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Fall, Flu Shots, and Fear

Posted by Dr. Suzanne Koven  September 13, 2011 07:15 PM

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It's not exactly like being a farmer or a tax accountant, but a primary care doctor's work is more seasonal than you'd guess. Allergies and gastrointestinal viruses peak in spring and fall; poison ivy and sunburn are frequent in the summer; and in winter--busiest of all--I see more bronchitis, pneumonia, heart attacks, and depression than at other times of the year.

Winter also brings influenza--the annual epidemic runs approximately from November through March in the United States--and fall is when I give vaccines to prevent influenza. It's also when I have conversations with my patients about flu shots.

It has always puzzled me that the flu vaccine inspires more fear and suspicion than just about any other medical intervention I offer. I've had patients who have undergone open heart surgery, taken various medications with potential dangerous side effects, and dutifully submitted to mammograms, colonoscopies, and other screening tests who absolutely refuse flu shots.

I've had many patients, in fact, who accept other vaccines routinely recommended for adults--tetanus, pneumonia, and hepatitis, for example--who won't go near the flu vaccine.

Furthermore, my patients often express their aversion to flu shots in an unusually emphatic way: "I don't believe in flu shots," many have said to me. In contrast, though I have certainly had patients refuse various other kinds of treatment, I have never had a patient tell me that they don't believe in penicillin or in MRIs.

So what is it about flu shots that causes so much apprehension?

Some of the problem is simply misinformation. One study showed that about a third of people who refuse flu shots are worried it will cause the flu--it doesn't. Many people are discouraged when the flu shot fails to protect them from colds, bronchitis, and other infections--it doesn't.

Also, people underestimate the potential seriousness of the flu. It's an absolutely miserable illness--I often tell people that if you "think you might" have the flu, you probably don't--that kills thousands of people every year. Publicity about severe illness and death among young, healthy people from the H1N1 strain in 2009-2010 increased vaccination rates, though only about 40% of Americans have had flu shots in the past two years.

Interestingly, though, vaccination rates have also been low among health care workers who, presumably, understand the dangers of flu and the risk that they will spread it to vulnerable patients. Many hospitals and clinics now require health providers to either have a flu shot or submit a signed refusal. Some even offer a cash bonus as incentive.

I think that some of the fear of the flu shot has to do with the fact that it changes every year. The vaccine is reformulated to protect against the strains of influenza projected to cause the coming season's epidemic. That makes some people uneasy.

Older people may recall the 1976 "swine flu fiasco" when several hundred people suffered serious vaccine side effects. But, as I just reminded a patient of mine who mentioned this incident as a reason not to have a flu shot, this happened a long time ago--during the Ford administration.

The bottom line is that flu is a potentially dangerous illness and the flu vaccine, now recommended for everyone over 6 months old, is a safe and effective way to prevent it. For more information, see the excellent CDC summary here.

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

Suzanne Koven, M.D. practices internal medicine at Massachusetts General Hospital in Boston. She writes a monthly column for the Globe's G Health section and her essays have appeared in the More »


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