Scott Webb (Host): The flu vaccine is our best defense against the flu or experiencing severe flu symptoms, and my guest today is here to emphasize this point and more. I'm joined today by Dr. David Main. He's a Pulmonologist with Carle.

Doctor, it's nice to have you here. We're going to talk about the flu, right? And it is always around this time of the year, we talk about the flu. How do we prevent the flu? What can we do to help ourselves? How can providers help us? All that good stuff. So let's just start there. Like what's the most important action for flu prevention and maybe what's the vaccine type this year? Like what do we need to know about that?

David Main, MD: Sure. The single most important action anyone could take would be getting the influenza vaccine. This year, the standard flu vaccine is a vaccine that has three types of influenza, two types of the influenza A strain, and one type of the influenza B strain.

Host: Okay. And I'm assuming the answer to this question is anybody who's old enough or well enough or can get themselves where they, wherever they need to be or wherever the vaccines are being offered. But who should be vaccinated?

David Main, MD: That's the proper question. And the answer is, basically everyone over age six months. That's a recommendation coming from the Center for Disease Control, the Society for Infection Disease, the American Association of Pediatrics, all agree that the vaccine should be given to anyone over age six months, unless there are some special reasons why they cannot.

Host: Yeah. I wanted to ask you about that. Are there some folks that have special considerations?

David Main, MD: Well, there are, in several ways. First, I would say the most strong recommendation from the professional societies, would include adults and children that have higher than normal risk of a severe infection should they get the flu. And that's a bit of a long list of people, but I'll mention a few of them.

It'd be everyone over 65, people in nursing homes, people with chronic medical conditions such as asthma, chronic obstructive pulmonary disease, most of the heart diseases, blood disorders, endocrine problems, the most common being, of course, diabetes, kidney and liver problems, or a suppressed immune system, a common situation. There might be HIV, or people in disadvantaged conditions. And again, that long list are the people that are most likely to benefit from prevention from having a severe influenza complication. And those complications would be things like pneumonia, respiratory failure, heart event or death. And then I should point out also recommended by these professional groups, are all other people over age six months, that should receive the vaccine.

Host: Right. So over the age of six months, we talked about some of the special populations, if you will, there. Doctor why is there a flu vaccine controversy, right? Like why do we still sort of have to, you know, see things in the media and social media and folks have such strong opinions, even though the many of them are not experts like yourself. Like what is this controversy about?

David Main, MD: Here in America, there's been considerable vaccine hesitancy over the years, various reasons. An aversion to medical care, vaccinations in particular that would include religious reasons, just being skeptical of organized medicine. Sometimes opposition to being told what to do.

There are other historical, cultural reasons. But in the last few years we've seen a rise in misinformation. After COVID, there's been a growing reluctance to receive vaccinations. In this country, perhaps in the western world, some growing suspicion of experts, science in general. Public health in particular, especially coming on after COVID.

And then if we add influenza prevention to that list of concerns, there we have it.

Host: Yeah. Yeah. So I think I know the answer to this one as well, but I love picking the brains of experts, just in general, Doctor, why should we be vaccinated for the flu? Is it because the vaccines work? I mean, it seems obvious to me, but from your perspective.

David Main, MD: Because it is the one thing that anyone can do to help make it more likely they won't get ill. If they do get ill with flu, it won't be a severe illness. And by severe illness, I mean they're more likely to not go into the hospital. If they do go into the hospital, less likely to go to the intensive care unit.

And if they do go to the intensive care unit or the hospital, they're less likely to die. So it is the one thing that a person can do to avoid having that kind of problem.

Host: Right. It's within our control. Right. It's something that we can do, we can be proactive about. And you know, I, I hear from folks, even my own kids doctor. Yeah. Well, I don't feel good for a day or two after I get the flu vaccine, so it's giving me the flu or, you know, whatever like children think and other folks might think is true.

But in reality, as you're saying, you may still get the flu even though you are vaccinated. It's the severity, right? It's that, as you say, you may get sick, but you won't end up in the emergency room or beyond the emergency room. Do I have that right?

David Main, MD: Oh, absolutely. That's it in a nutshell. And you touched on something else, people ask, can the flu vaccine give us flu? And no, the standard influenza vaccine is a inactivated or not active virus particle. It cannot, it will not give anyone the flu. One reason someone might think that is that if the flu vaccine is given later than it should be and when it should be, is before November 1st, but if it's given during the active flu season, December, January, February, the flu virus and other respiratory viruses are going on in the community. And if so, it's very possible that a person would get a flu shot and soon after would have respiratory symptoms. That really wasn't a result of that vaccine. It's result of exposure in the community to some other virus that just happened to happen at the same time.

Host: Right, right. And so many of these things all seem to share, you know, the list of symptoms that folks might experience, and you might think it's the flu, but it could be something else. How do we get Doctor to widespread flu vaccination rates? Is it just get everybody vaccinated or as many as possible? Is it just simple math?

