Flu Vaccines, MS, and
General Flu and Cold Information

October 25, 2004

Introduction   The Flu Vaccination Shortage
Flu Vaccinations for Individuals with MS  
When Not to Get a Vaccine  
Avoiding the Flu and Keeping Germs from Others Influenza (Flu) and Colds: How they are Transmitted, Symptoms, and Treatments  
Section one: The Flu
Section two: The Common Cold   
Diet Supplements, Saunas, Antibiotics, and Smoking
For More Information

Introduction
Individuals with MS need to pay extra attention to staying healthy and avoiding illness during the flu and cold season. MSAA's Vice President and Chief Medical Officer Jack Burks, MD, advises everyone with MS to consult his or her physician about getting a flu shot. With the shortage of vaccines, individuals with MS qualify as a group which should get priority for receiving a flu shot. Other steps may be taken to reduce one's risk of getting the flu, and this is important for both individuals with MS and others in the household. For those who catch the flu virus or who get a cold, this writing explains how the viruses are transmitted, what the symptoms are, and what treatments are available. Additional warnings about supplements, antibiotics, saunas, and smoking are included.

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The Flu Vaccination Shortage

Flu season has arrived but the needed supply of flu vaccines has not. According to WebMD, an estimated 60 million flu vaccines will be available in the United States for the 2004/2005 flu season, while the Centers for Disease Control and Prevention (CDC) estimates that as many as 100 million are considered at high-risk for getting the flu. The vaccines are being shipped weekly through mid-December in groups of 2.5 to 3 million from the supplier and government stockpiles. The 60 million vaccines include an extra 2.6 million doses that the supplier has agreed to produce, which will not be available until January.

Flu shots are recommended for October and November, although they can still be of value at anytime during the flu season. Because of this shortage, the CDC has instructed doctors and clinics to reserve flu shots for those who need it the most. The list is as follows:

• People 65 years of age and older
• Children ages 6 months to 23 months
• Adults and children 2 years of age and older with chronic lung or heart disorders including heart disease and asthma
• Women who will be pregnant during the influenza season
• Adults and children 2 years of age and older with chronic metabolic diseases (including diabetes), kidney diseases, blood disorders (such as sickle cell anemia), or weakened immune systems, including persons with HIV/AIDS [Individuals with MS would also fall under this category]
• Children and teenagers, 6 months to 18 years of age, who take aspirin daily
• Residents of nursing homes and other chronic-care facilities
• Household members and out-of-home caregivers of infants under the age of 6 months (Children under the age of 6 months cannot be vaccinated.)
• Healthcare workers who provide direct, hands-on care to patients

These recommendations are for the injected flu vaccine which has inactivated flu strains. A small supply (1.1 million doses) of the nasal flu vaccine, called “FluMist” will also be available, but this contains live flu viruses. For this reason, the FDA limits the use of the FluMist to those between the ages of five and 49 who are in good health and not pregnant. The nasal flu vaccine is not recommended for individuals with MS.

For more information about the flu vaccine shortage, please visit www.cdc.gov/flu/protect/vaccineshortage.htm . The American Lung Association has set up a “Flu Shot Locator” on the internet. Please go to www.findaflushot.com/lungusa/ to find a local clinic offering flu shots. (Please be advised that at the time of this writing, no clinics were available with the sample zip codes used, so this service may or may not be of assistance.)

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Flu Vaccinations for Individuals with MS

MSAA Vice President and Chief Medical Officer Jack Burks, MD, recommends the (injected) flu vaccine for almost all of his patients with MS. He stresses that individuals with MS should first consult their physician about whether or not to get a flu shot.

Dr. Burks explains, “The decision is up to one's doctor regarding a flu vaccination. Except in instances where the vaccine may aggravate another condition, I view the flu shot as a high priority for my patients with MS. According to the American Academy of Neurology (AAN), the flu vaccine has not been found to increase the risk of an MS attack.”

The AAN bases its decisions on the results of clinical trials published in peer-reviewed publications, such as the one noted below from the 2002 Fall issue of The Motivator :

An article written by A.E. Miller, MD (renowned neurologist and chief medical officer with the NMSS), et al, was published in the February, 1997 issue of Neurology, and provided the results of a multi-center, randomized, double-blind, placebo-controlled trial of influenza immunization in MS. The article states, “Prevention of a febrile viral illness is clearly desirable in MS, and previous studies suggest that immunization is safe. Despite this, many clinicians avoid vaccination because they fear precipitating an MS exacerbation.”

More than 100 people with MS at five MS centers were given the standard influenza vaccine or a placebo. The researchers concluded, “The two groups showed no difference in attack rate or disease progression over six months. Influenza immunization in MS patients is neither associated with an increased exacerbation rate in the post vaccination period nor a change in disease course over the subsequent six months.”

Dr. Burks continues, “In addition to the vaccine's proven safety for individuals with MS, the flu shot also provides many benefits. The flu vaccine is the best defense against catching the flu, which poses a much greater threat to a person's health when he or she has MS.

