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Shoot, Snort, Swallow or Run
(Flu Shot)

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed in the October 23-24, 2004 issue,
under title: Could You Send My Flu Shot to Some Needy American?
Reprinted in the November 17-18, 2006 issue of
The Mississauga News under the feature: Health & Wellness, Medical Matters.
Dr Peter W Kujtan photo

People are showing up at my doorstep seeking a flu-shot, just in case that avian thing shows up. This theoretical concept of bird-flu resulting in a human pandemic seems to have a lot of people worried. Avian Influenza refers to a particular flu-strain found in birds. A few humans have ended up as accidental hosts mostly in countries where people extensively eat, sleep and live with birds. This year's shot does "diddly" for people who think that sneezing birds are going to give them the flu. The Avian flu poses only theoretical danger to the human race at this time. Your money would be better spent wagering on the Leafs to win five straight. Secondly, anyone who pays taxes has already pre-paid for the flu-shots, so you might as well drop in and collect what is owing to you. An Epidemic refers to extensive illness and death in a given geographic area. A Pandemic refers to the spread of flu activity around the globe resulting in sickness and death. Asia is experiencing chicken flu epidemics. The virus mutates a lot, and one of those mutations might allow it to invade humans. And hence all the hype!

After a mild flu season last year, Influenza A activity has yet to make its presence felt in Ontario. Influenza is a group of closely related viruses, which produce sudden and severe respiratory illness. We loosely divide flu into Type A, B and C with the A group being more troublesome. Viruses are very small particles of genetic material within protein coats that are microbiological dwarfs compared to monstrous bacteria. The influenza virus exists by attaching to and invading human cells. This is essential for reproduction and survival. The A group, whose natural host has always been birds, is more likely to spontaneously mutate and produce a new strain as a way to get around immune systems and survive. We refer to subtypes by using the geographical location of first isolation along with year of discovery, coupled with short-forms for two different proteins found on the coat. Hence names like A/NewCaledonia/20/99(H1N1), or B/Jiangso/10/2003. It is possible to be infected by several different strains through the course of a season. Last year, the influenza season had a "light" impact on our health care system. Tens of thousands of Canadians were infected with over 800 different species of influenza. Symptoms appeared suddenly and quickly. Fevers, chills, muscle aches, stomach upset, cough, mild sore throat and fatigue to name a few. It has been described like being beat up. Thousands succumbed to it, mostly because they were ill to start with.

We have the distinction of being one of the few places in North America where a free mass vaccination program is in effect. Large-scale immunization has reduced diseases like hepatitis, polio and tetanus. We have been stabbing large numbers of people repeatedly for over a dozen years and seemed to have made very little headway. Yet in over a dozen years of "flu shots", we still mount a massive campaign every fall. Data is confusing with respect to the effectiveness of this strategy, and perhaps traditional and expensive strategies need to be re-evaluated. It is expensive and problems with distribution, duplication, delays and record keeping mount. If you use a public clinic to get your shot, ensure that you obtain documentation of which vaccine you received, the lot number and expiry date. I advocate getting your flu shot through your own doctor to keep your medical record complete.

There are different manufacturers competing for our dollars and hence several vaccines on the market. Most vaccines in Ontario are of the split-virion type. This year's flu-shot will protect against three nasty sub-types of virus (A/New Caledonia/20/99, A/Wisconsin/67/2005, B/Malaysia/2506/2004) This contrasts with the avian strain which is a H5N1 sub-type. The included strains are selected from data compiled by the World Health Organization on a best-guess basis. The art of creating a vaccine involves combining viruses together until you get a rugged one with the desired traits that grows easily in egg culture. It is then inactivated with formaldehyde and ultra-violet light. This is followed by chemical disruption and filtration to purify the components. There is no live virus in flu-shots anymore. Vaccination introduces the proteins found on the virus to our immune system. It is these proteins or antigens that our immune system uses to recognize foreign invaders. The idea is to get your immune system to respond, so that the feeling of a mild impending cold afterwards is normal. It is a fairly safe and effective method to prevent a few severe illnesses. Nasal flu sprays are not available in Canada yet, but would be a great alternative for the needle-phobic amongst us.

Flu-shots do not guarantee health. It will offer good protection from three severe forms. Alternatives are less effective, but merit mention only because influenza appearance is an annual happening. Some healthy patients chose to defer the flu shot and monitor the Health Canada Flu (influenza): FluWatch surveillance. What card-counters are to blackjack, these people are to flu mutation. They monitor outbreak activity along with sero-types and take their shots when they are certain the strains contained in the shot are imminent. But, there is a delay between outbreak and diagnosis. So how do you know? One tidbit from the trenches suggests that when 10 percent of your employees or students are down with influenza-like symptoms, there is a good chance that a major outbreak is occurring and hope that vaccine is still available. Others have taken the attitude of running. In this strategy, you seclude yourself from the air-borne sources in your community by staying indoors or moving to a non-infested location at the first sign of severe disease activity. This strategy is neither practical nor economical, but does work for some. Outbreaks in nursing homes by wild viruses are treated with medication called Tamiflu, which do not cure, but soften the blow. More viruses are resistant to the older and cheaper amantadine. Personal stock-piles of drugs like Tamiflu is discouraged.

Most fit and healthy adult Canadians have successfully fought off more than one bout of Influenza in their lives. Despite precautions and research, we have no potential to eliminate the influenza virus from our lives anytime soon. In the end, hygiene and common sense are effective strategies. During sickness, wash your hands, wear a surgical mask and cover your mouth when sneezing. Stay at home when the sudden and severe symptoms hit. Seek medical aid sooner than later. Come by and take the plunge!

Related resources:

Find flu vaccines in your area in the United States, from Centers for Disease Control and Prevention (CDC). Everyone 6 months of age and older needs a flu vaccine.

H1N1 Flu (Swine Flu) Shot Clinics in Canada. Find Clinics for H1N1 Flu Shots by Canadian Province, by Susan Munroe, About.com.

Key Facts about Influenza (Flu) Vaccine. Preventing the flu, from Centers for Disease Control and Prevention (CDC).

leaf Flu (influenza): Get your flu shot. Everyone 6 months and older should get the flu shot, from Health Canada.

leaf Weekly Influenza Reports from Health Canada.

Flu vaccine from Wikipedia, the free encyclopedia.

Flu Vaccine (Influenza Immunization) by Melissa Conrad Stöppler, MD, Rev. Editor: Jay W. Marks, MD, MedicineNet. Including: How effective is the flu vaccine? What is the nasal spray flu vaccine?

Preventing the Flu from familydoctor.org. What is influenza? Who is at higher risk? How can I avoid getting the flu?

Is the Flu Vaccine a Good Idea for Your Family? from KidsHealth.

Tamiflu Site intended for U.S. Audience only, from Roche Pharmaceuticals, USA.

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