Alternatives to Flu Shots

Flu shots are no longer available—many options: prescription antivirals, supplements and lifestyle

The news media is creating a mood of hysteria that is making moms feel guilty over not getting shots for their kids. Others feel like they have been negligent in their own care, and some are angry because they arranged to have their flu shots in late December and were not expecting the country to run out of vaccine.

Putting the situation into perspective, until a number of children died in Colorado, there was no compelling reason to think that this flu season was different than any other year. In a non-hysteria year, only about 1 in 5 people get flu shots. Last year, 12 million vaccines went unused.

The US Public Health Service recommends influenza vaccine for all persons over 50 years old, and encourages vaccination of healthy children 6-23 months old because they are at increased risk for hospitalization due to influenza infection.

We at YaffeRuden do encourage nearly everyone who cannot afford the time to be sick to get flu shots! We generally give about 3,000 per year in our office, and most of our other patients get their shots at their workplace.

The flu shot is not a live virus, so it cannot cause flu. It can occasionally cause an allergic response, including feeling feverish and achy for a day. We generally give flu shots through mid-January, as the flu often doesn't peak until February.

This year 99% of flu is type A. 25% of the flu so far is antigenically identical to the vaccine, and 75% is relatively similar, the Fujian strain, which will only be partially blocked by the vaccine.

(CDC has antigenically characterized 212 influenza A (H3N2) viruses collected by U.S. laboratories since October 1 and found that 54 (25%) were similar antigenically to the vaccine strain A/Panama/2007/99 (H3N2), and 158 (75%) were similar to the drift variant, A/Fujian/411/2002 (H3N2). The A/Fujian strain predominated in Australia and New Zealand during the recent Southern Hemisphere influenza season and is a drift variant related to the vaccine strain, A/Panama/2007/99. Antibodies produced against the vaccine virus cross-react with A/Fujian/411/2002-like viruses, but at a lower level than against A/Panama/2007/99 (H3N2). Vaccine effectiveness depends, in part, on the match between vaccine strains and circulating viruses and cannot be determined by laboratory testing. Although vaccine effectiveness against A/Fujian/411/2002-like viruses may be less than that against A/Panama/2007/99-like viruses, it is expected that the current U.S. vaccine will offer some cross-protective immunity against the A/Fujian/411/2002-like viruses and reduce the severity of disease. One influenza A(H1N1) virus was antigenically characterized and was similar to the vaccine strain A/New Caledonia/20/99.)

The last three flu seasons have been mild, and this year the strain seems to be a little more aggressive and it is hitting earlier. Hopefully SARS will not re-emerge with any intensity, as this could really confuse the winter flu picture. So far, so good on that account.

So with no flu vaccine imminent, and the strain of the vaccine being slightly off from the mutated virus that is actually occurring, what are your options?

Flumist, nasal flu vaccine may still be available by prescription in some drugstores. It should be used only by healthy people (ages 5-49) as it is a live virus and can cause the flu if someone is immune suppressed. It should not be given to family members or health care workers in contact with people whose immune systems are compromised.

Flumadine, amantidine, Relenza and Tamiflu are prescription anti-flu antivirals that can be given preventatively in some cases (there are side effects), or therapeutically if one is sick. Flumadine or amantidine can be taken for 7 days to treat the flu, and for up to 10 days in situations where prevention is critical. These drugs can prevent about 80% of type A flu only, not type B. Pediatricians can give these to kids 12 months and older. Insomnia, lightheadedness, nervousness, difficulty concentrating, delirium, hallucinations and seizures can occur in patients taking amantadine. These symptoms, which occur at recommended doses, are more common in the elderly and with concurrent use of anticholinergics or antihistamines. Flumadine also has similar effects, but they are less frequent than with amantadine. Both are given 100mg twice daily. Tamiflu is used in patients 1 year and older who have had flu symptoms for no more than 2 days. 75mg is given twice daily for 5 days. It is effective in 70-90% of type A and B flu if given early enough. Relenza is an inhaled antiflu treatment which must be started within 2 days of symptoms. Two inhalations must be taken twice daily for 5 days. Side effects include throat irritation, headaches and cough, and wheezing.

There are a number of vitamin and herbal supplements that seem to boost resistance to not only the flu, but to all viruses. We have a few of these in the office (Ultra-potent Vitamin C, Super Garlic 6000, and Mycoferon), and others are available in health food stores. Many of us who cannot afford to be sick, keep these very handy for ourselves, our significant others, and our schoolchildren!

