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Fears about the flu shot linger, our poll finds

Last updated: October 2010

This fall, vaccine makers are starting ahead of the H1N1 (swine) flu virus that caused the 2009 pandemic. But public sentiment for this season's flu vaccine may be lagging behind.

Drugmakers have promised a record supply—about 160 million doses—and the vaccines are arriving at stores and doctors' offices earlier than usual. But some Americans, perhaps reacting to the confusion and fear spawned by last year's dramatic flu season, have lingering concerns about the seasonal flu vaccine, according to a new, nationally representative poll of 1,500 adults from the Consumer Reports National Research Center.

This year's vaccine protects against three viruses: the 2009 H1N1 (swine) flu virus, the H3N2 virus, which frequently causes high rates of pneumonia and death in years that it circulates, and an influenza B virus. "Already in this early fall there have been infections in people in the U.S. with each of these three viruses," says Tim Uyeki, a medical epidemiologist in the Centers for Disease Control and Prevention's influenza division. While it's too early to predict how the flu season will unfold, Uyeki says that early monitoring suggests that the seasonal flu vaccine will be a good match.

The truth about last year. The 2009 flu pandemic spurred 45 percent of American adults to get a seasonal flu vaccine, a 4 percent increase over 2008, our poll found. And 15 percent of those who don't usually get the vaccine did so last year, a 5 percent jump. But only 37 percent of the respondents said they would definitely get this season's vaccine. Of those who plan to avoid this year's vaccine, one of the top reasons given was that they thought last year's epidemic was overblown.

It appears that many Americans see last year's swine flu scare as a barking dog that didn't bite. And indeed, recent analysis has found that last year's estimated death toll was about half that of an average seasonal flu season between 1976 and 2006. But "looking at the numbers of deaths does not reflect the severity of this pandemic," Uyeki says. "It had a disproportionate impact on younger adults." About 270,000 people in the U.S. were hospitalized and 12,470 died, according to estimates from the Centers for Disease Control and Prevention. In most years, about 90 percent of the deaths from seasonal flu are among those over 65. But last year 87 percent of the deaths during the pandemic were among those under age 65.

That message seems to have resonated somewhat; 58 percent of parents in this year's poll had their children vaccinated for seasonal flu in 2009, a big jump from last year's poll. Only 41 percent of parents had their children vaccinated in 2008. Fifty percent of the parents of children ages 6 months to 17 years definitely plan to get their children vaccinated this year.

As government and media campaigns publicize the risks of the flu, the benefits of vaccination, and the dangers of common misconceptions, more Americans might be convinced. Our poll shows that 31 percent are still undecided about what to do this year. Last year's media blitz on the flu was influential, according to the CR poll. The number of people who said the media played a role in persuading them to get vaccinated for the seasonal flu doubled last year, from 16 percent in 2008 to 35 percent in 2009. And more than half of the 22 percent of Americans who got the H1N1 vaccine last year cited the media as a factor.

This year, when we asked those who were undecided about their flu-vaccine plans, 57 percent said government guidelines might influence whether they get a vaccine. But, as in the past, health-care providers will have the largest influence on people's decisions: 73 percent cited them as a factor in decision-making.

New guidelines. To increase vaccination rates, the CDC has simplified its guidelines this year. It now recommends that all Americans older than 6 months get vaccinated. The agency continues to stress the importance of getting the vaccine for people at high risk, including pregnant women, young children, adults over 65, and anyone with an underlying chronic disorder, such as asthma, heart disease, or immune suppression.

Last year's pandemic brought new evidence that being very obese might also be a risk factor for flu complications. Other recent research has found that vaccinating pregnant women can also provide some immunity to their children through the sixth month, and that a high vaccination rate among children can lead to lower rates of infection throughout communities.

Just half of health-care workers got the shot. Despite the importance of vaccination for people in high-risk groups, our poll found that many Americans don't know they're at increased risk. Only 42 percent of people with a medical condition that puts them at risk of flu complications considered themselves to be at increased risk. And just 33 percent of those over age 65 considered themselves at higher risk due to their age. Even among those who consider themselves at risk for complications, only 56 percent said they'd definitely get vaccinated this year.

Perhaps even more alarming is that only 52 percent of health-care workers and those who work in residential nursing homes were immunized for seasonal flu last year, and just 34 percent for H1N1. That's surprising considering that they're among the most likely to catch the flu and spread it to patients at high risk for complications and death.

Reasons for skipping the flu vaccine. Of the 30 percent of respondents who said they would definitely not get vaccinated this year, 44 percent said they were concerned about side effects and 41 percent about the safety of this year's vaccine. Forty-five percent said last year's epidemic was overblown.

