Lupus and the Flu Shot: What You Need to Know

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Introduction

It is the beginning of the 2023-24 flu season, and here are some important things to think about concerning the flu, vaccinations and lupus.

If you have lupus, you should strongly consider speaking to your doctor about getting a seasonal flu vaccine. In this article, we will answer many questions regarding this particular type of vaccination. However, you may have specific conditions that require a healthcare professional.

Note: The Centers for Disease Control and Prevention (CDC) recommend that people get a flu vaccine in September or October. However, there may be good reasons for some to get their’s earlier and if it is past October, there are still benefits for getting vaccinated later.

The flu vaccine is the best way to protect individuals with lupus against the top influenza viruses that experts predict will be the most common and problematic for the upcoming year. Getting a flu shot can reduce flu illnesses, prevent flu-related hospitalizations, and protect people who have compromised immune systems or who happen to be more vulnerable to flu complications.

What exactly is the flu?

The word “flu” is a shortened name for the medical term “influenza,” which is a contagious disease that is typically most active between October and May in the Northern Hemisphere. It is caused by influenza viruses that target the respiratory system and is spread primarily by coughing, sneezing, and other forms of close contact. Like the common cold, the flu can cause sneezing, a stuffy nose, coughing and a sore throat, but usually includes a more significant fever, aches, chills, and weakness – and sometime a headache. Colds rarely cause serious health problems, but the flu can lead to more serious complications like pneumonia, especially for the very old or the very young.

Influenza virus can be divided into four types – A, B, C and D, though only types A, B and C currently affect humans, and only types A and B are targeted by the vaccine.

What are the updates with the flu shot this year?

As it does every year, the CDC recently updated their recommendations for the 2023-2024 flu shot season. The most significant updated information includes:

Timing: The best time to get vaccinated for most people are still the months of September and October. However …
- Pregnant people in their third trimester can be vaccinated in July or August if they want their newborn to be protected after birth.
- Children who need 2 doses can get their first dose earlier so that the second dose (4 weeks or more later) can be given in time.
- It is still a good idea to get a flu shot after October, if that timeframe is missed, and vaccinations for some seasons can be made as late as May or June – depending upon the flu risk at the time.
COVID: The flu vaccine and COVID vaccines can be taken at the same time, though again, it is best to consult your healthcare provider before planning on either.
All regular-dose flu shots will be quadrivalent. That means each vaccination will target 4 specific flu viruses. At times, in the past there have been trivalent (3 type) shots available.
For those with egg allergies:
- There is a recombinant flu vaccine that does not use chicken eggs or real influenza virus in its production and it also will target the same four specific flu virus strains.
There are additional approved types of vaccines for children 6 months through 35 months of age. Check with your healthcare provider about these options of young children. Also, children between the ages of 6 months and 8 years who need 2 doses 4 weeks apart, should start early enough so that the second dose is given by the end of October.
The age recommended for the cell culture-based inactivated flu vaccine, Flucelvax Quadrivalent (ccIIV4), changed from 2 years and older to 6 months and older.

For those over 65 years in age, the CDC recommends taking one of three special types of vaccines: Fluzone High-Dose Quadrivalent vaccine, Flublok Quadrivalent recombinant flu vaccine and Fluad Quadrivalent adjuvanted flu vaccine. Though these are not necessary, they have been shown to be more effective than standard vaccines.

Fluzone High-Dose is a specific vaccine licensed only for people 65 years and older. It contains 4 times the amount of antigen of a standard dose to initiate a stronger immune response – and so is problematic for those who are immunosuppressed.

If you have lupus, avoid the nasal spray flu vaccine, called FluMist. It is one way to avoid injections, but beware, it is a live (though attenuated) influenza vaccine, and it is NOT recommended for those with lupus or anyone living with them or those taking immunosuppressive medications and others. Definitely check with your healthcare provider to make sure you get the form of the flu vaccine that is best for you.

For more details on the CDC’s recommendations for 2023-24, here is their website: https://www.cdc.gov/flu/spotlights/2022-2023/flu-vaccination-recommendations-adopted.htm

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Who gets the flu, and who should get the flu shot?

Anyone can get the flu virus. While the risk is highest among children, the elderly and those with compromised immune systems are also more susceptible. The following high-risk groups can get much sicker than others with the same virus and should absolutely get the vaccine:

- Infants and children younger than five but especially those younger than 2 years of age. Some children should get two doses.
- Women who will be pregnant during flu season.
- Caregivers of children under the age of 5 but especially infants younger than 6 months of age (as they are too young to receive the flu vaccine.) To learn more about why all children should receive the flu vaccine, watch CDC’s video Why Flu Vaccination Matters: Personal Stories from Families Affected by Flu.
- Anyone with any condition that weakens the immune system, or those with chronic heart or lung conditions.
- Those who live in nursing homes.
- Anyone 65 years or older.
- Anyone who comes in close contact with people in the high risk groups, i.e. healthcare workers, family members, babysitters, etc.

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Why is it so important for those with lupus to get the flu shot?

