Does the flu vaccine prevent one from being a carrier of the virus(es)?

[WhyNot]

We've never gotten the influenza vaccines (well, I did one years ago and got a terribly swollen and sore arm from it) because we're not in high risk categories, and it just seemed ethical to leave the vaccine to those who need it more, especially in years of shortage.

This year we do have an at-risk household member, our 7 month micropreemie, WhyBaby. She'll be getting the RSV immunization, as well as pneumoncoccal and the rest of the standard baby shots (minus Hepititis and Varicella), but she's too young for the flu shot. Getting influenza would be deadly for her.

Would it help protect her any if I, her father and her school-age brother got the flu vaccine? Would it endanger her further? I know some vaccines shouldn't be given if someone in the household is high risk because it can make the vaccinated person shed virus and get the unvaccinated person sick. But I can't seem to find details on this vaccine in particular.

[SnakesCatLady]

Ask her doctor. As far as I remember, getting the flu vaccine doesn't necessarily keep you from getting the flu (it may prevent one strain), but it will be much less severe if you do encounter the one you are vaccinated against. I have had people who've received flu shots say they felt all flu-y after the vaccination. WhyBaby's doctor would be your best source on this one.

And just how is that precious angel? Her last crop of pics show a beautiful baby! Now I'm going to get out of here before I start talking baby talk, yes I am, you cutie....

[WhyNot]

Originally Posted by Snakescatlady

Ask her doctor....

Ah, right. I should've mentioned that I have asked her doctor, and she didn't know. She's asking her folks at the CDC, and I'm asking y'all. We'll see who gets answers first!

(And WhyBaby's doing great! Greatly? Whatever.)

[SnakesCatLady]

[slight hijack] Her doctor admitted she didn't know something? Wow - you have found an exceptional doctor! [/hijack]

[USCDiver]

There's millions of things I don't know, does that make me an exceptional doctor too?

From the WHO influenza vaccine website:

The following priority is recommended:

• Residents of long-term care facilities for the elderly and the disabled are considered at high risk of influenza and its complications.
• Elderly non-institutionalized individuals suffering from chronic conditions such as pulmonary or cardiovascular illness, metabolic diseases including diabetes mellitus and renal dysfunction, and various types of immunosuppression including persons with AIDS and transplant recipients.
• All adults and children aged over six months suffering from any of the conditions mentioned above.
• Individuals who are above a nationally defined age limit irrespective of other risk factors. Although the appropriate age for general vaccination may be considerably lower in countries with poor living conditions, most countries define the limit age as over 65 years.
• Other groups defined on the basis of national data.
• Health care workers in regular, frequent contact with high-risk persons.
• Household contacts of high-risk persons.
  

Bolding mine

[WhyNot]

Originally Posted by Snakescatlady

[slight hijack] Her doctor admitted she didn't know something? Wow - you have found an exceptional doctor! [/hijack]

Yep, I like her a lot. We had a real heart-to-heart when I interviewed her (before the baby was even released from the hospital and she had not seen her yet) where I told her exactly what I want from a doctor - a resource who can help provide me with the information I need to make informed health care decisions for my daughter. I don't do well with doctors who present themselves as authority figures first and caregivers second. I'm an intelligent and fairly well read woman who just needs a doctor's advice - not orders - and signature on school forms. I asked her if she was comfortable working under these conditions, and she said she'd be delighted to work with someone who was taking responsibility for their own health care for once. We're quite a match.

Part of that deal is that she's up front with me when she doesn't know something, and I give her a few days to go do research and tell me what she's learned.

But, as part of my not taking any one person as authority on everything, I like to ask others as well. If there's no conflict, great! Decision made. If I get conflicting answers, it tells me I need to do more research.

Thanks USCDiver! I think what Snakescatlady meant was having a doctor who admits to a patient that he or she doesn't have the answer is a rare gift. Too many (IMHO) doctors still try to play omniscient to their patients.

[USCDiver]

You're welcome WhyNot. I'd still be interested in what your pediatrician finds out from the CDC, because I use that argument with my colleagues who do not want to get the vaccine (I work in the ER, everyone who works there should get the shot).

[Mama Zappa]

If the vaccine prevents you, spouse, and WhyBrother from catching the flu and bringing it home, then yeah - it'll help prevent WhyBaby from catching the flu from you.

However, the situation in which you have contact with an infected person, have viruses on your skin, then touch WhyBaby while the viruses are still in place - *that* could (I imagine) lead to her catching the flu. IANAIDS (Infectious Disease Specialist... well, I'm not *any* kind of scientist) so I have no clue how likely that is to happen, but it is at least plausible. Of course, that would be a risk whether you'd been immunized or not.

It's possible the flu vaccine this year may not match the strains of flu that actually wind up going around. And it's possible that you might not gain immunity, even if the shot is accurate. Still, I'd think it makes sense to reduce the family's chances of catching the flu and bring home those nasty virii.

We used that logic when Moon Unit was an infant. I've gotten the shots for 20+ years because I'm higher-risk (asthma); the year Moon Unit was born, Papa Zappa got the shot too, for just the reason you're talking about.

