Antigen.” Dictionary.com.)
Written by Kysondra Brink. March 2013.
P.S. No kittens were harmed in the making of this post.