Ultra-Potent C-1000 is a product of Metagenics that enables better absorption, better tissue retention, and slower metabolism of ascorbic acid. It really is ultra-potent. 1000mg per day preventatively has been very effective personally, and we have been seeing far fewer colds in patients on this specific preparation. Vitamin C has been used a supplement for a long time. In 1981, Ester-C was developed which led to greater Vitamin C absorption and efficiency. It is felt that Ultra-Potent Vitamin C further enhances and prolongs tissue function. There is surprisingly little orange urine after using Ultra-Potent Vitamin C. At the first sign of a cold, increase to 3000mg daily. Available in the office and on the supplement site of the office.

Ultra Potent-C 1000 is a patented vitamin C formula that is designed to promote the uptake of ascorbic acid by body tissues and prolong its biological activity. This is important because multiple factors can negatively affect vitamin C activity and retention in the body. Due to its one-of-a-kind formulation, Ultra Potent-C 1000 may provide your patients with greater benefits than supplementation with regular vitamin C (ascorbic acid). Greater benefits may result in greater compliance by your patients and improved long-term clinical results associated with vitamin C nutrition.

These benefits include: A blend of mineral ascorbates that buffer the vitamin C to prevent potential irritation to the GI tract, thus increasing tolerance of high vitamin C intake.

Bioavailable ascorbic acid in both water- and fat-soluble forms for enhanced absorption. A metabolite support system of nutrients such as glutathione, lysine, and cysteine, which further enhance the retention and beneficial effects of vitamin C.

Metabolites of ascorbic acid such as xylitol and alpha-d-ribofuranose, which tend to slow the breakdown of ascorbic acid.

Mycoferon is a mushroom extract that boosts the immune system, and functions to prevent and treat all upper respiratory infections, including the flu. It can be used as a dropperful daily during the cold season, and at the very first sign of a sore throat—that feeling that a cold is coming on—dosage should be increased to a dropperful every couple of hours. I (Dr. Yaffe) have been using this personally for 10 years, and it has worked incredibly well on at least 4 occasions when it stopped the sore throat/cold in its tracks! It must be taken within a couple of hours of the virus getting into the system for it to be of any significant benefit. So you must keep it with you! We have it in the office, and is safe for anyone over the age of 10. It tastes likes mushrooms. Available in the office and on the supplement site of the office.

Super Garlic 6000 has been found to have excellent immune boosting function. It can be taken during cold season, and all year long with the additional benefit of cardiac protection, and triglycerides lowering. Super Garlic 6000 is enteric coated so it dissolves in the intestine and there is no garlic taste. Available in the office and on the supplement site of the office.

Echinacea (without goldenseal) boosts the immune response according to many responsible studies. It should be used for a couple of weeks at a time, and then it should be stopped for a week, in order for the immune system to recover. Goldenseal increases nasal mucosal function and is best used when there is a cold, not preventatively!

Zinc lozenges tend to shorten the duration of colds, especially if used early. The lozenges should be used every 2 waking hours, and can cause mild nausea. Zinc nasal spray (Zicam) may also be beneficial. Available in drug stores.

Olive Leaf Extract is available in health food stores and we have received some very good feedback on it both as prevention and as therapy.

Elderberry (Sambucol) is an herbal available in health food stores that tends to be effective especially if taken at the very beginning of an infection.

Dr. Alan Greene, pediatrican, wrote a wonderful column on his thoughts about practical measures to avoid flus and viruses.

When possible, I try to help keep my immune system functioning in peak form. Getting good nutrition (plenty of fresh fruits, vegetables, whole grains, and supplements for the areas in which my diet is not adequate) is a foundation for good health. Plenty of good sleep is vital. Plenty of activity, and lots of love and laughter both strengthen the immune system Avoiding inordinate stress helps too.

Whatever shape your immune system is in, it makes sense to minimize the overwhelming numbers of disease-causing germs you are exposed to. There are four key ways to do this:

Decrease the disease-causing germs on surfaces in the home.

Where are these germs truly a problem? Where does this really make a difference? In a number of different fascinating studies, researchers have carefully cultured every imaginable surface of typical homes to find where the disease-causing germs live. It turns out that the kitchen harbors more germs than any other room in the home -- yes, more than the bathroom. The greatest concentration is found in the moist germ havens we call kitchen sponges and dishcloths. These are the very same germs with which people in that household get sick. Sink drains, faucet handles, and doorknobs -- either in the kitchen or bathroom -- are the next highest on the list. Toilet seats had fewer germs than any other surface tested (Journal of Applied Microbiology, 1998;85(5):19--28)! If we can keep these objects clean -- especially the sponges and dishcloths -- we can cut the spread of infection.

But here's the problem:

Tossing a dishcloth in the washing machine, even with a strong detergent, doesn't appreciably cut down on surviving germs. The micro-crevices that make a sponge such an effective cleaning device make it even more difficult to disinfect. Running a sponge through the dishwasher makes it look clean but leaves it just as infectious. Even strong chemical disinfectants often aren't enough to disinfect them (Journal of Applied Bacteriology, 1990;68(3):279--283).

