In the past couple of weeks, I’ve heard a lot of talk and seen many discussions on our neighborhood virtual groups about this year being a “bad flu season”. Being the skeptic that I often am, I thought I’d bypass the hype and go straight to our expert pediatrician, Dr. Hugh Gilgoff, to get his take on the flu and the flu vaccine. Here’s his very eloquently written response to my long list of questions.
The Flu: Separating Fact from Fiction, and Deciding Whether to Get the Flu Shot
by Dr. Hugh Gilgoff
A lot of families have been rushing in lately in response to the warnings – from media, politicians and official agencies – about a particularly strong and dangerous flu season. This has forced many parents to come to terms with their understanding and emotions about this very stubborn and sometimes scary germ. So let’s review some very important topics regarding good old influenza.
Influenza virus has been around for a long, long time. I think many people scoff at the idea of these horrible outbreaks in the distant past, but they are very real. Yes, conditions nowadays are so different, and we all take precautions to limit the spread of germs. But the point is, influenza, or the “flu”, is a very strong virus, and there is no denying that it can kill. Yes, those who have slightly weakened immune systems are most at risk, but unfortunately that group includes the very young, and not just the very old.
Each winter there are slightly different strains of the flu that circulate. We all remember when the new H1N1 flu virus came to town. Luckily this new strain didn’t mutate into a very virulent form, but it remains one of the common strains of influenza. The actual science of the flu strains and antigenic mutation may be a bit beyond this article, but suffice it to say that there are actually many strains of the flu and some are worse than others. Each year scientists track the most prevalent strains and each year a new flu vaccine is made specifically geared towards those circulating strains.
I think a lot of confusion about the flu stems from the fact that we use the word flu to describe many illnesses and conditions. A stomach flu is a germ, but not influenza at all. A bad cold isn’t the flu either. There are a ton of “cold” germs actually, from rhinovirus, to parainfluenza virus, and one of my favorites – coronavirus! But the common cold, or an upper respiratory infection, is very different from the flu.
When the real flu comes to your house, you’ll know it. It is everything – cough, cold, runny nose, but also sore throat, fevers, chills, abdominal pains, muscle aches, weakness and lethargy. And that is in a strong person, or “host”. This interaction, between germ and host, is perhaps the most interesting and perplexing areas of medicine. Why are two different people challenged with the same germ and react so differently. Why did Uncle Joe only have a runny nose, but after coming to see the newborn baby, the baby got pneumonia or meningitis? This happens all the time – even within families – where some of the kids get strep, but the others don’t. Or some get a 5 day stomach flu, and others only 24 hours. It is not just the strength of the immune system, but a complex interaction between the bad guy (the germ) and the good guy (the person as a whole, including their immune system, genes, environment etc.)
So indeed, you are going to have tons of stories about how the flu isn’t so bad, and I too strongly believe in boosting our immune system, and letting the body battle and then heal without medicines or vaccines when appropriate. The problem is the flu can sometimes be a very dangerous germ. I sometimes look at the flu in a purely factual manner. I see the numbers from hospitals (both local and nation-wide) after a winter, and see the staggering amount of children admitted to hospitals from the flu. Younger kids, less than 4 years old, and especially less than 2 years old, are at very high risk from complications stemming from the flu. Those kids are getting dehydrated because they just don’t drink. They are getting pneumonia – both from the flu directly and from other bacteria that have an easier time infecting the lungs while they battle the flu. Oxygen levels can go down, and people can indeed die from the flu. Fortunately, that remains a somewhat rare outcome, but when it comes to very young kids who get the real flu, I would say the majority get quite sick.
So should everyone get the flu shot every year? Well – if you don’t have kids, or grandparents, and you are strong and brave – perhaps not. But if we are talking about the young or old, or anyone who lives or cares for them – I would say yes. For most of us then, the flu shot is indeed worth getting. In fact the American Academy of Pediatrics recommends the flu shot for each and every child. It is best to get the vaccine early in the season, perhaps September or October, but it is still worth it to get it until March or even April.
Now, we all know the flu shot isn’t 100% protective. The numbers released each year vary, and in good seasons you may see numbers such as 65-75% – but what do those numbers really mean? It is of course difficult to study – because not everyone with the flu sees a doctor, and even when doctors see the flu, we don’t always send a confirmatory test. Often we just make a clinical diagnosis, and this leads to underreporting of the flu’s prevalence. That being said, we do have well-done studies with large numbers of children showing the flu shot often works to prevent the illness altogether, or at least to lessen the severity of the symptoms in those exposed.
People also wonder about preservatives and the safety of the flu shot. None of the normal vaccines have thimerosal anymore, but there are some flu shots that do. Ask your doctor which vaccine they have, as of course most parents feel more comfortable getting a thimerosal-free flu shot. But thimerosal has been well-studied, and it has never been shown to directly cause illness or autism. Indeed, autism rates continue to rise despite having thimerosal-free vaccines since 2001, but this is an entirely different discussion.
The flu shot can’t cause the flu – it is an inactivated or dead shot. The nasal version or flumist is a live attenuated vaccine, and you can have a bit more of a flu-like feeling that night, but it really can’t cause the flu. Many people find they get sick weeks or months after the flu shot, but that is because we give flu shots in the winter, and this is the time where colds and coughs are rampant. The flu shot does nothing to protect you against the common cold, but it also doesn’t change or alter the immune system or make you more susceptible to colds or germs.
You don’t have to commit to getting the flu shot every year – and perhaps when the little kids are older you may decide to take the calculated risk and brave the flu. Older school age kids are more likely to get the flu, as they are in school, but statistically they are less likely to get admitted to a hospital or face serious complications.
The early stages of the flu may seem quite similar to the common cold, so it is really tough to know when to seek care or treatment. Tamiflu and other anti-flu drugs can indeed lessen the severity of the illness, but they work best when given early in the illness, and this is not always possible. The decision on whether to seek treatment is honestly dependent on many factors. In general, any hint of respiratory distress – fast labored breathing – or true lethargy or dehydration should warrant immediate medical attention. The flu can cause some pretty high fevers, but I base a lot of my medical decision-making not on the number of the fever, but on the clinical appearance of the child, especially as the fever temporarily breaks. No one is happy with the flu, but if your child can eat, drink, play and be a little happy, it is usually safe to stay at home and power through the 3-5 days of the flu. Supportive measures would include rest, lots of fluids, fever management, and good ol’ fashion TLC.
Good hand-washing techniques, covering your mouth when you cough, and choosing your play dates wisely may minimize your risk of catching the flu. But unless your child is the boy in the bubble, they are going to be social animals and mix it up with other kids at classes, daycare, school etc. Once a child has a 103 fever they are kept home. But the day before when they only had a cough or runny nose, they were very contagious. This is exactly how germs such as the flu spread so quickly. So while everything you do for your child has its pros and cons, or risks and benefits, I would strongly suggest that all young children and perhaps even all children get their flu shots. I think all parents and grandparents should get their flu shots as well – to protect themselves as well as their children. After 17 years of treating children with the flu, I have come to respect this nasty germ, and I think it’s best to make any and every attempt to protect us from its myriad of possible medical complications.
Dr. Gilgoff has been working with children since 1986, and has been a pediatrician since 1996. He practices with Drs. Turner, Messinger and Aronov, at the new Mount Sinai Brooklyn Heights Medical Group at One Pierrepont Plaza on Court street and Pierrepont, and can be reached at 929.210.6000.