Ask the Flight Surgeon / Dr. (LTC) Joseph Puskar: Q: I got the flu vaccine yesterday. Do I have to get a down slip for the immunization?
FS: You don’t need to get a down-slip and subsequent up-slip unless you develop a local or systemic reaction; then you would need clearance by the flight surgeon. Remember from the safety briefings on exogenous factors that the grounding period after a vaccine is twelve hours, or until any adverse effects have resolved.
The most common influenza vaccine in use this year is a quadrivalent formulation that protects against two type A (generally a more severe illness), and two type B strains. It is given intra-nasally and intra-muscularly. The intra-nasal vaccine known as Flumist generally gives a little bit better protection since it stimulates the formation of secretory immunoglobulin A antibodies that protect the mucus membranes from infection by the virus whereas the injectable version does not. The vaccine is cultured in eggs, and for people with truly severe egg allergies an egg protein-free option is available for adults only at the present time. Administration of the vaccine is recommended unless there is a history of a severe egg allergy such as anaphylaxis. The tiny micro-molar traces of egg proteins in the egg-cultured vaccines are more of a theoretical risk than a real one even for egg-allergic people.
Broadening the Scope
A newer type of vaccine, trade named Flublok, is made using recombinant DNA technology instead of virally-infected eggs to produce the vaccine components, and can be used in people allergic to eggs. It has hemagglutinin H1-H3 proteins among other components in it that cause the production of antibodies that prevent the attachment of these protein structures, and thereby the influenza virus itself to human cells. This recombinant technology allows the vaccine to be produced more quickly than the egg-derived vaccines, enables the vaccine to be protective against more strains of the virus than previous vaccines since the individual components can be selected, and quickly adjusted if the circulating strain of virus mutates rapidly as has happened this year. It has been shown in one study to be 43% effective against all flu strains in general, not just the ones selected to be cultured in the eggs as in the older type vaccine, and it can remain effective longer. Tamiflu is a medication that can be used for treatment of influenza within 48 hours of the onset of symptoms, and prophylactically in family members or other close contacts at risk of becoming sick later.
Vaccination of health care providers is now mandatory in many hospitals, and vaccination rates in health care personnel have risen from 40% to 90% in the past five years. This not only protects them from influenza, but helps prevent its spread among those they care for. Even some health care providers still mistakenly believe that the flu vaccine makes them sick. It may cause a run down, tired feeling or headache for a few days as part of the inflammatory process necessary to make protective antibodies, and sometimes an elevated temperature for a few days, but this is not a true illness. If a severe illness develops in the few days after getting the vaccine with the major muscle group aches, high fever, severe headaches, nausea, vomiting and diarrhea typical of a bad case of type A influenza, the odds are you were infected with the virus before you ever even got the vaccine, or before it could prevent illness. It takes approximately two weeks after getting the vaccine to develop the full response with protective levels of antibodies.
Take It Seriously
If you get a bad case of type A influenza, there will be three to four nights where you can feel like you don’t know whether or not you will live, and in some cases you may not. Influenza is a serious killer that should be taken seriously. Every year we lose between four to five thousand children to influenza, an average of 36,000 people die each year from influenza in the United States, and between a quarter to half a million die worldwide. During the influenza pandemic of 1918, between 50 and 100 million people who were mostly young and previously healthy died. Many died with a co-infection of pneumococcal pneumonia. This illustrates the importance of staying current on all vaccines, and seeking medical care if serious influenza-like symptoms develop. Vaccinations are the most effective thing we can do other than providing a clean, potable water source to protect large populations, and our troops from infectious diseases.
Safe flying, and see you at the flight line!
Question for the Flight Surgeon?
Dr. (LTC) Joseph Puskar is a flight surgeon and the director of the Army Flight Surgeon Primary Course at the US Army School of Aviation Medicine at Fort Rucker, AL.