Influenza and ALS

 

Information about the Seasonal and H1N1 (Swine Flu) Vaccines, and the Pneumonia Vaccine

by Edward Kasarskis, M.D., Ph.D,  Director of the University of Kentucky Neuroscience Center ALS Association Multidisciplinary Center in Lexington, Kentucky, professor in the Department of Neurology at the University of Kentucky, and Chief of Neurology at the VA Medical Center in Lexington KY.

Q: Should people with ALS – and their families and caregivers -- get the flu vaccine this year?

A: The short answer is yes.

People with ALS are already at increased risk for respiratory problems associated with viral and bacterial infection, and the flu can deliver a harsh blow. The flu season in just around the corner and can start as early as October, the most beautiful month of the year.  The flu can cause decreased appetite and a severe cough, both of which are significant problems for people with ALS.  Importantly, about 90% of the deaths due to the flu occur in persons older than 65 years, the same age group of many of our ALS patients.  So "yes," you need a flu shot.

The H1N1 vaccine is now included in the seasonal flu shot, so you no longer have to get two separate vaccines. The flu shot, which is offered every year, will now provide protection against H1N1, influenza A (H3N3), and influenza B.  This vaccine is expected to reduce illness, limit hospitalizations, and potentially save lives.

The vaccine can be given as a nasal spray and an injection. The nasal spray contains a live but weakened virus, unlike the injection, which is made of inactivated (killed) pieces of the virus. According to the CDC, the nasal spray is targeted for children and not adults.  As you are aware, many of our ALS patients experience thick secretions and have difficulty handling them in their mouth and throat.  Even if the nasal route was appropriate for adults, I can imagine that the nasal route of administration would be troublesome for our ALS population. I think that the injection is safer and less stressful for ALS patients.  So, go with the injection – the needle is sharp and it is over in a flash, much less time than it will take you to read the consent form.

No shortage of the vaccine is expected, but vaccine availability and demand can be unpredictable.  Here in Kentucky, the flu vaccine is available in pharmacies as an additional convenience.

Anyone with an allergy to eggs should not receive the vaccine, since chicken eggs are used in the manufacturing process.  The possible side effects of the vaccine are: pain at the injection site, muscle aches, headaches, and malaise (feeling run down).  This is a small price to pay to prevent a serious infection. Rarely, patients suffer severe allergic reactions to the vaccine.

I also recommend you get the pneumonia (Pneumococcal) vaccine to help prevent pneumococcal pneumonia, caused by the pneumococcus bacteria.  You may be able to get the pneumonia vaccine at the same time you get your seasonal flu vaccine. It’s a valuable vaccine, but the flu vaccination should be your first priority.  Go back about a month later after the flu vaccination "takes" and get the pneumococcal vaccination if you have not done this already.  Immunity to the pneumococcus lasts several years but you need a new flu shot each year.

Don't forget, the flu vaccination does not protect you against other seasonal viruses.  So if you come down with a "cold" this winter, don't blame the flu shot.  It probably is a different bug.  Don't use this as an excuse to bypass the flu vaccination each year.  No excuses . . .Get the flu shot.

For more information on the flu vaccine, visit the CDC website: http://www.cdc.gov/flu/protect/keyfacts.htm

Revised September, 2014

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