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Too Late To Get A Flu Shot? When You Should Get Vaccinated
If you didn't already get your flu shot in October, which was a good time to get it, the best time ... [+] to get vaccinated is as soon as you can after October. (Photo by Noam Galai/Getty Images)
Getty ImagesIt may be too late to dress up like Barbie or Ken for Halloween. It may be too late to dress up like Barbie or Ken for Thanksgiving dinner, too. But as long as it's still either the fall or winter season, it is definitely not too late to get the flu shot. As long as you are somewhere in the October through March timeframe, you probably want to get vaccinated against influenza as soon as you can.
That's because the influenza season in the Northern Hemisphere can extend all the way from as early as October to as late as May the following calendar year. In fact, until you've gotten well into the New Year, chances are you and everyone around you haven't even seen the worst of the flu season yet. Flu activity is typically highest from December through February with peak influenza virus activity most commonly occurring in February. That's why it's good idea to always secure your protection well in advance of Valentine's Day.
Now, flu activity can follow very different patterns each season. In the four decades from the 1982-1983 flu season through the 2021-2022 flu season, the peak of the flu season has been in February a total of 17 times. December has been the next most common peak month at seven times. January and March tied for third place at six times apiece. And October, November and April have been the peak months only once each, according to data from the Centers for Disease Control and Prevention.
There's a saying among epidemiologists that if you've seen one flu season, you've seen just one flu season. Every year can be different from previous years. Unless you have a DeLorean that serves as a time machine or some other way of traveling to and from the future, it's impossible to predict exactly what this current flu season will look like. You cannot be sure when peak flu activity will occur, how bad things will be or whether this will be the season when there is a surge in cases in the later spring.
If you haven't yet been vaccinated, it's a good idea to get the flu vaccine as soon as possible. Keep in the mind that the flu vaccine isn't like a trench coat and doesn't start protecting you the moment you get it. Your immune system has to first see the weakened or inactivated flu particles from the vaccine, essentially say, "WTF is this? This doesn't belong in my body!" and then mount an immune response against them, which can take up to two weeks.
This two-week lag time to protection is a big reason why it's important to get the flu vaccine now without further delay. This will help protect you in time for the last two weeks of December, which may be filled with interactions with other people, objects and surfaces, especially if you celebrate Christmas, Kwanzaa, New Year's Eve, New Year's Day and the annual unofficial holiday of going to stores to return all the presents that you didn't want but somehow received.
Late September to mid-October is typically the best time to get vaccinated against the flu to make sure you are protected before flu activity really starts to increase, as demonstrated by computer modeling studies published by our PHICOR Team in the scientific journals Vaccine, the American Journal of Managed Care and Medical Care. It is is possible to get vaccinated a bit too early, such as in August, since the protection offered by the flu vaccine may start waning after six months, leaving you less protected the following May when the flu may still be around.
Keep in mind that while the flu vaccine can offer good protection against the flu, it won't offer you 100% protection. Instead, its protection can vary from 30% to 60% depending on how well the flu virus strains put in the vaccines in the leadup to flu season end up matching the strains that actually circulate that season. So just because you got the flu shot already doesn't mean that you should stop washing your hands frequently and thoroughly, begin hugging and kissing people who may be coughing, sneezing, feeling run down or hot (hot temperature-wise, that is) and abandon all other infection prevention measures. Otherwise, your New Year's Eve may turn out to be a Flu Year's Eve.
Of course, reducing your chances of getting infected is not the only benefit of the flu shot. Even if you do end up getting infected, being vaccinated can significantly reduce the severity of your symptoms and your chances of getting hospitalized and dying. Most commonly, the flu will result in four to seven days of fevers, chills, coughing, a sore throat, a runny or stuffy nose, muscle or body aches, headaches, fatigue, vomiting, diarrhea or other not very pleasant symptoms. They can be so unpleasant that you end up missing school or work.
Things can get even worse, though, especially if you have a weaker immune system. Each year from 2010 through 2022, somewhere between 9.4 million and 41 million people have gotten sick from the flu, between 100,000 and 710,000 people have been hospitalized and between 4,900 and 52,000 people have died. Catching the flu is not the same as catching the common cold. The flu could leave you a lot more sick with some potentially terrible consequences.
Finally, even if you think you've had the flu already this year, it is still a good idea to get the flu shot. Many different microbes can cause flu-like illnesses such as respiratory syncytial viruses (RSV) and adenoviruses. So, unless you actually got tested for the flu, you cannot be sure if you've actually had the flu, meaning that its' probably still worth a shot.
Is A Flu Vaccine With Long-term Effectiveness On The Horizon?
Developing a long lasting flu vaccine could be highly beneficial for the health of society, and research is getting closer to this goal.
A study published in Science Translational Medicinefound that developing a vaccine that additionally targets an area of the hemagglutinin (HA) glycoprotein that experiences less mutation may be how we reach long-term flu vaccination options.
Researchers tested their vaccine in mice and ferrets and found it offered better protection than conventional vaccination. While more research is required, this successful test directs how to proceed with creating a long-term flu vaccine.
