It’s flu Vaccine time of the year again.  Whether you choose to get the vaccine or not, is that choice based on accurate scientific information?  While there may not be a one decision that’s right for everyone, it’s safe to say that making a choice based on myths is a mistake.

How do vaccines work?

When a person receives a vaccine, the body generates an immune response and produces antibodies that are specific to the infectious agent.  If that person is subsequently exposed to the infectious agent, an antibody response will quickly be generated to latch onto the target virus/bacteria and allow it to be cleared from the body quickly without causing an infection.  There are two main types of vaccines: live attenuated and inactivated.  Live attenuated vaccines contain a weakened version of the infectious agent, while inactivated vaccines contain an infection agent that has either been split or inactivated by some other means so it is not capable of replicating.  Live vaccines are generally not recommended for people with compromised immune systems as there is the potential for a mild infection to result.

The influenza virus and the flu vaccine

As shown in the diagram of an Influenza virus above, the virus consists of genetic material (RNA) contained within a capsule made of proteins and lipids.  Infection happens when the virus enters host cells and hijacks their cellular machinery in order to reproduce large numbers of copies of itself.  Variations in two of the surface proteins, hemagglutinin and neuroaminidase, are used to name influenza subtypes, hence the H1N1 type of nomenclature.

Every year, typically by February, the World Health Organization predicts the 3-4 strains of the influenza virus that are likely to be predominant in the upcoming flu season.  These are then used to produce the vaccine, which is cultured in chicken eggs, so that there will be a supply available for the next flu season..

Can the flu vaccine give me the flu?

The injectable Flu Vaccine is an inactivated type of  vaccine, so there is no replicating virus present to possibly cause an infection.  Depending on the formulation, this contains either “split virus” or isolated protein subunits.  Because the vaccine does not contain replicating virus, it is not biologically capable of causing an influenza infection.

The nasal spray version of the vaccine, however, contains live attenuated virus.  The weakened virus does have the potential to cause a mild influenza infection in individuals with weakened immune systems, so this form of the vaccine is not recommended for that population.

Why is the flu vaccine only good for a year?

The strains of influenza can vary considerably from year to year through a process known as antigenic drift.  Changes in the genetic structure will produce different variations in virus elements including H and N proteins.  With current vaccine technology, it’s not possible to produce a vaccine that will be effective against all strains.

What are the possible side effects?

You may feel mildly unwell as your body mounts the expected immune response.  People who receive the live vaccine may have mild flu-like symptoms.  There may be pain or redness at the injection site.  This is more likely with vaccine formulations that have an “adjuvant” to generate a stronger immune response.

There is a small possibility of serious side effects.  There may be an anaphylactic reaction, and the health care provider administering the vaccine will always have epinephrine on hand in case of this.  Other rare side effects include the neurological condition Guillain-Barre syndrome (in an estimated 1 in a million vaccinations) and oculo-respiratory syndrome.  It is important to consider these rare but serious effects in the context of the potential risks of an influenza infection and make a balanced decision about what is right for a given individual.

I got sick afterwards – is it the flu?

There are a few possibilities.  You may have already had an influenza infection but hadn’t become symptomatic yet when you got the vaccine.  You may have been exposed to an influenza strain that was not included in the vaccine.  You may have become infected with a bacteria (such as a strain of Streptococcus) or a virus other than influenza that targets the respiratory tract.  The “stomach flu” is a misnomer and is not in any way related to the influenza virus.

The effectiveness of the vaccine also varies from year to year.  It typically protects 60-80% of those immunized, with the elderly and other high risk groups tending to be on the lower end of that range.  However, even if the vaccine is not effective and an immunized individual does develops the flu anyway, having received the vaccine does not in any way increase their likelihood of developing the infection.

Conclusion

So, what’s the take-home message here?  Because the influenza virus changes so much, the flu vaccine is nowhere near as effective as many other vaccines.  However, it can be an important lifesaving measure for those who are at high risk of developing complications if they acquire an influenza infection.  Since the vaccine is not perfect, it’s also important for those who have close contact with these at-risk individuals to reduce the chance that they will expose that person to the virus, especially since the virus is contagious before a person even develops flu symptoms.  The influenza vaccine that the majority of people receive contains inactivated virus, which makes it biologically impossible for it to cause an influenza infection.

As a nurse who will come into contact with high-risk individuals, I’ve already gotten my flu vaccine this year.  Will you?  Why or why not?

Sources:

https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-statement-seasonal-influenza-vaccine-2018-2019.html

http://www.bccdc.ca/health-info/immunization-vaccines/vaccines-in-bc/influenza-flu-vaccine

https://www.healthlinkbc.ca/healthlinkbc-files/flu-vaccine-myth-facts