Can I get the flu shot and COVID-19 vaccine at the same time, or do I have to wait for a few weeks in between? 

Yes, you can get both at same time and this does not reduce the protection received.  Even the RSV vaccine that is in its second season, can now be received at the same time as Flu and COVID vaccine for those who are eligible – primarily older adults.

Do I still need to get a COVID vaccine if I was previously vaccinated during the pandemic? 

If you are an older adult or immune compromised, or if you are someone who cares for vulnerable populations – yes you should get vaccinated this season.  The virus that causes COVID is similar to the flu in that it is constantly changing which means that a seasonal vaccine is needed that is adapted to the current strain circulating.  Just like the flu vaccine is an annual seasonal vaccine, you should think of the COVID vaccine that way too.

Can I get the flu from the flu shot? I got sick after my shot last year.

No, the flu shot cannot cause infection. If you did get sick after getting the flu shot, there are a number of possible explanations:

• Maybe you had another virus (e.g., common cold) and this was not flu;
• You were in contact with the flu before vaccination (it takes 2 weeks to develop full immunity); or
• Because the flu shot doesn’t provide 100 per cent immunity, you can still get the flu if you get the flu shot, but your disease will be less severe on average than if you hadn’t received the vaccine. But the shot doesn’t give you the flu.

 If neither the flu or COVID shot can guarantee that I won’t get infected, why should I bother getting it?  

The greatest benefit of these vaccines is reducing risk of severe outcomes – like hospitalization or death.  This is why it’s so important to vaccine high-risk individuals to keep them safe during respiratory season.  While they do not always prevent infection – they do reduce the odds of getting infected which can make the difference between spreading it to others or not.  This is why it’s so important to make sure caregivers of vulnerable populations are vaccinated every season.

The flu doesn’t seem that bad. Why can’t I just take my chances and not get the shot?

You’re not only getting the flu shot for yourself, it’s offering protection to those around you. While the flu may not seem like a big deal, it can have deadly consequences for many people. Every season there are over 3000 deaths and well over 10,000 hospitalizations related to flu.  So even though less severe than COVID on average, it has devastating impact each year and results in major additional strain to our healthcare system.

What makes the flu so serious for some people?

The flu can be fatal in three major ways:

1. The flu can cause severe inflammation of vital organs, which is when the immune system attacks itself. This can lead to failure of vital organs and requires supportive treatment in the critical care unit.
2. The flu can progress into a secondary bacterial pneumonia or other respiratory conditions, which can be fatal.
3. Chronic diseases that are stable with medical treatment can become destabilized by the Flu.  An example is a person with limitations in mobility who can become weak and fall, or a person with known heart failure who can have difficulty breathing, or someone with heart disease can suffer a  heart attack, precipitated by the Flu.

 Is my immunity lowered after all these vaccines? Several years in a row, I got a cold right after the flu shot.

No, the flu and COVID shots do not lower your immune system – they boost it.  You likely became ill with something else, but due to the timing it is common for people to think it was caused by the vaccine.

Is it safe to get the flu and COVID shot while pregnant?

Yes, pregnant women should absolutely be getting both the flu and COVID shot. Being pregnant places you at risk of complication from either of these infections and these shots are strongly recommended for pregnant women at all stages of pregnancy, as well as those who are breastfeeding. The flu and COVID viruses, and not the vaccines we give to prevent these, can harm pregnant women seriously enough to land them in hospital and cause death.

Another reason for pregnant women to get vaccinated is that vaccines result in antibodies that get passed on to the developing fetus, providing protection to the newborn in the first months of life. A baby can also acquire antibodies through a vaccinated mother’s breast milk.

I live a healthy lifestyle (eat well, exercise, etc.) and consider myself to be a healthy person. I never get sick. Do I still need to get the flu shot?

Yes. You do. Public health agencies from around the world recommend everyone over the age of 6 months get the flu shot every year.  A flu shot not only protects you against the flu, it also helps protect your loved ones, colleagues, strangers on the street. By getting the shot, you are reducing your chance of spreading the illness. Even if you’re healthy, you should still get the flu shot.

Can flu be transmitted without symptoms like COVID?

