I had a little bird
And its name was Enza.
I opened up the window
And in flew Enza!

I don't get flu shots until later in the season, because I'm low risk, less likely to be seriously harmed by most influenza viruses* and there are often supply constraints. The people at greater risk -- elderly, health care providers, etc. -- need to get first crack at it.

**Yes, I know the Spanish Flu pandemic hit the young and healthy unusually hard

It's a lot harder to get flu shots in Georgia this year--the powers that be have decided that flu shots require a prescription. No more wholesale vaccination days at the grocery store!

I know in the past they've told healthy people not to get flu shots, because there wasn't enough supply for everyone, and that at-risk people, and folks who work with at-risk people (e.g., nurses, home health aides) should get the doses first.

Do we know if there is adequate supply this year to cover everyone? I'm healthy, and not in close contact with anyone with a weak immune system, so I'd rather face the flu myself than keep someone at-risk from getting a dose.

Here in Indianapolis, there seems to be a good supply. My pediatrician offered to give my three year old her shot at her annual check-up (we took her up on that) and that's the first time she's had them available for in-office dispensing. Usually she sends us to the annual "flu shot clinic" that the visiting nurse association holds.

The rest of the family (me, the Mr. and the 6 month old) will still be getting our shots at the clinic. If there are Indianapoloids in the Fluorosphere who want to know, I'm happy to share times/locations.

Lila@#3: It's a lot harder to get flu shots in Georgia this year--the powers that be have decided that flu shots require a prescription.

So if you haven't got the money for a doctor's appointment to get the scrip, you're s.o.l.? Way to go, Georgia . . . great way to keep the flu from spreading among the general population.

Flu shots--amen! I hate getting injections but I'm always first in line for a flu shot. I used to get the flu every winter, and every time was worse than the last. I started getting flu shots three years ago and haven't had the flu since. What a relief.

When I call my doctor's office and ask for a flu shot prescription, they write one for me free of charge.

Got mine yesterday. I was there to debrief the doctor on the nice fellow's demise and check my blood pressure, and they just up and asked me if I wanted it. I'm really, really high risk for getting almost any transmissible disease, especially ones transmitted by sneezing and coughing, because I work with babies -- and a bit elevated in risk as to how sick I can get from them -- and I certainly don't want to make myself a vector.

About washing hands -- Since I hate to leave the water running in an incipient drought (and we always have an incipient drought here) I have these two different methods I've been meaning to ask you about:

(1)wet hands. turn off water. Add soap. scrub all over (including nails, between fingers, and up the wrist) vigorously for a bit longer than you describe. Rinse thoroughly while scrubbing more.

(2) leave the water on and scrub under it the whole time, but have it only a tiny trickle.

The key question is -- is the water more effective as a relatively short blast, or as a continous trickle?

Last winter I took all the precautions I knew how to take and I was still horribly sick for ten weeks running (mostly because I couldn't take time off to get well). This winter I don't want to get sick at all if I can help it. We're bleaching the baby toys twice a week and washing the heck out of the linens. I'm down on the floor scrubbing the baseboards and getting people to wash the doorknobs and looking for other things to wash. I wish I could alter our diaper disposal system, but I have to be content with bleaching the hell out of that too.

More than adequate supply this year, at least in Texas. I generally don't get a chance at a shot until November, but I had a previously-scheduled doctor's appointment mid-September, and they were so eager to give me a shot, they almost forgot to have me sign all the bumph. (Perhaps because I'm now officially in an age-related risk group?)

And the groceries are already advertising their shot programs.

I had the flu, for the first time ever, in April. Makes me wonder if I ought to get a shot this year, because although I'm not in a high risk group, my boyfriend is--he's diabetic, and also old enough; while I was sick, I slept on the couch* so as not to infect him.

I wasn't badly off, really; got sick Saturday evening and was all better except for the laryngitis by Thursday. Though my fever got this close ][ to hitting 103, which was the official "go to the hospital" point.

* He'd have slept on it, but it isn't long enough for him to sleep comfortably, as he is considerably taller than I am. And really, it's quite a comfortable couch.

And, your ever handy flu clinic locater via the American Lung Association:
http://www.flucliniclocator.org/

When I was a resident, I managed to get the flu (or something darned close) three times in one winter. The second was more of a relapse of the first, as I hadn't realized I had the flu and kept on going. The third one left me flat on my back, with chills (never had those before!) and in dire need of more honey and lemons. Ever since then, I've made sure to get the flu shot (available through the employee health system here), and I'm rarely sick. Those viruses love me, and I'd like to avoid any reason to vomit or run fevers*. I just don't appreciate those things as much as I should, perhaps.

