As a pediatric intensive care physician who also cares for children in a pediatric urgent care setting, I have treated a wide spectrum of acute illnesses, ranging from splinters in fingers to children on life-support. Given that I have seen children on life-support with influenza and children die from influenza, there is one statement from parents that I still find baffling: “We don’t get the flu vaccine.”
The 1918 flu pandemic killed at least 50 million people worldwide, including an estimated 675,000 Americans. While the numbers of flu-related illnesses/deaths have decreased markedly since that flu pandemic, influenza still imposes a significant medical threat and burden upon society. A more globally connected world provides viruses the means and transmissibility to wreak havoc on any population. Indeed, widespread contamination of any virus is a looming prospect today, and protection from them is prudent because they still cause significant illness. Consider the recent 2017-2018 flu season, for which the CDC reported that an estimated 48.8 million people contracted the flu, and 22.7 million sought medical attention, while 959,000 required hospitalization. Overall, the CDC reported approximately 79,400 deaths from the flu that season. In addition, there were 186 pediatric deaths, with approximately 80% of those deaths in children who had not received a flu vaccination.
Looking past the published statistics and evidence that influenza puts one at risk for potentially life-threating complications and the need for hospitalization, most individuals will have some symptom that causes discomfort, missed school/work, time spent in a doctor’s office, or a visit to the emergency room or urgent care. After my personal experience with seeing children with influenza in the outpatient setting and in the ICU, I have come to one conclusion: There is no excuse for not seeking a simple flu vaccine to reduce the chances of contracting even mild illness from influenza, or worse.
Nevertheless, no treatment in medicine is 100% effective. The most common argument one hears against getting the flu vaccine is that it is not completely effective. Stories abound about people who have received the vaccine but still contracted the illness. In fact, that is exactly what happened to me last flu season. After receiving the vaccination, I still got sick with the flu. In fact, for the 2017-2018 flu season, the CDC estimated that the overall effectiveness of the flu vaccine against influenza A and B was only 40% (reducing a person’s risk of needing to seek medical care by 40%). However, in my clinical practice, for those who received the flu vaccine and still became sick with the flu, their clinical illness was not nearly as severe as for the individuals who did not receive the vaccine. However, the inconvenience of being sick with the flu and loss of productivity does not scare me as much as the life-threatening consequences that occur in healthy children, let alone those more vulnerable ones with additional medical conditions such as congenital heart disease or cancer.
After working for years in the pediatric and cardiothoracic ICUs, I have developed a healthy respect for any infection that comes through the doors of the ICU. Influenza is especially formidable, for when children have problems breathing because of the influenza infection and require intubation and placement on a ventilator, it can take weeks to extubate them and liberate them from the mechanical breathing support. Furthermore, in severe instances, I have actually seen children placed on ECMO support (Extracorporeal Membrane Oxygenation), a state in which the lungs are not functioning and require the blood from the body to be oxygenated through a machine outside the body. Influenza can destroy the lung tissue and, in most cases, set a child up for a secondary bacterial infection of the lungs. This assault on the lungs may be something from which a child may not be able to recover. In fact, according to a 2018 article from The Lancet by Iuliano AD, et al., a median estimate of 45,000 children young than 5 (studied from 92 countries) die annually from respiratory complications caused by influenza.
As we recover from last flu season, we must prepare ourselves for the upcoming flu season. Throughout my career in caring for acutely ill and critically ill children with influenza, I have learned that complacency is an enabler of infirmity. I wish families could see what I have seen. If they did, they would know the full extent of the risks involved and not hesitate to provide their children with protection from the flu. My family and I will continue to get vaccinated every year for the flu. Are we rolling the dice that it will be completely effective? Sure. But, I’d rather take this bet than gamble on getting the flu without a vaccination.