While this is not as common, yes flu can be transmitted in absence of symptoms.  This re-enforces the benefit of getting vaccinated against the flu since it reduces the chance that you could unknowingly spread it to a vulnerable person that could become an issue of life or death for them.

Besides seasonal vaccines, what other measures (if any) are still recommended? 

Your best protection against circulating viruses is seasonal vaccination.  Beyond that, if you do develop cold-like symptoms it is very important to stay home and especially never to come to the healthcare facilities or other high-risk areas where vulnerable populations are present – until you are fully recovered.  Wearing a mask when you will be in close contact with high-risk individuals is another way of increasing their protection.  At the height of the respiratory season we require universal masking at Sunnybrook when visiting or providing care to patients.

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Flu season is already here. Have you gotten your flu shot yet?

As a physician working in internal medicine and infectious diseases at Sunnybrook, I’m often asked about the flu and the flu shot. Here are answers to some of the most commonly asked questions I hear:

1. What’s the difference between a cold and the flu? What are the symptoms of flu?

A simple cold and the flu are actually quite different. A person with a cold may have a cough, sneezing, runny nose, and feel unwell. A person with the flu may have those symptoms and can be sicker with symptoms such as high fever and full body muscle aches. Most people can generally still function when they have a cold. Flu symptoms can cause a person to feel unable to even get out of bed.

Flu causes over 3000 deaths every year in Canada and is the tenth-leading cause of death overall. The very young and old are at highest risk of complications, but bad outcomes in otherwise healthy people can happen too.

2. Can I get the flu from the flu shot? I got sick after my shot last year.

No, you can’t, because the flu shot contains dead virus. If you did get sick after getting the flu shot, there are a number of possible explanations:

1. Maybe you had rhinovirus (common cold) and this was not flu;
2. You were in contact with the flu before vaccination (it takes 2 weeks to develop full immunity); or
3. Because the flu shot doesn’t provide 100 per cent immunity, you can still get the flu if you get the flu shot. But the shot doesn’t give you the flu.

3. Can I prevent the flu with holistic remedies (chicken soup, vitamins, infusers) instead of getting the flu shot? 

No. Hot liquids can soothe a sore throat and provide much needed fluids. But there is no evidence that chicken soup has any specific qualities that help prevent the flu. Your best protection against the flu is getting the flu shot, as there is lots of scientific evidence for this.

4. I heard there are a few different flu vaccines available this year. What are the differences? 

There are trivalent and quadrivalent vaccines available. The trivalent vaccine contains three strains of flu virus and higher levels of an antigen, which helps the body produce a stronger immune response. This vaccine is recommended for people over age 65.

The quadrivalent vaccine contains the same as the trivalent, plus an additional strain (four strains total), but with a lower dose of antigen. This vaccine is given to people over 6 months old to 64 years.

5. I heard there’s weird stuff like formaldehyde and thimerosal/ethylmercury in the flu shot. Are those things safe to put in my body?

Formaldehyde occurs naturally in your body, and is a product of healthy digestive function. While it can be toxic and potentially lethal in high doses, it’s present in such small amounts in a flu vaccination that it is harmless.

Thimerosal acts as a preservative, keeping the flu vaccine free from contamination by bacteria and fungi. Thimerosal is made of an organic form of mercury known as ethylmercury, a safe compound that usually only stays in the blood for a few days.

This is different from the standard mercury that can cause illness in large doses, and from the mercury found in seafood (called methylmercury), which can stay in the body for years.

6. Is it possible to receive a preservative-free vaccine?

Preservatives are only used with multi-dose vials. If you would like to receive a preservative-free flu shot, check with a pharmacy or doctor’s office for the type they have available.

7. If the flu shot doesn’t guarantee 100 per cent immunity from the flu, why should I even bother getting it?  

If you get the flu shot, your risk of getting the flu or flu-related complications is between 40-70 per cent lower. The flu shot doesn’t give 100 per cent immunity because the flu virus mutates and changes as the year goes along. But when it comes to becoming infected with a potentially fatal infection, or transmitting that infection to those you love, 40-70 per cent lower risk is not something to dismiss.

At a population level, the flu vaccine campaign each year prevents thousands of hospitalizations for flu in Ontario alone. The more people get vaccinated, the better our “herd immunity,” which keeps our community safe. We all need to do our part to reduce the burden of flu every year.

