Out of Line on the Flu Vaccine

by Adriane Fugh-Berman, M.D.

This time of year, it’s usually competition for some hard-to-get toy that provokes criminal behavior, but the coveted consumer item of 2004 is the flu vaccine. People have lied about their health status, stolen doses, even resorted to shoving matches for a better shot at, well, a shot. Some jurisdictions have held lotteries for the vaccine, with others passing laws that subject health care practitioners to hefty fines for administering the vaccine to those who aren’t at high risk.

About that risk thing. “I need the vaccine!” protested a perfectly healthy relative of mine. “I teach preschool, and the kids wipe their hands everywhere and sneeze into your face.” Her comment made me realize that many people don’t understand that the term “high risk” means you have a higher chance of dying from the flu, not just getting the flu.

Flu is nasty, but so are colds, strep throat, bronchitis, ear infections, sinusitis, asthma and pneumonia, all of which are more common in fall and winter—and all of which are impervious to the flu vaccine. The flu vaccine is no magic amulet against winter illness.

Or even against flu symptoms. Vaccination clearly reduces influenza-related deaths in the elderly, particularly those in frail health. And it makes sense for those with compromised immunity. But the robust among us should get out of line. From a public health point of view, you’re increasing your risk of respiratory illness just being around all those people. Moreover, the vaccine doesn’t work that well. A recent meta-analysis (which pools results from many studies) by the Cochrane Collaboration of 25 studies included 59,566 healthy people aged 14 to 60. It found that live aerosol vaccines (inhaled vaccines) reduced laboratory-confirmed cases of influenza by about half, while inactivated vaccines (the type most commonly used in injected flu vaccines) reduced cases by about two-thirds.

However, the vaccines reduced clinical influenza cases (physician-diagnosed “flu”) by less than a quarter. The reason for the discrepancy is that flu-like symptoms (fever, muscle aches, fatigue, etc.) are often caused by viruses that aren’t true influenza, and the vaccines are effective only against true influenza. So the shot reduces flu-like symptoms by about 25 percent. In other words, if you’re a healthy adult and your chances of getting a flu-like illness were originally 10 percent this winter, the flu vaccine will reduce your chances to about seven percent. Use of the vaccine reduced time off work, but only by about two hours.

Want to curb your risk of being sick? Try good old-fashioned infection control. Isolation works. If you get sick, lie down and act sick. Get someone to bring you soup and tissues, but otherwise stay away from people, especially the first few days. Catch up on sleep, watch sitcoms, read, meditate, call people, feel sorry for yourself, cheer yourself up by remembering this is temporary, and your good health will soon return.

If others are around, tie a scarf or bandanna around your neck, and cover your mouth and nose. Don’t hug people or shake their hands, and don’t make, share, or breathe on food. Blow kisses. Bow. Smile. Wave. From a distance.

There’s a public health move on to encourage people to sneeze into the crooks of their elbows instead of their hands. Well, okay, that would help, but I think it’s a bit impractical. Hands are easier to wash than the insides of elbows. Besides, mucus-coated sleeves aren’t attractive, not to mention the dry-cleaning costs. If you must venture from your sickbed, carry tissues, use them, toss them, and wash your hands with soap and water or antibacterial cleaner every time you sneeze. Remember that hand-washing is better at preventing germ transmission than preventing germ receipt. True, germs can survive on doorknobs and faucets for awhile, but you can wash your hands until they’re raw and still catch the virus when someone sneezes in an elevator.

Here’s something else you can do. Instead of clamoring for flu vaccine, let’s use that energy to shame the sick into staying home. Our workaholic culture encourages sick people to drag their clogged and germy carcasses into workplaces, where colleagues smile supportively and say, poor thing, coming to work as sick as you are. Public ridicule and physical avoidance measures (take a tip from the kids: fingerpointing, making signs of the cross, jeering, “eeww, he’s got cooties”) should drive the germridden back to their beds. As you push them out the door, disinfecting doorknobs and elevator buttons behind them, be sure to shot “and don’t take the bus home!”

Of course some workers don’t get sick days, and you may have other good reasons to venture from bed, but even then you can behave responsibly. In China, people with respiratory illnesses wear surgical masks. We’re a long way from masks being socially acceptable here, but it’s a good public health measure, and surely some marketer could come up with trendy versions.

Have a healthy, sensible winter.

Adriane Fugh-Berman, M.D., is an associate professor in the Department of Physiology, Georgetown University School of Medicine, and a former chair of the NWHN.

Reference: Demicheli V, Rivetti D, Deeks JJ, Jefferson TO, “Vaccines for preventing influenza in healthy adults.’ Cochrane Database Systemic Review 2004(3):CD001269.