'FLU VACCINATION

The 'flu usually comes in epidemics in the Winter months and early Spring though sporadic cases occur throughout the year. The virus that causes it is a bit like a chameleon because it is frequently changing to get around our immunity. Most years the changes are small but when there is a big change the population becomes vulnerable to a major epidemic.

The 'flu is not just a bad cold - some severe colds may incorrectly be called 'flu so a dose of real 'flu comes as a nasty shock to some people. As well as some cold-like symptoms, which may not themselves be too bad, 'flu causes severe lethargy, muscle pains, headaches and a high fever. The patient, or carer, may believe this to be a severe and dangerous illness such as meningitis and indeed some illnesses such as meningitis and malaria can cause diagnostic difficulty, even to experienced doctors, in their early stages and especially during a 'flu epidemic. For most healthy people, excluding the very young and very old, 'flu is very unpleasant but self-limiting and benign and needs only rest, plenty of fluids and either paracetamol, aspirin or ibuprofen - all of which can be self-administered. For those with chronic health problems and at the extremes of life 'flu can pre-dispose to serious infections, mostly of the chest and should be seen by a doctor quite early on, in case anti-biotics are required. Also if there is doubt about the diagnosis ring for advice from the duty doctor - things to look out for, and which may indicate a more serious illness, are sensitivity to the light, inability to bend the head forward to touch the chest, drowsiness, poor colour, a rash (especially if it looks like blood spots and does not fade on pressure), severe chest or abdominal pains or evidence of localised infection such as an abscess. Recent foreign travel - especially to tropical countries - makes it very important to get urgent advice as tropical diseases can start like the 'flu. A cough which produces coloured phlegm may indicate a chest infection as can a sharp pain on breathing or unaccustomed breathlessness - in which case it is important to get your chest sounded.

The manufacturers of 'flu vaccine are continually working to respond to the strains of 'flu that are thought to be likely to cause trouble in the current year by the leading experts in the field. Each year therefore the vaccine is unique and different from previous years which is why immunisation needs to be repeated annually unlike other vaccines. Usually the current vaccine protects against the three top strains around. Very occasionally further immunisation against a fourth strain later in the year has proved necessary, though not in recent years.

Who needs the vaccine? Currently it is not recommended for the majority of the population who are at low risk of dangerous complications. Partly this is due to cost but mainly this is to ensure that vaccine and the resources to give it are not denied to those in real need. This year the Government has accepted the advice that all those of 75 years of age and above should be added to the list. The other categories include those in residential care (to protect against epidemics), those with chronic kidney, chest and heart conditions and diabetics and those who may have impaired immunity by virtue of illness, such as HIV, or treatment such as chemotherapy or who have had a splenectomy.

Some misunderstandings:

• "'Flu vaccine protects against colds." It doesn't. There are many viruses which cause the common cold. They are all very different from the 'flu virus and there is no reason to suppose that 'flu vaccine will protect against them. Indeed there are also some non-epidemic 'flu viruses around which differ from the strains in the vaccine and this may account for some apparent vaccine failures.
• "I always get the 'flu if I get the 'flu-vaccine." Can't happen. 'Flu-vaccine unlike, for example, polio vaccine, is a killed virus vaccine. Most don't even contain complete viruses. Consequently it cannot infect you - however some people do get a mild reaction which feels a bit like a mild dose of 'flu and this is not entirely surprising because most 'flu symptoms are caused by the body's reaction to the virus rather than directly by the virus itself.
• "I can't eat eggs so I can't have the 'flu vaccine." Not true. The vaccine is produced in eggs so that people with serious allergic reactions to eggs can't have the vaccine but this is rare. If in doubt ask the doctor or nurse.
• "'Flu-vaccine isn't very effective." Not true. It affords a good level of protection against the three strains it contains. It doesn't protect against anything else, such as colds or other strains of 'flu which are all quite common around the same time of year. Even if you do get the 'flu it is likely to be less severe and less likely to lead to complications. Regular vaccination each year probably increases your general level of protection as last years strains may still be around.
• "I'm not too well today so I shouldn't have the 'flu vaccine." Not really. Unless you have an acute infection with a fever it is better to have it than risk delaying and getting the 'flu instead.
• "You can always treat the 'flu with anti-biotics so why have the 'flu jab?" Not true, I'm afraid. 'Flu is a virus infection for which, currently, there is no cure. Anti-biotics are used occasionally to treat or avert complications but have no effect on the 'flu itself. Anyway, isn't prevention better than cure?
• "I never get colds or 'flu." I think it is probably true that some people do suffer less from what we call "upper respiratory infections" than others but the 'flu vaccine is designed to protect against current epidemic viruses to which many people have little or no natural immunity. Apparent resistance to the common respiratory viruses that come we come into regular contact with is unlikely to confer to us any protection against these epidemic viruses. Apart from past exposure to the same or similar viruses the only thing which will do that is influenza immunisation.

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"How can I get the 'flu vaccine?"

• Every year we have special nurse-run sessions aimed at those in the at risk groups. Many patients have become used to their annual visit to one of these sessions. In addition to those who have come previously we now recommend that all those of 75 years and above should come along to one of these sessions.
• In surgery. If the doctor or nurse thinks that you are in an at-risk category you will probably be offered the "jab". If you think s/he may have forgotten please ask - it may be you don't qualify but we will always be happy to advise you.
• For the truly housebound we can arrange for a nurse to call to immunise you.

"When will the vaccines arrive?"

• Usually we get our first supplies around the end of September. For those on repeat prescriptions look out for the message on the order slip. There will also be notices up in the surgery at the time about the immunisation sessions.

"What about the pneumonia jab?"

• Good point. Most people who qualify for the 'flu jab should also be immunised against a bacterial infection called pneumococcus. This isn't related to the 'flu but the risk factors for serious 'flu complications are similar to those for pneumococcus. The pneumococcus jab has been much improved in recent years and is a good and safe vaccine. Normally it only needs to be given once, unlike the 'flu vaccine, but you may chose to have it at the same time.

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