Among those who didn't get a seasonal flu vaccine last year, most (60 percent) said they wanted to build natural immunities. And 41 percent said they just didn't get the flu, a finding that was more pronounced among men. That's a significant drop from the 54 percent who provided the same rationale in 2008, which suggests that more Americans are getting the message that they can't count on being immune to the flu.

Other reasons for skipping a flu vaccine include "medicine and other remedies can treat the flu" (38 percent), and "worry about side effects or getting the flu from the vaccine" (36 percent). We've examined these flu-shot excuses, and found them lacking.

Bottom line.
There is no reason to fear this year's vaccine, according to our medical advisers and consultants. The flu vaccine has proved to be safe over many decades. While estimates vary, in general it has been found to reduce the risk of catching the flu by about 70 to 90 percent in healthy adults. It's less effective in older people and those with compromised immune systems, but it can lessen the severity of the flu, limiting serious complications and deaths.

Inside the flu vaccine

We talked to Carolyn Bridges, M.D., associate director for science, influenza division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention.

Why do we need a new vaccine every year?
With influenza, you're always working with a moving target. The seasonal flu virus can mutate from year to year. We update the vaccine each year so it is as effective as possible against new strains of flu. Occasionally a pandemic occurs, as it did last year with H1N1, the first pandemic in 40 years. The seasonal flu vaccine was already in production by the time the first H1N1 strains were identified, so we had to make a separate H1N1 vaccine. But this fall people will need only one vaccine, not two.

How is the new vaccine made?
The CDC collaborates with health departments in the U.S. and abroad and with the World Health Organization to monitor influenza around the world. It's a year-round process because it's always flu season somewhere. Decisions about which strains should go into the vaccine each fall are made the preceding winter based on what is spreading and causing illness. This year's vaccine protects against influenza B, the H1N1 virus from last year, and another "A" virus called H3N2. We need a lead time of almost a year to make the vaccine, from selecting the strains to growing the viruses in pathogen-free eggs to purifying, testing, and distributing the final product.

Who should get a flu shot?
Anyone 6 months of age or older. There's no approved vaccine for infants under 6 months, but they are at high risk of serious influenza complications. The best way to protect them is to make sure everyone around them is vaccinated, including grandparents, parents, siblings, and other caregivers. Pregnant women should also get vaccinated to protect themselves and their babies. Recent studies show that infants whose mothers were vaccinated during pregnancy have a lower risk of influenza, apparently because the mothers transmitted their antibodies prenatally and also got influenza less often.

The high-dose vaccine

This year a new flu vaccine, Fluzone High-Dose, which provided higher levels of antibodies in clinical trials, was introduced for adults 65 years of age and older. Officials hope that the vaccine will help prevent more flu illnesses in older people, but that has yet to be proven.

One drawback is the higher incidence of side effects, including soreness at the injection site, headaches, muscle aches, and fever. While the vaccine appears to be both safe and effective, our medical advisers are waiting for a longer track record before recommending it over the standard flu vaccine, except perhaps for the very sick or immune compromised.

5 bad reasons for skipping the flu shot

Fifty-five percent of the adults in a recent survey by the Consumer Reports National Research Center said they didn't get the seasonal flu shot last year. Here are their flu-shot excuses—and our responses.

1. I believe in building my natural immunity (60 percent)
The vaccine builds immunity, too—without the risk of disease or its complications. And since flu viruses change from year to year, the protection you develop one season from the disease might not help much the next, anyway.

2. I don't get the flu (41 percent)
That's probably just good luck. You can also get the flu with symptoms so mild you don't even notice them—yet still spread the disease.

3. Medicine and other remedies can treat the flu (38 percent)
There are lots of over-the-counter flu remedies on pharmacy shelves, but most are only mildly effective at easing symptoms, and many pose potentially serious risks. The prescription antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) can make flu symptoms less severe and shorten the duration by a day or two. But they work only if they're started within two days of the onset of symptoms. And overuse of them might breed antiviral-resistant strains.

4. I worry about side effects or getting the flu from the vaccine (36 percent)
Side effects are uncommon and usually limited to soreness at the injection site, aches, low-grade fever, and, in very rare cases, serious allergic reactions or possibly Guillain-Barré syndrome, a neurological disorder. But the shot's benefits against illness far outweigh its risks. It contains an inactivated virus and can't cause the flu. The nasal spray contains a weakened live virus and might cause mild symptoms but not a full-blown infection.

5. I don't like shots (24 percent)
The flu shot uses a small-bore needle so it causes little pain for most people. If that doesn't reassure you, look away. If you think you might faint, lie down for the shot and stand slowly afterward. Or ask your doctor if you're a candidate for the nasal spray.

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