The flu is a common infection, affecting billions of people each year. The World Health Organization also estimates that the flu is responsible for 3-5 million cases of severe illness and 290,000 to 650,000 respiratory deaths yearly. Certain people are more at risk for severe illness or complications from the flu, including children under five and older adults.
Influenza viruses cause the flu, and these viruses change. Currently, the strategy for protection from the flu is the use of annual flu vaccines. Experts create these vaccines based on what influenza viruses they believe will be most common during flu season.
Changes in influenza viruses in influenza viruses are part of the challenge of creating a long-term vaccine. These changes often occur in the virus's surface proteins, like hemagglutinin (HA).
Non-study author Yoshua Quinones, MD, board certified internist with Medical Offices of Manhattan, noted the following to Medical News Today:
"The difficulties with flu vaccines include needing to update them every year because the flu virus changes, certain parts of the virus making the vaccine less effective, and not being able to protect against all types of the flu virus. It's also hard to make sure everyone can get the vaccine. But getting the flu shot can help reduce how many people get sick, help protect those who can't get the shot, and maybe one day there will be a vaccine that works for all types of the flu. Making the immune system respond better to the flu shot could also help protect against more types of the flu."
The researchers of the current study note that annual flu vaccines help create antibodies that target specific areas of HA globular head. However, this region often experiences frequent mutation.
Thus, if they could figure out a way to target an area of the HA that doesn't change as much, the stalk, they may be able to create a vaccine that could protect against many flu strains. However, while this has been tried in the past, it has not been effective in also eliciting an effective response in the head region.
Thus, researchers wanted to create a vaccine that could produce head and stalk-directed antibodies to offer long-term immunity against multiple flu strains. Ultimately, they made an HA antigenic mixture–based vaccine. This vaccine contained a mixture of HA proteins with a conserved stalk region and various mutations at a key site in the head.
Researchers in this study tested the vaccine's effectiveness on mice and ferrets. They compared the response to conventional vaccine approaches.
They found that their vaccine elicited a better antibody response than the control vaccine option. The vaccine even offered protection when mice were exposed to lethal viral doses. It also offered protection against multiple H1 viral strains.
However, this newly developed vaccine appears most effective after receiving an initial prime dose and a booster rather than just a single dose.
Non-study author Linda Yancey, MD, Infectious Disease Specialist, Memorial Hermann Health System in Houston, commented with her thoughts on the study to MNT:
"This is a nice step in the direction of a universal flu vaccine. Producing one has been the goal of researchers for years. It has proven to be a complex and difficult task, so it is nice to see solid progress being made towards it. At this time scientists are still working on developing the building blocks of a vaccine. We probably won't see any changes in clinical practice based on this for a few years. But every step in the right direction brings that universal vaccine a little closer."
This study has limitations, mainly because animal testing differs from testing something in people. These animals had also not experienced any previous flu vaccine or flu exposure, which could have affected the observed results. Researchers note that most people have some pre-existing immunity to influenza, which could minimize or influence the response to this type of vaccine. The study also only looked at one H1 HA, so it's unclear how the approach would impact other HAs. In addition, not all animal experiments were conducted in a blinded manner.
Researchers also acknowledge that further study is required to understand more of the underlying mechanisms and confirm why they observed the response they did. They acknowledge that "the protection from infection may not always be correlated with decreasing classical antigenic site-directed responses."
Even if this potential vaccine is developed, experts, government agencies, and health professionals will need to address distribution and acceptance. Non-study author David Cutler, MD, board certified family medicine physician at Providence Saint John's Health Center in Santa Monica, CA, noted the following:
"While safety and effectiveness are the major concerns, vaccine uptake is also an important issue to consider. Presently, only about 50% of adults receive a flu vaccine. Any improvement in effectiveness could be offset be reluctance to receive a new vaccine. It is the role of our public health agencies to convince people that the benefits of approved vaccines greatly exceed their risks. So, while scientists may develop new, improved vaccines the benefit to society may not be realized if the vaccines do not get administered."
However, the research sets up the potential development of a long-term flu vaccine. This could make it easier to maximize the vaccine's impact and ultimately minimize the detrimental health effects of the flu.
Quinones was hopeful about the results and noted the following:
"The new flu vaccine might work better than the old ones. If it works in people like it did in animals, it could mean fewer people getting sick from the flu each year. It might also lead to a vaccine that works for all types of the flu, which would be a big deal for keeping people healthy."
Q&A: What To Know About COVID And Flu Vaccines This Fall
Published September 13, 2023With the start of fall approaching, so too does the season when it's more likely you will catch the seasonal flu.
And this year, there's another reason for concern as COVID strains continue to be a threat with a late summer spike in cases.
Influenza activity usually begins in October, peaks between December and February, and can continue until May, according to the Centers for Disease Control and Prevention (CDC).
Meanwhile, the North Carolina Department of Health and Human Services (NCDHHS), reports that hospital and emergency room visits due to COVID, as well as the detection of COVID in wastewater tests, have been steadily increasing in North Carolina since July, now hitting levels not seen since last winter.