David Main, MD: Well, to large extent that's true. The way we're going to get there, I believe, is people listening to their healthcare providers, whether the doctor, whether the nurse, hear the reasons why they need to get or would benefit from getting the vaccine. If they wish or read information coming from local public health departments, from CDC, to have even more information and then to reach out to get the vaccine in whatever way it's the easiest.

Sometimes it's not the easiest to go to a healthcare provider because you can't get an appointment or there are other roadblocks. Well, that's why it's now fortunately, commonly available here in America at just about any drug store, most county public health departments. So availing oneself of what's pretty easy to get is what's important.

Host: Right? Yeah. However you do it, do it, I guess is the message. Are there some other personal habits, Doctor, that we could help you know, stave off the flu? Obviously we we're stressing here today, the vaccine is critical, but beyond that, is it washing hands, wearing masks, that kind of thing?

Like, what else can we do to help ourselves?

David Main, MD: Well, absolutely. It would be really frequent hand washing, especially after, you know, you've touched something that maybe someone else has handled that, you know, is ill or might be ill. Avoiding touching your mouth, touching your face with your hands, definitely cuts down on that virus transmission.

Host: Yeah, I, I read somewhere, Doctor, this is purely anecdotal, but I, I read somewhere at some point during COVID just, how often or how much we all touch our faces during the day, right? Rubbing our eyes, touching our mouth, things like that. I don't know if it's like 90, a hundred times a day, something like that.

And when you think about that, how often, if you really think how often we touch our faces, good idea to wash our hands, right? Maybe use hand sanitizer, that kind of thing, right?

David Main, MD: Absolutely. And I think since the COVID outbreak years ago, we've become pretty familiar with that. And so yeah, no, that's the right answer.

Host: Right. For sure. I want to have you talk about antiviral therapy for flu prevention. Like what is that? How does that work? That sort of thing.

David Main, MD: Well, just quickly about that, there are a few medications that serve the purpose of fighting a virus, once the virus is in the body. So the most common one is called oseltamivir or Tamiflu, is it's drug name.

Host: Sure. Yeah.

David Main, MD: It's a medication to take by tablet. And of course it's usually used in people who already have the flu symptoms and if taken within a few days of onset of the symptoms, it, it does help prevent severe illness. But for prevention, it can be used especially for people in households,  where there's someone that's a high risk of having a severe influenza complication, or people themselves who are high risk of complication and they've been exposed. and they've been exposed

Host: Okay. Yeah. So obviously, uh, the vaccines to help prevent or limit the severity of the flu, obviously, you're mentioning there are a couple of treatment options. Just wondering, Doctor, you see, you know, lots of folks, talk to lots of folks about this in your capacity as an expert, as a doctor. What are some of the frequently asked questions that you get?

David Main, MD: Well, people are going to ask, can the flu and COVID vaccine given be given at the same time? And they certainly can.

Host: Okay.

David Main, MD: We've already touched on can the flu vaccine cause the flu? We've already touched on that. It cannot. And, sometimes here in recent years, people ask about bird flu and we might talk a few moments about bird flu.

Host: Yeah. Is there any connection I wanted to ask you? That was actually my last question I had for you today was about the bird flu and just because it has the word flu in it, is there any connection to regular influenza? You know, help us sort that out.

David Main, MD: It is the influenza virus. It's a different strain. It's different in so many ways. Different in the sense that, when there have been outbreaks of bird flu being transmitted to humans, they, it tends to be worse than typical flu. People are quite ill, death rates being higher. So, bird flu would be nothing to ignore.

Fortunately there have not been many outbreaks as yet in this country. It all happens according to the biology or the, the natural, actions of the flu virus, when it, uh, attacks a bird or other animal population. And that's what makes it, a little bit unknown, what to predict in the future.

So, yeah, it's something to be aware of. There has been bird flu identified in some wild birds here locally in the last year. As far as we know, there have not been hospitalizations related to it. It's just something to be aware of. And, we'll see in the future just how that plays out.

Host: Right. Well, I certainly appreciate your time and your expertise today. Just want to give you a chance here at the end, final thoughts, takeaways. You know, when it comes to the flu, I like to put my faith in the experts that you tell me to get vaccinated. That's what I did. But from your perspective, the takeaways for folks.

David Main, MD: Well, I think that's really, the key takeaway. Get the vaccine if you're at all able. Keep those hands away from your face. Last thing I, I might mention, if you are around someone you know has the flu, asking that person to wear a mask to protect yourself. From their spreading the virus would be reasonable and also reasonable for you, yourself to use a mask in that setting.

Host: Absolutely. Well, again, I appreciate your time today. You know, it comes up every year. We have flu season every year. We always want to emphasize the importance of vaccines, those who can get it, you know, and the benefits of course. So, thanks for your time. Appreciate it.

David Main, MD: Sure, my pleasure.

Host: For more information and to get connected with one of our providers, please visit carle.org. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I'm Scott Webb. Stay well.