Flu and Pneumonia Vaccines

2012-2013 Flu Vaccine Update

The influenza vaccine (flu shot) is a highly effective vaccine made from an inactivated (killed) virus. It is given once a year to people who are at risk for complications of influenza infection, such as those with lupus and other autoimmune diseases and conditions. About two weeks after vaccination, the body develops antibodies that provide protection against the influenza virus infection. It is thought; although there is not good evidence, that a vaccine against a particular infectious agent (such as a germ, bacteria, or virus) could occasionally trigger an autoimmune disease flare, but people with lupus generally do not have any side effects from the flu vaccine. When they do, their symptoms are usually mild, such as a few days of fever and muscle aches. Overall, the influenza vaccine is considered to be safe and effective for people with lupus, and it is recommended that lupus patients receive the flu vaccine every year.

The influenza vaccine formulation is updated every year to combat the flu virus strains that are most likely to cause illness during the upcoming season. The 2012-2013 flu vaccine is being made in the same way as seasonal vaccines have been made for decades.

Flu vaccines are designed to protect against the three influenza viruses that experts predict will be the most common during the upcoming season. Each season, this includes an influenza B virus, an influenza A (H1N1) virus and an influenza A (H3N2) virus. (These are the three virus subtypes that are circulating most commonly among people today). Even if you received last year’s seasonal vaccine, you should to be vaccinated with this year’s 2012 seasonal flu vaccine.

According to the Center for Disease Control (CDC), The Food and Drug Administration (FDA) has recommended that the United States 2012-2013 influenza vaccine is made from the following three viruses:

an A/California/7/2009 (H1N1) pdm09-like virus;
an A/Victoria/361/2011 (H3N2)-like virus;
a B/Wisconsin/1/2010-like virus (from the B/Yamagata lineage of viruses)

While the H1N1 virus is the same as the 2011-2012 recommendation, the recommended influenza H3N2 and B vaccine viruses are different from those recommended for the Northern Hemisphere for the 2011-2012 influenza vaccine.

It is very important that pregnant women get vaccinated as there have been maternal deaths from H1N1.

Here are some common FAQ’s about the seasonal flu vaccine and people with lupus:

How is the vaccine given?
There are three different flu shots available:

The nasal-spray flu vaccine — a vaccine made with live, weakened flu viruses that is given as a nasal spray (sometimes called LAIV for “Live Attenuated Influenza Vaccine”). The viruses in the nasal spray vaccine do not cause the flu. LAIV is approved for use in healthy people ages two through 49 who are not pregnant.

Is there a flu vaccine that is NOT recommended for those with lupus? 
Flu-Mist® is not recommended for individuals with lupus who are taking immunosuppressant medications, or for their family members or anyone with whom they come into close contact. Because the inhaled flu prevention treatment (Flu-Mist®) contains a form of attenuated (weakened, but still live) virus, it is not considered safe for people with any immune-compromising disorder, or anyone taking immunosuppressant medications (prednisone or cyclophosphamide, for example).   

What about the use of thimerosal (mercury) in the flu vaccine? 
According to the FDA, the 2012-2013 seasonal influenza vaccines are being produced in two injectable formulations. The two formulations are:

a multi-dose vial with thimerosal (a mercury derivative added as a preservative)
a preservative-free, single-dose, pre-filled syringe without thimerosal

You should consult with your doctor about which formulation is recommended for you. The use of thimerosal has not been shown to increase lupus activity. However, women who are pregnant should receive the thimerosal-free vaccination. OB/GYNs have this in single dose vials.

Does the flu vaccine used in the United States contain an adjuvant? 
According to the CDC, the vaccines provided in the United States to include the seasonal flu vaccine have never included adjuvant (another protein that increases the immune response).  

Is the pneumonia vaccine recommended for those with lupus?
The pneumonia vaccine (pneumonia shot) is also recommended for people with lupus, and a second dose should be given five years after the first dose. This vaccine can help to prevent most (but not all) kinds of pneumonia. 

How effective are the flu and pneumonia vaccines for people with lupus? 
Several research studies showed that the flu vaccine caused a protective antibody response in people with lupus, although the antibody levels tended to be lower than in the healthy control group. Because illness and death related to influenza and pneumonia are more common in immunocompromised people, it is recommended that everyone with lupus receive the annual flu vaccine and pneumonia vaccine every 5 to 7 years.

People with lupus should always talk with their doctor before receiving any vaccine, especially if they are pregnant or have had allergic reactions to medications in the past.  

Protecting yourself from the flu and pneumonia  
Below are simple steps that people with lupus and their family members can take to lessen the likelihood of contracting influenza, pneumonia, and other germs.

Avoid anyone—including family members—with symptoms of fever (over 100º F), nausea, vomiting, or diarrhea. Specifically, you should avoid close, personal contact, such as hugging, kissing, and shaking hands.
Wash your hands (tops, palms, and fingers) frequently with hot soapy water for at least 15 seconds.
Remember that surfaces—especially in bathrooms, on shared office equipment, on store countertops, and in restaurants—can retain the H1N1 virus. Keep alcohol-based gel or wipes handy, both out in public and at home.
Avoid touching your eyes, nose, or mouth. Germs spread this way.
Use the crook of your arm to shield coughs and sneezing. Do not use your hands or handkerchiefs as they carry moisture that spread viruses.
Stay home from work or school if you are sick.
Please remember that you should never discontinue medications used to treat your lupus without first consulting with your doctor.

Related Information

2012 – 2013 Flu Season
Centers for Disease Control

Watch Dr. Christopher Collins discuss the H1N1 flu.
This requires Windows Media Player.

The Value of Vaccines
Summer 2009 issue of Lupus Now magazine

Immune Responses to Flu Vaccine Diminished in People with Lupus -- However Vaccinations Still Recommended

FluMist® Nasal Spray Influenza Vaccine
American College of Rheumatology (ACR)

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