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Thursday Jan 09, 2020

Try These Tips to Overcome Flu Vaccine Hesitancy

The Baltimore Ravens are having an awesome season, so life is pretty good for me right now. It was great to hear in late December that the team had earned a first-round bye in the NFL playoffs so everyone would have a chance to rest and get healthy before the divisional playoff game against Tennessee on Jan. 11.Then my Twitter feed hit me on New Year's Eve with the news that quarterback Lamar Jackson and other Ravens were fighting the flu.(www.google.com) Nooooooo!

This illustration depicts a 3D computer-generated rendering of a whole influenza virus, showing the surface proteins hemagglutinin and neuraminidase in light and dark blue, respectively.

It really shouldn't have surprised me, considering I've already been seeing a lot of influenza and influenza-like illness in my office in neighboring Pennsylvania. We normally see the worst of the season around February, but influenza activity has been high across the United States since late November. As of Dec. 28, the CDC estimated there had been at least 6.4 million flu illnesses, 55,000 hospitalizations and 2,900 deaths from the flu. (Curious about flu activity in your state? Check out the CDC's website.(www.cdc.gov))

The CDC's Advisory Committee on Immunization Practices and the AAFP recommend

  • vaccination against seasonal influenza for everyone 6 months and older, and
  • annual vaccination against influenza for all health care personnel and people training for health care professions.

These basic recommendations haven't changed in years, yet I've noticed that many of my confirmed influenza cases are in patients who declined the influenza vaccine earlier this fall, and a surprising number of those patients are people who work in health care settings. It turns out that although we have made great progress in increasing influenza vaccination rates among health care personnel (from 63.5% during the 2010-11 flu season(www.cdc.gov) to 78.4% in 2017-18(www.cdc.gov)), about one in five health care workers is still not being vaccinated against influenza.

Despite increased risk of exposure and our first-hand experience with the devastating consequences of influenza and its complications, health care personnel cite the same misguided reasons for declining the vaccine that I hear from other patients: The vaccine doesn't work. They don't like needles. It makes them sick. They never get the flu.

Don't worry. I'm not going to give you the side-eye look with a deep sigh, but I would like to offer some of what I share with my patients who are reluctant to be vaccinated.

The Influenza Vaccine Is Effective

I'm not about to yell "fake news" at skeptics, and I know some of you are already pulling up your internet search for the CDC reports that say the vaccine is at best 40% effective in any given year. Getting a flu shot does not mean you will have zero chance of getting sick in the upcoming year. There are many different types of influenza viruses circulating any given year, and our current vaccine induces immunity against four of them. Really smart people try to predict which four strains are most likely to pose a threat in any given year, but nothing is perfect.

I think of getting the flu vaccine as giving my body a head start in the race against influenza. Even if the strain I encounter later in the season wasn't a part of the vaccine, my body has a better chance of fighting the infection with that head start. The critical point people miss in news coverage about effectiveness is that even in a poorly matched year, the people most likely to be admitted to the hospital or die from influenza or influenza-related complications continue to be those who were not vaccinated. So, while it may not completely prevent me from getting sick this winter, even during a bad match year, the influenza vaccine clearly protects me from hospitalization and death. That's a win!

It Makes Me Feel Sick

This is where you are expecting me to launch into my "Flu vaccine doesn't cause the flu" speech. Well, that's true. Flu vaccine doesn't cause the flu. It might make you feel lousy for a few days afterwards. My arm feels sore for a day or two. I get a headache and my muscles ache. What I don't get is the flu, which is much worse. That's still a win!

I Am Afraid of Needles

If you are age 2-49 years and don't have chronic medical issues, the nasal influenza vaccine is an option. For everyone else, we have to go with the needle.

My two favorite tactics for getting through the fear:

  • Distraction. Bring a buddy to hold your hand and distract you. You would be surprised how many folks I've gotten vaccinated before they realized it because we were laughing about something while the nurse was injecting the vaccine.
  • Vibration and cold to ease discomfort. Devices that can provide both cold and vibration have been shown to reduce pain in children undergoing painful procedures. At a minimum, applying a cold pack can lessen the discomfort.

It isn't too late to give (or get) the influenza vaccine. Keep vaccinating patients until the CDC gives us the all clear, which is usually around March but can be later if the viruses are still circulating.

If you are looking for additional resources about seasonal influenza, check out the AAFP's immunizations webpage for more information and best practices regarding influenza vaccine and other immunizations.

Stay healthy!

Margot Savoy, M.D., M.P.H., is a member of the AAFP Board of Directors.

Posted at 01:52PM Jan 09, 2020 by Margot Savoy, M.D., M.P.H.

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