Influenza (flu) vaccine?

[mantana]

Some facts about influenza vaccine and influenza (the way I understand it at least):

- the vaccine protects against 3-4 strains of influenza, depending on manufacturer, type etc.

- the vaccine changes slightly each year, due to highly evolving nature of the influenza virus - because of this, vaccine efficacy varies each year and is only around 50–60%

- one develops antibodies 2-3 weeks after vaccination

- protection offered by vaccine takes only around 6 months, and already starts to wane 3 months after vaccination

- influenza is seasonal - and seasons are different in different parts of the world (northern, southern, or central); for example, in my country, influenza season is said to begin in the middle of September, ends in the middle of April, with the highest infection rates in January, February, March.

I've heard from a family doctor, and also read in some articles, that due to the fact that the influenza vaccine only offers 6 month protection, and because highest influenza activity begins quite late in the season - one should not vaccinate right at the beginning of influenza season, but rather, should wait a month or two. While this can appear to make sense, there are also plenty of arguments to do the vaccination as early as possible, and the answer can really differ by individual circumstances.

How about us with CLL? Should we get influenza vaccine as soon as it's available? Should we wait? Take two influenza shots in a year? Any thoughts - especially science-backed - appreciated!

[lankisterguy Volunteer]

Hi mantana,-

My CLL expert doctor has suggested getting the strongest available shot ( this year it is called a Senior dose for those over 65 years old). And getting one dose at the start of the season and a 2nd dose in early January.

-

Len

[cllady01 Former Volunteer in reply to lankisterguy]

As I am just beginning treatment with V+O, I got the high dose senior shot in August, as suggested by my Dr. rather than getting it during treatment. I will be inquiring about a possible 2nd Flu during treatment. It won't hurt to have the discussion, may give incentive to conversation between the Specialists/researcher Drs.

[Hidden]

mantana & Len,I agree with both of you, two shots a year for immunocompromised people is reasonable.

[LeoPa]

I got the flu shot last year for the first time in my life. I think it was a mistake. I won't be getting it this year. I'll just do my best to not catch covid or the flu. If I manage to avoid covid I won't get the flu either. If I get one I'll probably get the other one too. In that case the flu will be the least of my problems.

[mantana in reply to LeoPa]

> I think it was a mistake

Why do you think flu vaccination was a mistake? Could you elaborate?

> In that case the flu will be the least of my problems.

Flu with covid co-infection increases disease severity and mortality:

virologyj.biomedcentral.com...

nature.com/articles/s41422-...

[LeoPa in reply to mantana]

My ALC was fairly stable around 4.5 before the flu shot. Two months later I went for a CBC and it was 5.6. That was a huge jump for me. All of a sudden my HCMBL started to look like on the way to mature into CLL. Half a year later it was a bit less but still above 5. Then I went for the covid shots. Next bloods in 2 months and I'm concerned about what numbers I will see this time. It will be 4 months after the second covid shot. I am wary of trying to grab the sleeping rattlesnake by the tail. Taking vaccinations feels like doing just that. I'd rather leave my immune system alone. It's broken, so why keep provoking it unnecessarily. Who knows, vaccines might speed up progression and that's the last thing I want. The covid shot - ok, there is a risk reward consideration. But catching both at the same time is highly unlikely for me.

[mantana in reply to LeoPa]

> But catching both at the same time is highly unlikely for me.

Please decide - a few hours later you claimed exactly the opposite: "If I get one I'll probably get the other one too. "

😀

[LeoPa in reply to mantana]

Yes. But not at the same time. What I meant to say is that it is very unlikely that I catch either one and even more unlikely that I catch both at the same time. I'm a certified recluse working from home 😁 I do get out to do the shopping, properly masked one leg in one leg out no fooling around. I take care to pick slack times in the shop when there are not many people around. I don't use public transport. I ride a bike everywhere and if it's out of town I use a car. The only person I could catch this from is my wife but she is double vaccinated, and that is a risk I have to take. Oh, and she is quite the recluse too 😁

[HopeME in reply to LeoPa]

Leo

If you had a tooth ache after receiving your flu shot would you assume it was caused by the shot?