8. Can you receive the flu shot if you’re feeling under the weather (cough, runny nose)?

If you have a mild cold, you may still receive a flu vaccination. Vaccination won’t be given if you have a serious, acute illness, such as anything with a fever or requiring antibiotics. Some people choose to wait until they are feeling “100%”; however, as we get in to colder weather and longer days, this may not happen and receiving the vaccination will keep being postponed.

9. Is it safe to get the flu shot while pregnant?

Yes, pregnant women should absolutely be getting the flu shot. In fact, the flu shot is recommended for pregnant women at all stages of pregnancy, as well as those who are breastfeeding. The flu itself, not the flu shot, can harm pregnant women seriously enough to land them in hospital and cause death. The flu poses a major threat to fetuses, too.

Another reason for pregnant women to get the shot: flu vaccination causes the body to produce infection-fighting antibodies. When a pregnant woman receives a flu shot, her antibodies get passed on to the developing fetus, providing protection to the newborn in the first months of life. A baby can also acquire antibodies through a vaccinated mother’s breast milk. This is particularly important since infants can’t receive the flu shot, and are at higher risk of complications if they do get the flu.

10. The flu doesn’t seem that bad. Why can’t I just take my chances and not get the shot?

You’re not only getting the flu shot for yourself, it’s offering protection to those around you.

While the flu may not seem like a big deal, it can have deadly consequences for many people. The flu can be a serious illness and cause hospitalizations and deaths, especially in people over 65 and young children like Jude, who was a healthy two-year-old when he died from Influenza B.

This year’s vaccine is quadrivalent, meaning it provides some immunity to four strains of the flu virus.

11. When someone gets the flu, how could it actually cause them to die?

The flu can be fatal for different reasons, including (but not limited to):

• The flu can cause severe inflammation of vital organs, which is when the immune system attacks itself. This could leads to failure of vital organs and requires supportive treatment in the critical care unit
• The flu can progress into a secondary bacterial pneumonia or other respiratory conditions, which could then become fatal
• A person could have other medical conditions that can become unmanaged or more complicated when sick with the flu, such as exacerbation of lung disease, heart failure, kidney failure, or delirium. There is also evidence that flu can increase your risk of a heart attack, especially within the week after the infection 

12. Is my immunity lowered after the flu shot? Three years in a row, I got a cold right after the flu shot.

No, the flu shot does not lower your immune system – it boosts it.  You likely became ill with something else, but due to the timing it is common for people to think it was caused by the vaccine.

13. I live a healthy lifestyle (eat well, exercise, etc.) and consider myself to be a healthy person. I never get sick. Do I still need to get the flu shot?

Yes. You do. Public health agencies from around the world recommend everyone over the age of 6 months get the flu shot every year.

A flu shot not only protects you against the flu, it also helps protect your loved ones, colleagues, strangers on the street. By getting the shot, you are reducing your chance of spreading the illness. Even if you’re healthy, you should still get the flu shot.

14. I got the flu shot so that’s all I have to do to stop spreading the flu, right? Or can I spread the flu even if I feel well?

Your chance of spreading the flu is significantly reduced if you have been vaccinated. But whether you’re vaccinated or not, you can be a carrier of the flu even without symptoms. About 20 to 30% of people carrying the influenza virus have no symptoms at all. So, wash your hands after every contact you have with other people.

There are a number of steps you can take to protect yourself during flu season besides vaccination. Avoid contact with people who have the flu, wash your hands often, cover your mouth when you cough or sneeze, avoid touching your face, stay home when you are sick, clean and disinfect surfaces and shared items.

This article was posted November 21, 2018.

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When she went to wake the boys up, Jude was unresponsive. Jill called 911. Emergency personnel descended on her street and home. They took Jude to the nearest hospital.

An hour later, Jude was pronounced dead.

Jill’s healthy toddler was gone. And she didn’t know why.

Months later a pathologists report indicated how Jude died: influenza B.

Influenza A and B — known as the flu — are responsible for 13,000 hospital admissions a year in Canada. The flu kills more than 3,500 people a year in Canada alone. That makes the flu one of the top 10 causes of death in the country.

