After I put my post up on this years influenza fiasco on Friday, the CDC declared it an official ‘epidemic’.  Since one of the main excuses for not getting the shot this year are “It’s a hassle.”/“Number one, I’m lazy” (UUUUUUUGH THAT WAS ME TOO! GET THE SHOT!! The flu SUCKED!!!!), I thought it would be a good time to repost an article I wrote last year. You should get the vaccine, if not for you, for the people around you.

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EMAIL! (technically, a paraphrased really great question from someone at FreeOK!)

Dear ERV–

Is there any reason why I, a young healthy adult, really *need* to get the flu shot every year? Even if I do get the flu, wont that just make my immune system stronger?

 

 

Blech. Flu shots. Every damn year people are bugging us to get the flu shot. But no one likes shots. They cost like $10-$20. Have to take off work or run to get one in between classes. And then your arm hurts allllll daaaaay and you might get a headache or a little fever. UUUUUUUGH WHYYYYY????? WHYYYY????

“Do I *have* to get the flu shot every year?” I totally understand where you are coming from.

The answer isnt an easy yes/no.

First, the basic ‘WHY??????’ behind the flu-shot-every-year thing.

Heres the deal, influenza has a couple different ways of changing. The one that probably jumps into your head immediately was ‘Oh, yeah they mutate’. Yup! Influenza is an RNA virus. The enzyme that makes RNA from RNA makes a lot of mistakes. Those mistakes in the RNA genome/messages translates (heh) into variation in amino acid sequences, thus variations in protein structure, ‘antigenic drift‘. Start with Protein A and then you get ‘Kinda Protein A’ and then ‘Kinda Sorta Protein A’.

But influenza is a segmented RNA virus. So if something is infected with +2 different ‘kinds’ of influenza, the viruses can shuffle their genomes. Thats called ‘antigenic shift‘. Start with Protein A and then you get ‘Protein Not-A’.

While influenza has these different sources of genetic diversity, that diversity is under selective pressure from *us*. The human population is generating antibodies to variants of influenza, either from getting sick or by getting vaccinated. This selects out the influenza variants the human population doesnt have good immunity to, so those variants are the ones that infect us the next year, and so on and so on.

We are caught in this evolutionary treadmill because 1) influenza can change a lot, and 2) we cant make antibodies to *one* influenza infection or *one* influenza vaccine that protects us from *all* kinds of influenza.

Thats why scientists were super pumped about identifying antibodies that *could* work on lots of different kinds of influenza.

So, thats why we have to get new shots every year to ‘influenza’– usually every year, the shot is slightly different mix of three influenza variants than it was the years before (sometimes there are duplicates).

To answer the second part of that question first “Wont getting sick rather than getting the shot make my immune system stronger?” The answer is ‘Yes, kind of, but it doesnt matter.”

When you get sick, you make antibodies that are really, REALLY good at attacking the virus you were infected with.

When you get a vaccine, you make antibodies that are pretty good at attacking a virus you might be infected with. Vaccines are composed of crippled/dead viruses or just chunks of viruses– while they train your immune system to fight off a pathogen, its not as ‘robust’ of a training as you get from actually getting sick. So if you compared the antibodies from a person who got sick and a person who got the shot, the person who got sick would have ‘better’ antibodies for that variant of influenza.

But since influenza changes all the time, theres not really much of a point to getting a ‘stronger’ immune response from getting sick. The influenza circulating this year is going to be different from last years– who cares if you got sick last year? The flu vaccine is trying to train your immune system for the *modern* virus, not the one that was hanging around last year.

On to the first part of the question– “Do I need to get the shot every year?” Well, it depends on who you are and who you are around.

In these cases, your decision to not get a vaccine could kill or seriously harm someone else(I might be forgetting some):

  • Did you/a relative just have a baby? You better get the shot to keep you from infecting baby.
  • Do you hang out with your grandparents a lot? You better get the shot to keep you from infecting Grandma and Grandpa.
  • Do you hang out with someone who is immuno-compromised? If you are around anyone who has to be on immuno-suppressive therapy for a medical condition or is otherwise immuno-compromised, you better get the shot to keep you from infecting them.
  • Are there extenuating circumstances? Sometimes something non-normal happens, eg Swine Flu. If something weird pops up like Swine Flu, or a flu that is differentially affecting ‘young healthy’ people as opposed to the normal ‘very young’/’very old’ groups, then you better get the shot.

In these cases, your decision not to get a vaccine might not be so dramatic:

  • Are you a student? Schools, gyms, and dorms are warm, moist petri dishes. If one person gets sick, EVERYONE gets sick. If you dont want to be part of that, if you *cant* miss class or the district basketball finals, you better get the shot.
  • Can you afford to get sick? Can you afford to miss work/household duties for a week? Can your business/household afford for you to be out of commission for a week? Can you afford the potential medical complications that could arise from ‘only the flu’? This might be something those of us in work-a-holic-no-healthcare US people think about, but it *is* something that I weigh when I am debating ‘do I need to get the shot this year?’

