Q&A: flu shots

Monica asks:

"What are your thoughts on the flu vaccine for babies? In my case, my ped doesn't offer the vaccine without thimerosal and I can't find one willing to vaccinate my son in the near future. Would you get the regular vaccine or skip it all together?
 

Also, why can my son sleep through a thunderstorm, but not the sound of my footsteps as I creep out of his room!?"

I don't want to open a whole vaccination can of worms, so let's make this clear that this is only my thoughts about the flu vaccine. Not vaccines or vaccination in general.

Now, I like to look at the benefits vs. the costs. The benefit is, obviously, not getting the flu. But I'm not convinced (and haven't been for years) that the flu shot is actually that great at preventing the flu. My suspicions were confirmed when I read about a study appearing in The Lancet (British medical journal) of elderly people who got the flu shot. A summary of the study results is here, but the money quote is

The researchers found that flu vaccines, when well matched to circulating flu strains, reduced the risk of hospitalization for flu or pneumonia by 45% for elderly (65 or older) nursing home residents. For people living at home, flu vaccines were 26% effective in preventing hospitalization for flu or pneumonia. However, vaccination didn't significantly lower the risk of laboratory-confirmed influenza in either group.

And those benefits, note, are only when the flu shot is well-matched to the flu strain that goes around. Which happens sometimes, but not every year. I don't know whether we can assume that the effects are the same on kids as they are on the elderly, but we don't have any studies of the flu shot on kids yet.

Then there's the anecdotal evidence that that last 3 times I got the flu shot I got the flu within days. (Who knows why? All I knew was I got the flu.) Now, "the plural of anecdote isn't data," (thank you, Jo Leery Polyp) but I have to think that if anyone's going to have the same results of a flu shot that I did, it'll be my kids. Someone who's had a great experience with the flu shot in the past is going to have a radically different view of the benefits than I do.

The costs: There are a bunch of toxic and/or allergenic ingredients in flu vaccines (MSG, thimerosol, a few different antibiotics, formaldehyde, and eggs). Not much of those in each shot, but since I go out of my way to avoid MSG, formaldehyde, and mercury, I'm not crazy about the idea of shooting them straight into my kid's bloodstream.

So, what's the answer? Well, it's different for everyone. If you have a child with a compromised immune system, you will probably get the shot. If you have a kid allergic to eggs or poultry or certain antibiotics, you won't get the shot. The rest of us just have to pick a side by going with our guts.

The odd thing about all of this is that the media makes us think the only way, or even the best way, to protect ourselves against the flu is by getting the flu shot. That's not true at all. The single best way to avoid the flu is to wash your hands a lot. A lot. Many times a day. Not with antibacterial soap, but with regular soap and water. And makes sure you scrub for the length of time it takes you to sing the "Happy Birthday" song. You still probably won't spend as much time each day washing your hands as you do thinking about whether or not to get the shot.

The other great ways to avoid the flu are to up your Vitamin C intake during the winter, drink plenty of water, make sure you're eating plenty of vegetables (easier said than done with a 3-year-old), get as much sleep as possible, and stay away from sick people. You can also try the herbal remedies like echinacea and Airborne, or the homeopathic Oscillococcinum (apparently it can be used to prevent flu by taking 2-3 of the teeny little pellets--not the whole vial--once a week during flu season).

Monica, for your second question I can only say that he does that for the same reason mine can sleep through 3 fire engines screaming down the street past his window, but wakes up when I crack the door to make sure he's still OK.

Comments

[kate]

Moxie - I'm so happy that you started this site! I was just grappling with this issue yesterday at my son's 6 month appointment. Luckily for me, my ped's office had the thimerisol free flu shot, b/c I don't know what I would have done if they hadn't. Either way, I would have felt like I was being a negligent mom. Anyway, great information.

[Katie]

I did not get the flu shot for my kids for many of the same reasons. Also added to it is that they are in home day care with at the most 2 other kids (or my inlaws) so they are not exposed to the germ mass at larger child care centers.

[Cat, Galloping]

Ha! As if you have the length of "happy birthday" to wash your hands when there's a screaming infant in your arms (and you can only do one hand at a time, which must not be as effective and must then require happy birthday for each hand). ;-)

I'm still pissed that they shot me with the flu on my way out of the hospital after my c-section, without asking, when I was too drugged to protest. At least they didn't shoot the bambino.

Seriously though, I think the real issue with Monica's question is that this version has thimerisol. I'm so confused. I thought that was pulled off the market! Except for, you know, sending it to China and Africa...

[Lala]

Come to Canada, we don't have Thimerosal in our flu vaccines. You'd have to pay for it though.
And good on Moxie for providing a trusted voice that we all can relate to.

[wix]

we did the flu shot last year, but i don't think we're going to do it this year. hell, we don't even have a pediatrician that i like right now.

[Brooke]

Two (no make that three) quick thoughts:

1)Flu shots don't go directly into the bloodstream. I know it's a small difference, but if you are going to be debating the merits of any vaccine, get the facts absolutely right seems important.

2)Thimerisal isn't the same type of mercury as the stuff you need to really worry about. It's no skin off my nose if you are concerned about it, although I'm not. But if you are concerned about it, I hope you are way, way more concerned about any fish/seafood you eat since that is pretty high, at the very least much higher than any vaccine in mercury and it's the very bad form of mercury.