Find Your Flu Vaccination
Staff and faculty can get vaccinated at several sites at Duke this fall.
See the schedule
Hospitalizations and deaths due to COVID are also on the rise nationally.
To date, 1.1 million COVID-19 deaths have been reported in the U.S.
Working@Duke talked with Duke's Employee Occupational Health & Wellness Executive Director Dr. Carol Epling and Duke Professor of Medicine Dr. Cameron Wolfe, an infectious disease expert, about seasonal influenza, COVID-19, and boosters.
WHAT IS HAPPENING WITH COVID?Wolfe said the current rise in COVID-19 cases is expected. Summer travel, more gatherings and relaxed restrictions have likely contributed to the late summer increase in infections, emergency department visits and hospital admissions.
Also, the virus itself is continuing to evolve, Wolfe said. Mutations lead to newer – sometimes more contagious – strains, such as the current BA.2.86 variant, which can lead to an increase in COVID-19 cases.
"For a number of different reasons, it seems there are repeated spikes, which tend to happen toward the end of July and into August, and then again in the winter," Wolfe said. "We've seen the summer spikes for the last four summers in a row, sadly. It's a healthy reminder that the virus is still out there."
WHAT CAN WE DO TO PROTECT OURSELVES FROM COVID-19?Nearly halfway through the fourth year of living with COVID-19, the conventional wisdom for avoiding the virus still holds. If you have symptoms, it's important to get tested, isolate and wear a mask.
Another key step Wolfe recommends is getting the updated new COVID-19 booster, which will likely be available in late September or early October. The new booster will be formulated to protect against newer strains of the virus and, if taken in the fall, will provide strengthened immunity during the winter months when the risk of contracting respiratory diseases are highest.
"I think the reality of this moment is that COVID continues to mutate and cause older adults and immunosuppressed adults a lot of problems," Wolfe said. "Even for healthy adults, I think we all know people who have been knocked down by the virus in the past month or so. So there's good motivation to get the updated vaccine. People should view this new vaccine like a flu shot which enables them to stay healthy. Nobody wants to go through a bunch of days feeling sick; no one wants to get Long Covid. They can avoid that with a 30-minute trip to a pharmacy. It's that simple. The virus is here to stay. We need to do what we can to control it."
Due to the end of the COVID-19 Public Health Emergency, which helped fund Duke's COVID-19 vaccination and booster efforts for the campus community, staff and faculty will need to get the updated vaccine through pharmacies or their health care provider.
COVID-19 boosters are covered in full, with no co-pay, under all of Duke's employee medical plans.
With the approval of the updated formula, the bivalent vaccine introduced last year is no longer approved by the FDA for emergency use. Duke and other healthcare providers have discontinued administration of the bivalent vaccine until they receive the updated formula, which should be within the next couple weeks.
WHAT SHOULD I DO IF I FEEL SICK?The symptoms for COVID-19 and seasonal influenza are similar and include runny nose, scratchy throat, cough, headache, fatigue and fever. Anyone experiencing these symptoms should isolate, wear a mask, and seek out a COVID-19 test.
Employees who are experiencing symptoms or would like to report an exposure should visit My COVID Link to report and self-schedule an appointment for testing. This link should also be used to report a positive home or outside COVID-19 test.
Staff and faculty may also contact the Duke EOHW Exposure Hotline to report symptoms or seek guidance, by calling 919-385-0429 (choose option 1) from 8 a.M.-5p.M. On weekdays and 8 a.M.-noon on weekends.
According to Epling, wearing a mask is an especially important step in slowing the spread of both COVID-19 and influenza. Anyone experiencing symptoms should wear a mask whenever they're around others.
"Just put your mask on," Epling said. "Even if you test negative for COVID, you can help prevent the spread of all of the viruses that are causing respiratory conditions. Sometimes tests can be falsely negative when you actually have COVID. Or you can have some other virus. But masking will help us all."
HOW TO GET A SEASONAL FLU VACCINATION:Getting an influenza vaccination remains an essential step in keeping you and your loved ones safe during the months when the flu virus – which the CDC estimates killed between 19,000 to 58,000 Americans during the 2022-23 flu season – is especially active.
EOHW will offer no-cost flu vaccinations at clinics at Duke Regional Hospital, Duke Raleigh Hospital and at the main EOHW location in the Orange Zone subbasement of Duke Clinics. There will also be pop-up locations around campus beginning in late September. Click here for dates and locations.
The quadrivalent vaccine, which protects against several strains of the flu will be administered at pop-up vaccination sites. High dose vaccinations for people 65 and older and egg-free options are available at EOHW clinics.
Influenza vaccinations are a condition of employment for Duke University Health System, the Duke University School of Medicine and the Duke University School of Nursing. The deadline to show proof of vaccination or receive an approved exemption is 10 a.M. On Tuesday, Nov. 7. Vaccinations are strongly recommended for Duke University students, staff and faculty.
"By getting vaccinated against the flu, you're protecting yourself from severe illness, but you're also protecting the people close to you," Epling said. "You can be infectious the day before your symptoms ever start. So you can transmit the flu to others before you know you have it, which can be devastating to another person."
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