The flu vaccine: Good enough isn’t, but it has to be for now

As December has rolled in, flu season is upon us and will soon be in full swing. If Australia provides any indication, which it often does, of what we might be in store for here in the US, then we are likely in for a rough season. In the time leading up to flu season, scientists in the US always pay close attention to influenza trends in the Southern Hemisphere in places like Australia to provide an idea of what we might expect in the States.

Data coming out of Australia is causing concern amongst scientists due to record high numbers of case incidence and outbreaks in the country in addition to increased numbers of hospitalizations and deaths per year due to influenza.

Flu season, the seasonal flu vaccine, and discussion of the prospect of a universal flu vaccine was discussed in a recent New England Journal of Medicine article authored by Paules et al.

Millions of people worldwide come down with the flu each year, and hundreds of thousands die as a result of the flu annually. People I talk to and information I see on social media sometimes ignorantly stakes the claim that this issue is not centric to the United States, which couldn’t be farther from the truth. As the article correctly states, the United States is burdened with anywhere from anywhere from 140,000 to upwards of 700,000 influenza-related hospitalizations and thousands die annually right here in our backyard at home.

Influenza is subject to a process known as antigenic drift, where the the virus’ proteins change over time. It is because of this process that new flu vaccines come out every year based on data from elsewhere in the world regarding what antigenic changes are occurring.

Sometimes the annual influenza vaccine is not as effective as intended due to changes in the antigens on the virus after it has already been decided what antigens the vaccine for that year will target. Alternatively, a strain of the virus with a different set of antigens could predominate over the predicted strain for that year. By no stretch of the imagination is it a guessing game, but rather the annual vaccine composition is a calculated prediction based on worldwide data.

Keeping this in mind, there are years where the vaccine is largely ineffective such as the vaccine in 2014-15 where the vast majority of the circulating strain in the United States differed from that year’s vaccine as mentioned in the NEJM article.

Despite the imperfections of the annual vaccine, it undeniably remains an essential public health tool and IT IS ALWAYS BETTER TO GET VACCINATED THAN NOT. Based on data put forth by the Centers for Disease Control (CDC) in the United States, it is likely that tens of thousands of cases of the flu in the United States alone every year. Get vaccinated. Flu season is already upon us, but if you still haven’t gotten vaccinated it isn’t too late. Every major pharmacy still has flu shots. I even just got my own relatively recently. An ironic aspect of medical school is that while it is a duty of ours to promote and encourage patients to make smart choices for the sake of their health, we sometimes don’t have the time to do the same for ourselves, but I still found time. It takes 15 minutes.

Given the imperfections of the flu vaccine, the NEJM paper makes the claim that we can do better. I agree. I think we can and we will. Ideally, with time, researchers will continue to work diligently towards a universal flu vaccine that is capable of providing adequate coverage for the virus despite its antigenic changes. The work for does not stop and will not stop, as it shouldn’t, until a universal vaccine is available for all. However, if this was an easy thing to accomplish, it be available already.

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