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Timely flu shot for all is the responsible, careful choice

Q: Where’s the worst place for an immunization advocate to be accosted by an apathetic non-immunizer?

A: In the dentist’s office. Here’s the scenario from a week or so ago.

Dentist: “Have you been giving flu shots yet this year?”

Me (Dentist fingers and tonsil sucker in my mouth): “Mmmfff!” (That’s a yes, if you couldn’t tell.)

Dentist: “I never get the flu shot. And I never get sick.”

Dental assistant: “I don’t get it either. I got it once and got so sick!”

Me: “Fffmmm!!!.” (They’ll never know if that was an expletive or not.)

Let me assure you that I am very fond of my dentist; I’ve been going to his practice for many years. My dentist probably should have kept his fingers in my mouth until he could beat a retreat, but he didn’t, so I lit into him. I was easier on his assistant, because I don’t know her as well. Both are careful to wear gloves and masks most of the time, though my dentist doesn’t like the mask to cover his nose.

“Here you are,” I said, “a careful and responsible health-care provider, and you’re neither protecting yourself nor your patients. You see patients of all ages all day and you’re friendly and cheerful with all of them, both before and after you put on your mask.

“Think of yourself first: About 5 percent of all Americans will get the flu every year; you’ve been lucky so far, but suppose you’re one of that 5 percent? You’ll not die (few people your age die of it), but you may wish you had – you’ll have high fever, cough, body aches, lousy appetite, maybe pneumonia, maybe vomiting. It won’t be pleasant. Think about your office: you’re in a one-dentist practice (I love that – I get to see you each time I go in), and everything would grind to a halt and a bunch of people who need to work would be in limbo.

“Think of the people you see. Think of your father, who is almost my age! It’s people his age – my age – who die from influenza, about 22,000 of them each year! You don’t want to give your father the flu! Think about all the elderly people you see in the office every day – you don’t want to be giving them the flu, which you can do if you have the virus and aren’t yet sick. Of course, once you’re sick, you won’t be in the office infecting other people anyway, you’ll be lying in bed.”

To the dental assistant, a very nice young woman: “You know, you can’t get influenza from a flu shot. There is nothing infectious in the vaccine, nothing live in the injected vaccine, while the vaccine given nasally to younger people is a live vaccine that only infects the nose. You can get a little fever for a day or two with either vaccine, a sore arm or a runny nose (with the nasal vaccine), but that’s it.”

Getting the flu from the flu vaccine is a persistent myth, and I’m not sure where it comes from. Maybe it’s because there are so many viruses causing disease at this time of year and we doctors haven’t done very well at confining the term “flu” to the real influenza. “Stomach flu” is not influenza, for example, and influenza vaccine doesn’t prevent it.

So you can get “stomach flu” caused by other viruses at any time, including right after you get the vaccine. Also, influenza vaccine doesn’t begin to be effective until about two weeks after it’s been given, so it’s possible to actually contract influenza in that two-week period – not from the vaccine, but from someone else.

Why is this appearing in a column on child health? Because, like health-care providers, children are expert at spreading the virus to others in the community. There’s good evidence from Japan, from Houston and now from Albuquerque that children get the virus first and then spread it to their elders.

So the argument is really the same with children as it is with dentists and other health-care providers: aside from avoiding flu yourself, you protect the most vulnerable people in society from having influenza if you protect yourself with either the nasal or the injectable vaccine.

I can cancel my appointment with my dentist if it’s during flu season, but I can’t and won’t cancel a visit with my grandchildren, even though they’re as likely to be small germ factories as any other child if they haven’t had the flu vaccine.

I love my dentist, but he was probably wanting to crown me somewhere else than on my tooth. I do hope he and his assistant have had the flu vaccine by now. I hope you and your children have, too, but it’s certainly not too late.

Lance Chilton, M.D., is a pediatrician at the Young Children’s Health Center in Albuquerque, associated with the University of New Mexico. Send questions to lancekathy@gmail.com.

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