You Don't Need the Flu Shot. Unless You Do

Sud

denly, everyone in America wants a flu shot. Companies are throwing open their in-house clinic doors while highly visible public figures like New York Mayor Rudy Giuliani urge everyone to rush out and get immunized. Getting a flu shot, the logic goes, means staying healthy during the looming flu season. Perhaps and, perhaps more important, it means warding off symptoms that might be confused with anthrax infection.

Fair enough, health officials concede. But there is a catch that seems lost on many anxious Americans: There simply is not enough flu vaccine to go around. CDC estimates put the best-case dosage figures at 87 million — hardly enough to cover all 300 million U.S. citizens.

This means, health officials explain, that healthy folks should hold off on their vaccine for the moment, at least until the elderly and the chronically ill are immunized. It’s not that doctors don’t understand the public’s concern: About 20,000 Americans die each year from the flu and 114,000 are hospitalized. The majority of those cases, however, occur in the elderly or people with weakened immune systems — people whose bodies, in other words, are not prepared to deal with the onslaught of a powerful virus.

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Even getting the flu shot doesn’t mean you won’t get the flu, doctors emphasize; the success rate for the current vaccine ranges between 70 and 90 percent. And no shot, of course, can guard against the equally nasty, far more common viruses that circulate all year round — or the dreaded winter cold.

In an attempt to sift through current news about the flu and flu shots, TIME.com spoke with Dr. Jennifer Daly, clinical chief of infectious disease and immunology at the University of Massachusetts hospital and UMassMemorial Healthcare in Worcester.

TIME.com: Who should be first in line to get a flu shot?

Dr. Jennifer Daly People who should definitely get vaccinated are those with asthma, heart disease, kidney disease or any other long-term health problem. Anyone with an immune defect, cancer, transplant, or HIV/AIDS should also get a shot. As should women who are pregnant and will be in their second or third trimester during flu season (winter), health care workers and essential community workers. We also suggest that people in dorms or other crowded living conditions go ahead and get the vaccine.

We generally start vaccinating high-risk patients in October, people over 65, those with long-term illnesses. In November, we move down to people over 50 and others at lower risk. It’s important that we stagger the vaccine distribution in order to match the supply to the need.

Are there people out there who should not get a flu shot?

Those who’ve had a serious allergic reaction in the past to flu shots, serious allergy to eggs, or history of Guillain-Barré syndrome should not get a flu shot. Beyond that, the flu shot is pretty well tolerated, although doctors will sometimes tell patients who have a fever to come back in a week for the shot.

What are the possible side effects to the vaccine? What should people expect after getting the shot?

Some people have some soreness in their arm, as with any shot. Occasionally, people get some body aches or a low-grade fever. They will not get the flu from the vaccine.

What exactly does the current vaccine guard against?

Each influenza season, immunologists look at the strains that have been predominant in the rest of the world during the year, and try to decide which strains will be coming to our area. This year they’re using three different antigens to create the best vaccine against the types of flu coming here.

Some years, of course, a strain hits that’s not part of the vaccine, and those are the years we see a lot of cases. (A few years ago, for example, we got hit with the A-Sydney strain).

And finally, the $64,000 question: Are there any outward distinctions between anthrax and the flu?

Runny noses and sore throats are more likely seen with influenza, they’re not seen with anthrax.

We’re learning more about inhalational anthrax as we see more cases. Using an X-ray or a CAT scan, a doctor will be able to see inflamed lymph nodes in the patient’s chest, and that’s a telltale sign of anthrax.