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Vaccines in the time of Corona

Flu shots in the time of Corona:
I'm currently recommending:
  • Please DO get your flu vaccine this year, particularly if you are over 65 or have underlying medical conditions would make you high risk for influenza.
  • The flu season in our area is often late, February or March, so I recommend delaying the vaccination until the first or 2nd week of October, so that immunity will last.
  • Whatever you are currently doing to protect yourself against exposure to Covid 19, please step up those precautions during the couple weeks before and after receiving the flu shot, because it may increase risk of severe disease if you are incubating Covid 19 or are exposed to it around the time of receiving the flu shot.
  • Contact your pharmacy and ask if they are willing to give flu shots outdoors or are planning any sort of drive through flu shot clinic. (I am hoping that this suggestion coming from enough clients will inspire someone to do so.)

My reasoning:
As I have discussed with many of you, I have some ambivalence about flu shots this year, because although I do believe that the flu shot can be lifesaving for patients over 65 or with underlying risk factors, they may actually increase the risk of acquiring other respiratory infections for children and possibly some others. (See articles below regarding this possibility.)

That said, it appears that the greatest risk may be in the first few weeks after vaccination, which is also part of why we recommend giving vaccines either on the same day or 6 weeks apart, because the 2nd vaccine will not have a robust response while your body is in the middle of reacting to the first vaccine. My suspicion is that your body may also not respond normally to a new infection within the first week or 2 after vaccination. This has been seen with the Hib vaccine for meningitis in children, where there is an increase in meningitis in the first week after successful vaccination, but then lifelong protection thereafter. A similar phenomenon was apparently seen with typhoid vaccine more than a century ago.

At the same time:
1. influenza may be difficult to distinguish from coronavirus clinically
2. We sadly cannot rely on our neighbors to universally use precautions to decrease the transmission of flu this year, since they do not seem to be doing that even with Covid-19, and
3. Anyone getting seriously ill from influenza is likely to need to seek care in a setting where patients with Covid-19 also will be seeking care, increasing the risk of acquiring the 2nd infection, and also further overwhelming healthcare resources.

Thus, I am asking patients to get their flu shots but take extra precautions to make this safe.
If you are due for a Pneumovax, please get it at the same time as your flu shot.
If you need a tetanus booster because of a high risk injury, get the tetanus shot. (Tetanus has a 50% mortality!)
On the other hand, shingles rarely kills - I would recommend waiting on the Shingrix series until you are immune to Covid-19. . .

References:
Association between the 2008–09 Seasonal Influenza Vaccine and Pandemic H1N1 Illness(external link) - multiple observational studies suggested that seasonal flu shots increased risk of pandemic H1N1 illness
Assessment of temporally-related acute respiratory illness following influenza vaccination(external link) - the risk of respiratory infections other than influenza was higher in the 2 weeks after the flu shot in children
Epidemiology of respiratory viral infections in children enrolled in a study of influenza vaccine effectiveness(external link) - kids who got the flu shot got more non-influenza respiratory infections
Haemophilus influenzae Type b Meningitis in the Short Period after Vaccination(external link), Disease Caused by Haemophilus influenzae Type b in the Immediate Period After Homologous Immunization(external link) - children may be at increased risk of meningitis in the first week or so after receiving the Hib vaccine