Flu Vaccine- NOT TOO LATE!

* The "C" in the flu tests pictured above is for "control"

Friends, family, colleagues and everyone else- FLU SEASON was mild to begin with, but now we are really gearing up. Pictured above are two positive flu tests from one morning this week (two of many). The extra good news is that so far I have not seen anyone with the flu who was vaccinated, though certainly that can happen. Remember that seasonal influenza causes thousands of hospitalizations and deaths every year in the United States, and the flu vaccine is our best method to prevent or at least reduce the severity of the flu.

This year, we hit a home run on the strains in the vaccine, as we have a very good match between the vaccine and the current strains. Yesterday's CDC press release notes that the overall effectiveness of this years vaccine is 60%. While that number might not sound super impressive, reducing the total healthcare burden of people needing to seek care for flu symptoms by 60% is huge in our total population! Also, keep in mind that if you receive the vaccine but in your case it is not fully effective so you still get the flu, your symptoms should be less severe, and your infection is likely to resolve more quickly. I'm posting this today, though, not for adamant anti-flu vaccine holdouts, but for the well-intentioned stragglers that simply never got around to getting the vaccine. Please, it's not too late- GO GET VACCINATED!

CDC data shows happily that only two states- Arizona and Oklahoma- are having HIGH levels of flu-like illnesses right now. Texas, along with Arkansas, Connecticut, Florida, Hawaii, Illinois, Maryland, Nevada, New Jersey and New Mexico are close behind with "moderate" levels, which is no surprise with what I am seeing in my patients.

Remember- not all flu looks the same. Fevers can be high or minimal. Headaches, sore throats, muscle aches, cough, runny nose and fatigue are common. Stomach symptoms with nausea, vomiting or diarrhea can occur independently or with the other symptoms.

When should you go to the doctor? If you are MISERABLE- feeling like a truck hit you, rather than a common cold or allergies causing upper respiratory symptoms, then go sooner rather than later, because if you do have the flu, the anti-flu medications are maximally effective when started within 2 days of symptoms beginning.

Does everyone need medication if they have the flu? No. Most otherwise healthy young people can manage without anti-viral medications, but they may certainly benefit from a cough suppressant or decongestant.

Why bother testing for flu? There are several reasons, partly for you, the patient, and partly for public health/your family. If a college student living in close quarters in a dorm has the flu, for example, we would rather they not infect their roommate and classmates. Knowing they have the flu helps us advise them on when to return to class, or perhaps help parents who live nearby to decide to whisk them home for a few days of chicken soup and true rest. Remember, if a flu test is POSITIVE- you've got the flu. If it is NEGATIVE...you still might have the flu. (For more explanation, see Was My Rapid Flu Test Accurate?)

BOTTOM LINE: Flu season is still here and it is NOT too late to get vaccinated!

'Tis the FLU SEASON

It's that special time of year again...so please give yourself (and your family) the GIFT of a flu vaccine NOW so you are not struck down with this illness at the busiest time of year! Flu shots have been available for a few weeks and seem to be available everywhere.  Clinics, schools, grocery stores, pharmacies and many employers are all offering flu shots these days. Add a flu shot to your grocery list- I'll bet the pharmacy there is stocked and you won't even have to add an extra stop on your weekly errands.

Who should get the flu vaccine?
The Center for Disease Control and Prevention (the CDC) recommends annual flu vaccines for everyone over the age of six months.

What is different this year?
As with last year, we have quadrivalent vaccines (that include protection against four strains- 2 influenza type  A strains, and 2 influenza type B strains) in addition to the usual trivalent vaccines. Pick one or the other, you don't need both. If you have egg allergies, make sure to ask for the trivalent vaccine that is egg-free.

Didn't I hear that the flu vaccine this year doesn't match the strain that is going around? 
Well...unfortunately, yes. We are early in the season, and the CDC is seeing that most of the diagnosed cases are a result of the H3N2 strain (as opposed to the H1N1 that was so devastating several years ago), and although that strain is included in the vaccine this year, there has been a mutation in roughly half of the circulating virus that makes it resistant to the vaccine. The take-home message, however, is that even if the vaccine is LESS effective, it is still the best protection that we have AND it should still reduce the severity of the infection if you happen to contract one of those mutated strains.

But I hate needles...no problem, just ask for the vaccine that is delivered via a nasal spray! The only caveat here is that this is a live vaccine, so there are some restrictions: you must be age 2-49 years, not pregnant, have no major problems with immunity (such as having AIDS or cancer), not take aspirin daily, and not have asthma.

Hate needles and have asthma? There is also a trivalent shot that has a tiny needle which is injected just below your skin, rather than into the muscle.


What is FLU? Influenza is not a simple cold, nor is it a twenty four hour stomach virus. The flu causes fever, chills, cough, runny/stuffy nose, muscle aches, headaches, fatigue, and sometimes involves vomiting and diarrhea (more often in kids). Colds and allergies tend to bother you from the neck up- stuffy, sore throat, headache- but don't knock you down for the count, and coughs are generally less bothersome.