3)There was a study in Japan on the effect of vaccinating 2-4 year olds against the flu. It showed that vaccinating that population greatly reduced the incidence of flu in the elderly. More even than vaccinating the elderly I think. So, you might help protect the grandparents (who could have a much worse reaction to the flu) by vaccinating your kids, if they spend much time with the grandparents. Which may or may not matter to you, but it's something else to consider.

[ALG]

I'm only 26, single, and childless, so I don't know much. However, I've never had a flu shot and, as far as I know, I've never had the flu. (I was wondering aloud at work about whether I'd ever had it, and someone told me that if I'd had it, I'd know. I've never had a fever lasting more than five days or so and never been achy.) I have friends (my age) who get flu shots, though, and I don't really get the point. Maybe if I'd had the flu, I'd feel differently.

Moxie, how do you feel about hand sanitizers that don't contain antibacterial stuff, but kill bacteria with alcohol? I don't use anti-bacterial soap but do use generic Purell, because I don't think they cause hardier strains of bacteria. And they're way easier/faster than washing with soap and hot water.

[Linda]

Thanks, Brooke, for correcting the bloodstream part. I assumed that Moxie meant that the vaccine is given intramuscularly and then absorbed into the bloodstream, but not everyone would read it like that.

I get a flu shot because I work in the ICU with a lot of patients with crappy lungs and hearts and various chronic diseases. I vaccinate my kids because who knows what crap I bring home with me and we're all a lot less likely to carry the flu along to our immunocompromised friends/family that way.

However, I can see how if you are a healthy person with a healthy kids, you would hesitate. It's definitely a "best guess" sort of vaccine, not 100% at any rate (no vaccine is).

I'd like to point out that the only way to REALLY know if you have the flu is to trot over to the doctor and have someone stick a long q-tip up your nose and place it in a really pretty pink medium for testing. A lot of people mistakenly think that the "stomach flu" (vomiting and diarrhea) is the flu or that a bad cold is the flu. You can see the signs/symptoms of the flu here:

http://www.cdc.gov/flu/about/qa/disease.htm

Also, ALG's question is very interesting. Most infection control doctors/nurses will quote studies about how alcohol containing hand sanitizers are actually BETTER at preventing the spread of infection than washing with soap and water. This is basically because no one washes long enough (see Moxie's Happy Birthday song) with soap and water. At any rate, they're good, great even, and anything's better than the antibacterial crap.

[Adria]

Just wanted to lyk I enjoy your blog. Your post about the flu shot was very good IMO.

[Monica]

Thanks, Moxie. Great advice, as always. I can see that there is no clear answer - and no right answer either. I had no idea that you were supposed to wash your hands that long - seems like a piece of info I should have been aware of, but no.

I also just wanted to make clear that I wasn't making a judgement about those who choose to get the flu vaccine - just trying to get feedback on making the best choice for my family.

Brooke, I agree that there are many, many other environmental factors to be concerned about - just one of many reasons we're a vegetarian household.

[kelly jeanie]

I have nothing to add to the discussion on whether or not to get flu vaccination; however, I'd like to thank Moxie, as now I can't wash my hands without humming "Happy Birthday" to myself. Which, I suppose, is the point.

[Moxie]

Brooke makes some great points.

I definitely should have been more precise with my language (although I was being deliberately somewhat casual because I wanted to emphasize that the decision-making process is so hugely subjective). Shooting directly into the bloodstream would be a little too Fifth Element--I really mean bypassing the body's normal system of defenses and filters to go into the muscle (then into the bloodstream).

It interests me that the defense of thimerosol is that we eat worse when we eat fish. Because I'm guessing that population that actively avoids thimerosol (instead of grumbling about it but just getting it anyway) already avoids other mercury-containing foods. Personally, I haven't eaten tuna since 2000, and El Chico has never eaten it. I eat other fish maybe once every 6-8 weeks. Which is a freaking shame, because I could eat moules frites every day of my life. I'm also concerned about other contaminants in my food, and try to limit my consumption of animal fat, or at the least go with organic dairy products when I can to try to limit the damage to my system. (One side "benefit" of living in NYC is that regular groceries are so expensive that there's not much cost difference between regular and organic.)

Fascinating about the Japanese study! Unfortunately, the House of Moxie doesn't come into a whole lot of contact with elderly people (there are a few elderly people at our church, but that's really only once a week). We'll be spending a week with my parents at Christmas, but while they're old enough to belong to AARP, they're definitely not elderly. But it's interesting that the effect was stronger when vaccinating kids than when vaccinating the population itself.

I never really thought about hand sanitizers before, but will give them another look, thanks to Linda's comments.

[Emilin]

"I really mean bypassing the body's normal system of defenses and filters to go into the muscle (then into the bloodstream)."

By "normal system of defenses," I can only assume that you mean the fact that the body breaks down the stuff we eat into other things. Unfortunately, methylmercury is not changed at all when passed through the digestive system. As it works its way through your small intestine, it poses the same risk of absorption into the fatty tissues as does ethylmercury when injected intramuscularly.