Tag Archives: flu

What is Flu Vaccine Anyway?

We spend a lot of time each fall talking about influenza and flu vaccine. A great deal of hard work by very smart people goes into making this magic fluid each year.

'Flu Vaccination Grippe' photo (c) 2010, Daniel Paquet - license: http://creativecommons.org/licenses/by/2.0/

The first thing you need to make flu vaccine is a flu virus. Those come in many different flavors, some old standbys trying to make a comeback, occasionally some new virus. Because the earth is tilted, our summer is the Southern Hemisphere’s winter. They are having this year’s flu season 6 months before we do. The best place to look for new influenza viruses are poor rural areas in Southeast Asia. In these areas, humans and animals frequently live close together. I’m sure you have noticed all influenza viruses have animal names (swine flu, bird flu…) – that is because the virus jumped from an animal to a person.

The World Heath Organization (WHO) is in charge of collecting flu viruses. They culture a bunch of sick people (nasal swab) to find the new and dominant viruses that season. They get pure cultures of the three worst viruses.

Now the magic begins.

Each virus is combined with a harmless standard lab virus. The result is a new virus that looks like the bad influenza virus on the outside, and like the harmless lab virus on the inside. That is important because the human body generates antibodies to the outside of the virus (it can’t see the inside). Now we have a copy of the virus that can’t make people sick, and grows well in chicken eggs. All this happens at the WHO labs.

Next it’s off to the vaccine manufacturers.

This harmless copy virus is injected into fertilized chicken eggs that are 9 to 12 days old. Three days later there are almost countless copies of the virus in the egg white. The virus is then separated from the egg white. Now it’s time to kill the virus with chemicals as we don’t want anyone being infected by this new virus (even though it is harmless). Now the virus is broken up to get a solution of the surface proteins (those on the outside).

This solution, called antigen, is then diluted to the proper concentration for use.

Next, it’s sterilized and packaged in vials and syringes.

There are hundreds of quality assurance tests done at each step of the process.

So your flu vaccine contains just the proteins from the outside of the original bad virus. It doesn’t have the ability to infect you as there is no living virus in the vaccine.

When you get your flu shot, these proteins (antigens) in the vaccine stimulate your body to make antibodies against this interloper. These antibodies will attach to the original virus and destroy it. In about 9 days you have enough antibodies to fight off an assault by the original virus.

It takes six months from finding a new virus to mass-producing the vaccine. That original virus was found in our spring (the Southern Hemisphere’s fall) and is ready for use by our fall season – just in time for flu season.

Producing the new trivalent (3 viruses) vaccine each year is one of the things the human race does very well; it requires worldwide cooperation to pull it off.

So, when you get your flu shot this year (and do it soon to maximize your protection), appreciate the “magic” that half cc of vaccine represents.

Take care

Dr B

Top Ten Flu Shot Myths: Don’t Fall for Them

It seems most people won’t get a flu shot this year – many turning to what can only be called the Top Ten Flu Myths. Here goes:

'Finally Got A Flu Shot $25.' photo (c) 2010, Jake Metcalf - license: http://creativecommons.org/licenses/by/2.0/
1. The flu shot can give me the flu. No way, no how. Injectable flu vaccine is 100% dead, broken-up virus – it is not infectious.

2. I won’t get the flu. That is Russian roulette. How often this winter will you be in the same room/elevator/auto with someone who is coughing, sneezing and doing their best to infect everyone? You will find yourself trapped like a rat.

3. I’m healthy, so getting the flu is no big deal. Influenza hits even the strong and healthy like a Mack Truck. Think 104 fevers and every muscle in your body screaming at you. Not much a doctor can do after you have the flu.

4. The Flu vaccine is dangerous. This is the old argument regarding the preservative Thimerosal. There is zero scientific evidence that this preservative is harmful. Given the hundreds of millions of flu shots given, even a tiny risk would be found. If you still fear this preservative, the flu vaccine is available in preservative free form (no Thimerosal) and the FluMist nasal spray has none. For the record, my children, wife and I had the regular flu vaccine (with Thimerosal).

