The other day, a patient sent me a message: what about the news that the flu shot is only 10% effective this year?
At first, I thought, Internet exaggeration strikes again, why can’t there be more news stories that educate rather than mislead folks?
So I looked – and found an article in the New England Journal of Medicine, from just 2 weeks ago.
Short version
The 2017 flu season is in full swing in Australia, with nearly 4 times the number of cases as during the 2009 pandemic, and the vaccine effectiveness against the predominant H3N2 strain is estimated to be only 10% effective. And that’s the same H3N2 strain that’s in our 2017 North American flu vaccines.
Well, alrighty, then.
Longer version
Australia isn’t the U.S., and it’s not clear that the same thing will happen here. But there’s nothing quite like real-world data, and it’s reasonable to think that we will see more cases of The Flu, even with folks who’ve been vaccinated.
Of interest, however, is speculation that different vaccinations might work considerably better. Most flu shots are made using egg-based production methods, and when the virus grows in chicken eggs, it changes slightly, possibly just enough to decrease the effectiveness of the final product:
“In the United States, most influenza-vaccine viruses are propagated in eggs…During the egg-based production process, the vaccine virus acquires amino acid changes that facilitate replication in eggs, notably changes in the hemagglutinin (HA) protein that mediates receptor binding. Since the influenza HA is the primary target of neutralizing antibodies, small modifications in this protein can cause antigenic changes in the virus and decrease vaccine effectiveness.”
There’s evidence supporting this idea: a study on the 2016 influenza virus that demonstrated poor responsiveness to the strains in the egg-based vaccine, but a strong antibody response to viruses from a non egg-adapted vaccine.
And, yes, there are non-egg based flu vaccines available in the U.S., and have been for some time: Flucelvax and Flublok, neither of which derive their H3N2 part of the vaccine from egg-sourced viruses.
So, conclusions
1. The Party Line still holds
Get the flu shot – any flu shot. Even with marginal protection, the CDC has always said that some protection is better than none. Influenza is a serious, contagious, and potentially lethal lung infection. 650,000 people die from it worldwide each year, and around 40,000 Americans (or about a dozen 9/11s). Being under the weather for a few days is preferable to being in bed or the hospital for a few weeks – or worse.
2. You may want to rethink which flu shot you get
If the speculation in the NEJM article is correct, the egg-culture based (standard) flu vaccines may not be as immunogenic and protective as the cell-based (Flucelvax) or recombinant DNA (Flublok) vaccines. Your regular doctor may carry them, but if not, check the websites (www.flucelvax.com and www.flublok.com) and input your zip code to find pharmacies near you that do.
3. These alternative shots are for adults, only
You must be 18 or older to get them, younger folks still need to get standard flu shots recommended for their age range. They’ve not been proven effective in teens and children; in one study cited in the Flublok package insert, the vaccine seemed to underperform the regular vaccine in children under 3.
4. An ounce of prevention
Is still worth a pound of cure. Vaccines definitely fall under the heading of prevention, but so does using hand sanitizer alcohol gel after touching surfaces in public, keeping your hands and fingers away from your face, and being prudent about close contact with folks coughing up a lung. There’s a reason why folks in Asia wear masks in the winter, and it’s not for the pretty colors.
5. Finally, be thoughtful of others
If you’re sick, stay home. Don’t share the wealth, your colleagues and friends will not appreciate you “toughing it out” to carry your weight so they won’t have to. The Flu will put you on your back soon enough, but not before you infect everyone in your area.
And please, don’t go see The Last Jedi if you’re hacking your brains out. That’s just wrong.
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Dr. Bunten is originally from Huntington Beach, CA. He attended high school in Tokyo, Japan, went to college at UC San Diego and then to medical school in the Midwest. He returned home to California for residency training in Family Medicine at Long Beach Memorial Medical Center. His immediate family all reside in Huntington Beach.
Dr Fishbein has been in the practice of family medicine for over 35 years in Irvine. He received his undergraduate degree from Southern Illinois University, medical degree from Chicago Medical School, and completed his family medicine residency at Memorial Hospital of Long Beach.
Dr. Kim is the Medical Director of Family Care Centers, Chair of the Department of Family Medicine at Hoag Hospital, and a recipient of the Physicians of Excellence award from the Orange County Medical Association. He is Board Certified in Family Medicine, and has been practicing in our community for over 20 years.
Dr. Memon is a board certified Family Medicine physician and recently completed her fellowship in Geriatrics at the University of California, Irvine Medical Center. She attended Saint George’s University, School of Medicine and completed her residency at Arrowhead Regional Medical Center. Her interest in medicine started at an early age and has since evolved into a passionate career.
Dr. Gina Nguyen obtained her Bachelor of Science degree in Biology at UC Irvine where she graduated Suma Cum Laude. She went to USC Keck School of Medicine, and returned to UC Irvine for a Family Medicine Residency. Since 2005, she worked at Kaiser Permanente, VNCOC, and Family Care Center Urgent Care.
Dr. Williams is Board Certified in Family Medicine and Sports Medicine. He is a native to Orange County and returned home after completing his medical degree at the University of New Mexico, Albuquerque. After completing his residency in family practice he successfully completed a fellowship in sports medicine.
Dr. Hye Lee is a board-certified Family Practice Physician, affiliated with the American Osteopathic Association and the American College of Osteopathic Family Practice.She obtained her Bachelor of Science degree in Biology at UC Riverside and earned her medical degree from Des Moines University Osteopathic Medical Center. Afterward, she did her internship at Downey Regional Medical Center in California and has been a primary care physician since 2005.
Dr. Coyne is a board certified family practice physician and a California native. He completed his undergraduate degree at UCLA before earning his medical degree at George Washington University in Washington, D.C. Dr Coyne spent 6 years in the US Air Force at Andrews and Luke Air Force bases, eventually separating as a Major. He enjoys working with patients of all ages.”
Dr. Jay Friehling is a Family Practice physician who has worked in Orange County since 1981. Born in Florida, he received his undergraduate degree from Cornell University and then earned a Medical Degree at the New York Medical College.” His healthcare interests include Diabetes, Geriatric Care, and Hospice Care.
Dr. Jennifer Shoquist is board certified in Family Medicine. Her special interest is woman’s health and her practice accepts patients from 6 years old to seniors. Dr. Shoquist received her M.D. degree at The University of Texas Medical School at Houston in Houston, Texas, and did her residency with Memorial Family Practice at memorial Southwest Hospital in Houston, Texas.
Dr. Tom is a board certified family medicine physician and native Californian. He received his bachelors of science with great distinction in biochemistry and honors in chemistry. Dr. Tom was awarded a Regents Scholarship to attend medical school at UC Irvine.
Dr. Yan attended Kirksville College of Osteopathic Medicine and completed her Family Practice residency at Kern Medical Center in Bakersfield, California. She joined Family Care Center in 2001. She chose Family Practice because she enjoys working with a wide variety of people and because it provides a unique opportunity for continuing care.
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