Flu vaccine recommended as this winter looks to be worse than previous flu seasons 

Host Amber Smith: Upstate Medical University in Syracuse New York invites you to be "The Informed Patient" with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. As the weather turns cooler in Central New York, it's time for picking apples, raking leaves, and scheduling flu shots. Here with me is Dr. Elizabeth Asiago-Reddy. She's the chief of infectious disease at Upstate University Hospital, and she's here to talk about this year's flu season. Welcome back to "The Informed Patient," Dr. Asiago-Reddy.

Elizabeth Asiago-Reddy, MD: Thank you for having me, Amber.

Host Amber Smith: Is it true that incidents of flu decreased during the pandemic?

Elizabeth Asiago-Reddy, MD: Yes, it did. And it was quite significant, and very much related to the degree to which people were masking, as far as we can tell.

Host Amber Smith: So what about this season, then? People aren't really masking that much.

Elizabeth Asiago-Reddy, MD: Yes, we have reason to be concerned that the flu season this year will be more difficult than it has been for the last couple of years. And, one of the major concerns that we have is because we have the data from the Southern Hemisphere where they've already experienced their flu season. And it was quite a difficult flu season, for example, in Australia with a lot of young people getting sick in particular, because those young people likely had not been as much exposed during their early lives to circulating influenza due to the reductions we just talked about.

Host Amber Smith: Does the continued presence of Covid -- because that's still in our community, and it's overseas. It's everywhere, still -- does that impact, or will it impact flu rates?

Elizabeth Asiago-Reddy, MD: So I think, like I was mentioning before, the most likely impact is going to be on any mitigation strategies that we use to kind of keep people apart from each other during the flu and Covid season. So I already brought up masking. Of course there were others, where we reduced the amount of gatherings that people were having, or the number of people who were attending gatherings. That really seems to be the major driver of whether or not we experience high levels of flu, as well as high levels of Covid. So both of them are infectious viruses. Both of them are transmitted through respiratory routes. So when you get a bunch of people together, then you could experience high levels of one or the other.

Host Amber Smith: If a person is sick with flu, does that make them more susceptible to catching Covid, or does it protect them from Covid?

Elizabeth Asiago-Reddy, MD: These are two completely different viruses in terms of their lineage, how they're structured. They have different ways they interact with our immune system. So it's not thought that one would confer immunity to the other. Whether or not our immune systems responds to one -- so say if I just got over Covid, am I more susceptible to another virus? -- I don't think we have enough information to say that for sure. Basically you would see this as the risk of anything that you come in contact with, you could potentially get it. You know, if you don't have immunity to it, you could potentially get it.

Host Amber Smith: Could you get both at the same time?

Elizabeth Asiago-Reddy, MD: Yes, unfortunately. And that was seen during the flu season in the Southern Hemisphere, that there were, especially, young people who were getting both at the same time.

Host Amber Smith: Most people who get the flu will recover from it, but each year, the flu kills thousands of people. Can you explain why it can be a deadly disease in some people?

Elizabeth Asiago-Reddy, MD: There are two main factors, and we've gone over some of the very similar things with Covid. So the first is the immune status of the individual who is experiencing the infection, and anyone who has immune compromise is at elevated risk of severe complications. That includes very young people as well as older individuals and people of all ages with immune compromising conditions, including pregnancy. And then the other factor is whether or not your immune system has experienced this particular virus in the past. As it relates to Covid, we saw that a lot of the were particularly severe when the virus was new because, basically, no one had experienced this particular virus before.

And influenza has the capacity to shift the proteins on the surface. When those proteins shift, it may become a virus that looks more or less similar to viruses that people have experienced in the past. So the goal of influenza vaccination is to try and keep up with the shift in the virus, which I know we'll talk about a little bit. But whatever viruses end up predominating, the extent to which people have been exposed to similar viruses, either through past infection or through vaccination, will play a major role in the degree to which people get sick.

Host Amber Smith: I wanted to ask you about the reliability of the flu vaccine in preventing people from getting the flu. So let's start with who needs to be vaccinated. Are we talking about children, pregnant women, the immune compromised? Do they all need to be vaccinated?

