Podcast Intro
Here to tell us about this years flu vaccine and what to expect is Dr. Jonathan Berz, he is a general internal medicine physician at Boston Medical Center and Director of the Preventive Medicine Residency Program.
Jonathan Berz, MD
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Jonathan Berz, MD is a general internal medicine physician at Boston Medical Center and Director of the Preventive Medicine Residency Program.

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Jonathan Berz, MD
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Melanie Cole (Host): Influenza is a serious disease that can lead to hospitalization and sometimes even death. Every flu season is different and that is why the CDC updates the seasonal influenza vaccine so that it is designed to protect against the influenza viruses that research indicates are most likely to spread and cause illness among people during the upcoming flu season. Vaccination is one of the best ways you can protect yourself and your family from this potentially dangerous disease. Here to tell us about this year’s flu vaccine and what to expect is Dr. Jonathan Berz. He is a general internal medicine physician at Boston Medical Center and the Director of the Preventive Medicine Residency Program. Welcome to the show Dr. Berz. So, explain a little bit about influenza and the devastating effects it can have around the globe.

Dr. Jonathan Berz, MD (Guest): Yeah, I mean influenza is as you said, it can be a devastating illness, easily transmitted, especially in those who are elderly and who are very young and in those who have chronic illnesses such as lung disease or heart disease. So, preventing it through vaccination is one of the most important ways to do that and so the CDC now recommends that everyone above the age of 6 months be vaccinated. So, it is no longer a qualified recommendation for vaccination but everyone should be vaccinated.

Melanie: So, tell us a little bit about this year’s flu. What can we expect?

Dr. Berz: You know each year, the strain, if you will, of the flu does changes, and so the vaccination is changed each year to match that as closely as possible. It is not really known until later in the flu season exactly the specifics of how severe it will be or exactly what strain will be circulating most often, but what we do know is that vaccination season is at us, we are on it right now, in fact the clinic at BMC, our vaccines are coming in in the next week or two. So, I do recommend everyone start to get vaccinated now through October.

Typically, the peak of the flu season is a little bit later, so December through March on average, though sometimes it can be even later than that. So, getting your vaccine October, November is key. But even if you haven’t gotten it by then and December, January rolls around and you think well is it too late to get my vaccination? I would say definitely not. Just go get your vaccination.

Something probably a little different from years past; the nasal mist is no longer recommended, after a number of years of trying it, it was shown to not be particularly effective. That’s no longer an option. The thing that is now an option in many places is especially for higher risk older adults is the high dose flu vaccine. So, young, healthy adults can continue to get the regular flu vaccine as they always have as an injection. But those who are 65 and older, I would ask your doctor if they have the high dose flu vaccine. Because that has actually been shown to be more effective than the standard dose of the flu vaccine.

Melanie: And what’s the best way to protect young children that are too young to receive that vaccine?

Dr. Berz: The best way to prevent them from the flu is for everyone around them to be vaccinated with the flu vaccine. So, the mother when she is pregnant or before she becomes pregnant, the family in the house, any relatives who are going to be visiting the child and then of course, other sort of routine precautions when you are sick. If you think you have flu symptoms, not to be visiting with the child and then everyone should be washing their hands routinely. You know the standard stuff. If you are sneezing, sneeze into a tissue or into the crux of your elbow of your arm, those kind of common sense ways to prevent spread.

Melanie: Can you still get the flu if you have been vaccinated?

Dr. Berz: Yes, unfortunately, you can. The vaccine is not 100% effective. The latest numbers that I was looking at on average it is about 40% effective and so you still can get it. But that being said, it is still vital that as many people in the community get it because that way it prevents spread around the community. So, if you have had the vaccine and you do get the flu or you have symptoms of the flu; still think of that as being the cause and take the standard precautions in terms of not going to work and preventing yourself from spreading by wearing a face mask and we can get into those types of things as well. But yes, unfortunately, you still can possibly get it.

Melanie: So, let’s get into some of those types of things. If you do suspect that you have the flu and different than a cold, so explain a little bit about what we might notice that would be different from the average cold and then what you would like patients to do. Should they go off to the doctor, get tested? Is there a medication to help speed the process? What do you want them to do Dr. Berz?

Dr. Berz: For the first question, I think how do you figure out if this is the common cold or if this is the flu? Typically, the flu, the common symptoms can be fever, it is much more of a sudden onset of a fever, along with a headache, a cough and body aches. A little different from a cold where often times the symptoms are prominently in the nose and then maybe a cough. But the flu is going to just sort of generally make you feel crummy and so if you have those symptoms again, including a fever and body aches then that is the time to think of it. I will say that those who are older adults, so again, the elderly may not always have a fever. So, fever is not 100% indicator of the flu or not having the flu.

If you are young and healthy, a young adult, healthy adult; you don’t really necessarily have to come in to the doctor because on average, the flu lasts about 3 days in healthy people. Sometimes some of the symptoms will linger for a bit longer but most healthy people will get better on their own. People who have chronic medical illnesses like I was saying before; lung disease or heart disease or diabetes perhaps or immunosuppressed in any way should definitely call their doctor because they will likely be the most important candidates for medication, a pill to take to treat the flu. There is one class of medications now that are used to treat the flu; they are called neuraminidase inhibitors, that’s the class name but you are right, Tamiflu is what people are most often familiar with and that can basically decrease the length of a flu by about a day, so it is not a dramatic improvement but those who have the chronic medical illnesses I alluded to; for them it is even more important and it can prevent a more serious case of the flu or even hospitalization from having the flu.

Melanie: How long are you considered contagious?

Dr. Berz: Good question. On average, I would say adults are contagious for about a week, about seven days or so.

Melanie: So, would you like people to stay home from work for that full week, if they are contagious, obviously, and school and then how do you know when it is okay to start going back to these things whether you go back wearing a mask or telling people to stay away from you. What would you like people to know about that?

Dr. Berz: Yeah, that’s a good question. So, definitely when you are in the throes of the illness, where you are feeling crummy, you have a fever, you are coughing a lot; it is really important to stay home from work or from school. I think a lot of sort of want to push through and just go to work anyway, but that is probably the most effective way to prevent the flu is just to stay home. So, definitely do that. The judgement as far as when exactly to go back is hard to make a general recommendation on that. I think I would call your doctor and see how long you have been sick, but I would say, if I were to make a general recommendation; I would say once you have had no fever for 48 hours then you can think about going back to work. It would not be unreasonable to think about going back after that time. So, not to say that everyone needs to stay home for seven days; I think that is unrealistic for most of us who work or go to school. But definitely in those initial probably on average three days of illness, where you are really feeling crummy, you have a fever and coughing; definitely do stay home and then for another day or two after that fever goes away.

Melanie: That’s great information Dr. Berz, so wrap it up for us. What would you like people to know about this year’s flu vaccine and the importance of receiving it and getting it at Boston Medical Center?

Dr. Berz: Yeah, so again, I think it’s the most important way you can prevent yourself from getting ill and also from spreading it to the community and please call your doctor to schedule that appointment. At Boston Medical Center, you don’t need to see your doctor, so, in other words, you can see just a nurse for the flu vaccine, which is sometimes a little bit easier to get in. So, again, that should be coming in stock in the next coming week, so I highly encourage it and again for those who are elderly, ask about the high dose flu vaccine.

Melanie: Thank you so much Dr. Berz for that great information. This is Boston Med Talks with Boston Medical Center. For more information, you can go to www.bmc.org. That’s www.bmc.org. This is Melanie Cole. Thanks so much for listening.