Another flu season is right around the corner. And this year, the world is grappling with Novel Coronavirus (Covid-19) pandemic while we are going to face the flu. As a patient with Sjögren’s you are wondering about whether or not you should receive a flu vaccine this year. I do believe it is important to gain some knowledge about the flu.
The estimated mortality of flu death in 2019-2020 season was around 24,000-62,000.
People with flu can spread it to others up to about 6 feet away and should use use masks. The same precautions are needed for Covid-19 prevention. Most experts think that flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk and less commonly from surfaces, which is similar to Covid-19. People with flu are most contagious in the first 3 to 4 days after the illness began. Most healthy adults may be able to infect others beginning one day before symptoms develop and up to 5 to 7 days after becoming sick. Children and some people with weakened immune system may pass the virus for longer than 7 days.
While it’s not possible to say with certainty what will happen in the fall and winter, Centers for Disease Control (CDC) believes it’s likely that flu viruses and the virus that causes Covid-19 will both be spreading. In this context, getting a flu vaccine will be more important than ever.
Antiviral drugs can lessen symptoms and shorten the time you are sick by 1 or 2 days. They also can prevent serious flu complications, like pneumonia. For people at high risk of serious flu complications, treatment with antiviral drugs can mean the difference between milder or more serious illness possibly resulting in a hospital stay. CDC recommends prompt treatment for people who have influenza infection or suspected influenza infection and who are at high risk of serious flu complication.
An annual seasonal flu vaccine is the best way to help protect against flu. Vaccination has been shown to have many benefits including reducing the risk of flu illness, hospitalizations and even risk of flu related complications. Flu vaccine causes antibodies to develop in the body about two weeks after vaccination. These antibodies provide protection against infection with the viruses that are in the vaccine.
The seasonal flu vaccine protects against the influenza viruses that research indicates will be the most common during the upcoming season. Traditional flu vaccine (called “trivalent” vaccines) are married to protect against three flu viruses and influenza A (H1N1) virus, and influenza A (H3N2) virus, and an influenza B virus. There are also flu vaccines made to protect against four flu viruses (called “quadrivalent” vaccines). These vaccines protect against the same viruses as the trivalent vaccine and an additional B virus. Patients over age 65 need high-dose vaccine.
Annual vaccination against seasonal influenza is recommended for all U.S. persons aged ≥6 months. Effectiveness of seasonal influenza vaccine varies by season.
A paper by Wahren-Herlenius and colleagues, published in 2017 addressed the effect of H1N1 flu vaccine in patients with Sjögren’s. Untreated Sjögren’s patients had an exaggerated response with higher IgG levels to H1N1 flu vaccine, hydroxychloroquine treat- ed patients did not show any exaggerated response.
Patients with Covid-19 should delay getting their influenza vaccine, not because of any evidence about how the virus affects vaccination, but in order to ensure others in the healthcare setting are not exposed unnecessarily, CDC officials said on a call with clinicians on Thursday.
Routine vaccination should be deferred for patients with suspected or confirmed Covid-19, regardless of symptoms, and patients should be screened for Covid-19 symptoms before and during the visit. In addition, clinicians should use personal protective equipment (PPE) during vaccination, including masks, eye protection and gloves, when appropriate.
To summarize, I strongly recommend inactivated injectable flu vaccines for Sjögren’s patients but caution is warranted when considering vaccination in non-treated Sjögren’s patients who have really active disease with multi-organ involvement. It is more im- portant than ever to protect yourself and others from the flu, not only for you and your household, but for the entire community. If you get sick and have to go to the doctor, your chances of being around some- one with Covid-19 are much higher. The patients on immunosuppressive medications (like prednisone, methotrexate, azathioprine, mycophenolate mofetil, rituximab) should not receive live attenuated influenza vaccine (the nasal spray flu vaccine).”
by Mehrnaz Maleki Fischbach, MD
This article was first printed in the Foundation's patient newsletter for members. Click here to learn more about becoming a member.