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Flu Vaccine


About Influenza ("Flu") Vaccine

Influenza, or the "Flu", is a respiratory infection caused by a Virus. Every year, approximately 5% - 15% people get the infection. Most people have an uneventful recovery from the Flu, although it can lead to serious complications and even death in others.[5]

The Flu is Contagious 24 hours before Symptoms are felt so transmission of the disease can occur from people before they even realize they have been infected.[6]

The Flu Virus changes often so it is necessary to get the Flu Vaccine every year.[11]

The Flu Vaccine can help prevent the Flu or reduce Symptom Severity, and likelihood of complications including death.[5]

Vaccination is most effective in healthy, young people (not babies), although older persons and those with preexisting conditions can often benefit.[5]

Risks associated with Flu Vaccination are usually mild.

Symptoms of the "Flu"

Not all patients with the Flu will have all symptoms. Flu symptoms are similar to the common cold but the Flu is more severe and affects the entire body where the common cold typically affects the head and neck. Typical symptoms of the Flu include:
Diarrhea (more common in children)
Fever - 100 degrees or higher (not everyone has a fever)
Myalgia (sore muscles / body aches)
Nausea (more common in children)
Sore Throat
Stuffy and/or Runny Nose
Vomiting (more common in children)

Who is at Risk for Flu Complications?

Certain High Risk Groups can have a higher likelihood of complications (including death) from the Flu. These complications can include Exacerbation of Current Illness, Bronchitis, Heart Attack, Myocarditis, Pneumonia, Stroke, etc. Although the Flu causes respiratory symptoms and can lead to Pneumonia, the virus reproduces in the heart in 10% of patients. This can lead to heart complications and even heart failure. Heart involvement is more prevalent in patients with severe Myalgia symptoms.[2]

High Risk groups include:
Certain Age Groups
- Babies, the Very Young - 5 Years and younger
- Older Persons - Over 65

People with certain Conditions or Diseases, including:
- Asthma / COPD / other Lung Diseases
- Cancer
- Cirrhosis of the Liver
- Epilepsy
- Heart Disease
- High Blood Pressure
- Diabetes
- Immunosuppressed Persons
- Infections (ex. HIV / AIDS)
- Kidney Disease / Kidney Failure
- Pregnant Women
- Transplant Patients

Prevention of the Flu: Vaccine

Vaccination is important if you are a "High Risk" group or in contact with "High Risk" persons (example: Caregivers or if you live with someone in a "High Risk" group).

If you have trouble affording vaccines for your child, the Vaccines for Children Program (VFC) may be able to help. Please see Vaccines for Children Program (VFC)

Children under the age of 6 months are not able to receive the vaccine.[3]

Children between 6 Months and 8 Years of age should have two doses of Influenza Vaccine about 4 weeks apart.[4]

The "Flu", Vaccines, and IBD

People of High Risk for complications from the Flu are encouraged to get the Flu Vaccine. Patients with Inflammatory Bowel Disease (IBD) generally respond well to the Flu Vaccine. However, a study in Children with Crohn's Disease indicates they may be less likely to obtain immunity following Flu Vaccination. This is primarily true for Vaccines against the Influenza B Virus.[1][11]

In general, IBD patients are recommended to have standard Vaccines (as always, check with your doctor). Vaccine recommendations may vary depending on Immunosuppression level.[11]

Immunosuppression and Vaccines

Patients on Immunosuppressive Therapies or who have less functional Immune Systems are at higher risk for many illnesses including Flu complications. This risk varies depending on the type of therapy and the patients level of Immunosuppression. Although most patients tolerate the Flu Vaccine well, Immunosuppression reduces the rates of Vaccine effectiveness.[1][9][11]

Many therapies used to treat patients with Crohn's Disease include medications that suppress the Immune System.

IBD patients on Combined Immunosuppressive Therapy have a less effective response to Vaccine than patients on Immunosuppressive Monotherapy.[11]

Although many IBD patients could benefit from Vaccination, only a small number actually receive them (Influenza Vaccine, 28%; Pneumococcus Vaccine, 9%).[13] Low vaccination rates are largely due to the patient not being made aware of Vaccine recommendations by their health care providers.[13][14] The healthcare providers themselves may not be fully aware of Vaccine recommendations and contraindications. One report states 20%-30% of Gastroenterologists would recommend Live Virus Vaccines to Immunosuppressed patients[14] (Live Vaccines are contraindicated in Immunosuppressed individuals).

