As influenza outbreaks spread across Alaska and the rest of the U.S., so does the debate over whether it's necessary -- or wise -- to get the vaccine.
No state has been left untouched by the influenza virus, but the outbreak is worse in some areas. In New Jersey, for instance, hospital emergency rooms are packed with folks sick with the flu. Boston declared a public health emergency last week after 700 cases were confirmed since Oct. 1, or 10 times the number of flu cases reported in 2011.
So far, Alaska has been hit with a moderate outbreak of the flu, but that could increase, the Associated Press reports. The percentage of doctor visits for influenza-like-illness last week in Alaska was 2.2 percent, whereas nationally the percentage was nearly double that, according to Alaska's epidemiology website.
40 Alaska cases last week
All told, some 337 cases, composed of several strains of influenza, have been reported in Alaska since Sept. 30, with 40 new cases confirmed last week, said Donna Fearey, nurse epidemiologist with the state. She believes the flu is "probably to some degree under reported."
"Clinicians are seeing so much flu in the community," Fearey said. "We know influenza is circulating" through every corner of the state.
Getting a vaccine is "the best way to prevent the flu" according to the state epidemiology website, and there are still plenty of vaccines available in Alaska. So why wouldn't you?
Three main reasons people cite are the vaccine's effectiveness, the fact that it can make people sick, and concerns over preservatives in vaccines.
But first, a low-down on the virus and vaccine: Influenza is a highly unpredictable and contagious virus that causes a respiratory illness categorized by fever, cough, sore throat, fatigue and muscle aches, among other symptoms. It's "very unstable," Fearey said, and mutates all the time; that's why there's a new flu vaccine every year, and several strains of the virus circulate during flu season.
Four strains next year
Every spring, researchers from the World Health Organization, the Centers of Disease Control and Prevention (CDC) and other institutions study virus samples from around the world, making recommendations as to which strains should go into that year's vaccine, the CDC reports. Historically, three strains have been chosen per year. But starting next year, four strains will be selected, a development Fearey called "exciting" because it will increase the vaccine's effectiveness.
The virus strains are then grown in eggs (which is why people with severe egg allergies should steer clear of the shot) and developed into a vaccine.
This year, there are four major strains of flu in the U.S. The current vaccine is a "good match" for several of the "A" type strains circulating, Fearey said, but there is one type of "B" strain not covered in the vaccine. And that strain accounts for about 30 percent of the "B" strains making its way through the population now.
Which leads to one of the first debates: Is the influenza vaccine effective?
This year, the CDC estimates, the effectiveness rate is about 60 percent -- the same as last year. That effectiveness also depends on the age and health of the person vaccinated. "In general, the flu vaccine works best among young healthy adults and older children," the CDC said.
The elderly, one of the groups most recommended to get a flu vaccine, also develop less of an immunity after getting the vaccine, meaning that the group needing protection the most receives the least benefit from the shot. That's why it's important for others in the community to get vaccinated -- to minimize the chances of exposing high-risk populations, Fearey said.
The 60 percent efficacy is "not great," Fearey said. On top of that, the vaccine takes around two weeks to start protecting against the flu, meaning people can get sick in the interim. But it still leads to fewer hospitalizations, less antibiotic use, and greater protection for communities.
Not everyone believes that the vaccine is effective. In a Facebook post, Ed Feraco wrote, "Flu vaccine is dangerous and is less than 30 percent effective! Use homeopathy!"
But can the vaccine alone make people sick?
Immune system reacts
The viruses in the vaccine are dead, meaning it is impossible to contract influenza from the vaccine. Still, some people report feeling sick the day after getting a shot.
Naturopathic doctor Suzette Mailloux explained "the point of the vaccine is to develop an immune response," and that immune response is what makes people feel ill. The virus isn't making people sick, but the body's response can trigger feelings of illness. The same goes for when people actually contract the flu. Their body's immune system kicks in, and that's what accounts for the aches and fatigue. Still, the effects are short lived, Fearey said, and not everybody reacts negatively to the vaccine.
Some people shouldn't get the vaccine, including children with compromised immune systems. People who have had a severe allergic reaction to a vaccine also should not get it.
But what about the other stuff in the vaccine? Is it safe?
Fearey said there's a lot of "bad information circulating" that dissuades people from getting vaccines. "I think people have good intentions," she added, "but the science supports the (safety of) the flu vaccine."
Thimerosal concerns
Mailloux said the biggest concern among her patients is thimerosal – a mercury-based preservative used in vaccinations since the 1930s – that is used in the flu shot. The thimerosal debate has gotten lots of media attention in the past few years and will surely receive more scrutiny. But Mailloux pointed out a little-known fact that thimerosal is only in some flu shots. Patients can request a shot without any.
Thimerosal is used in multi-dose vials (vials that contain more than one dose of the vaccine). People looking to avoid thimerosal should ask pharmacists if they use single-dose vials, which do not contain thimerosal. The CDC has a list of which influenza vaccines contain the preservative as well.
Fearey said that the state program for vaccinating children and pregnant women who are uninsured uses vaccines without thimerosal, and thimerosal-free vaccines are available throughout the state.
Regardless of the debate, there are other good habits that will cut your risk of contracting the flu. Mailloux recommended washing your hands frequently and not touching your face. Stay home if you are sick, get plenty of sleep, limit sugar, alcohol and stress – especially sugar, which depresses immune function for several hours, and can create a window where you are more likely to contract flu virus.
"I encourage everyone, especially in Alaska, to get their vitamin D levels tested," she said, because low vitamin D can mean lower immunity. She also points to evidence that high-dose vitamin C and elderberry can help decrease the severity of influenza.
Contact Laurel Andrews at laurel(at)alaskadispatch.com.