Influenza-who should get the vaccine? by Mark B. Levin, M.D., Louis J. Tesoro, M.D. and Timothy J. Patrick-Miller, M.D. The Pediatric Group, P.A., Princeton

This is the twentyfirst article in a series written for Princeton Online. Click here for an archive of other articles.

We are all familiar with the "flu", so much so, in fact, that we commonly generalize the name to any illness that has similar symptoms. But influenza is a specific disease with specific symptoms and occurs in a unique set of circumstances.

Influenza, also termed "the grippe", is typically a winter infection that spreads rapidly through schools and workplaces causing mass absenteeism. The unpleasant symptoms of influenza are characterized by sudden onset of fever, chills, headache, muscle pains and cough. This is followed by sore throat, nasal congestion, abdominal pains, nausea and vomiting. The illness lasts 7-10 days. Rare complications in an otherwise healthy individual include pneumonia, acute calf muscle inflammation and Reye Syndrome. The very young, very old and those who are immunocompromised have a higher rate of complications.

Every year at about this time, the media and medical care agencies encourage us to get a "flu" shot. Although many people interpret this to mean that if they get this shot they will not become ill during the winter, it is unfortunately not true. Influenza vaccine, if it works for an individual, will protect only against influenza virus infection, and only for one winter season. It will not protect a vaccinee from the myriad other virus that circulate throughout the winter.

Why, then, should anyone get a flu shot? Aside from the dismal feeling we experience from the grippe, loss of work time can be costly. So, many adults get the vaccine to maximize their chances of not missing work days. People who are at high risk for acquiring influenza infection (medical personnel and those living in a close space with many others, such as college students, nursing home clients and military personnel) often opt for the vaccine. Any person over 50 years old or with an underlying medical condition that would predispose that person to a complicated course of influenza (secondary infections, dehydration, aggravation of the underlying condition or hospitalization) should get the vaccine. If you are unsure about the appropriateness of influenza vaccine for yourself, contact your physician.

Generally healthy children are not encouraged to receive influenza vaccine, unless they fall into one of the categories listed above for adults. Examples of underlying medical conditions that would necessitate immunization for children include significant asthma, diabetes, seizures, cystic fibrosis or other chronic lung disease, adrenal insufficiency or metabolic disorders, congenital heart disease, immunologic insufficiency states, metabolic muscle diseases and malignancies.

Why, then, shouldn't everyone get a flu shot? Any medical intervention has risks. The risk of influenza vaccine varies from simple side effects to serious allergic reactions. The influenza vaccine is a killed vaccine grown on chicken eggs and contains several preservatives (Thimerosal, Neomycin, Polymixin, Beta propriolactone and phosphate buffered saline). It should not be given to those who have a significant reaction to egg white or who are allergic to any of the components of the vaccine. Side effects include 1-2 days of local inflammation in less than 1/3 of recipients. Infrequently, 1-2 days of fever, malaise and achiness occurs 6-12 hours after the injection. Immediate allergic reaction (hives, asthma, shock) are rare. The vaccine protects about 1/3 of recipients from influenza. In another 1/3, influenza will be milder than it would otherwise be without the vaccine. Another 1/3 derive no benefit from the vaccine.

A newer, safer, more effective influenza vaccine is under current development. It is administered by nose drops, lasts about 5 years and has only a drippy nose as a side effect. Unfortunately, this new vaccine is not yet available for general use. Once it is available, we anticipate that the recommendations for influenza immunization will be broadened. Check with your physician or your pediatrician if you are unsure whether to seek influenza vaccine for you or your child.

For those of us unfortunate enough to acquire influenza, treatment options are limited. Chicken soup, the old stand-by, may or may not help, but it certainly tastes good! Humidifiers, fluids, cough medicines, pain relievers, at least a small amount of caloric intake and a quiet, dark room are the mainstays of symptomatic care. Some newer medications, intended for adults, may shorten the course of the disease if taken within the first day or two. Check with your doctor early regarding the appropriateness of these medications for you if you think you have influenza.

This all seems rather unpleasant, but take heart. Uncomplicated influenza is self-limited, resolving in 5-10 days. Have a healthy winter!

Dr. Timothy Patrick-Miller

Dr. Patrick-Miller has been a member of the staff at The Pediatric Group since 1985. Dr. Patrick-Miller has served on several Departmental and hospital committees. He has published original work while at The Pediatric Group. He and his wife enjoy travel. He also likes hiking, biking, gardening and reading.

Dr. Mark B. Levin 

Dr. Levin has been a member of the staff at The Pediatric Group since 1977. Currently an attending Pediatrician at the Medical Center at Princeton, he has been Chairman, Department of Pediatrics, Medical Center at Princeton, 1984 to 1986, 1989 to 1992, and past President, Medical and Dental Staff, Medical Center at Princeton, 1987 to 1988. Dr. Levin has served on numerous Departmental and hospital committees. He has published original articles both while at Upstate Medical Center in Syracuse and at The Pediatric Group. He has a wife and three children. Dr. Levin enjoys alpine skiing, jogging, hiking and camping, travel, computers and racquetball.

Dr. Louis J. Tesoro

Dr. Tesoro has been a member of the staff at The Pediatric Group since 1988. Dr. Tesoro is Chairman, Department of Pediatrics, Medical Center at Princeton, 1996 to present and Attending Pediatrician, Medical Center at Princeton, 1988 to present. He has served on several Departmental and hospital committees, lectured at the Universiy of Pennsylvania and has published original articles both while at The Children's Hospital of Philadelphia and at The Pediatric Group.