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Tracey Koehlmoos: Flu season in the US

22 Jan, 13 | by BMJ

Tracey KoehlmoosTo many people in the US, flu season is rather like world cup football is to the rest of us. Flu has been on the front page of many newspapers and has been covered in the television news. It may have been a slow news week after the Christmas and New Year holidays, but everyone I met or overheard was talking about the flu shot and how many people they know have become sick, and for how long, and with what symptoms.

As someone who works in health and got my start working with vaccines, I love it when everyone in the country is talking about things like the effectiveness of this year’s flu shot. Vaccine really is the bread and butter work of global health. There is always a period of public speculation as to whether this year is an epidemic or just a regular flu season. Each week the press and the public eagerly await the Friday release of an update from the Centers for Disease Control and Prevention (CDC), called the “flu view.

It is more than just a spectator event. The reality is that the US and Canada are the only countries that promote blanket, annual vaccination of the entire population over six months of age and without counter indications for the seasonal influenza vaccine. This broad recommendation started in 2010. Previously only certain high risk groups were targetted, but they accounted for some 75% of the population so it became easier to target the entire population.

However, because flu is the word on everyone’s lips, there are many myths. Frequently people say the flu shot gave them the flu—it does not, it is a dead vaccine. People say that they don’t need it because there is not a real risk to their health, yet each year thousands of people die or are hospitalised, and in the US many of these people do not have health insurance or jobs that allow them to take paid sick leave. People also believe that they can benefit from herd immunity. However, unlike more effective vaccines, the seasonal influenza vaccine is not effective enough nor received by enough of the population to provide herd immunity. But, you can imagine how excited my public health heart gets when I am at the beauty salon or grocery store and people are talking about herd immunity.

Do I like getting a shot every year? No—and neither do my boys. I do wish that there were a single influenza vaccine that was longer lasting or a greater availability of the nasal spray.

Once in a while I encounter the flu shot naysayer who tells me, “I never get the shot and have never been sick,” or “I got the shot once and got the flu.” I try to enlighten them with the evidence. I try to resist the temptation to classify these people together with the people who feel the need to share with me that their “Granny smoked a pack of cigarettes and drank a bottle of Jack Daniels every day and lived to be 100.” Really? Rather than making a personal judgment, I think it is more polite and professional to go with the statistics—“outlier.”

As for me, some of you will remember that last winter and spring in addition to cyclospora (Nepal) and chikungunya  (Indonesia), I picked up influenza while travelling between New Delhi, Jakarta, and a meeting at the Rockefeller Foundation’s conference centre in Bellagio, Italy. I felt like Patient Zero in some perverse version of “Eat, Pray, Love.” For all my considerate respiratory hygiene practices, I brought flu germs into a meeting room with people from every corner of the planet. Moreover, I just felt terrible. This year, I got the shot.

If you are interested in learning more about the theory and reality of seasonal influenza vaccination in the US, you might wish to read the Centre for Infectious Disease Research and Policy’s October 2012 report: The compelling need for game changing influenza vaccines.

Tracey Koehlmoos is adjunct professor at George Mason University, Washington DC, and adjunct scientist at ICDDR,B.

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