Gambling with the Flu: What Millennials Should Consider Before Rolling the Dice on Flu Shots

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By: Melissa Schenkman, MPH, MSJ

The signs were all there, but I just couldn’t see them. A little more tired than normal, I still went out for my daily run.  After, I developed a low-grade fever. A few short hours later, I had a sore throat, cough, and a stuffy nose. By the time the next morning rolled around, I could barely get out of my bed. The chills and body aches were overwhelming. 

While I can’t remember how I even drove to the clinic, I do remember being told I had the flu. Not just any flu though. It was the swine flu, a novel strain of influenza A (H1N1) virus. It was October 2009 and the United States was in the midst of an H1N1 Pandemic and young people were dying.  I was 28 years old, and it was the one year, I hadn’t made time to get my flu shot.

Ever since then the fear factor of getting sick like that again has me getting a flu shot every fall like clockwork.

But as a group, most millennials need more than fear to make them take the time out of their busy schedules to get vaccinated. People need to know things like why they should get vaccinated if they are already healthy and if there’s some greater purpose than ourselves that it serves.

David Serota, MD, is an assistant professor of clinical medicine at University of Miami Miller School of Medicine in the Division of Infectious Diseases. He just finished 10 years
of medical training in June 2019 and has recently been released into the world! Dr. Serota sees adult patients with all types of infectious diseases in the hospital and in the clinic with a focus on treating people living with HIV.

As peak flu season begins this year and before the mad dash of holiday travel through airports in which we will be exposed to the flu, I asked infectious disease doctor and fellow millennial, 32-year-old, David Serota, MD, to shed light on the vaccine. He tells us reasons why we should consider the shot, what we already have in our favor, what we don’t, and debunks some of the common myths about the way the vaccine works (or doesn’t).

YMyHealth: In a 2018 data analysis by Insurance Quotes, they found that millennials were the least likely age group to get a flu shot. As a millennial, what do you think about the fact that a lot of millennials will opt out this year?

Dr. Serota: I think it’s pretty disappointing, but not entirely surprising. I’ll admit that the flu shot can be a tough sell for people who are healthy, have little contact with the healthcare system, and don’t particularly fear getting the flu too much. They may think: “Why should I get a shot that might cause me arm pain for a few days for something that isn’t even 100% effective?”

YMyHealth: Now, as a millennial and a physician, what is your reaction to millennials opting out of the flu vaccine?

One of the really important aspects of the flu shot that often goes unsaid is the benefit to those around you. It is true that statistically speaking, since the flu is not super common, the chances of an individual person being saved by a flu shot are relatively small. But a lot of the benefit for all of us as individuals in getting the flu shot is that it protects the elderly, very young, and people with weakened immune systems that live among us.

Some super healthy people get the flu and barely know they have it, however they can still spread the virus (termed “asymptomatic shedding”) to those around them. In fact, a healthy person spreading flu all over their environment is almost worse for public health than someone who gets so sick that they stay home from work or school.

Millennials are famously conscientious about the world around them and getting a flu shot fits in perfectly with those values. Sure it’s annoying to drink a soda without a straw, but we’ll make that sacrifice to minimize plastic waste in our environment. Sure antibiotic and hormone free meat might cost more, but if it’s better for society we’re all about it. There’s no better expression of your selfless wokeness (aka. awareness of social justice issues) than getting a flu shot.

YMyHealth: Many millennials think that because they are young and healthy, they are immune to getting the flu. Or if they have escaped it so far in their lives, they are never going to get it now. Can being a healthy millennial actually protect them? Why or Why not? Is there any truth to this “immunity theory”?

Dr. Serota: So, definitely being young and healthy makes it less likely that someone might have severe life-threatening complications from the flu, but it certainly doesn’t prevent them from getting the flu altogether.

YMyHealth: For all of the non-believers out there… can the flu shot really give you the flu? Why or why not?

Dr. Serota: No. 100% no definitely not. The influenza vaccine recommended for adults uses an inactivated virus to allow your immune system to “see” the virus particles and develop a primed immune response before you’re actually exposed to the real thing. The inactivated virus is missing key pieces of machinery that would allow it to replicate in your body.

When your body is exposed to the inactivated virus, there can be an immune response from your body causing “flu-like” symptoms that are usually mild and short-lived. This is very different than having a true infection.