Although a minority of IBD patients actually receive the indicated Vaccinations, one questionaire based study stated 80% were willing to receive Vaccines recommended to them.[15]

Low Vaccination rates among IBD patients may also be the result of the belief among certain Gastroenterologists that Vaccinations should be performed by the patient's General Practitioner (GP) or Primary Care Provider (PCP).[14]

Some patients (22%) do not receive Vaccinations due to fear of side effects[15] or that Vaccinations may worsen their symptoms of IBD.[15]

In order to reduce the risk of severe infections in patients with IBD, certain Vaccines are recommended:
  • Hepatitis A
  • Hepatitis B
  • Human Papillomavirus (HPV) Types 6, 11 16, 18 (Gardasil)[11][12]
  • Influenza (the "Flu") - Trivalent Inactivated Vaccine (TIV) [11]
  • Meningococcus (MCV4 or MPSV-4)[11]
  • Pertussis (PV13 or PPSV23)- prior to Immunosuppression Therapy, if possible[11]
  • Pneumococcus (Tdap or DTaP) - prior to Immunosuppression Therapy, if possible[11]
  • Tetanus (Td, Tdap, or DTaP) [11]

The Following Vaccines are NOT Recommended for IBD patients on Immunosuppressive Therapy:
  • Anthrax Vaccine
  • Herpes Zoster (Live Vaccine)
  • Influenza (the "Flu"), Live, Attenuated Vaccine - Nasal Spray
  • Measles Mumps Rubella Vaccine (MMR)
  • Polio (Live, Oral Vaccine)
  • Smallpox
  • Tuberculosis Bacillus Calmette-Guerin
  • Typhoid (Live, Oral Vaccine)
  • Varicella Zoster
  • Yellow Fever

Flu Vaccine by Nasal Spray or Injection?

The Flu Vaccine can be administered using a Nasal Spray or by Injection. There are some key differences between the two types of Vaccination.

Nasal Spray Vaccine, FluMist

The Nasal Spray Flu Vaccine is also called the Live-Attenuated Influenza Vaccine (LAIV), or FluMist (MedImmune).[7] Although this method may be preferred by persons with a fear of injections, certain people should not receive this method of the Flu Vaccine.
Aspirin Therapy
Children and Adolescents on Aspirin Therapy should not receive the Nasal Spray Vaccine.[7]

Egg Allergy
The Nasal Spray Flu Vaccine should not be taken to people who are allergic to Eggs.[4]

History of Hypersensitivity / Severe Allergic Reaction
Patients that have had a severe Anaphylactic Reaction, Hypersensitivity or Allergic reaction to the Vaccine or any of the Vaccine's ingredients should not receive the Flu Vaccine (Injection or Nasal Spray).[6][7]

Do not receive the Vaccine if you have had a Severe Allergic Reaction (Anaphylaxis) to any of the following:
Nasal Spray Vaccine (FluMist):
Egg Protein

Persons that have a weakened Immune System should not receive the Flu Vaccine Nasal Spray. This Vaccine contains weakened Live Virus. Although rare, it is possible for those with less functional Immune Systems to actually become ill with the Flu.[4]

Healthcare workers and persons living with, or in contact with Immunosuppressed IBD patients should not receive the Live, Influenza Nasal Spray because Live Virus can be cast off for multiple days after Vaccine is given.[14]

Pregnant Women
Pregnant women should not receive the Nasal Spray Flu Vaccine.[4]

Reactive Airway Disease
The Nasal Spray should not be given to people with Reactive Airway Disease or Wheezing.[6]

Very Young and Elderly Persons
The Nasal Spray Flu Vaccine is only for healthy persons between the ages 2 and 49 Years. These persons may instead choose to receive the Flu Vaccine by Injection.[4]

Injected Flu Vaccine

The Flu Vaccines for Injection is offered in multiple different formulations:
Fluarix® Quadrivalent[9]

Egg Allergy
The Flu Vaccine for Injection may be received by persons with mild Egg Allergy symptoms (ex. Hives), but is not recommended for those with severe Allergies (ex. Anaphylaxis).[10] As always, check with your doctor.

Febrile Seizures
There is a low risk for Febrile Seizures in Children receiving the Flu Shot.

History of Hypersensitivity
Patients that have had a severe Anaphylactic Reaction, Hypersensitivity or Allergic reaction to the Vaccine or any of the Vaccine's ingredients should not receive the Flu Vaccine (Injection or Nasal Spray), or should be appropriately monitored by health care personnel after Vaccination[6][7][9]

Pregnant Women
Some formulations of the Injected Flu Vaccine are Pregnancy Category B or C Drugs and can be administered to Pregnant Women (check with your doctor)[9][19]


A new Intradermal Flu Shot exists, Fluzone Intradermal (Sanofi Pasteur). This Vaccine is given Intradermally, or within the skin, instead of into the muscle. This shot requires less Antigen and less fluid per injection. The needle is also 90% smaller than the needle used for the standard Intramuscular flu shot.[17]

