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Data Confusing Regarding Protection from Flu

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 37 in the November 14, 2012 issue of
The Mississauga News under the feature: Health & Beauty, Medicine Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

After a mild flu season last year, Influenza A activity has yet to significantly hit Ontario. Influenza is a group of closely related viruses, which produce sudden and severe respiratory illness. We loosely divide flu into Type A, B and C with the A group being more troublesome. Viruses are very small particles of genetic material within protein coats that are microbiological dwarfs compared to monstrous bacteria.

The influenza virus exists by attaching to and invading human cells. They borrow us to replicate and kill us mostly by accident. The A group, which natural host has always been birds and pigs, is more likely to spontaneously mutate and produce a new strain as a way to get around immune systems and survive. We refer to subtypes by using the geographical location of first isolation along with year of discovery, coupled with short-forms for two different proteins found on the coat. Hence names like A/California/7/2009(H1N1), A/Victoria/361//2011(H3N2) or B/Wisconsin/1/2010.

It is possible to be infected by several different strains through the course of a season. Last year, the influenza season had a “light” impact on our health care system. Tens of thousands of Canadians were infected with over 800 different species of influenza. Symptoms appeared suddenly and quickly. Fevers, chills, muscle aches, stomach upset, cough, mild sore throat and fatigue to name a few. It has been described like being beat up. Thousands succumbed to it, mostly because they were ill to start with. Your chance of dying from an influenza virus is in the range of 0.03%. Compare that to SARS, a mutated cold virus with similar symptoms that has reappeared in Saudi Arabia, and a death rate of 12% (with death rates of 50% in those over 50).

Is it worth taking a flu shot? The simple answer is that it will give you 60-90% protection to the three strains contained in it. It will not confer blanket protection to all flu strains. The larger question is whether the current mass vaccinations programs are effective? We spent untold millions giving these shots out for the last 20 years. Data is very confusing depending on where you stand, on whether we have accomplished much doing this. When we went after the polio or smallpox virus, one shot did it, and we largely eradicated a nasty disease. It is a call to move forward to develop more effective vaccines. There is a new drug being tested in Hong Kong that can be used after the onset of symptoms.

I advocate getting your flu shot through your own doctor to keep your medical record complete. There are different manufacturers competing for our dollars and hence several vaccines on the market. Recent news headlines told of the Novartis vaccine problems, but few tell that it was resolved in days. The included strains are selected from World Health Organization data on a best-guess basis. The art of creating a vaccine involves combining viruses together until you get a rugged one with the desired traits that grows easily in egg culture. It is inactivated with formaldehyde and ultra-violet light. This is followed by chemical disruption and filtration to purify the components.

There is no live virus in flu shots anymore. Vaccination introduces the proteins found on the virus to our immune system. It is these proteins or antigens that our immune system uses to recognize foreign invaders. The idea is to get your immune system to respond, so that the feeling of a mild impending cold afterwards is normal. It is a fairly safe and effective method to prevent a few severe illnesses. Nasal flu sprays are an alternative for the needle-phobic amongst us.

Some people claim to never get flu. Most adults have had several bouts, but often don’t recognize what it is. There is some evidence that Vitamin D can help prevention. Flu makes its rounds in winter, when we don’t get sun. Vitamin C may have some effect, but only once you get infected. Outbreaks in nursing homes by wild viruses are treated with medication called Tamiflu, which does not cure, but softens the blow. More viruses are resistant to the older and cheaper amantadine. Personal stockpiles of drugs like Tamiflu are discouraged.

Despite precautions and research, we have no potential ability to eliminate the influenza virus from our lives anytime soon. In the end, hygiene and common sense are effective strategies. During sickness, wash your hands, wear a surgical mask and cover your mouth when sneezing. Stay at home when the sudden and severe symptoms hit. Seek medical aid sooner than later. Come by and take the plunge!

Related resources:

Get Your Flu Shot! from Ontario Ministry of Health and Long-Term Care.

Ontario's flu program safe despite Novartis suspension from CBC News 28 Oct. 2012. 2 vaccines suspended by Health Canada after virus particle clumps found.

2012 Flu Shots and Clinics in Canada by Susan Munroe, About.com Guide. Seasonal Flu in Canada and Flu Shot Clinics for 2012.

Mixed messages from provinces on flu vaccine stoke confusion by André Picard, The Globe and Mail, 29 Oct. 2012.

Let's Beat the Flu from Toronto.ca. Protect yourself from the Seasonal Flu. The influenza vaccine is free and available to people six months of age and older who live, work or attend school in Ontario.

Fall Is the Time to Get Your Free Flu Shot from Ontario.ca, Ministry of Health and Long-Term Care. Ontario is making it easier than ever to get your free flu shot close to home - through your family doctor, nurse-led flu immunization clinics and now at participating pharmacies.

Will you be getting a flu shot from a pharmacist this year? By Lauren O'Neil, CBC News, 22 Oct. 2012.

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