5. Flu shots are difficult to find and useless after November. The flu season changes every year. Things like air travel spread viruses quickly to far flung places. It takes 9 days to develop immunity after being vaccinated. You will still get immunity whenever you vaccinate. In terms of finding the vaccine, the vaccine is plentiful even late in the season. If you decide a flu shot is a good idea, why risk getting the disease for months before getting a shot?

6. I get sick even if I get the flu shot. Influenza takes a couple of days to develop after you are infected. So you can also get exposed a couple of days after the vaccine, but before you are immune. Influenza vaccine doesn’t prevent colds. So any of those situations can lead people to think the vaccine didn’t work.

7. I don’t have the money. A Canadian study found an average savings of $43 in healthcare expense for every vaccinated person. Doctor visits and work absence were all significantly reduced in the vaccinated population.

8. Only old people die of flu. In normal years, 90% of flu deaths are 65 years and over. H1N1 had the opposite with almost all the deaths in the young. It is your contribution to the public good to not be passing around flu this winter. We call that herd immunity. The sum is greater than the parts.

9. I am still immune from last year’s shot. The flu vaccine is redesigned every year based on the early emerging virus types in Southeast Asia (they have their winter during our summer). When we measure immunity, flu vaccine gives very strong immunity for six months or longer. You don’t still have high antibody levels the next flu season.

10. Flu shots hurt. In my clinic, we use #30 needles that are the thickness of a human hair. The vaccine is not irritating to the muscle. There is very little pain with a carefully given flu shot. If you are needle-phobic, you can always take the nasal spray (FluMist).

We have plenty of vaccine, what are you waiting for?

Dr. B

Plenty of Good Reasons to Get Flu Shot This Year

'Finally Got A Flu Shot $25.' photo (c) 2010, Jake Metcalf - license: http://creativecommons.org/licenses/by/2.0/
So far, it’s been a pretty uneventful flu year with no scary new strains. We picked the right flu virus to make vaccine out of, so it’s a one-shot year.

When discussing the flu, “same old-same old” means 41,000 people will die in this country of the flu this winter. That’s as many people as get killed on U.S. highways in a year. It would be nice to be able to vaccinate against automobile deaths, wouldn’t it?

Most of the flu deaths will be people 65 or older. Most of them will catch the flu from younger people around them.

We get the flu vaccine or not according to our own private equation, weighing our health, the chance of getting the flu, our memory of last winter, and the hassle factor of both illness and getting the vaccine. All this is almost unconscious, and steers us either toward or away from opportunities for vaccination. Public health folks tear their hair out trying to convince us of the benefits of herd immunity.

I recently came across some data that looked at flu vaccination from a different perspective. The study looked at respiratory illness rather than just flu. Respiratory illness includes anything that makes you congested and cough, presumably 20 dozen different cold viruses and the flu. They vaccinated a bunch of healthy working adults and watched what happened. Those vaccinated adults had 25 percent fewer respiratory illnesses, 43 percent less sick days from respiratory illness, and 44 percent fewer visits to a physician for a respiratory illness. The savings on average for each person vaccinated was almost $47.

At first glance it appears that the flu vaccine helps protect you against a bunch of cold viruses as well as influenza. That would be a heck of a flu shot – sign me up. Sadly, it doesn’t.

What it actually means is there are a bunch more cases of flu going around than anybody realizes. And the flu is a much bigger part of what makes us cough in the winter. One would suppose from this data that a third or even a half of our winter respiratory illness is flu based. Who knew?

So maybe you get vaccinated for some noble reason, like saving an elderly person’s life, or trying to keep the kids healthy this winter, or missing less work, or simply to save a buck (or $47) — it all works.

There is plenty of vaccine, and winter is coming, so what are you waiting for?

Take care,

Dr. B

As the Peak of Flu Season Hits, Study Shows Importance of Hygiene

With the peak of flu season usually occurring this month, a recent study on the spreading of flu can teach us an important lesson about hygiene.