Elizabeth Asiago-Reddy, MD: Yes. All of those individuals are recommended for influenza vaccination, and that is starting from six months of age. Prior to age six months, the infant is expected to have some immunity transmitted through their parent, hopefully, especially if immunization was received during pregnancy. So after age six months, all the way up, it is recommended to get an annual flu vaccine. Babies who are six months of age, they will need to get two vaccines to get started because it takes more to generate that initial response to the vaccine. After that, individuals would receive a single dose of vaccine every year.

Host Amber Smith: You and I are speaking at toward the end of October. This is flu shot season, but when is it too late to get your flu shot? You want people to get them now, right?

Elizabeth Asiago-Reddy, MD: Yes. September and October are the ideal times because what you want is a nice peak of antibodies at the time when the season is really peaking itself. So if you get vaccinated in September or October, you'd be anticipated to have high levels of antibody throughout the flu season. If you're vaccinated too soon, the antibodies might wane by the time the season is still in gear, and so you might miss out on some degree of protection. The only exception to that, in terms of early vaccination, is pregnant women. So people who are pregnant in their third trimester during the summer, if they have access to the vaccine, it is recommended that they be vaccinated during that period of time because those antibodies could nurture their infant during the flu season.

Host Amber Smith: Is it safe to get a flu shot at the same time you get the Covid booster?

Elizabeth Asiago-Reddy, MD: Yes. And CDC (Centers for Disease Control and Prevention) is recommending that. Obviously it's much more convenient to get the two of them at the same time if you're recommended for one, or either, or both.

And the other thing I want to mention is that if you miss out on being vaccinated during September or October, that doesn't mean that you should skip the whole season. It would still be recommended that you should go ahead and get your vaccination whenever it is that you happen to be seen by your provider or you happen to have the opportunity to go and get vaccinated. And that recommendation would last all the way up through the early spring, potentially as late as March, because we continue to see circulation of influenza virus all the way through the end of April.

Host Amber Smith: We've been talking about flu shots. Is there a nasal, or inhaled option this year?

Elizabeth Asiago-Reddy, MD: There is, although it is less available because of a lot of stipulations and restrictions related to its use. So it's only available for certain age groups, age five to 49, and it's also only available for individuals who do not have immune compromising conditions, pulmonary conditions, cardiac conditions, and who are not in contact with any immune compromised individual. Given all of those different features, many of the places that offer flu vaccines do not stock that one, although some practices do stock it.

Host Amber Smith: I understand there are a lot of different brands of the flu shot on the market. How should someone go about choosing which one is right for them?

Elizabeth Asiago-Reddy, MD: Generally speaking, all of them will have similar efficacy in looking at the accumulation of trials that have happened over the last several years. It is important for people who are age 65 and older to have either the high dose vaccine or adjuvanted vaccines, because those have shown to increase the efficacy of the vaccine and older individuals significantly. And, I think the practices, pharmacies, et cetera, that are stocking these vaccines are well aware of that and will typically be stocking the doses for younger individuals and those for age 65 and older. But certainly that's an important question to check on if you are in that age group. Otherwise the only other thing to consider is, potentially, someone with a very severe egg allergy. There are certain kinds of flu vaccines that are prepared on eggs, whereby someone with a very severe a allergy has a theoretical risk of having a reaction to that vaccine. And there are others that are genetically engineered, which do not have, they're not created in eggs. So anybody who has an egg allergy could seek out one of those specifically. Interestingly, however, because the proteins are so incredibly broken down, even in the egg-based vaccine, there are no data actually to show that people who have egg allergies have a reaction to that vaccine. So CDC actually recommends to go ahead and get whatever one is available to you, but that if you do have a severe egg allergy and you're getting one of the egg-based ones, you should do it in a clinical setting where you can be monitored afterwards.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith, and I'm talking with Dr. Elizabeth Asiago-Reddy. She's the chief of infectious disease at Upstate University Hospital, and we're talking about the 2022, 2023 influenza season.