The Flu is Serious! During the 2017-2018 flu season the CDC estimated that approximately 960,000 Americans were hospitalized due to influenza, and approximately 79,000 died from flu complications. Most of the fatalities occur in the elderly, infants, and the immunosuppressed (those who have weakened immune systems). Flu can also lead to pneumonia, and make existing medical conditions worse. A pneumonia vaccine (called Prevnar 13) is also available and recommended for lupus patients. This is given as a shot and should be followed by a second dose five years after the first dose.

The flu can trigger flares and hospitalization! In 2021, a study of over 24,700 patients with SLE found that influenza infections significantly increased the likelihood of hospitalization – a risk factor in all age groups, sexes or co-morbidities.

Note: This blog is for general information purposes only and is not meant to give medical advice or to suggest treatments. As always, check with a qualified healthcare professional for any medical advice that you may need.

Those with the autoimmunediseases like lupus, are at an increased risk for developing infections because the immune system in lupus patients negatively affects the way the body fights off foreign invaders like viruses and bacteria. Many lupus patients take immunosuppressive medications to help control an overactive immune system. These medications can reduce the ability of the body to fight off foreign invaders such as the flu virus. This is why lupus patients should do everything possible to lower their chances of contracting the influenza virus.

Note again: Most studies have concluded that there is no increase in flares or a worsening of SLE activity after vaccination for the flu.

I got the flu shot last year; do I need to get it this year as well?

The answer is yes. Because flu viruses change every year, and even between seasons, it is very important to get the vaccine every year to insure that you are protected from the various strains. The CDC suggests that every person should get a flu shot yearly by the end of October to maximize their protection. In 2018, the CDC stated that getting vaccinated significantly earlier, such as in July or August, may be too early, and this can reduce your protection later in the flu season, especially for older adults.

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How long does it take for the vaccine to take effect?

It takes about 2 weeks for protection to develop after the vaccination, and protection lasts several months to a year. So it is possible to get sick with the flu even after you have been vaccinated if: you may have been exposed to a flu virus shortly before getting vaccinated.

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Are there any reasons that I should NOT get the flu vaccine?

Here are three reasons that someone might not want to get the flu shot. Please discuss these with your physician if you have any concerns.

1. If you have any severe, life-threatening allergies: If you have ever had a life-threatening allergic reaction after a dose of flu vaccine, or have a severe allergy to any part of this vaccine. Most, but not all types of flu vaccine contain a small amount of egg protein. If, for example, you have an allergy to gelatin, antibiotics, or eggs, you may be advised not to get vaccinated. The American College of Allergy, Asthma and Immunology says the vaccine contains such a low amount of egg protein that it’s unlikely to cause an allergic reaction in those with an egg allergy. If, on the other hand, you have severe egg allergy (anaphylaxis), please speak with your physician before getting the flu shot to learn about other options.
2. If you ever had Guillain-Barré Syndrome (a severe paralyzing illness, also called GBS): Some people with a history of GBS should not get this vaccine. If you are not sure about this or know you have had GBS, please discuss the flu shot with your doctor before receiving the vaccine.
3. If you are not feeling well: It is usually okay to get flu vaccine when you have a mild illness, but you may be advised to wait and come back for the vaccine later if you have a fever.

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Are there any side effects of the vaccine?

There are possible side effects from the flu shot, however, the benefits of getting the vaccine outweigh the risks. Serious side effects are very rare, but if they do occur, it is usually within a few minutes to a few hours after the vaccine was given. Side effects can include:

Some experience redness, soreness, or swelling at the injection site.
Mild muscle aches
Low-grade fever

What are the symptoms of the flu?

fever/chills
headache
runny or stuffy nose
sore throat
muscle aches
fatigue
cough

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What should I do if I think I might have the flu?

Antiviral medications should be taken within 48 hours, especially for those who are most at risk for complications. Please call your physician immediately if you start to feel sick or are having any of the above listed symptoms. It is very important to wait for at least 24 hours after your temperature has returned to normal (98.6) before returning to work, school, or traveling to avoid spreading the illness to others.

When and where can I get the flu shot?

The flu season begins around October and can continue until as late as May in the Northern Hemisphere, but it peaks in January or February. It is best to get the vaccine as soon as it is available in your area, but it is not too late in December, January or beyond. To find the nearest location for receiving a flu shot in your area, please visit flu.gov. Many neighborhood pharmacies such as Rite Aid, Walgreens, Safeway, CVS, etc. offer easy and convenient locations to get the flu shot from a certified immunizing pharmacist without needing an appointment or referral from a physician.

Even if you do not have insurance,

Please, speak with your physician sooner than later about getting your seasonal flu shot. It is not worth the risk if you have a compromised immune system from a disease like lupus.

In fact, why not give them a call today?

References

Brause, B.D. (2019, October 11). Vaccinations and lupus: What you should know. Hospital for Special Surgery. https://www.hss.edu/conditions_vaccinations-lupus-update.asp

Centers for Disease Control and Prevention. (2023, October 1). Flu Season. https://www.cdc.gov/flu/season/index.html

Joo, Y.B., Kim, KJ., Park, KS., & Park, YJ. (2021). Influenza infection as a trigger for systemic lupus erythematosus flares resulting in hospitalization. Scientific Reports 11, Article 4630. https://doi.org/10.1038/s41598-021-84153-5

Author: KFL Team (2023)

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All resources provided by us are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views expressed here do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your healthcare practitioner with any specific questions or concerns.

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