The study, published by the National Academy of Sciences, looked carefully at the H1N1 flu season in 2009. They studied schoolchildren, classmates and their families as the epidemic was happening. They suspected that many children were spreading the flu to their classmates in school.

Their findings actually disproved that school was an important source of infection. They found instead that the close contact of friends who played together outside of school was a common source of illness. Typically, children who played together outside of school have more close contact with each other. They use little hygiene such as hand washing or covering a cough.

Hand Washingphoto © 2010 Anthony Albright | more info (via: Wylio)

It was striking that children did not get sick from just sitting next to a classmate in school who was sick. This went against the prevailing wisdom of closing schools to prevent the spread of flu.

In reviewing households with sick children, most of the time adults in the household did not get sick from their children. They were probably making a special effort to limit exposure to the obviously ill family member. Again, the study results suggest the more likely source of infection was in the community at large where efforts at hygiene were forgotten or non-existent.

Day 59, Project 365 - 12.18.09photo © 2009 William Brawley | more info (via: Wylio)

We know that the flu virus does not fly through the air attacking a person over the shoulder while they look the other way. If someone coughs or sneezes on you point-blank within a couple feet, mucus droplets are broadcast with the virus; however, the most common denominator is you. We are the last link to acquire the infection. By touching our own hands to our face and mouth, we’re most likely to get the illness. Hands touch so many public places and surfaces that we forget that our own hands are such germ-laden instruments. Washing hands before eating or food preparation remains one of the most important means of protecting yourself from illness.

The researchers noted that the flu virus spreads very rapidly among school age children. The results reinforce that it is not the classroom or seating arrangement that is the problem. It is more likely due to the fundamental lack of hygiene practices in children and adults in the community that facilitate spread of the disease.

We all can learn a lesson from this study, so be sure to wash up.

– Dr. Bruce Kaler

The Top 5 Places to Catch the Flu

Here we are just into the opening weeks of a new year, and influenza is well into its annual assault on America. Germs aren’t hard to find this season, but where they hide might surprise you.

At the Office
We spend more than a third of our lives at the workplace. This tops our list for flu exposure. Depending on the layout of where you work, you may find yourself uncomfortably close to a sneezing, sputtering coworker. Perhaps you share a telephone with several others. Breath is heavy with moisture and creates a nice warm place for bacteria and viruses to multiply in the telephone mouthpiece. So you may be sharing more that simply a telephone.

Keyboards also get pretty germy. Our fingers are moist and a bit oily, and leave a film on the keyboard surface. This is a perfect place to grow germs. Keyboard use is a good way to both leave and pick up germs. One study found more germs on a keyboard than a toilet handle. Where is that can of Lysol?

How about that break area at the workplace. Which refrigerator gets cleaned more often, the one at home, or the one at work? Washing coffee mugs at work usually takes a quarter of the time and half the amount of soap that the same mug would get at home. Not surprisingly, they don’t get too clean and can be a source of influenza germs. Has that sponge in the break room been replaced since the company opened? Old sponges smell bad for a reason. Old magazines in the break room have been read by generations of people, few of which wash their hands. Put those same magazines in a doctor’s waiting room, and they get to heroic levels of germs rather quickly. Magazines don’t do too well in the washing machine.

DSC_3958photo © 2005 Michael | more info (via: Wylio)

At Home
We all try pretty hard to not leave used tissues lying around the house – these are the hand grenades of the germ world. Germs are sneaky and inventive in their hiding places. The remote control gets handled by many greasy hands – chips and TV anyone? The kitchen at home is cleaner than the one at work but still contains more germs than the bathroom. When is the last time you cleaned the cabinet door to the kitchen waste basket? How about the refrigerator handle? Care to guess how many germs get tracked in on your shoes from the outside?

On the Go
Start with your own car. Rarely do we risk an accident by sanitizing the steering wheel after a good sneeze. Anyone else drive your car? Public transportation in its many forms also serves as a germ reservoir. From elevators and escalators to city buses, large numbers of often sick people pass though, leaving more than a footprint. Who last pushed that elevator button? Who last used the hand rails? I need to take a break and wash my hands.