“The young, the old, and people who are pregnant or chronically ill are more at risk for complications from the flu,” Dr. Jerome Leis, medical director of infection prevention and control at Sunnybrook, says. “But no one is entirely protected; healthy people can become very ill with the flu.”

The respiratory flu can cause fever, chills, headache, body aches, cough, sore throat and more. This isn’t to be confused with the winter vomiting bug (also nasty, but not what we are talking about here).

“And the flu is not the same as the common cold,” Dr. Leis says. “It’s a real public health challenge. There’s often talk like, ‘it’ll be a mild season,’ but make no mistake: the flu leads to hospitalizations and deaths every year. So rather than focus on predicting if it’ll be a ‘mild’ or ‘severe’ year, which may make some people let their guard down, let’s instead focus on what everyone can do to help minimize the effect of the flu.”

Jill and Jude and the rest of the family had received the flu shot in 2016. Jill says she knows she did everything she could to prevent Jude’s death. She has now become a fierce advocate for the annual vaccine.

“How many homes was that flu in before it got to mine? What steps can we take to stop the spread of flu in our communities?” Jill asks. “I don’t see the flu shot as a personal choice. It’s a public choice.”

There are many misconceptions about the flu and the flu shot, Jill and Dr. Leis agree. Here, they dispel some of those common myths.

Myth 1: The flu shot gave me the flu.

No. It didn’t. The flu shot contains dead virus. You can’t get the flu from the flu shot. Maybe you have rhinovirus (common cold). Maybe you were in contact with the flu before vaccination (takes 2 weeks for full immunity). Maybe you have a different strain of the flu than the vaccine targets. The flu shot doesn’t provide 100 per cent immunity, so you can still get the flu if you get the flu shot. But the shot doesn’t give you the flu.

Common symptoms of the flu shot are red, tender arm, swelling at injection site, headache, muscle ache for 1 to 2 days. Tylenol can help reduce these symptoms.

Myth 2: I’m healthy so I don’t need the flu shot.

Yes. You do. Public health agencies from around the world recommend everyone over the age of 6 months get the flu shot every year.

A flu shot not only protects you against the flu, it also helps protect your loved ones, colleagues, strangers on the street. By getting the shot, you are reducing your chance of spreading the illness. Even if you are healthy as an ox, or however that old saying goes, you should still get the flu shot.

If you get the flu shot, your risk of getting flu or flu-related complications is between 40-70 per cent lower. The flu shot doesn’t give 100 per cent immunity because the flu virus mutates and changes as the year goes along. But when it comes to becoming infected with a potentially fatal infection, or transmitting that infection to those you love, 40-70 per cent lower risk is not something to dismiss.

Myth 3: Once I get the shot, I’ve done my part to avoid the flu.

Wash your hands and wash them often. Avoid contact with the flu by trying not to touch your face (droplets go into mouth, eyes, nose). Wipe down surfaces. You can be a carrier even without symptoms, so wash your hands.

Dr. Leis says flu immunization rates have been on the rise in Ontario, but we can do better.

This year, go get your flu shot #ForJudeForEveryone

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Answer from an oncologist: In most cases, yes, says Sunnybrook medical oncologist Dr. Mark Doherty.

“This is actually one of the most common questions I get from my patients,” he said. “And the answer in most cases is yes. A flu shot can help protect you from a severe respiratory illness.”

The flu shot itself won’t make you sick, he said. (More on that here)

“The flu shot is made from killed virus so you won’t get sick from it,” Dr. Doherty said. There is a nasal spray vaccine which contains some live virus, which is not recommend for people with cancer.

It takes the vaccine about two weeks to work, so you could still come down with the flu if you contracted the virus before getting the vaccine. 

For a person with a compromised immune system, like a patient undergoing chemotherapy, the respiratory flu can be very serious, Dr. Doherty said.

“Many patients find themselves hospitalized. The flu can be a life-threatening situation for a person with cancer,” he said.

Practice good hand hygiene (that’s washing your hands with soap and water, or using alcohol-based hand sanitizer), and consider wearing a mask when you are around someone who may have been exposed to a cold or flu, as well as asking others to do so when visiting, particularly during the flu season. It’s also beneficial for your family members and caregivers to have the flu shot, as this can reduce the chance of them passing the virus on to you.

