Overcoming Inflammation

Flu vaccines and autoimmune diseases

September 19, 2017
Should people with autoimmune diseases get a flu vaccine? If so which ones?

Have you received your annual flu vaccine?  Flu season is just getting started.  People who suffer from autoimmune diseases, like rheumatoid arthritis, lupus, and Sjogren’s syndrome, often have a weakened immune system, either from the disease itself or from the medications used to treat their disease.  Today I’d like talk about the flu also known as influenza, and discuss what steps you can take to protect yourself this season.

What is the flu or influenza?

The medical word for the flu is influenza.  Influenza is a type of virus that mainly attacks the respiratory system.  There are two general types of influenza: influenza A viruses and influenza B viruses.  Different components make up the flu virus: one hemagglutinin (H1, H2, H3) and one neuraminidase (N1, N2). There are many different strains of influenza and to make matters worse, it tends to mutate.

The stomach flu is NOT caused by influenza.  The stomach flu is a general word used to describe a gastrointestinal infection caused by other types of viruses like Norovirus, the most common cause of gastroenteritis in the United States.

What are some of the signs and symptoms of the flu?

The signs and symptoms of the flu vary widely and are rather nonspecific.  They can include:

  • High fever
  • Muscle pain
  • Rigors, uncontrollable shaking
  • Headache
  • Malaise
  • Sore throat
  • Nonproductive cough
  • Runny nose

Complicated cases

Sometimes the flu can morph into a much more serious illness.  It can cause viral pneumonia and then can lead into a secondary bacterial pneumonia, sinusitis, and/or an ear infection.  This tends to happen in people who have a weakened immune system like children and older adults.  People with autoimmune conditions and especially people taking medications that weaken the immune system also are at high risk.

How is the flu transmitted?

The flu spreads from person-to-person by large particle droplets.

  • Airborne droplets: Coughing and sneezing
  • Skin-to-skin: handshakes and hugs
  • Saliva: Shared drinks and kissing
  • Touching contaminated surfaces: Keyboard, doorknob

What are the best ways to prevent the flu?

The best ways to prevent the flu are first, by washing your hands and second, by getting vaccinated for the flu at the beginning of each flu season.  Choosing healthy lifestyle practices, like eating clean, exercising, and getting a good night’s sleep, are also important.

What are the most convincing reasons for getting vaccinated against the flu?

  • During the 2016 – 2017 flu season, it caused 5.1% of outpatient visits.
  • Pneumonia and the flu caused 2% of reported deaths.
  • There were at least 18,000 confirmed flu related hospitalizations, 60% of cases occurred in people aged 65 years and above.
  • There were 98 confirmed flu related pediatric deaths.[1]
  • Risks of complications, hospitalizations, and deaths from the flu are the highest among people age 65 and above, young children and people who have medical conditions that weaken the immune system.
  • If you end up getting the flu, the flu vaccination may make your flu illness milder
  • By getting the flu vaccine, you decrease the risk of passing it on to the people you love

Who should get a flu vaccine?

Everyone six months and older.  This is especially important for people who have a high risk of getting flu-related complications.  These include:

  • Children younger than five
  • Adults 65 years of age and older
  • Pregnant women, up to two weeks postpartum
  • People that live in a nursing home or another type of long-term care facility
  • People that have a medical condition that weakens the immune system, this includes almost everyone with an autoimmune disease

Medical conditions

  • People with weakened immune systems (autoimmune diseases, cancer, HIV or AIDS, people on chronic steroids and biologic medications)
  • Asthma
  • Neurological and neurodevelopmental conditions
  • COPD and cystic fibrosis
  • Coronary artery disease and heart failure
  • Diabetes mellitus
  • Blood diseases like sickle-cell anemia
  • Kidney disease
  • Liver disease
  • People with an extremely high body mass index (BMI) > 40

When is flu season and when should I get my flu vaccine?

In the United States, flu season occurs during the months of October into May.  Historically, the greatest number of cases occur during the month of February.  The CDC recommends that people get a flu vaccine by the end of October.  If you’ve missed the deadline, no worries, better late than never!

What viruses will the 2017 – 2018 flu vaccines protect against?

Every year, manufacturers must change the structure of the flu vaccine, because the virus is constantly changing.  Scientists use data from the previous year to try to guess which strains will be more problematic in the upcoming season.  Flu vaccines typically have 3 to 4 specific strains of influenza.  This year, the vaccinations that have three types of virus should contain the following:

  • A/Michigan/45/2015 (H1N1)pdm09-like virus (updated)
  • A/Hong Kong/4801/2014 (H3N2)-like virus
  • B/Brisbane/60/2008-like (B/Victoria lineage) virus

Vaccines that contain four strains should contain the above as well as the following:

  • B/Phuket/3073/2013-like (B/Yamagata lineage) virus

Where can I get a flu vaccine?