These lists are non-exhaustive– People might bring up more situations in the comments.

But my point is, there is no inherent ‘benefit’ to getting sick from influenza. There is no reason to get sick from influenza. We have a vaccine. Yeah, sometimes we gamble wrong when guessing what strains to put in the influenza vaccine, and you might get sick anyway, but any way I can stack the deck in my favor, towards ‘not getting sick’, Im going to do it.

Comments

  1. #1 Thanny
    January 14, 2013

    I never get the flu shot, because I never get the flu. I’ve had a cold exactly once in the last 20 years. When I get sick, it’s bacterial (tonsillitis, strep, bronchitis), and I take antibiotics.

    If I can be a carrier without getting any symptoms, I’d get the shot to protect others, but I don’t think it works that way.

    So that’s the item missing from your list – some people just never get the flu, and don’t need the shot.

  2. #2 Chris Talbott
    Barre, MA
    January 14, 2013

    Can you explain why it’s a good thing to keep breeding more and more viruses (the ones that survive and reproduce after each cycle)? What is the ultimate benefit of that? You will never reach 100% compliance, so the viruses will simply get stronger. As public policy, this seems expensive and pointless.

  3. #3 JustaTech
    January 14, 2013

    Chris, I’m confused about your question. The vaccine doesn’t work like antibiotics; you get the vaccine and then your immune system (doing what it always does) kills the virus. If you didn’t get the vaccine either your immune system would kill the virus anyway (it would just take longer and you would feel worse) or you would die. In no instance does the vaccine act directly on the virus, so there is no selection pressue on the virus. Some people might argue that the vaccine *removes* a selection pressure from the human population, but the vaccines don’t act directly on the pathogen.

    With some pathogens that have very limited hosts, a vaccine can eliminate the hosts so the pathogen goes extinct (smallpox), but given the number and variety of hosts for influenza, the point of the flu vaccine is to mitigate the impact of the disease, not to eliminate it.

  4. #4 ERV
    January 14, 2013

    Thanny– If you have never gotten the flu, its by luck, not design ;) I dont know of any genetic determinants that protect someone from being infected with influenza (like delta-CCR5 protects people from HIV). May the odds be ever in your favor ;)

    Chris– Its a weird idea, but some viral proteins, especially the ones on the outside, are evolved to have high ‘plasticity’. That means it can change a lot without really getting any ‘better’ or any ‘worse’. So, the influenza proteins that are the target of our immune system can change from year to year, and its not getting any more or less pathogenic. Its just different.

  5. #5 Randy
    January 15, 2013

    Recently we had two years with identical vaccines. Was there any benefit to getting the second shot of identical vaccine?

  6. #6 Bob of QF
    Tulsa, OK
    January 15, 2013

    Alas, I’m one of the unlucky who is allergic to raw eggs. Quite allergic, actually. So I do not get flu shots.

    On the other hand? I don’t get the flu either–never have, as far back as I can remember– oh, I can get sick, I’ve had pneumonia (bacterial–it was checked by antibiotics), strep throat, and so on. But influenza? Never had one of those “2 weeks sick” things–at most, I get stuffed up for about 2 days, with a mild fever, but within 3 days, I’m good to go, feeling fine.

    I do not attribute this to anything special– I’m definitely pro vaccine. I just wish they would use something other than egg whites to culture these things. If they did, I’d get it semi-annually just because.

  7. #7 WLU
    January 15, 2013

    For everyone saying “I don’t get the ‘flu”:

    Questionable.

    First, do you go to a lab regularly to look for evidence that you’ve got the ‘flu? Many symptoms are fairly nonspecific, so that ache you attribute to extra time at the gym might be low-grade influenza. Second, there is such a thing as asymptomatic carriers. Even if you aren’t sniffly, there’s a chance you’re still breathing it on people, things and pets.

    ERV – question for ye. I read John Barry’s very enjoyable The Great Influenza. It talked about how the young and healthy were the ones who died in greatest numbers, possibly because the variant during the Spanish Influenza epidemic died of the over-reaction of the immune system to the ‘flu (essentially drowning the lungs in the side effects of fighting the virus). Have you heard of this, do you have any handy links or general wisdom?

    Thanks!

  8. #8 Thanny
    January 15, 2013

    Yeah, I wish I had $1 for everyone who appears on a comment thread and proclaims they never get the flu, or they haven’t had the flu in 20 years, or haven’t had the flu in 20 years since they started drinking Gonga Juice(TM) (insert various health regimes). Sure are a lot of amazing medical anomalies running around out there.

    I had a nice run for a couple years where I didn’t get a cold. I chalked it up to luck.