Totally isolating yourself from others because you are afraid of the flu isn’t the answer, Dr. Doherty said. 

“Get your flu shot and practice good hand-washing to help minimize those risks,” he said. “It’s important for you to maintain the connection with your friends and family so that you don’t become too isolated.”

There are some instances when a flu shot is not recommended. Be sure to speak to your doctor or healthcare team about getting the flu vaccine if you are undergoing cancer treatment.

The post Should I get the flu shot if have cancer? appeared first on Your Health Matters.

“While flu season can happen anytime between October and April, it does seem to be starting earlier in Ontario this year,” says Dr. Andy Simor, head, department of microbiology and infectious diseases consultant at Sunnybrook.

With that in mind, here are five things you should know about the 2017-2018 flu season:

1. Australia was hit hard by the flu this year

Each year, experts look to Australia’s flu season (which occurs during their winter, between May and October) to get an idea of what our flu season might be like. While the influenza (flu) vaccine match was good this year in Australia, the country saw a much higher number of cases than usual, resulting in an increased number of hospitalizations and deaths.

“If the experience of southern hemisphere is predictive, we’re in for a more difficult flu season than usual,” says Dr. Simor.

2. There’s more than one flu strain circulating

There are usually several strains of the flu circulating each year. As a result, the flu vaccine is trivalent, which means the shot protects against three different strains. This year, those three strains are influenza A (H1N1), H3N2 (the prevalent strain that was seen in Australia) and B.

The World Health Organization (WHO) determines which strains to include in the flu vaccine every year. With input from experts around the world, the WHO tries to predict which virus will be the most dominant. As a result, the flu shot protects against different strains every year. So, even if you got a flu shot last year, it won’t be effective against the flu strains circulating this year.

3. Getting the flu shot is safe and effective

The flu vaccine is safe and effective, particularly in preventing serious complications that may occur from the flu (such as pneumonia, which can become deadly for some people).

“The flu can cause severe illness, especially in the very young and the elderly. The most effective thing we can do to protect ourselves and others against the flu is to get the vaccine,” says Dr. Simor.

4. You can’t get sick from the flu vaccine

“The flu vaccine is made entirely of killed virus and cannot cause you to get sick,” says Dr. Simor. Studies have found that symptoms occur just as often in people who get a placebo shot versus the real thing. However, you can definitely still get a sore arm!

It’s important to note, though, that it takes two weeks for the flu shot to work. “If you get sick in those first two weeks, it’s because you had already been infected or you weren’t yet fully protected,” says Dr. Simor.

5. Clean your hands to prevent the flu from spreading

While the flu vaccine is safe and effective, it’s not perfect, and it doesn’t provide a 100% guarantee that you’ll avoid getting sick.

This is why it’s so important to take steps to prevent the spread of the flu, like cleaning your hands often. If you do get sick, don’t go to work and try to stay away from crowded places so you don’t pass the flu virus on to someone else.

“If you get the flu, you’ll feel sick for 5-7 days, and you’re contagious for the first four days. It’s important to limit your contact with other people during that time,” says Dr. Simor.

The post Flu season is here! 5 things you should know appeared first on Your Health Matters.

Flu season runs from about November to March in North America, and each year it varies in length and severity. However, we often see a spike in flu cases at this time of year (during or just after the holidays), as people gather together in large numbers.

This year is no exception. The most predominant flu strain circulating now is H3N2, which disproportionately affects the elderly and people with pre-existing medical conditions such as diabetes or heart, lung and kidney disease. These people get sicker and are more likely to require medical care and hospitalization — hence the surge of patients into emergency departments and hospitals.

We are seeing a lot more activity this year compared to last year’s flu season, which was relatively mild. This year is still not as severe as the 2014-2015 season, when there was a poor vaccine match for the circulating and predominant H3N2 strain, resulting in more people becoming ill.

It’s important to understand that the flu strain circulating each year can change every flu season. Using data from previous flu seasons, researchers work hard to predict which flu strain will be most prominent during the next flu season, months in advance. This means there may be year-to-year variation in how well the vaccine and circulating flu virus strains match. Still, significant protection against getting the flu is provided even during years where the vaccine isn’t a perfect match.