YMyHealth: Does the shot really prevent the flu?

Dr. Serota: Yes, absolutely. But nothing in life is 100% certain, and the flu vaccine is not completely protective. This effectiveness differs from year to year based on how well researchers predict which strain will predominate and also some random chance involved regarding how the virus mutates.

Wearing a seatbelt doesn’t protect you 100% from getting hurt in a car accident, but it sure decreases your chances of bad things happening. The flu shot is no different. On a population level, we know with certainty that more flu shot use is associated with fewer cases of the flu, fewer hospitalizations, and fewer deaths.

So can you get the flu shot and still get the flu? Definitely. But you’re a lot less likely to get it. The bad thing about vaccines is that when they work well, you don’t ever know you’ve benefitted.  But then there’s your annoying friend with the anecdote about how they got the flu one time after getting the flu shot in 2004 who feels compelled to retell their story every time the flu shot comes up in conversation…

YMyHealth: If you were a person who had H1N1 (aka. the swine flu) during the pandemic in 2009, are you still susceptible to getting it this flu season?

Dr. Serota: There are two main components of the influenza virus coating to which we develop an immune response, the hemagglutinin (H) and neuraminidase (N). There are a few major types of H and N that circulate each year. This is what public health officials work to predict when they decide which strains to include in the seasonal flu shot; for instance, H1N1 and H3N2 are included this year.

Within each H and N combo, there is further variability, however. It’s sort of like trying to guess what size parking spot your friend needs based on the brand of their car. The H and N tell you if you can expect a Honda, Chevrolet, or a BMW, but within each brand there’s a lot of different sized cars.

If you’ve been exposed to an H1N1 influenza in the past, you’re more likely to have some immunity to it, but not completely. Because there are multiple strains of flu that circulate each season, it is unlikely you’d be fully immune to all circulating strains.

YMyHealth: What’s the difference when chronic disease is thrown into the mix? Are millennials who suffer from a chronic disease like diabetes, Crohn’s disease, cancer etc. more susceptible to flu? How does the prescription for flu protection differ for this group?

Dr. Serota: People with chronic diseases are at higher risk of complications if they get the flu. Among the chronic medical conditions affecting younger people, those with lung diseases (like asthma or cystic fibrosis) and those with weakened immune systems are particularly prone to bad things happening from the flu.

Complications include influenza pneumonia, a secondary bacterial pneumonia, muscle inflammation and breakdown (myositis, rhabdomyolysis, and myocarditis), brain and spinal cord inflammation, and sepsis.

Some categories that young people with weakened immune systems fall into include millennials who use immune suppressing medications for autoimmune diseases like Crohn’s disease, receive treatments for cancer, or have HIV infection.

Another plug for the “social responsibility” aspect of flu vaccination is that people with weakened immune systems at the highest risk of severe influenza are also not able to make as strong of a response to the vaccine. So it’s especially important that those around them get the flu shot to help protect them.

YMyHealth: Why would you recommend that your fellow millennials take a few moments out their day to get a flu shot? 

Dr. Serota: Definitely! It’s still a personal choice, and not everyone wants to get it. I’m not into vaccine-shaming people into getting the flu shot, but I at least hope that everyone has all the accurate information available to them before they make their choice.

YMyHealth: When will getting a shot be too late in the season to protect themselves?

Dr. Serota: It only takes a few days to weeks to develop an immune response to the vaccine, so as long as there is circulating flu virus in the community, it’s not too late to get the vaccine. The CDC and state health departments put out weekly influenza activity reports each week during the flu season, but in general, if it’s still winter, I think it’s still worth getting the vaccine.

YMyHealth: Anything else that you would like millennials to think about when it comes to this flu season?

Also, keep in mind that the flu AKA “influenza virus infection” is not the same as a cold. A cold, or medically speaking: upper respiratory infection (URI) is caused by a number of different viruses that are different than influenza virus. Unlike influenza, typical URIs are very common and generally harmless to most people but very uncomfortable.

A lot of time people colloquially refer to a URI (which includes sore throats, runny noses, and bronchitis) as “having a flu”. The flu shot only works against influenza, which is usually a much more severe illness. So getting a flu shot but then getting a cold in the same season doesn’t mean the flu shot didn’t work.

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