How is the FLU spread? This virus is spread from infected people when the cough, sneeze or talk, via tiny respiratory droplets, and the scary part is that you are contagious a full day BEFORE you develop symptoms (as well as for about a week after you feel sick.)

How can you prevent the FLU? Get vaccinated. Get vaccinated. Get vaccinated! 

Who should NOT get vaccinated? Those with bad reactions to vaccine in the past; infants younger than 6 months; and those people with a history of an uncommon disease called Guillain-Barre. If you are sick with a fever, wait till this illness is over before getting the vaccine.

BOTTOM LINE:  Your best gift for good health this season is the FLU VACCINE!

Is it Ebola? Or "just" the FLU?

You have a fever, chills, sore throat muscle aches, headache, nausea and vomiting…is it Ebola Virus? Or perhaps that new respiratory virus (Enterovirus 68)? While technically speaking, it is possible for your illness to be caused by one of these dreaded agents, the odds are very much against it. However, you very well may have the FLU.

NOW is the time to get your flu vaccine- please! The flu vaccine is recommended for EVERYONE aged 6 months and older (who does not have a contraindication for the immunization.) We are already seeing cases of flu here in Austin, as others are across the United States. Instead of fretting about the two cases of Ebola virus here in Texas, recognize that last year in Texas alone, twenty children died from the flu. Twenty. Children. Gone. And, according to the CDC,  across the United States we have over 23,000 deaths and over 200,000 hospitalizations from influenza.

"But Dr. Grimes, the flu shot always gives me the flu!"
No, it does not. The flu shot does NOT contain live virus- it is not capable of causing influenza. In randomized, blinded studies the only difference between people who got a placebo (salt water) vs those who receive the actual flu vaccine is that the real vaccine makes your arm more sore for a few days.

There are no absolutes in medicine, but I will share that in my 20 years of practice, 99% of my patients who have actually HAD a real case of influenza make it a priority to get a flu shot each year so they don't have to experience the flu again. This is not a perfect vaccine, but annual flu vaccines greatly reduce your chance of getting the flu, and definitely decrease the severity of the infection if you end up with influenza.

BOTTOM LINE: The CDC recommends ANNUAL FLU VACCINE for everyone* over the age of 6 months. I got mine- did you get yours yet?

(*Flu vaccine is not indicated for the minority of people with "severe, life-threatening allergies to flu vaccine or any ingredient in the vaccine. This might include gelatin, antibiotics, or other ingredients. ")

Resolutions for BETTER HEALTH in 2014

Happy New Year! Many people start each year with resolutions surrounding their health, so I'd like to  jump in and suggest that you put one EASY resolution at the very top of your list. This resolution should take up well less than an hour of your life, yet can make a tremendous difference in your health for 2014...so here it is: GET YOUR ANNUAL FLU VACCINE!

If you have already received yours, pat yourself on the back & remember to encourage your friends and family to get theirs. I will confess that certain members of my family kept putting off their shots for a variety of reasons (including one trip to two pharmacies who were temporarily out of the vaccine last month), but we are 100% vaccinated now. My major message is two-fold: one, it is NOT TOO LATE in the season to get a flu shot, and two, just glance at the CDC's map above to see how widespread the flu has become this year! Last year, influenza caused over 380,000 people to be hospitalized. This flu season, we are seeing a resurgence of the pH1N1 strain (originally known as swine flu, though the "p" is for "pandemic", not pig). This particular strain is the type of flu that was so severe in 2009, but happily, all of the current flu vaccines DO include this strain. Note that pH1N1 can produce very severe illness, especially in young and middle-aged adults.

More questions about the flu or the flu vaccine? Check out "I Got Mine" or the CDC's "Flu Basics".

BOTTOM LINE: Start 2014 off right & GET YOUR FLU VACCINE (if you haven't yet this season).

I Got Mine! Did You Get Yours?

As we zip into the holiday season, give yourself the GIFT of a flu vaccine NOW so you are not struck down with this illness at the busiest time of year! Flu shots have been available for a few weeks and seem to be available everywhere.  Clinics, schools, grocery stores, pharmacies and many employers are all offering flu shots these days. Add a flu shot to your grocery list- I'll bet the pharmacy there is stocked and you won't even have to add an extra stop on your weekly errands.

Who should get the flu vaccine?
The Center for Disease Control and Prevention (the CDC) recommends annual flu vaccines for everyone over the age of six months.

What is different this year?
This year, we have quadrivalent vaccines (that include protection against four strains- 2 influenza type  A strains, and 2 influenza type B strains) in addition to the usual trivalent vaccines. Pick one or the other, you don't need both. If you have egg allergies, make sure to ask for the trivalent vaccine that is egg-free.

