Every year my patients ask me if they should get a flu shot, and what treatments they should consider if they do get the flu—both are great questions, but let’s start with a bit of background.

The influenza virus (the flu) represents a group of RNA viruses that vary from year to year and are constantly evolving. With an influenza infection, there is typically sudden onset high fever (often to 103 to 105, body aches, cough, headache, and marked fatigue and especially in high-risk individuals, people can become severely ill with the flu. The flu kills over 500,000 people worldwide every year.

Each year a vaccine is developed to either prevent or decrease the severity of illness when infected. The effectiveness of the vaccine varies from year to year, but typically it helps prevent the flu in 30-50% of cases—this year so far, it appears to be 38% effective, but even if it doesn’t prevent you from getting the flu, it likely reduces the length and severity of symptoms and decreases the chance of high-risk people dying from the flu.

So who should get the influenza vaccine (the flu shot)?

Clearly, people at highest risk for severe infections and possible death from influenza are those that absolutely should get the flu shot.

They include:

• Children less than 5 years of age (especially infants less than 2 years)
• People with impaired immune function, such as those with cancer who have had chemotherapy
• People with advanced heart disease, in particular heart failure
• People with advanced lung disease, such as emphysema and asthma
• Frail elderly adults, starting after age 65
• Women who are pregnant

The other group that absolutely should get the flu shot includes:

• Caregivers, or family who come in contact with high-risk people, such as family caregivers for a sick relative, relatives who visit an infant, and medical caregivers. After all, you do not want to unintentionally give a frail loved one influenza.

Lastly, people who don’t want to miss work and don’t want to spend a week ill should consider this vaccine as an option.

Many of my patients can’t afford to miss up to one week of work if they were to get the flu, especially those flying frequently on airplanes are more at risk. They won’t die from the flu, but it could cost them on the financial side if they were out of work for an extended period of time. I offer the flu shot to any of my patients that want it.

I choose to get the flu shot every fall for two reasons. First, I feel an obligation to protect my patients  from me, as I could easily get the flu and be infectious (Along these lines, many hospitals and clinics require that their employees either get the influenza vaccine, or  wear a mask while at work, all day long, all winter long, if they refuse the vaccine.)

Second, I don’t have time to be sick and miss work, and if I can minimize my sick time by a few days, that is a greater benefit for me than the risk from the flu shot itself.

From a public health perspective, the more people that get the influenza vaccine, the less the disease is spread. Since high-risk people may not get full immunity from a flu shot, they depend on the people around them to not get sick and giving them the flu. Some alternative providers might say that for low-risk people, the flu shot has more risk than benefit, but I have never seen any definitive proof to support this claim.

What are the risks of the flu shot?

• About 1 person in 1 million vaccinated could get Guillain-Barre syndrome, a neuropathy that can cause muscular weakness for weeks to months. This is a serious risk, yet, the chance of injury from getting sick with the flu is clearly higher than the risk of getting Guillain-Barre syndrome.
• Allergic reactions can occur, but this is predominantly in people who are allergic to eggs (don’t get the flu shot if you have an egg allergy).
• Some people will get some aches and pains (and perhaps a local skin irritation) for a couple of days associated with activating their immune system after receiving a flu shot. However, for people with active auto-immune disease, or for those with high levels of inflammation, there is some controversy about whether the flu shot can trigger auto-immune activity—the more traditional medical groups would say it doesn’t; yet, in light of this concern, I don’t push my patients with auto-immune issues, or those that are highly inflamed or chemically sensitive to get the flu shot, unless they are otherwise in a high-risk category noted above.
• I personally don’t recommend the live nasal inhaled form of the vaccine which can rarely give you a mild case of influenza. In the old days, the flu vaccine used a live virus, and you could get the flu from the vaccine. In my office, we do not use any live virus flu vaccines, and you can’t get the flu from most vaccines. The vaccine does take 7-14 days to be effective, so you could potentially get the vaccine and catch the flu before the vaccine becomes effective in your body.
• What about mercury in vaccines? Some influenza vaccines have 20 doses per bottle, and they contain a mercury preservative to keep the bottle sterile. I think it is dumb to inject people with mercury, as mercury is a neurotoxin. Most chain pharmacies, hospitals, and clinics use flu shots with mercury as a preservative (it decreases the cost of the vaccination). In my clinic, we order a vaccine that comes in single-dose vials, no mercury included. You can order mercury-free flu vaccine yourself from your pharmacy, but often this must be requested in advance and costs extra; I think the few extra dollars are worth it to have a mercury-free vaccine.