Most doctor’s offices carry the flu shot.  Call your primary care provider or specialist to see whether they can give you your flu shot this year.  If not, most pharmacies also give this service as well.

Still unsure, please follow this link to find a flu shot near you.

Which flu vaccine should I get?

According to the CDC’s of published guidelines for the 2017 – 2018 season, they recommend the use of the inactivated influenza vaccine or IIV, or the recombinant influenza vaccine (RIV).  These come as injections.  They recommend against vaccination with the nasal spray flu vaccine.  The latter is a live attenuated vaccine.  People who take biologic medications should not receive live attenuated vaccines.

Can I get a flu vaccine if I’m allergic to eggs?

The following are the CDC recommendations regarding egg allergies and the flu vaccine.

  • People who have experienced only hives after exposure to egg can get any licensed flu vaccine that is otherwise appropriate for their age and health.

  • People who have symptoms other than hives after exposure to eggs, such as angioedema, respiratory distress, lightheadedness, or recurrent vomiting; or who have needed epinephrine or another emergency medical intervention, also can get any licensed flu vaccine that is otherwise appropriate for their age and health, but the vaccine should be given in a medical setting and be supervised by a healthcare provider is able to recognize and manage severe allergic conditions. (Settings include hospitals, clinics, health departments, and physician offices). People with egg allergies no longer have to wait 30 minutes after receiving their vaccine.[2]

Disclaimer: I have some safety concerns about the latter.  I’m simply stating what the CDC has issued.  When in doubt, talk to your doctor.

Why does the flu vaccine sometimes cause flu-like symptoms?

Here are a few reasons.

You have the flu

The incubation period is between one and four days.  It also takes about two weeks for your body to build immunity after receiving the vaccine.  Therefore, you can get the flu after a flu shot if your body hasn’t had time to build immunity yet.

You have a cold

Rhinoviruses are a common culprit.  These are the viruses responsible for the common cold.  In severe cases, the common cold can feel like the flu and you can catch it the same way.

The vaccine failed

Last year, the vaccine was only 34% effective at protecting against influenza A (H3N2) and 56% against influenza B viruses.  Unfortunately, over the past six seasons, vaccines have been less and less effective.[3]  However, any immunity is better than no immunity.

The flu vaccine gave you the infection

This can occur if you’ve received a particular type of flu vaccine that uses a live attenuated virus.  This is the vaccine that comes as a nasal spray.  Live attenuated vaccines are vaccines that contain a less potent form of the real virus.  The immune system reacts to the virus and develops antibodies without causing the infection.  Sometimes the virus is stronger than the immune system.  The real infection can occur when this happens.

The CDC advised against the use of this particular type of vaccine.

Most common cause, your immune system is reacting to the vaccine

Scientists make injectable flu vaccines with inactivated virus or without any virus at all.  Therefore, by definition, these are not infectious.  You cannot get the real infection from them.

Some people may experience some soreness, redness or tenderness from the shot itself.  Some people actually develop a low-grade fever, headache, and muscle aches (i.e., flu-like symptoms).  These typically last about 2 days and resolve without any intervention.  This is your body’s way of telling you that it’s mounting an immune response to the vaccine.  This means your body is responding to the vaccine and making antibodies to protect you from the real infection, which is MUCH more severe.

Final thoughts

I know vaccines have received a bad reputation over the past few years.  However, when you look at the data, vaccination particularly for the flu, ultimately saves lives.  Let’s take example.

During the 1918 – 1919 flu season (i.e., the Spanish Flu), 1/3 of the world population experienced a terrible flu pandemic. About 50 to 100 million died.  Now this was a particularly bad season, “the mother of all flu seasons”, and the reason it was so deadly has to do with many factors that we have yet to confirm. The CDC has experimented with an influenza virus that has the genetic material from the 1918 virus.  Their results suggest that our modern-day vaccines and FDA-approved antiinfluenza medications like Tamiflu, would have worked against the 1918 virus.[4]

Bottom line, flu vaccines save lives.

If you want to learn more about the flu, please follow this link.

References

Fingers smiling against flu shot message image by wavebreakmedia via Shutterstock

[1] http://www.mdedge.com/jfponline/article/145540/vaccines/latest-recommendations-2017-2018-flu-season

[2] https://www.cdc.gov/flu/about/season/flu-season-2017-2018.htm

[3] http://www.mdedge.com/jfponline/article/145540/vaccines/latest-recommendations-2017-2018-flu-season

[4] https://wwwnc.cdc.gov/eid/article/12/1/05-0979_article

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis and treatment.

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Flu vaccines and autoimmune diseases
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Flu vaccines and autoimmune diseases
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Have you received your annual flu vaccine? Should people with autoimmune diseases get a flu vaccine? Which flu vaccines are safe?
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RheumDoctor
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  • theautoimmunepilot September 20, 2017 at 11:16 am

    Good to know! I have always gotten the flu shot, but this is my first year with autoimmune issues.