Vaccine Ingredients

Many Vaccines contain Antibiotics, but may only contain trace amounts.
  • Gentamicin in Fluarix,[16] FluMist[16]
  • Neomycin in Afluria,[16] Fluvirin[16]

Egg / Egg Protein / Ovalbumin
All Flu Vaccines are prepared by placing the Influenza Virus into Eggs. The quantity of Egg Protein, or Ovalbumin, remaining in the Vaccine after purification varies between each Vaccine and between batches (Lot Numbers) of Vaccine.[18]

Pharmaceutical companies are not required to list the amount of Egg Protein / Ovalbumin in each Vaccine. However, some companies do choose to list it in the Package Insert or will give this information when requested.[18]

People with Severe Egg Allergy (Anaphylaxis) can also have a Severe Reaction to the Egg Protein in the Flu Vaccine. However, some people with mild Egg Allergy can still receive the Flu Shot. Please consult with your doctor.[18]

Sometimes, the Flu Vaccine will be given in two doses to those with Egg Allergy. The first dose is usually a very small dose followed by close observation of the patient. If there is no reaction the person may be given the remainder of the dose later.[18]

Many vaccines contain very low amounts of the Mercury based preservative, Thimerosal. Thimerosal prevents contamination of vaccines by bacteria and fungi. If you have an allergy to Thimerosal you can request that your doctor order (in advance) a Flu Shot that does not contain Thimerosal[8] (ex. Fluarix)[9]


1. deBruyn JCC, hilsden R, Fonseca K, Russell ML, Kaplan GG, Vanderkooi O, Wrobel I. Immunogenicity and safety of influenza vaccination in children with inflammatory bowel disease. Inflammatory Bowel Diseases. 2012; 18(1): 25-33. doi: 10.1002/ibd.21706

2. Rezkalla SH, Kloner RA. Influenza-related viral myocarditis. Wisconsin Medical Journal. 2010; 109(4): 209-213. https://www.wisconsinmedicalsociety..../109/4/209.pdf

3. Your one-stop access to U.S. Government seasonal, H1N1 (swine), H5N1 (bird), and pandemic flu information. Accessed January 2013. Also Try Flu Vaccine Finder

4. Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP) — United States, 2012–13 Influenza Season. Morbidity and Mortality Weekly Report (MMWR). Updated August 17, 2012. 61(32): 613-618. Accessed January 2013.

5. Greene LR, Cox T, Dolan S, Gray P, Khoury R, Kulich P, Myers FE, Ludlow C, Streed S. APIC Position Paper: Influenza vaccination should be a condition of employment for healthcare personnel, unless medically contraindicated. APIC. 2011. Accessed January 2013.

6.Influenza Vaccine Pocket Guide - Immunization Action Coalition. Accessed January 2013.

7. FluMist[R] (Influenza Vaccine Live, Intranasal). Intranasal Spray. 2012-2013 Formula. Initial U.S. Approval: 2003. Highlights of Prescribing Information. MedImmune. Accessed January 2013.

8. Immunization Action Coalition. Accessed January 2013.



11. Dezfoli S, Melmed GY. Vaccination issues in patients with inflammatory bowel disease receiving immunosuppression. Gastroenterol Hepatol (N.Y.). 2012; 8(8): 504-512.


13. Melmed GY. Vaccinations and the utilization of immunosuppressive IBD therapy. Gastroenterol Hepatol (N.Y.). 4(12): 859-861.

14. Boroujerdi-Rad L, Melmed GY. Vaccination considerations for patients with inflammatory bowel disease. Inflammatory Bowel Disease: A Practical Approach, Series #70. 2011: 33-40.

15. Teich N, Klugmann T, Tiedemann A, Holler B, Mossner J, Liebetrau A, Schiefke I. Vaccination coverage in immunosuppressed patients. Dtsch Arztebl Int. 2011; 108(7): 105-111.

16. Epidemiology and Prevention of Vaccine-Preventable Diseases. Appendix B: Vaccine excipient & media summary. Excipients included in U.S. vaccines, by Vaccine. The Pink Book: Course Textbook. 12th ed. 2012. Updated February 2012; Accessed January 2013.

17. Intradermal Influenza (Flu) Vaccination. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD). Updated July 2012; Accessed January 2013.

18. Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011. Morbidity and Mortality Weekly Report (MMWR). August 26, 2011; 60(33);1128-1132. Accessed January 2013.

19. Prevention and Control of Influenza with Vaccines. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Morbidity and Mortality Weekly Report. August 6, 2010; 59(RR-8). Accessed January 2013.

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01-07-2014, 09:10 PM   #1
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Join Date: Jan 2010
Location: Grimsby, United Kingdom
Reasons why to get the flu jab
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2x 1200mg Mezavant, 3x50mg Azathioprine, Infliximab (6 weekly)
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