What can you do?

Wet your sponge or dishcloth and then pop it in the microwave for 2 minutes. Then you'll have safe, germ-free tools to use. For items that you can't microwave, such as faucet handles, a household cleaning solution containing hypochlorite is the best for cleaning, but be sure to rinse thoroughly (Journal of Applied Microbiology, 1998;85(5):819--828).

Decrease disease-causing germs in the air we breathe.

I use every opportunity to teach children (and adults) to cover the mouth and nose for every cough and sneeze. This simple maneuver has spectacular results in decreasing the aerosolized viruses and bacteria floating about the room for us to inhale. Of course, this does leave the hands or tissues teeming with germs, but we'll deal with that in a moment.

To keep the air clean, I also rely on special air filters. These high-efficiency particulate-arresting (HEPA) filters, available at discount drug stores for about $40 to $100, can remove 99.97%+ of the pollen, dust, animal dander, and even bacteria from the air. They are especially effective at preventing infections for those that get a bit stuffy from allergies but can also decrease respiratory infections for everyone. I have several in my pediatric office (you know what waiting rooms are like!) and several in my home, so that the room air is completely filtered six times an hour. Houseplants are also excellent air purifiers (if no one is allergic), although they work much more slowly.

Avoid antibiotic soaps (except for medical scrubbing).

At this year's science fair at my children's school, young students performed an elegant experiment using antibiotic soaps. They put a few drops of the soap in one test tube, a few drops diluted 10x in water in the next, a few drops diluted 100x in water in the next, and a few drops diluted 1000x in water in the final tube.

They took normal bacteria from classmates' hands and placed a sample in each tube. All hand bacteria were killed in the first three tubes, but a few survived in the most dilute tube.

They kept these survivors, grew them in an incubator, and repeated the experiment using these hardy bacteria. This time they were able to survive in two of the test tubes. By continuing this process, they were able to breed increasingly resistant bacteria.

The children reasoned that whenever we wash our hands, some areas around the edges get only dilute concentrations of soap. This is the ideal breeding ground for the bacteria we want to avoid. They proved that, as is the case with oral antibiotics, antibiotic soap can produce increasingly troublesome bacteria.

In most cases, antibiotic soap gives no added benefit, and may even increase your chances of getting sick. Note: disinfectants (on surfaces) and antiseptics (on people) mechanically destroy germs. They are different than antibiotics and are useful in preventing infections.

Wash hands at many important times throughout the day.

Most common infections are "caught" when the germs get on our hands and then we touch our eyes, noses, or mouths. Proper hand washing is an enormously effective method of prevention. I wash my hands before and after seeing each patient in my office. I recently underwent neck surgery. I'm more pleased that my neurosurgeon scrubbed his hands thoroughly than that he wore sterile gloves. Hand washing is more important.

Even in 1999, lack of proper hand washing remains the number one source of infections acquired in hospitals (Annals of Internal Medicine, 1999;130(2):126--130)! Practicing what we already know could prevent unnecessary suffering and misery.

The same is true for children. In a recent study of 341 children's daycare centers, infrequent washing of children's or providers' hands after nose wiping, after diapering, before meals, and before food preparation was spectacularly associated with a higher frequency of illness. Use of shared cloth towels instead of individual paper towels and washing of sleeping mats less than once a week were also associated with a higher frequency of illness. Hand washing and other hygiene practices actually do reduce the spread of disease (Public Health, 1998;113(6):544--551).

The most important times for most of us to wash our hands are after sneezing or coughing, after toileting, upon leaving "high-risk" places (pediatrician's waiting rooms, ball pits, daycare centers, fast-food chain play structures, high-traffic door knobs, etc.), and always upon arriving home (to keep outside germs outside). Of course, hand washing before meals and snacks is a must. (Before a child picks his or her nose would be nice but is not always practical.)

Lots of water and a moisturizing soap are a great way to wash, but this isn't easily available at all the right moments. I've found a recent innovation to be portable, practical, and fantastic. Instant Hand Sanitizers, pioneered by Purell, are a wonder (they are now available in many other brands). Talk about convenient! A small bottle can be carried about in a purse, glove compartment, or even a hip pocket. A little dab will kill 99.99% of germs without any water or towels. It uses alcohols to destroy germs physically. It is an antiseptic, not an antibiotic, so resistance can't develop. They've added moisturizers and vitamin E to counteract the drying tendency of the alcohols. A few people find it irritating to the skin, but most find it refreshing to use and that their hands feel smooth and soft afterward. You may want to use an additional moisturizer.