  • Katarzyna January 1, 2018 at 5:53 am

    Can I have scientific research confirming that the vaccine is safe in all the conditions you listed? As far as I know the vaccine was not tested on pregnant women, AIDS patients or people with neurological conditions. It was not tested on babies either. For me those people you list should absolutely not get the vaccine. People with AIDS and on steroids? What do you think their immune response will look like?

    • jessica@rheumdoctor.com January 3, 2018 at 9:51 pm

      HIV/AIDS
      Abzug MJ, et al. Safety and immunogenicity of 2009 pH1N1 vaccination in HIV-infected pregnant women. Clin Infect Dis. 2013 May;56(10):1488-97.

      Hakim H, et al. Immunogenicity and safety of high dose trivalent inactivated influenza vaccine compared to standard dose vaccine in children and young adults with cancer or HIV. Vaccine. 2016 Jun 8;34(27):3141-3148.

      Pregnancy
      Munoz FM. Safety of influenza vaccines in pregnant women. Am J Obstet Gynecol. 2012 Sep;207(3 Suppl):S33-7.

      Naleway AL, et al. Safety of influenza vaccination during pregnancy: a review of subsequent maternal obstetric events and findings from two recent cohort studies. Vaccine. 2014 May 30;32(26):3122-7.

      Blanchard-Rohner G, et al. influenza vaccination given at least two weeks before delivery to pregnant women facilitates transmission of zero protective influenza – specific antibodies to the newborn. Pediatr Infect Dis J. 2013 Dec;32(12):1374-80.

      Autoimmune diseases, e.g., SLE
      Murdaca G, et al. Influenza and pneumococcal vaccinations of patients with systemic lupus erythematosus: current views upon safety and immunogenicity. Autoimmun Rev. 2014 Feb;13(2):75-84.
      Biologics

      Salemi S. Influenza vaccine administration in rheumatoid arthritis patients under treatment with TNF alpha blockers: , safety and immunogenicity. Clin Immunol. 2010 Feb;134(2):113-20.

      Asthma
      Schwarze J, et al. influenza burden, prevention and treatment in asthma – a scoping review by the EAACI Influenza in Asthma Task Force. Allergy. 2017 Nov 6. doi: 10.1111/all.13333. [Epub ahead of print]

      COPD
      Bekkat-Berkani R, et al. Seasonal influenza vaccination in patients with COPD: a systematic literature review. BMC Pulm Med. 2017 May 3;17(1):79.

      Cystic fibrosis
      Schaad UB, et al. Comparison of immunogenicity and safety of a virosome influenza vaccine with those of the subunit influenza vaccine in pediatric patients with cystic fibrosis. Antimicrob Agents Chemother. 2000 May;44(5):1163-7.

      CAD/CHF
      Phrommintikul A, et al. Safety and tolerability of intradermal influenza vaccination in patients with cardiovascular disease. J Geriatr Cardiol. 2014 Jun;11(2):131-5.

      Diabetes Mellitus
      Remschmidt C, Wichmann O, Harder T. Vaccines for the prevention of seasonal influenza in patients with diabetes: systematic review and meta-analysis. BMC Med. 2015 Mar 17;13:53.

      Sickle cell anemia
      Hambidge SJ, et al. trivalent inactivated influenza vaccine is not associated with sickle cell hospitalizations in adults from a large cohort. Vaccine. 2011 Oct 26;29(46):8179-81.

      Renal disease
      Remschmidt C, et al. influenza vaccination patients with end-stage renal disease: systematic review and assessment of quality of evidence related to vaccine efficacy, effectiveness, and safety. BMC Med. 2014 Dec 19;12:244.

      Liver disease
      Gaeta GB, et al. Influenza vaccination in patients with cirrhosis and liver transplant recipients. Vaccine. 2009 May 26;27(25-26):3373-5.

      Neurological Conditions, e.g., MS
      Mehta L, et al. Immune response to seasonal influenza vaccine in patients with relapsing – remitting multiple sclerosis receiving long-term daclizumab beta: a prospective, open label, single arm study. Int J MS Care. 2017 May-Jun;19(3):141-147.

      Per CDC guidelines as listed, there are safety concerns with influenza vaccination in patients with a history of Guillain-Barre.

      https://www.cdc.gov/flu/protect/vaccine/guillainbarre.htm

      Alcalde-Cabero E, et al. Guillain-Barré syndrome following the 2009 pandemic monovalent and seasonal trivalent influenza vaccination campaigns in Spain from 2009 two 2011: outcomes from active surveillance by a neurologist network, and records from a countrywide hospital discharge database. BMC Neurol. 2016 May 21;16:75.

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