“The reason why the flu is more difficult and potentially damaging to individuals with MS is three-fold. First, when individuals with MS get the flu, they must endure the associated aches and pains in addition to their normal MS symptoms. Second, high fever accompanies the flu, and an elevated temperature may increase MS symptoms, affecting one's overall well-being. Finally, the body responds to the flu with an outpouring of gamma interferon, a chemical that increases the risk of an MS exacerbation. For this reason, individuals with MS who catch the flu have a greater chance of experiencing an MS attack within several weeks following their influenza (flu) illness.”

Dr. Burks concludes, “While the benefits of the flu vaccine are clear, individuals with MS should still consult with their physician before getting a shot. For those who receive the vaccine, they may experience a mild temperature and slight increase in MS symptoms for a day or two following the injection. Anyone experiencing more severe or longer-lasting side effects from the flu vaccine should contact their doctor.”

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When Not to Get a Vaccine

The American Lung Association instructs people not to get a vaccine if:

• They do not qualify as being in a “high-risk” group (from the listing under “The Flu Vaccination Shortage”)
• They are allergic to eggs or any component of the vaccine (or if they have had a reaction in the past to flu vaccines)
• They have a history of Guillain-Barre Syndrome
• They have an acute illness and fever; individuals should wait until they are feeling well before receiving a flu vaccine

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Avoiding the Flu and Keeping Germs from Others

In addition to receiving the vaccine and avoiding people who are sick, the CDC and Prevention Magazine (according to ABC News) make the following recommendations to avoid catching the flu:

• Wash hands as much as possible.
• Keep a hand purifier gel or lotion nearby at all times, and carry moist towelettes for quick hand washings.
• Avoid touching one's own eyes, nose, or mouth before washing [when in a public place or near someone who has been sick -- germs may be “caught” this way].
• The CDC notes that three antiviral medications have been approved to prevent the flu; these are: amantadine (Symmetrel®), rimantadine (Flumadine®), and oseltamivir (Tamiflu®). These are available by prescription through one's physician, and are estimated to be 70 to 90 percent effective for preventing influenza illness in healthy adults who may be at risk of being exposed to a virus.

Dr. Patricia Clancy (speaking to ABC News) explains that good-health practices can help, including good hygiene, seven to eight hours of sleep per night, good nutrition, and regular exercise. David A. Relman, associate professor of medicine at Stanford University warns, “The likelihood that you're going to pick up a transmissible agent is directly related to the number of people you have close physical contact with,” so staying away from crowded areas may not be a bad idea during the flu season.

People who have the flu should follow these tips from the CDC to avoid spreading germs to others:

• When sick, keep at a distance from others to protect them from getting sick too.
• Keep one's nose and mouth covered with a tissue when coughing or sneezing – and dispose of the tissue afterward.
• Wash hands after coughing or sneezing – with soap and warm water, or use an alcohol-based hand cleaner.
• Stay home from work or school to help prevent others from catching the illness.

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Influenza (Flu) and Colds: How they are Transmitted, Symptoms, and Treatments

SECTION ONE: THE FLU

According to the American Lung Association, the flu is an infection of the respiratory system caused by one of three types of influenza viruses. Strains of these viruses change constantly and circulate around the world, so a new vaccine is needed each year to fight the new viruses.

The flu virus may become airborne when someone coughs, sneezes, or speaks. Tiny droplets of flu particles may be inhaled by another, and the virus then grows in the upper and lower respiratory tracts. The flu virus may also be spread by direct contact as well.

Flu symptoms are more severe than colds and appear abruptly. The flu may be serious (or even fatal) for individuals who are elderly, have chronic disease, or have a weak immune system. While most people recover from the flu within one to two weeks, older individuals or people with other illnesses may continue to feel weak for a long period of time. If complications occur such as difficulty breathing, chest pain from coughing, or coughing up yellow, green, or bloody phlegm, consult a doctor immediately.

Flu symptoms include:

• high temperature (101 degrees or above in adults; 103 to 105 degrees in children)
• cough
• muscle ache
• headache
• sore throat
• chills
• tiredness
• feeling badly all over

To treat the flu, the American Lung Association notes that individuals may be prescribed one of the following four antiviral medications: oseltamivir (Tamiflu®), zanamivir (Relenza®), amantadine (Symmetrel®), and rimantadine (Flumadine®). Treatment must be started within two days after flu symptoms appear and has been shown to reduce the length of illness by at least one day – with early treatment leading to faster results. These drugs and their side effects should be discussed with one's physician before they are prescribed. Antibiotics are ineffective against the viruses that cause influenza and should not be taken to treat the flu except when used to treat bacterial complications (such as an ear infection or pneumonia). For more information about antiviral drugs and the flu, please visit www.cdc.gov/flu/protect/antiviral/ .