  9. #9 david
    oxford
    January 15, 2013

    Yeah Thanny, it is a distasteful modern phenomenon whereby some people act as if by thier own will power and whatever supplements they have been conned into, they will ‘never get sick’ and wont need any modern medicine – and others that are and do are somehow deserving of it for being ‘weak’. All its going to take is that next mutation….

    @WLU I found this…
    http://scienceblogs.com/effectmeasure/2009/04/03/more-on-the-science-of-the-inf/

    Flu is a clever nasty little thing exploiting our most obvious weakness and the fact that we all must breath – it deserves respect and a better understanding through proper education – not stoopid news articles about ‘bugs’ and vaccine scares.
    Good post.

  10. #10 Sannica
    January 15, 2013

    Randy: Getting the second shot was essentially a booster, like you get for tentanus or hepatitis B. Generally, flu shot immunity only has to last a year, maybe two, before the virus changes enough to render it not-particularly-useful. Because the strains circulating were pretty much the same for two years, your first shot /probably/ carried you through the second year, but a boost never hurts, and now you’ve got longer-lived protection should any of those strains rear their ugly heads again a la H1N1.

  11. #11 denise
    January 15, 2013

    Thanny, I’ve only had the flu once, when I was 32 (I’m 63 now). But once was enough to make me get the shot every year. It was more awful than it seems you can imagine. I was in bed with a fever over 102 for seven full days, and I was wobbly for at least another week and coughing for a month. You really don’t want to get it.

  12. #12 Thanny
    January 16, 2013

    I did not write the comment above with the picture avatar. I also take exception to the insinuations.

    I don’t pretend to be some kind of super-healthy person on account of some amazing Natural™ product.

    I do get sick, as I clearly stated, but for the last 23 years or so, only one case has been viral – a cold last year (in the summer). Everything else has been strep, non-strep tonsillitis, or bronchitis. The 23 year cutoff is because around then, I did get a nasty intestinal virus for a couple weeks (during which I consumed literally nothing but ginger ale – nothing else would stay down, including plain water).

    But I have never had influenza, as far as I know, despite being in contact with people who have (growing up, my sister got the flu, and I got strep – not at the same time).

    Because of that, I don’t bother with the flu vaccine. I am pro-vaccine, however, and if I thought I could be a flu carrier without any symptoms, I would get the vaccine to protect others. Again, as I stated quite clearly in my first comment.

  13. #13 WLU
    January 16, 2013

    david – bitchin’ article, thanks!

    Thanny, you seem to be missing a rather notable point – unless you have some pretty complex lab tests done on a regular basis, you don’t really have any idea if you have the ‘flu or not. Bronchitis, for instance, is a sequelae of influenza. The “as far as I know” part is critical – you really don’t know, nor do you know how many people you may have infected without knowing it. Possibly zero. Possibly my grandmother.

    So if you’re pro-vaccination, may I suggest getting the vaccine? The alternative (getting regular lab tests to confirm or disconfirm the presence of influenza) seems more bother, and more expensive.

  14. #14 david
    January 16, 2013

    I apologise responding to those comments. You clearly are not the type of person I was refering to, or I thought you were refering to!

    Its great that you have never had flu, since as denise described, once gotten, never forgotten. Unfortunately this is part of the problem with flu awareness. It is so easliy mixed up with ‘a cold’ or ‘some sort of virus’. Its like talking about depression. Everyone feels sad, so have a hard time sympathising with people who are hospitalised with the ‘common cold’ of psychiatry.
    Everyone has had a bad cold, so thinks “how bad can it be?” Unfotunately when you find out you never forget it. And aside from the illness itself, the downstream problems can be very difficult to deal with, such as the longer than expected revovery time, or the fact that you really cannot just ‘push through it’ and get things done etc.

    With regards to the next Spanish flu type epidemic most experts agree that its not a question of if, but when. So it might seam newsworthy to make mockery of over reaction, or those that ‘got it wrong’ but really the world wide vigilance is necessary.

  15. #15 Bob of QF
    Tulsa,OK
    January 16, 2013

    I just love it when people whom I never met, pretend to know more about my heath than I do. It’s ever so lovely to read that– reminds me of how godbots act, what with their “god loves you, you know” shyt.

    I do have an over-active immune system–have had since I was a wee child, and have had over the years, various skin conditions due to that overly-protective immune system.

    But I’ve never had the 2 week long influenza virus, for as long as I can remember. No unaccounted aches or pains either. Take it or leave it, I don’t care.

    But I cannot take modern vaccines, due to strong eggwhite allergies (that over active immune system again).

    One day, perhaps, science will figure out a way to deliver flue shots without using eggs during the processing of the vaccine.

    At least, that is my hope. Meanwhile, I encourage everyone I know to get flu shots, if their health will allow it. Likely that’s one of several reasons why I never got the flu.

  16. [...] writes that the influenza virus is highly mutable, and we must devise a fresh vaccine every year in anticipation of its new forms.  This year’s vaccine has an efficacy of 62%, better than average.  Meanwhile, on We [...]

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