As I understand it, you should probably avoid FluMist because that uses a live, weakened virus that could put high-risk family members at risk.

[Smeghead]

From the WHO link:

These vaccines are of three types:

* whole virus vaccines consisting of inactivated viruses;
* split virus vaccines consisting of virus particles disrupted by detergent treatment;
* sub-unit vaccines consisting essentially of haemagglutinin and neuraminidase from which other virus components have been removed.

Out of those three types, the safest for you would be the last, assuming equal efficacy between the three. The chance of you getting infected with live virus from any of the three is very low, but lowest from the third, because they're only injecting a couple of proteins rather than entire virus particles.

[WhyNot]

OK, so here's what she said (with cites!):

We should all, including the baby, get vaccinated this year. Makes me damn nervous vaccinating an infant this young, but apparently the recommendations are for 6 months and up actual age, preemies not considered differently. *gulp*

We should not get the live virus injection or the nasal spray, because both of those do lead to viral shedding. Theoretically, this viral shedding could increase the chances of those around us who aren't vaccinated, or whose vaccinations aren't effective, getting influenza. The studies she could find confirmed viral shedding, but did not examine whether or not that shedding actually made anyone sick. Still, she's recommending we all be very conservative: vaccinate the baby, because she's technically 7.5 months (even though she has the body of a 3.5 month old), and then vaccinate us in case her vaccination doesn't "take".

She did mention, USCDiver, that the CDC does say anyone working with at-risk individuals should be vaccinated, both to prevent getting it themselves and to protect those individuals from getting it from them. ER workers are definitely in that group.

Here's the CDC report on the live attenuated virus vaccine, which includes information about viral shedding studies, including:

Shedding and Transmission of Vaccine Viruses. Available data indicate that both children and adults vaccinated with LAIV can shed vaccine viruses for >2 days after vaccination, although in lower titers than typically occur with shedding of wild-type influenza viruses. Shedding should not be equated with person-to-person transmission of vaccine viruses, although, in rare instances, shed vaccine viruses can be transmitted from vaccinees to nonvaccinated persons.

This site also says, however, that only persons working with or who have household member who are "severely immunocompromised" should avoid the live vaccine. All other workers are advised to avoid working with or coming in close contact with severly immunocompromised patients for 7 days if they recieve the live vaccine, and people visiting or working with those who are not severely immunocompromised have no restrictions, no matter which vaccine they've gotten:

Close contacts of persons at high risk for complications from influenza should receive influenza vaccine to reduce transmission of wild-type influenza viruses to persons at high risk. ACIP has not indicated a preference for inactivated influenza vaccine use by health-care workers or other persons who have close contact with persons with lesser degrees of immunosuppression (e.g., persons with diabetes, persons with asthma taking corticosteroids, or persons infected with HIV) or for inactivated influenza vaccine use by health-care workers or other healthy persons aged 5–49 years in close contact with all other groups at high risk. Use of inactivated influenza vaccine is preferred for vaccinating household members, health-care workers, and others who have close contact with severely immunosuppressed persons (e.g., patients with hematopoietic stem cell transplants) during those periods in which the immunosuppressed person requires care in a protective environment. The rationale for not using LAIV among health-care workers caring for such patients is the theoretical risk that a live, attenuated vaccine virus could be transmitted to the severely immunosuppressed person. If a health-care worker receives LAIV, that worker should refrain from contact with severely immunosuppressed patients for 7 days after vaccine receipt. Hospital visitors who have received LAIV should refrain from contact with severely immunosuppressed persons for 7 days after vaccination; however, such persons need not be excluded from visitation of patients who are not severely immunosuppressed.

That's seems like a pretty clear recomendation to me, USCDiver: "Close contacts of persons at high risk for complications from influenza should receive influenza vaccine to reduce transmission of wild-type influenza viruses to persons at high risk."

Here's the National Institute of Health report on the vaccines, which specifies contraindications for the nasal mist due to the potential for viral shedding:

Pregnancy—Influenza vaccine (“shot”) has not been shown to cause birth defects or other problems in humans.

The nasal mist vaccine should not be given to a pregnant women.

Breast-feeding—Influenza vaccine (“shot”) has not been reported to cause problems in nursing babies.

The nasal mist vaccine may cause viral shedding in the mother. This shedding could infect the infant while breast-feeding.

Children—Use is not recommended for infants up to 6 months of age. In addition, only a split-virus influenza vaccine (“shot”) should be given to children 6 months to 12 years of age. Some side effects of the vaccine, such as fever, unusual tiredness or weakness, or aches or pains in muscles, are more likely to occur in infants and children, who are usually more sensitive than adults to the effects of influenza vaccine.

The nasal mist vaccine should not be used in children less than 5 years of age.

So it's split-virus vaccines all 'round, then!

Thanks all for your help.

[USCDiver]

Thanks, interesting stuff. I still doubt I'll be able to convince my hardheaded colleagues to get the shot.