Flu Vaccines for the 2009/2010 Flu Season

Two flu vaccines, the seasonal flu and the H1N1 (“swine flu”) vaccines, will be available for the 2009/2010 flu season. The seasonal flu vaccine protects individuals from three types of flu and is currently available. The H1N1 flu vaccine protects individuals from the newest type of flu, which was first detected in people living in the United States in April 2009. The H1N1 vaccine is expected to be available in early to mid-October 2009.

Each of the vaccines will be available in two forms: injected and intranasal. The injected type of flu vaccine uses the inactivated (or killed) viruses and is considered safe for individuals with MS. The intranasal vaccine, given by nose with a mist, contains live viruses and is not recommended for individuals with MS.

The new H1N1 vaccine is manufactured using the same processes as the seasonal flu vaccine. In previous studies, seasonal flu vaccines (with inactivated viruses given via injection) have been shown to be safe for individuals with MS. These vaccines did not cause one’s MS to worsen, nor did they cause an increase in exacerbations (symptom flare-ups). People cannot develop the flu from the injected vaccines, since these contain non-infectious particles.
In studies, the most commonly reported side effects of the vaccine are injection-site tenderness and pain, muscle aches, and systemic symptoms such as headache. Protection from the flu is likely to be established within two weeks.

As a group with a chronic health condition, individuals with MS qualify to get priority for receiving a flu shot. Other individuals who get priority for a flu shot include: pregnant women; household contacts or caregivers for infants younger than 6 months; healthcare and emergency medical services personnel; children and young adults 6 months to 24 years of age; and persons aged 25 to 64 years who are at greater risk of influenza-related complications because of underling medical conditions.

Given the fact that the flu may have a greater impact on people with MS, MSAA’s Chief Medical Officer Jack Burks, MD, recommends the injected flu vaccines for most of his patients with MS. Individuals with MS are advised to check with their doctor or other healthcare provider before getting these two flu shots.

Although initial supplies may be limited, shortages for the season are not expected. Both vaccines are given in one dose each (via individual injections), and may be given at the same time, provided the injections are made at different locations on the body. People who have an allergy to eggs or other ingredients in the vaccines, or who have had a reaction to a vaccine in the past, should not get the flu vaccines. The two intranasal vaccines, which use live viruses, may not be given at the same time — and again, these are not recommended for individuals with MS.

Flu Vaccinations for Individuals with MS
MSAA’s Chief Medical Officer Jack Burks, MD, recommends the injected flu vaccines for almost all of his patients with MS. He stresses that individuals with MS should first consult their physician about whether or not to get the vaccinations.

Dr. Burks explains, “The decision is up to one’s doctor regarding flu vaccinations. Except in instances where the vaccines may aggravate another condition, I view flu shots as a high priority for my patients with MS. According to the American Academy of Neurology (AAN), earlier flu vaccines have not been found to increase the risk of an MS attack. These earlier flu vaccines were manufactured using the same process as the newest vaccines given today, including the H1N1 ‘swine flu’ vaccine. The flu vaccines are the best defense against catching the flu, which poses a much greater threat to a person’s health when he or she has MS.

“The reason why the flu is more difficult and potentially damaging to individuals with MS is three-fold. First, if individuals with MS get the flu, they must endure the associated aches and pains in addition to their normal MS symptoms. Second, high fever accompanies the flu, and an elevated temperature may increase MS symptoms, affecting one’s overall wellbeing. And third, the body responds to the flu with an outpouring of gamma interferon, a chemical that increases the risk of an MS exacerbation. For this reason, individuals with MS who catch the flu have a greater chance of experiencing an MS attack within several weeks following their influenza (flu) illness.”

Dr. Burks concludes, “While the benefits of flu vaccines are clear, individuals with MS should still consult with their physician before getting vaccinated. For those who are vaccinated, they may experience a mild temperature and a slight increase in MS symptoms for a day or two following the injection. Anyone experiencing more severe or longer-lasting side effects from the flu vaccines should contact their doctor.”

