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Health authorities and the media are rolling out, as always in the northern hemisphere at this time of year, a strong case for getting the flu jab. We’re told it’s the best protection we can get against the flu that is expected to kill thousands this winter. But we’re only being told part of the story.

It’s therefore refreshing when you read reasonably balanced pieces about the seasonal flu and the vaccine, like the article published last Monday by the Irish Times.

When to comes to being open and transparent about vaccines, health authorities have a long way to go. Take Public Health England (PHE) for example, that publishes annual flu reports.

The 2016/17 report makes for interesting reading. Some highlights are as follows:

  • Peak numbers of cases of confirmed flu infection occurred in the last 4 weeks of 2016 and the first 4 weeks of 2017
  • Large numbers of cases occurred in institutions, especially care homes

But the report fails to connect two crucial pieces of information – what was the vaccination coverage for the elderly and vulnerable in care homes? This is a rather crucial piece of information, as it is seminal to determining effectiveness of the vaccine among this key group, whose immune systems are often heavily compromised by inadequate nutrition and low circulating vitamin D levels.

Contrary to what people are normally told, most studies suggest that vaccine effectiveness is around 50%, although in some years, such as 2014-15, it can be on average as low as 34%.

No one is suggesting that people in care homes, health workers or other vulnerable groups with high risk of infection should abstain from getting a flu jab. But that doesn’t mean everyone should have it regardless. And it also doesn’t mean that there aren’t other options available for those who choose to avoid vaccination.

Some of the reasons why people might not want the flu jab

  • You are concerned about low effectiveness, that might be linked especially to genetic drift in the virus causing a mismatch between the virus strains in the vaccine and the circulating seasonal flu viruses
  • You are concerned that regular, annual exposure to the vaccine might reduce its effectiveness, something that might be of particular concern in a year when a highly virulent strain of influenza were to circulate. A 2013 study published in Clinical Infectious Diseases showed lower effectiveness in individuals where vaccination had occurred in the current and previous season. The same study showed no protection conferred to members of the same household who had been vaccinated.
  • Evidence from studies of young children and the elderly, the two most vulnerable groups, show modest effectiveness at best. But what about if you look after your immune system by eating a healthy diet, supplementing with vitamin D (e.g. 4,000 IU/day) taking physical activity, engaging in mindfulness practices, etc. There are no studies comparing such vaccinated and unvaccinated populations, while there is a good body of clinical evidence showing that people with elevated vitamin D blood levels, consuming good quality diets and in a good state of health have ample immunological competence to deal with flu in the event they become infected. In fact, vitamin D experts argue that the seasonal incidence of flu infection may actually be linked to low vitamin D levels during the winter months.
  • People are concerned about adverse reactions, especially in young children. Fever or febrile convulsion adverse events for trivalent vaccines can be unacceptably high. A 2015 study published in the Euro Surveillance journal suggested these adverse events occurred at a rate of some 5%-37% of children vaccinated with the inactivated trivalent flu vaccine.

Options to help protect you against the flu

  • Vaccinate if none of the above is of concern to you. At ANH-Intl, we support vaccine choice and informed consent.
  • Minimise risk of infection by using the best possible hygiene practices such as washing hands regularly, using tissues to cover your nose and mouth when you cough or sneeze and disposing tissues in a bin as soon as possible, keep surfaces such as keyboards, telephones and door handles clean and disinfected.
  • Minimise your exposure to infected individuals. In some countries in the EU you can use the influenzanet data based on public input. The UK mapping data are particularly useful to gauge regional infection patterns. Data from the influenzanet project for the following EU countries are also available:

Netherlands and Belgium

Portugal

Italy

France

Sweden

Ireland

Denmark

Spain

  • Adults should ensure they take between 4,000 IU (100 mcg) and 10,000 IU (250 mcg) of vitamin D3 (cholecalciferol) daily during the winter months, with the aim of achieving a blood level of 100-150 nmol/L (40-60 ng/ml) 25-hydroxy vitamin D. A nutritional practitioner or doctor can assess your blood levels, or you can use test kits using a blood spot that are widely available (e.g. in UK via Cityassays or Better You).

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