But I hate needles...no problem, just ask for the vaccine that is delivered via a nasal spray! The only caveat here is that this is a live vaccine, so there are some restrictions: you must be age 2-49 years, not pregnant, have no major problems with immunity (such as having AIDS or cancer), not take aspirin daily, and not have asthma.

Hate needles and have asthma? There is also a trivalent shot that has a tiny needle which is injected just below your skin, rather than into the muscle.


What is FLU? Influenza is not a simple cold, nor is it a twenty four hour stomach virus. The flu causes fever, chills, cough, runny/stuffy nose, muscle aches, headaches, fatigue, and sometimes involves vomiting and diarrhea (more often in kids). Colds and allergies tend to bother you from the neck up- stuffy, sore throat, headache- but don't knock you down for the count, and coughs are generally less bothersome.

How is the FLU spread? This virus is spread from infected people when the cough, sneeze or talk, via tiny respiratory droplets, and the scary part is that you are contagious a full day BEFORE you develop symptoms (as well as for about a week after you feel sick.)

How can you prevent the FLU? Get vaccinated. Get vaccinated. Get vaccinated! 

Who should NOT get vaccinated? Those with bad reactions to vaccine in the past; infants younger than 6 months; and those people with a history of an uncommon disease called Guillain-Barre. If you are sick with a fever, wait till this illness is over before getting the vaccine.

BOTTOM LINE:  FLU SEASON has begun again- get vaccinated!

Flu Vaccine- It's Not Too Late!

Okay, it's January, and now EVERYONE you know is getting the flu! Is it too late for you to get vaccinated? ABSOLUTELY NOT! The truth is that now that we're all scared, it's tough to find somewhere that has the flu vaccine in stock! Call your doctor or your pharmacy and find out how many they have left, then jump in your car and head over.

This year is another one of those "really bad" flu years. Yes, if you are vaccinated today, you have to wait a couple weeks for your shot to protect you. BUT...the flu season is just catching its stride, so all you have to lose is a temporarily sore shoulder.

This year's flu seems to be bringing with it the added bonus of nausea and vomiting, as if muscles that feel like a Mack truck hit you were not enough. The flu is NOT just a stuffy or runny nose and cough- that's a cold. The flu is OMG, I can NOT get out of bed and function, because my head is splitting, my muscles are screaming, and yes, this year's bonus is the vomiting and diarrhea. Believe me, a sore arm for a few days is a happy trade for the flu.

Who should be vaccinated? Hello, it's EVERYONE. The CDC (Center for Disease Control and Prevention) recommends that everyone over the age of 6 MONTHS get a flu vaccine each year.

Wash hands, wash hands, and oh yes, wash your hands...for 20 full seconds! When you dash them under the water or take 5 seconds to apply hand sanitizer, you are nicely moving your germs around, so spend the extra 15 seconds and scrub a bit to be more effective.

BOTTOM LINE: FLU SEASON is in FULL SWING- Strike back by getting your FLU VACCINE and WASHING YOUR HANDS...for a full 20 seconds!

For more info, check out the current stats on this year's flu at the CDC at: 
http://www.cdc.gov/flu/about/season/flu-season-2012-2013.htm

Flu Season 2012- Ready or Not!

While we are rushing around in December, take a moment to think about whether or not your family has received the flu vaccine this year. The CDC reports show that unfortunately, we are jumping into the season early this year, especially in TEXAS, Alabama, Louisiana, Mississippi, and Tennessee. In fact, this is the earliest in the flu season to reach this level in almost a decade (since 2003-2004). The good news is that the viruses identified with testing DO largely match the strains that are included in this year's vaccine. More good news is that they are susceptible to our antiviral medications, although I am not a huge fan of these drugs in otherwise healthy individuals.
Both types of influenza- A and B- are being documented, with the usual ratio of nearly 3:1 from A:B.

What is FLU? Influenza is not a simple cold, nor is it a twenty four hour stomach virus. The flu causes fever, chills, cough, runny/stuffy nose, muscle aches, headaches, fatigue, and sometimes involves vomiting and diarrhea (more often in kids). Colds and allergies tend to bother you from the neck up- stuffy, sore throat, headache- but don't knock you down for the count, and coughs are generally less bothersome.

How is the FLU spread? This virus is spread from infected people when the cough, sneeze or talk, via tiny respiratory droplets, and the scary part is that you are contagious a full day BEFORE you develop symptoms (as well as for about a week after you feel sick.)

How can you prevent the FLU? Get vaccinated. Get vaccinated. Get vaccinated. It's not too late for this year- get vaccinated. The flu vaccine is indicated for EVERYONE over the age of 6 months, EVERY YEAR.

Who should NOT get vaccinated? Those with severe chicken egg allergies; bad reactions to vaccine in the past; younger than 6 months; history of an uncommon disease called Guillain-Barre. If you are sick with a fever, wait till this illness is over before getting the vaccine.

BOTTOM LINE: It's FLU SEASON again- get vaccinated!