So far, this year’s vaccine does appear to be a good match. Even though the vaccine only provides 50 to 60 per cent protection, it is still important that you get the flu shot. Not only does it reduce your own risk of getting sick by 50 to 60 per cent, it also reduces the chances that your loved ones will get sick, especially those who are at high risk for severe flu.

Although we are well into this year’s flu season, it is still not too late to get the flu shot. Because the flu strain you’re being protected against is constantly changing, you should get the vaccine every year. I always get my flu shot, as do all the members of my family.

In addition to getting the flu shot, there are other things you can do to prevent getting or spreading the flu. It’s important to clean hands before and after using the washroom or handling food, covering coughs and sneezes with tissue (and disposing of the tissue immediately in the garbage) and then cleaning your hands.

Practice healthy habits to keep the immune system strong, like having a balanced diet and getting enough sleep, and stay home from work, daycare or school when sick. These are all good habits to adopt, and will increase your chances of staying healthy through the flu season.

The post This flu season seems worse than last year’s. Here’s how to protect yourself. appeared first on Your Health Matters.

Here are my tips for pregnant women:

1. You’re protecting yourself and your baby: Whatever stage of pregnancy you’re at, the flu vaccine keeps you and your baby healthy. Pregnant women are at a much higher risk of hospitalization from influenza – four times more likely to land in a hospital ward than a non-pregnant person. When you’re vaccinated, you develop antibodies to protect your body from the virus. In turn, you also pass along these antibodies to your baby, so she will be protected during her most vulnerable months after birth.
2. Don’t delay (it’s free and easy to access): There are so many places to receive the flu vaccination. From local pharmacies, to your doctor’s office, to public health flu clinics, it is free and easily available. Add it to your list of errands.
3. “But I’m really healthy”: Even if you have a healthy diet, exercise, take your vitamins and get lots of rest, changes in your immune, heart and lung functions during pregnancy make you more likely to get seriously ill from the flu.
4. No link between flu vaccine and autism: Some of my patients are determined to have a “natural” pregnancy and feel anxious about being vaccinated. There is no link between vaccines and autism, in fact there have been several scientific studies refuting this claim. Speak with your doctor if this is a concern.
5. Don’t take a chance: Severe illness in a pregnant mother can be dangerous to your fetus, and increases the chance for serious problems such as premature labour and delivery.

What if…you get the flu when you’re pregnant?

If you do find yourself with the telltale symptoms – fever, chills, cough, sore throat, headaches, muscle and body aches and fatigue – call your doctor right away. There are antiviral drugs that can treat the flu and help prevent serious flu complications. These drugs are safe for pregnant women. Your fever can cause problems with your unborn baby, speak to your doctor about reducing your fever with Tylenol.

Every day, I see mothers agonize over decisions related to their pregnancy. Receiving the flu vaccination should not be one of them. It’s a no-brainer: get vaccinated to protect yourself and your baby. And don’t forget the usual steps you should take every year, like cleaning your hands regularly to combat any viruses you may come into contact with.

Stay healthy and enjoy your pregnancy!

The post Should I get the flu shot when I’m pregnant? appeared first on Your Health Matters.

Now that you spend your days in a hospital amongst vulnerable people, it’s definitely something you should consider if you haven’t already. It’s safe. It won’t make you sick (your arm might hurt a little!). And it’ll protect your patients – even if you are young and can fight off the flu, you can spread the flu to others.

Not convinced it’s right for you? Can Canadian funnyman Rick Mercer help?

You can get the shot from a pharmacist, your family doc or it’s also still available at Sunnybrook, St. John’s Rehab and the Holland Centre. Visit Occupational Health and Safety at the Bayview campus (HG-46A) from 7 a.m. to 4 p.m.  At the Holland Centre, please call Occupational Health and Safety in the second floor at (416) 967-8510.  At St. John’s Rehab, call ext. 7090 or visit Room S266.

Here’s Sunnybrook’s Chief of Microbiology Dr. Andrew Simor debunking some flu / flu shot myths on Sunnyview with Monica Matys:

Protect yourself, your patients and your family by getting the vaccine.

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