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. I’m already seeing some people in my community with the flu and it causes a decreased appetite and a severe cough, both of which are significant problems for people with ALS.

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 and two additional common strains of influenza viruses.  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. I have talked with some people who have had the nasal spray and they found it uncomfortable; they feel like they get a clogged-up nose. As you are aware, many of our ALS patients experience thick secretions and have difficulty handling them in their mouth and throat.  I can imagine that the nasal route of administration might be troublesome for them. I think that the injection would be safer and less stressful for ALS patients. However, if the nasal spray is the only available route at this time in your community, talk with your physician to decide what is best for you.

No shortage of the vaccine is expected, but vaccine availability and demand can be unpredictable..

Anyone with an allergy to eggs should not receive the vaccine, since chicken eggs are used in the manufacturing process.  If you have a weakened immune system, you should not receive the live virus nasal spray; get the injection with the killed virus instead.

The possible side effects of the vaccine are: pain at the injection site, muscle aches, headaches, and malaise (feeling run down).  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 pneumoccus bacteria. There are more than 80 different types of pneumococcus bacteria, and 23 of these are covered in the currently available vaccine. But of the 80 different types, the vast majority of infections are caused by the 23 serotypes contained in the vaccine. 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.

For more information on the flu vaccine, visit the CDC website: http://bit.ly/anjvzn

Revised September, 2010

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