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Give us all a break, roll up your sleeve

If you're healthy, you may be able to fight off the flu quickly. But what about all those other people you could infect?

Why do so many people refuse to get the vaccine that is the best way to fend off influenza and help stop its spread through our communities?

Over the years, I have heard every excuse in the book: A flu shot isn't natural, it's better to get the flu and fight it and build up my immune system; the vaccine isn't safe; you can get the flu from the vaccination; I never get the flu . . .

Let's put this into perspective. When SARS hit, I was overwhelmed by the number of people anxious about how contagious it was and when there would be a vaccine. Not to underestimate the impact of SARS, but I wonder why many people, in comparison, underestimate influenza's seriousness?

Influenza is the sixth-leading cause of death in Canada, directly or indirectly linked to 4,725 deaths in 2002, the latest year for which statistics are available. In a typical year, flu-related symptoms account for about 75,000 hospital admissions. Complications from the flu include sinusitis, bronchitis, pneumonia, ear infections, worsening of asthma and croup, myocarditis (an inflammation of the heart), and Reye's syndrome, a neurological disease in children.

Influenza viruses change every year, which is why you need an annual shot.

The virus is highly contagious; an outbreak can affect about 20 to 50 per cent of a population. Typically, an outbreak begins in children, preceding that in adults by about two weeks.

This year, the Canadian Paediatric Society recommends that all babies aged six months to 23 months receive the flu shot. The data show us that the rate of hospitalization of infants for treatment of flu is roughly equal to the rate among adults over age 65. Until this year, the shots had been recommended for children deemed to be at high risk for severe complications due to influenza, and those who live in chronic-care facilities or who have contact with high-risk children or adults.

A vaccination is 70- to 90-per-cent effective in preventing the flu in healthy adults, and a new study of elderly people found that an annual flu shot reduced the risk of death by up to 24 per cent.

So think about it. You might be healthy and fight off the flu quickly and without complications, but if you get sick, what about all the other people you could infect? The more people who are immunized, the more likely the chain of transmission is to be broken. (This is called a herd effect.)

The National Advisory Committee on Immunization's currently recommended list of those who should get the flu shot is long: children and adults with certain chronic diseases or whose immune systems are suppressed; children and adults in chronic-care facilities or who live with high-risk people; children and adults who are in contact with babies under the age of six months; adults over age 65; health-care workers, and more. However, the Canadian Task Force on Preventive Health Care recommends all citizens over six months receive the flu shot.

The list of who shouldn't get the shot is short: babies under the age of six months; those who have a true allergy to eggs (because chicken eggs are used to make the vaccine); those who have had a previous serious reaction to the flu shot; and those with an allergy to thimerosal (a mercury-based preservative used in the vaccine).

So why isn't everyone getting a flu shot? Let's look at some of the common objections.

First, you can't get the flu from the shot; it is not a live vaccine. You might feel local soreness from the injection, and some people say they feel achy, but it is short-lived and doesn't interfere with activities.

Getting sick with the flu does not build your immune system and increase the likelihood of future immunity (remember, the virus changes over time).

There is no convincing evidence thimerosal causes harm, given that it is present in the vaccine in low levels. Still, to allay concerns, some manufacturers are trying to reduce or eliminate its presence.

As well, the flu shot is safe for pregnant and lactating women, although some health-care workers prefer not to give the vaccine in the first trimester of pregnancy.

My final thought?

Immunization programs already focus, and should continue to focus, on those at high risk of developing flu-related complications, those capable of transmitting flu to high-risk people, and those who provide essential community services.

But flu season can bring serious illness to even healthy people, and is a significant expense to society as a whole, in terms of lost work time and costs to the health-care system. So healthy adults and children should also be vaccinated. If you won't do it for yourself, then do it for the rest of us!

Dr. Marla Shapiro can be seen daily on Balance: Television for Living Well on CTV. Questions about general health issues can be sent to her at: health@globeandmail.ca

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