I know people should stay home from work or school when they're sick to avoid spreading germs. So let's go over the symptoms of flu. Is there distinguishing characteristics that can help with the diagnosis?

Elizabeth Asiago-Reddy, MD: You know, any respiratory virus is going to have a variety of symptoms, right? So all of the typical respiratory symptoms -- cough, sore throat, nasal congestion, fevers -- are going to cross over for most of the respiratory viruses. If you look at some features that might be more classic for flu, it's the sudden onset and high fevers are kind of classic, compared to some of the other respiratory viruses. So it tends to have more severe symptoms, and more lower respiratory tract symptoms with cough and pneumonia, compared to some of the other respiratory viruses, which may present more with the nasal congestion and not be as likely to cause high fevers and severe coughs. But that having been said, you truly can see the whole spectrum of illness with influenza.

Host Amber Smith: I know there are Covid tests available over the counter. Is there anything like that for flu that a person could take to tell them whether it's influenza or not?

Elizabeth Asiago-Reddy, MD: As to my awareness, these have not been approved for, in-home use at this point. And that really gets just to, the demand and need for the test, which was so high for Covid that the processes were in place to try and make them available. Rapid tests are available for flu. They're administered typically in a clinical setting, so the possibility exists that that could move into the home setting in the future.

Host Amber Smith: Now if someone is feeling a little bit under the weather, but they live alone, they need groceries, would it make sense for them to wear a mask to guard against them spreading disease and run into the grocery store? Because during Covid we were masking kind of to protect ourselves. So this would be kind of the opposite of that. Would that be helpful?

Elizabeth Asiago-Reddy, MD: I would say absolutely it is helpful. I mean, everyone has to kind of weigh the pluses and minuses of the different decisions they're going to make. But, if you're known to be Covid negative and as far as you're aware, and you're concerned that you have respiratory symptoms, but you need to interact with others, absolutely. Wearing a mask is a very viable way of protecting other people. And in fact, that is what in the past, we would typically ask even health care providers to do if they had influenza. So for example, if a health care provider was infected with influenza, after their fever was gone for two days, they would be required to wear a mask until all their symptoms had been completely resolved. So that's definitely a known phenomenon and way of protecting other people.

Host Amber Smith: In terms of treatment, how would you advise someone to take care of themselves at home if they suspect they have the flu?

Elizabeth Asiago-Reddy, MD: As with any infection or any concern that you have health wise, if you are concerned about how you feel, your symptoms are significant, obviously touching base with your primary care provider is very important because some individuals might be eligible for treatments. They might be recommended to get testing done to assess which treatments they might need. So that's always very important to keep in mind. And otherwise, once you have determined your treatment status, then there are no specific home remedies for influenza. Similar to other respiratory viruses, this is symptoms management, so things that make you feel better -- rest, hydration, and possibly over-the-counter medications to reduce your symptoms.

Host Amber Smith: How long might it take to recover from influenza?

Elizabeth Asiago-Reddy, MD: This is variable, but, it can definitely, on average be about a week before someone is recovered, and it could be shorter or longer depending on their vaccination status and immunity and overall health, et cetera. But it oftentimes can be about a week.

Host Amber Smith: If a person is infected with the flu in October, early in the flu season, does that protect them for the rest of the season from catching it again? Or do they still need to look at a vaccination maybe?

Elizabeth Asiago-Reddy, MD: So it may not protect them because, the vaccines that we receive are targeting a number of different influenza viruses to include two different versions of influenza A as well as two different versions of influenza B virus. So, you would still actually be recommended to get your vaccine. And unfortunately, somebody could experience an infection with a different virus, particularly, the possibility of influenza B, if you started out with A. B tends to peak later, which is why I chose that order in my head as an example.

Host Amber Smith: Well, Dr. Asiago-Reddy, I really appreciate you making time for this interview.

Elizabeth Asiago-Reddy, MD: Thank you so much.

Host Amber Smith: My guest has been Upstate University Hospital's chief of infectious disease, Dr. Elizabeth Asiago-Reddy. "The Informed patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at Upstate.edu/Informed. This is your host, Amber Smith, thanking you for listening.