The 2009 H1N1 Influenza Virus
This particular flu virus was first seen in individuals in the United States in April 2009. It was originally referred to as “swine flu,” because in the laboratory under a microscope, the genes in this virus appeared similar in form to flu viruses sometimes found in pigs of North America. Later observation found that these viruses were actually from those found in pigs in Europe and Asia, as well as in birds and humans. The term “swine flu” has since been replaced by the virus name of “H1N1.”

The H1N1 virus is believed to be spread mainly through coughing, sneezing, or speaking when close to others, similar to other types of flu viruses. The flu virus may become airborne and tiny droplets of flu particles may be inhaled by another person nearby, and the virus then grows in the upper and lower respiratory tracts. In addition to being close to someone with the flu, touching a surface (such as a door knob, shopping-cart handle, or counter, etc.), which has droplets of the virus from an infected person who may have coughed or sneezed nearby, and then touching one’s own nose, eyes, or mouth, is a common way to catch the virus.

To reduce the risk of catching the flu, the Centers for Disease Control and Prevention (CDC) advise that people wash their hands often and use an alcohol-based hand rub when soap and water are not available. People should avoid touching their nose, eyes, or mouth when out, and to avoid close contact with others who are sick.

The seasonal and H1N1 flu viruses may be spread beginning the day before someone gets symptoms, and then for five to seven days afterward. Studies show that the virus may remain present for up to 12 days in a small percentage of individuals, but it is not yet known if the virus is still contagious at that point. The CDC also recommends that anyone who has been sick, should stay away from others and remain home for at least 24 hours after the fever is gone (specifically, the fever must be gone for 24 hours without the use of fever-reducing medicine). If someone is sick and must go out, Dr. Burks strongly advises that he or she wears a face mask (covering the nose and mouth) to avoid spreading the virus to others.

Please note that the H1N1 virus is not spread through eating pork or any other food. It is unlikely that the virus may be transmitted through drinking water, as influenza viruses are normally inactivated through water treatment in tap water. These flu viruses are also not transmitted through swimming pools, hot tubs, and other water used recreationally, as the disinfectant levels inactivate flu viruses.

The symptoms of the H1N1 flu are similar to those of other flu strains. These symptoms include:

• fever
• cough
• sore throat
• body/muscle aches
• headache
• chills
• tiredness/fatigue
• feeling badly all over
• in some cases, vomiting and diarrhea

With the H1N1 flu, some patients have experienced respiratory symptoms without a fever. Additionally, this virus may cause severe illness (such as pneumonia and respiratory failure) in some individuals, and some patients with the H1N1 virus have died. So far, most of the patients with H1N1 flu have experienced only mild symptoms.

The symptoms of the H1N1 flu can range from mild to severe, but individuals younger than 25 years of age appear to be at risk of the most serious disease burden. In general, those who are of greatest risk of complications from the flu are older people (over the age of 65), children under 5 years of age, pregnant women, and individuals with chronic conditions.

Anti-viral medications are available by prescription to treat the H1N1 flu. These include oseltamivir and zanamivir. If an individual develops an infection from the flu, he or she may also be prescribed an antibiotic. One’s healthcare professional may advise using over-the-counter pain relievers or cold medicines, but individuals should always check with their doctor and read labels carefully before using these types of products.

When someone has the flu, the CDC lists the following warning signs that need urgent medical attention.

In children:

• Fast breathing or trouble breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Severe or persistent vomiting
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough

In adults:

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms improve but then return with fever and worse cough

For More Information
For more information about the flu and flu vaccines, please visit www.cdc.gov/flu or www.flu.gov. The CDC also has a hotline at (800) CDC-INFO, or (800) 232-4636. To find local clinics, stores, or other facilities which are offering flu shots, please visit www.findaflushot.com. To speak with one of MSAA’s Helpline consultants, please call (800) 532-7667.

Written by Susan Wells Courtney
Reviewed by MSAA’s Chief Medical Officer, Dr. Jack Burks