Airplanes are particularly worrisome as far as influenza virus is concerned. The air in a commercial jet is re-circulated, perhaps better put, recycled. A couple hundred people are shoulder-to-shoulder and breathing the same recycled air. The air is filtered but lots of interesting germs can be cultured right off the filter. There is not enough space to separate you from the germ factory sitting next to you, and it’s always next to you, isn’t it? The aircraft bathroom holds the record for the “germiest” of public bathrooms – all of the usual sources of germs in one-tenth the space. The interesting roaring sound the aircraft toilet makes actually can put colonic bacteria (ecoli) into the air for all to breathe.

Your Retail Life
At least they have figured out shopping cart handles and placed disinfectant wipes close by. You might wipe more than just the handle, as the last user could have had a sick child in the cart seat.

Credit Cardsphoto © 2008 Andres Rueda | more info (via: Wylio)

Everybody knows money is dirty, but credit cards get handled a lot more and are never cleaned. How about the keypad in the grocery line with the credit card swiper? None are cleaned on any kind of regular schedule.

The gas pump handle also sees a lot of hand traffic but no cleaning.

Finally, your cell phone is not always your best friend. Pass it to friends to make a call, show a picture or share a Facebook comment – lots of hands, no cleaning.

Although it seems tempting, I don’t recommend you actually live your life in a bunny suit. Your immune system is designed to help you survive the various insults. You can give it a big help with a yearly flu shot.

Be well,

Dr. B

5 Surprising Places the Flu Can Linger

KSAZ FOX 10 in Phoenix stopped by U.S. HealthWorks Center Medical Director Dr. Donald Bucklin’s office this morning to talk to him about 5 places where you can catch the flu. Check out the segment here.

What Would You Do If A Colleague Came To Work With The Flu?

Last week, our very own Dr. Steve Sorsby spoke with Q13 FOX in Seattle about dealing with co-workers who are sick and how to prevent spreading illness at work. Check out what advice he had:

What Would You Do If A Colleague Came To Work With The Flu?

By Angela King & Q13 FOX News Online
January 11, 2011

Does it drive you crazy when your colleagues come to work sick? They’re coughing and sneezing all over the place, forgetting to cover their mouths? What would you do in that situation? It’s not always easy to tell your fellow adults to “cover up”, but it might be worth thinking about, especially now.

The flu is starting to emerge on the east coast and in the south. It usually doesn’t peak here in the northwest until February. Doctors aren’t anticipating a severe flu season like the one we saw last winter. Since 2009, H1N1 has killed thousands of people, and sickened many more worldwide. (Read the rest here)

Vaccines for Grown Ups

I was just sewing up a patient’s lip when I asked about his last tetanus shot. He shrugged and mumbled something about childhood, which it turns out, is a pretty common response.

We worry about vaccinating our kids, but what about us? Vaccines prevent disease in big people too. With that in mind, here are the major ones you need to be sure are up to date:

Vacuna influenza / Flu vaccinephoto © 2009 El Alvi | more info (via: Wylio)

Tdap
Until recently, we knew adults needed protection from tetanus and diphtheria, but pertussis is mainly a childhood disease, so we didn’t vaccinate for it. Trouble is, it can be fatal to kids, and usually kids catch it from an infected adult. So this vaccine is a 3-in-1. You get great immunity from tetanus, diphtheria and pertussis with a single Tdap vaccination. This vaccine should be received every 10 years.

Flu
Flu vaccine is next in importance. There are more than 40,000 influenza deaths per winter in this country alone. This is a yearly vaccine and is another 3-in-1. The Center for Disease Control and Prevention and World Heath Organization closely monitor the various strains of influenza circulating around the world. They pick the three stains of flu most likely to hit the U.S. this winter and make a new vaccine against all three. Because there are different influenza strains every winter, you need a new flu shot every fall or early winter. The flu vaccine is recommended for almost everyone.