If you get influenza (whether you had the flu shot or not), what treatment options are available?

The following are therapy options that I share with my own patients and this list is intended as information only; this is not a treatment plan for how you should treat an illness such as influenza on your own. Always check with your physician who knows you when deciding on the right therapy for a severe illness.

1. Anti-Viral Medication for the flu is available and requires a prescription from your physician:

• For it to be effective, you need to start it during the first 24-48 hours of getting sick, and the sooner you start it the more effective it will be.
• Especially for high-risk people, taking an anti-viral medication (such as Tamiflu) will decrease the severity and duration of illness. For an average person, it will only shorten the duration of illness by ½ to 1 day, so from 7 days to 6-6.5 days, not huge, but if you happen to be high risk for a serious infection because you are frail, decreasing the severity could be life-saving or keep you out of the hospital.
• Not every healthy person needs to take the anti-viral medication for the flu, but it is available to those who want to decrease the severity of their symptoms.
• If you have a family member at home with documented influenza (they had a positive test for the flu) and you are exposed, you also have the option to take anti-viral medications to help you prevent from getting the flu. This is not 100% but fairly effective, and especially recommended for any high-risk people who might be exposed.

2. Zinc Lozenges also decrease the severity and duration of viral respiratory symptoms, including the flu.

• Look for zinc gluconate, the most effective form of zinc lozenges.
• Aim for 10-25 mg lozenges every 3-4 hours for the first 3-4 days of an infection. Let them slowly dissolve in your mouth.
• Some people notice nausea with zinc, so decrease the dosage as indicated, using half a lozenge or less as needed.
• Meeting your zinc requirements daily will improve your immune function and help prevent the flu. This is yet one more reason that you should take a good quality multivitamin daily.

3. Elderberry syrup (also called sambucol, a black elderberry extract) will help viral respiratory symptoms, including the flu.

• Elderberry syrup appears very safe, and has been long established to help with upper respiratory illnesses (don’t use the leaves or stems, they may be toxic)
• Aim for a dosage of syrup 3 to 4 times per day.
• Sometimes you’ll see elderberry combined with Echinacea root extract—I am fine with this combination being used, but Echinacea root effectiveness has been debated in clinical studies.
• You can buy pre-made syrup (it often contains sugar or honey, but I’m not concerned about its sugar content for a few days if you actually have the flu), or you can make your own from either fresh or dried elderberries, for a recipe, visit my friend Kate’s recipe at wellness mama: https://realfoodrn.com/homemade-elderberry-syrup/

4. Vitamin D levels impact the severity of flu symptoms. People with low vitamin D levels are more likely to get the flu, and they get sicker if they get it.

• Long term you should take between 2,000-5,000 IU daily; clarify your dosage with your own doctor. (Children should be taking at least 1,000 IU daily, but check with your child’s physician for the best dosage)
• The high-quality multivitamin packages that I recommend all have 2000 IU of vitamin D. Get started today if you aren’t already taking one.

5. Vitamin C seems to help people with a viral upper respiratory infection if they are deficient in Vitamin C.

• For people who eat poorly and don’t take a supplement, take 3,000 mg of vitamin C daily if you become ill, for about 5 days.
• Ideally, everyone should get 500 to 1000 mg of vitamin C daily from food and supplement intake combined. This is yet another reason to take a high-quality multivitamin and to eat your five cups of fruits and vegetables daily.

6. Sage and Thyme infusions (make herbal tea with fresh sage and thyme) with honey will soothe your throat during a respiratory illness.

Beyond the flu shot, to help prevent the flu during the flu season, especially when you are out in public, frequent hand washing with soap and hot water will decrease your risk for getting the flu. Further, taking a probiotic daily has also been shown to improve your immune function and decrease your risk for infections.

I hope you don’t get the flu this winter, but if you do, you’ll have a better idea of treatment options that are available.

I wish you the best of health!

Steven Masley, MD, FAHA, FACN, FAAFP, CNS