Is it too late to consider a flu jab?

Maybe you opted for the annual flu shot back in November. Maybe you never got around to it and unfortunately got ill, or maybe you had the jab and still got the flu. Maybe you never get the jab and refuse to consider it at all. Or maybe, just maybe, you don't ever get the jab but this year you're a bit more worried and are now wondering if actually, is there still time to get it?

Here in the UK, we are suffering from the Influenza A(H3N2) strain that also circulated last winter. Recent figures from the Royal College of GPs reported more than 30,000 people visited their local GP just last week, with flu like symptoms. There are three red flags with this flu season; 1)H3N2 viruses typically cause more hospitalisations and deaths in older people, 2) there are difficulties in producing effective H3N2 vaccines and 3)there’s more than just H3N2 to consider, especially in the UK this year.

Every year the World Health Organization (WHO) picks three strains of flu most likely to be circulating when making the vaccine. This year's vaccine in the UK is a 'trivalent” that protects against three flu viruses (H1N1, H3N2 and one of the two kinds of influenza B). This year, though, the other type of influenza B (Yamagata) is more common, meaning that those with the trivalent vaccine will be protected less, although they would likely get some cross-influenza B protection.

The NHS advises that 'the best time to have a flu vaccine is in the autumn... but not to worry if you missed it, there is still time'. With peak flu season upon us now, it is still recommended to have the jab, particularly vulnerable groups such as young children, the elderly and pregnant women. This season, the vaccine is estimated to be about 20 % protective.

Last year, vaccine effectiveness (VE) data published by Public Health England (PHE) in their report on Influenza vaccine effectiveness (VE) in adults and children in primary care in the United Kingdom (UK): provisional end-of-season results 2016-17 , showed vaccine effectiveness at 40.6% in 18-64 year olds, with no significant effectiveness in ≥65 year olds.

VE was 57% for influenza A(H3N2) for 2-17 year olds receiving quadrivalent live attenuated influenza vaccine and 78.6% for influenza B.

The CDC's VE rates below also suggest that last year’s data was not as favourable for the elderly, but one could argue that lower efficacy rates still had a percentage of the elderly population inoculated and protected.

Effectiveness rates of seasonal flu vaccines

Year Effectiveness rate

2006 - 2007 52%

2007 - 2008 37%

2008 - 2009 41%

2009 - 2010 56%

2010 - 2011 60%

2011 - 2012 47%

2012 - 2013 49%

2013 - 2014 52%

2014 - 2015 19%

2015 - 2016 48%*

2016 - 2017** 42%**

Centers for Disease Control and Prevention (CDC)

When the flu jab campaigns begin, there is often contentious and heated debate. Medical professionals, the Center for Disease Control and Prevention (CDC) and World Health Organization (WHO), publish data supporting and advocating vaccination while the antivax argue against efficacy claims and draw their own conclusions that flu vaccines make people sick, or that the WHO is biased and works with ‘Big Pharma’ to profit from worldwide distribution of vaccines.

Personally, I struggle every year to be completely confident with my 'to have or not to have' flu jab decision. Ever since the pandemic swine flu in 2009, I am always wary of the unwavering opinions on both sides. Particularly in 2009, a tremendous amount of often conflicting information was flooding the media regarding treatment, while an alarming number of individuals continued to come down with this flu. As a mother of young children discussing options and hearing personal stories, it was a confusing and emotive time.

Back then, I had not qualified as a nutritional therapist, but my son had been suffering from recurring ear infections, so I was in contact with medical professionals and an osteopath and homeopath on a regular basis. Their collective opinions on Tamiflu were clear. Demand was outpacing supply and there was concern over the lack of data supporting the efficacy of the drug and its risk associated side effects. News of Tamiflu shortages dominated the press as it was reportedly given to people at a rate of something like 1000/week during the pandemic. It was fast and furious and it just didn't sit well with me for reasons I cannot explain, because I was not a medical expert and did not have a qualified opinion. Only unqualified feelings.

I continued to fret about what was best and did not have the jab.

I read that the manufacturer of Tamiflu, Roche, claimed at the time of the 2009 swine flu outbreak that trials had shown that it would reduce hospital admissions and complications such as pneumonia, bronchitis or sinusitis. As a result of these trials, the Department of Health bought around 40 million doses of Tamiflu at a cost of £424 million and prescribed it to around 240,000 people. In 2009, 0.5 per cent of the entire NHS budget was spent on the drug.

In the US, $1.3 billion was spent on stockpiling antiviral drugs, much of it Oseltamivir - trade name Tamiflu.

So why am I bringing all of this up now? I suppose it is due to a conversation I had with a close friend last night. Her son had had a fever for 2 days and she was very worried about any complications from flu symptoms. He has a history of asthma and he was extremely uncomfortable. When she took him to the doctor, he was given Tamiflu.

In 2014, the NHS published a report from the Cochrane Collaboration's conclusions that Oseltamivir (Tamiflu) drugs shorten the symptoms of influenza-like illness by about half a day in adults (but not in asthmatic children), compared to a placebo. It also concluded that there was 'no reliable evidence that either drug reduces the risk of people with flu being admitted to hospital.' The report also concluded that 'there was no effect in asthmatic children – but in otherwise healthy children, there was an average reduction in the time it took to first alleviate symptoms of 29 hours.'

I was surprised to learn that Tamiflu is routinely offered in the US to 'shorten the symptoms' of flu and have since researched that here in the UK, the National Institute for Health and Care Excellence, (NICE) BNF guidelines advises its use 'When influenza is circulating in the community, oseltamivir is an option recommended (in accordance with UK licensing) for the treatment of influenza in at-risk patients who can start treatment within 48 hours of the onset of symptoms.'

So if you are not in the vulnerable or 'at risk' category, should you even consider this year's flu shot? Or Tamiflu to 'shorten symptoms' by half a day?

The decision is of course a very personal one, but I would at the very least, discuss the options with a medical professional and do a bit of independent research on any risks and potential side effects. But most importantly, consider other factors as well.

Is there anything you could be doing naturally to strengthen your own immunity and optimize your own wellbeing? Even if you opt for the jab, any unwarranted side effects could potentially be minimized if you make the choice from a healthier starting point.

I am not anti prescription medicine, but I am convinced that there is so much more we can be doing for ourselves. By supporting our health with nutrition, lifestyle choices, sleep maintenance and stress management techniques, we are in a much better position to cope, and even recover, if and when we do get ill, because we have stronger tools in the toolbox, so to speak, than the ones we've thrown away or left out to rust in the rain.

Every year I think about it, and every year, I have not had the flu shot. Nor have my children. Once the chilly air hits in autumn, I start to boost their immune systems with nutrient dense and Vitamin C rich foods. I supplement with a probiotic and a good quality fish oil. If they start to feel run down, I add an elderberry, zinc complex and I drastically reduce their sugar intake.