Best

Mark

[LeoPa in reply to HopeME]

Of course not. But I don't believe in coincidences either.

[HopeME in reply to LeoPa]

Your answer is contradictory. Immunology is a complicated subject best left to the experts.

Best

Mark

[LeoPa in reply to HopeME]

I don't think it's contradictory. What's contradictory about seeing your lymphocyte numbers go up after a flu shot? That's why you take the shot because you want to produce antibodies no? But 8 months later I would have expected them to go back to the previous count, with a few memory cells remaining circulating and they did not.

[HopeME in reply to LeoPa]

Contradictory in the sense you say you wouldn’t associate a vaccine with a toothache but you are associating it with the trajectory of your CLL.

[LeoPa in reply to HopeME]

Maybe because a flu vaccine has nothing to do with the tooth but it has a lot to do with lymphocyte numbers.

[AussieNeil Partner Administrator in reply to LeoPa]

Seriously LeoPa, when you get a better appreciation of how much lymphocyte counts vary from test to test, from day to day or even during the same day, you'll hopefully appreciate how meaningless your deductions are. Just have a look at figure 2b and table 1 from this paper to get a better feel for the inherent variability of lymphocyte count testing, which can vary by up to 15% on the same blood sample:

onlinelibrary.wiley.com/doi...

Or this paper from 2018

onlinelibrary.wiley.com/doi...

How sure can you be that your blood tests were even done on the same analyser or if so, that it had been regularly calibrated?

I've had over two hundred blood tests, with several sequences of testing done daily. Lymphocyte counts are inherently fairly noisy, so you really can't deduce that any changes were due to your vaccinations.

Neil

[LeoPa in reply to AussieNeil]

Neil, up to 15% ok, but mine was almost a 25% jump. With full blown CLL the absolute number ( 1 ) is not much but for me it was a large jump. I never had this rate of increase previously. And that is what scared me. So I'll think twice before getting any non essential vaccines in the future. I'm more afraid of disease progression than the flu as of now. It will sure change in the future though. Once its the other way round I'll get the flu shot again.

[mantana in reply to LeoPa]

Just for the record, right before my CLL diagnosis, my absolute lymphocyte counts were as follows (please note these are a few days apart):

2019-09-20 -- 7.79

2019-09-26 -- 13.86

2019-10-01 -- 9.31

2019-10-17 -- 11.17

My newborn son had some vaccinations around these days - could this be the trigger?

After diagnosis, my ALC went up to as much as 18.83, and as low as 3.03.

Seriously, LeoPa - if scientific world was jumping to conclusions as fast as you do (after a single observation), we'd still be in the middle ages.

[LeoPa in reply to mantana]

I understand what you are saying, seriously. But in case of doubt have no doubt. I prefer to err on the safe side. I'm not saying I'm sure it was the vaccine. But what if? It was quite a coincidence.

[AussieNeil Partner Administrator in reply to LeoPa]

It was up to 15% variation for the same blood sample. Your lymphocyte count varies during the day and from day to day. The most likely reason for your relative stability is that you just don't have enough samples to get a real feel for your natural variability. I've personally seen much bigger jumps over a week - doubling and halving. Mantana has likewise shared their experience. I've also several times punished the variations of 21 trial patients, showing such variations are the norm. Finally, your lymphocyte count is made up of your healthy B-cells, CLL cells, helper and cytotoxic T cell. Without a flow cytometry test, you have no way of knowing which lymphocytes increased. Some of your increase is desirable - a natural and wanted response to vaccination.

Neil

[LeoPa in reply to AussieNeil]

Thank you, that makes total sense!

[Farrpottery in reply to LeoPa]

I believe if you take all the masking, distancing and hand sanitizing precautions you’ve already been using ...you’re correct that you most likely won’t come down with either one. Also no group indoor functions... my hubby takes all these precautions plus no weddings, funerals or indoor restaurants. Bless him so far he’s managed to stay well.

When he goes in three times a week to his small veterinary practice...its mask on 😷 EVERY ONE!!

Bless you!

Farrpottery