Symptoms may be treated through over-the-counter medicine as recommended by one's physician to reduce fever, aches, congestion, cough, and sore throat. Bed rest, drinking plenty of fluids (without caffeine or alcohol), and good nutrition are also vital for a speedy recovery. (Children under the age of 18 should not be given aspirin for flu or cold symptoms as it may be involved with the development of Reye Syndrome).

For more information about the flu and its treatments, please refer to “Cold and Flu Guidelines: Influenza” at the American Lung Association's website by visiting www.lungusa.org . The specific address for this paper is: www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35868 .

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SECTION TWO: THE COMMON COLD

Colds are highly contagious and most often spread when droplets of bodily fluid containing the cold virus are transferred by touch. For example, a typical way that the cold germ is carried is if someone with a cold sneezes into his or her hand and then touches a counter, and someone else touches the same spot on the counter, who then rubs his or her eyes, nose, or mouth. Fluid droplets may also be in the air and inhaled.

As noted by the American Lung Association, cold symptoms include:

• Runny nose
• Congestion
• Sneezing
• Weakened senses of taste and smell
• Scratchy throat
• Cough
• Adults and teens are less likely to develop a fever than young children

The antiviral medications listed to help prevent or reduce the effects of the flu are not useful with treating the common cold and should not be taken for this purpose. The same is true for antibiotics, except when used to treat bacterial complications (such as an ear infection or pneumonia).

Similar to flu symptoms, cold symptoms may be treated through over-the-counter medicine as recommended by one's physician to reduce fever, aches, congestion, cough, and sore throat. Bed rest, drinking plenty of fluids (without caffeine or alcohol), and good nutrition are also vital for a speedy recovery. (Children under the age of 18 should not be given aspirin for flu or cold symptoms as it may be involved with the development of Reye Syndrome.)

For more information about colds and their treatments, please refer to “Cold and Flu Guidelines: The Common Cold” at the American Lung Association's website by visiting www.lungusa.org . The specific address for this paper is: www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35873 .

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Diet Supplements, Saunas, Antibiotics, and Smoking

Prevention Magazine (according to ABC News) recommends building the immune system through foods and supplements to help avoid flu. These include: Brazil nuts and walnuts, salmon, shellfish, milk and yogurt; black elderberry, ginseng, raw garlic, Echinacea, and astragalus. The American Lung Association notes that many herbs and minerals (Echinacea, eucalyptus, garlic, honey, lemon, menthol, zinc, and vitamin C) receive publicity as cold remedies, but state that “none of these claims are solidly supported by scientific studies.” [Please see note about Echinacea two paragraphs down.]

MSAA's position on these types of remedies is that our organization does not recommend or endorse any specific treatment or product. Individuals considering these supplements should be wary of any claims made without the FDA's approval or confirmed study results. Individuals with MS are strongly encouraged to consult their physician before making any changes to their diet or supplement regimen.

Additionally, some “natural” or herbal supplements can interfere with prescription medications and have unusual side effects, so patients need to be sure to inform their doctors of everything they are taking. Just because something is natural, does not mean that it is safe for someone to use. For example, Echinacea is not recommended for people with autoimmune diseases, including MS.

Some sources have noted saunas (two per week) as being helpful in avoiding illness. Taking a sauna, however, is not recommended for individuals with MS, and taking a sauna may even cause their symptoms to worsen.

Dr. Relman (through ABC News) reminds patients not to use antibiotics recklessly in an effort to prevent or treat viruses that cause influenza, as they do not affect these viruses. “They [antibiotics] have a detrimental impact on the individual's health and the health of the population because they promote the growth of antibiotic-resistant organisms.”

Finally, the American Lung Association advises individuals with the flu to keep away from smokers, as inhaling their smoke will further irritate the throat. The CDC goes on to list a number of issues which involve smoking and the negative health consequences, including the fact that smoking increases the risk of: more influenza infections and lower respiratory tract infections; higher mortality rate from influenza; chronic coughing, bronchitis, and emphysema; suppressed immune function; and harm to nearly every organ of the body.

The CDC lists several sources to assist someone who would like to quit smoking, and points out that within 20 minutes after the last cigarette, the body begins a series of positive changes that continue for years. For more information, please go to www.cdc.gov/flu/protect/smoking.htm . The Online Guide to Quitting Smoking is available at www.smokefree.gov/ .

For More Information

Please visit the websites listed for more information on any of the topics mentioned. Individuals may also speak with an MSAA consultant by calling (800) 532-7667 between the hours of 9 am and 8 pm (ET) Mondays through Thursdays, and between 9 am and 5 pm (ET) on Fridays. Spanish-speaking individuals may contact a bi-lingual consultant between 9 am and 5 pm on weekdays by dialing extension 108.

By Susan Wells Courtney, MSAA Writer
Multiple Sclerosis Association of America
National Headquaters
706 Haddonfield Road
Cherry Hill, NJ 08002
(800) 532-7667

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