Pneumonia
Pneumococcal pneumonia is still a very serious disease. This bacterial pneumonia was called “the old man’s friend” as it commonly caused death in the elderly. That’s no kind of friend I like. Pneumonia is most dangerous to those who have less robust heath due to age, disease or smoking. For that reason, this one-time vaccine is recommended for those over 65, people with heart or lung disease, or smokers.

Chicken Pox/Shingles
Varicella vaccine – this is marketed as either the chicken pox or the shingles vaccine. It protects against both because both diseases are caused by the same virus. Because it is a herpes-type virus, the virus lies dormant in the nerves for decades after active infection. If your immunity against this virus goes down, the virus can travel down the nerves and cause painful blisters in one area of your body (shingles). This is another one-time vaccine, and most adults should consider receiving this.

Prevention is always easier than facing the disease. In many ways, children are stronger and healthier than the grown ups who take care of them because they get vaccinated. Give yourself the same chance, and take a minute to talk to your doctor about these vaccines.

Take care,

Dr. B

Healthy Holiday Travel Tips

Here are some tips to make sure you reach your destination this holiday season without contracting a nasty cold or the flu.

long checkin line at st. louis airportphoto © 2010 The Consumerist | more info (via: Wylio)

Get a flu vaccine as soon as possible. The current vaccine is widely available in almost all communities. It takes a minimum of two weeks to develop any immunity after receiving the flu shot. Although this requires acting soon and planning ahead, it is the absolute most important factor.

Get adequate rest the night before travel. Having seven to eight hours of restorative sleep will give you a fighting chance of resisting whatever exposure you get when traveling. Travel days are usually long and hectic. If it can be avoided, you don’t want to start your day already run down.

Make sure you have a pocket-sized Kleenex, Purell, and saline nasal spray. Using hand sanitizer periodically after touching public surfaces once you settle into your seat and before eating is important. Avoid touching your own face, nose or mouth with contaminated hands. Usually illness such as the flu and other common respiratory illnesses are not airborne. They don’t fly over your left shoulder while you are looking the other way. The majority of transmission is self-inflicted. You have the germs on your hands and then eat, touch your nose or mouth.

Keep an arm’s length from other travelers and airport attendants when possible. Be aware that others may be sick and not be so mindful when they cough or sneeze. This is tough to avoid in close quarters, especially in your seat on an airplane. However an understanding and awareness could prevent you from being the unsuspecting target of their germs.

During your flight, stay well hydrated. The cabin air is usually very dry. For comfort, occasional use of saline nasal spray is good. Keeping the nasal mucosa moist and generally staying well hydrated will make you less vulnerable to the unavoidable germs you may encounter. Eat wisely and avoid alcohol during your flight.

Prolonged sitting in cramped positions puts you at risk for blood clots or phlebitis. Even a healthy person is at risk. The cramped position, lack of regular muscle movement in the lower extremities, high altitude and not drinking enough water can put you at risk. Deep Venous Thrombosis (DVT) is a very serious medical condition caused by blood clots in the legs. If untreated, it can lead to life threatening problems. Wear comfortable nonrestrictive clothing. Wiggle toes and feet. Stretch legs periodically if the space allows. Get up and move around the cabin briefly every 20 to 30 minutes. Changing position and physical activity can help restore sluggish circulation which puts you at risk.

If you have any chronic medical problems, consult your health care provider before your trip. Even some medications can increase your risks. Your physician may recommend a medication or aspirin prophylaxis for the trip.

Don’t let paranoia about germs or DVT distract you from the enjoyable goals of holiday travel. A few simple steps and planning should help you have a happy, healthy and successful trip.

– Dr. Bruce Kaler

Is it a Cold or the Flu? Dr. Baxter Debunks the Myths on FOX Dallas

When winter rolls around, so do the germs. But does that cough and fever mean you have the flu or just the common cold?

Dr. Shiu-Yueh Baxter, Center Medical Diretor of our Carrollton clinic, spoke with KDFW-TV FOX Dallas this morning to discuss the difference between the two and to explain the truth behind common winter flu myths. The segment is available here.