*Although the fever I had following a tetanus booster wasn't so bad -- it spiked fast, responded rapidly to ibuprofen, and went down every day for the next four days. Very odd.

Already got mine. HMSA (the primary insurer here in Hawaii) goes to each of the Longs drugstores here on different days running a free flu shot clinic for those with HMSA or Medicare insurance. Walk in, stand in line filling out a form, show ID and insurance, get your shot, walk out.

I saw a headline proclaiming "Flu Vaccine Supply Plentiful" some weeks back, but I can't swear whether it was a Denver or Boulder paper or the USA Today. It was in a newsstand and I didn't take a closer look.

I am soooo helpful today. :-/

My Cleveland suburb holds a flu shot program every year, and it's open to the general public. The shots are free for folks on Medicare, and $10 each, IIRC, for everyone else.

I never used to get them, but about five years ago I was offered a free one while doing temp work in the central office of a major HMO, and took them up on it. Not getting the flu that winter was awesome, and I've been getting them ever since. Now that my elderly father lives with us, both DH and I get them as well as making sure he gets one.

I skipped flu shots for several years, as there were shortages and I wasn't in a high risk population. But last winter I got the flu twice*, and I don't want to think about how many people I may have infected at work or on the bus -- or how many people my husband may have infected, after catching it from me both times. I'm getting a flu shot this year.

* 3.5 months apart, and I moved across the country in that time period, so I don't think it was just a relapse of the same bug.

I got the flu shot for the first time last year. I also got the flu, for the first time since 1980. Now that I'm a health care worker, I feel obliged to get the shot to help cut the risk to my patients, but I don't have a lot of confidence in the vaccine-designers' ability to bet on the correct strains.

I usually get my flu shot at work - the program starts in November. If I felt like I was at higher risk or was expecting to travel overseas in October, I'd probably get one from my doctor.

I've been doing a lot of traveling over the last few months, and for the first time, I got sick on the road. I picked up a really nasty cold in Sydney, followed up by Montezuma's (or perhaps Maharaja's) revenge in India. It took me weeks to feel right again, and I worry that I spread the non-local cold to my friends here in Seattle.

Even though I got all of the recommended vaccinations for both India and southern LatAm this year, I now feel even more aware of how a single traveler can transport contagions from the opposite side of the planet.

So - flu shot? You betcha!

Lila @ 3 - WTF Georgia? Although it sounds more like a trade group is trying to protect their members against liability more than anything regulatory.

I have had pneumonia, and weak lungs run in the family. I get a flu shot, even though I'm only 33. Thanks for the reminder!

My employer offers flu shots during working hours, but of course right now I'm getting a cold, so requiring anything else of my immune system right now is probably not a good idea.

May I say, "Thank you" to those of you getting innoculated for those of us who cannot have the shot?

The flu virus is cultivated in duck egg albumin, and I'm allergic* to that. I understand that there are other ways to produce the vaccine that don't involve that culture medium, but they're too expensive for the drug companies to for mass production.

I'd been throwing false positives to TB tests for years -- turns out the common ingredient is duck egg albumin, and none of the school nurses thought to inform my mother of the problem.

*Swine flu vaccine, circa 1976 -- I'd never had a flu shot before, but I'd had allergies for years so when I started wheezing, itching and feeling like I was going to faint I took a Benadryl.

I wish I didn't feel embarrassed about walking into my daily shared commute (the ferry) with a surgical mask on. Whatever that ferry manages to cook up---the island's got a lot of little kids running around too---has managed to put me in the hospital once, where some virus or *something* had affected me to the point where I no long remembered what my name was and they had to ambulance me across the sound to a hospital (the hospitals on my side of the water were full).

(At some point they even discussed helicopters, which was cool, but didn't happen.)

Plus I'm at risk for respiratory bad stuff. Apparently once you've had pneumonia twice, you're likely to get again, but worse.

If I could work from home for all of flu weather, I would. I hated the bit where I didn't remember anything and ended up in a hospital with no friends around because they were all sick, too. That was a few years ago, but the memory sticks. Plus since then I've passed out twice when I was ill at home, then lain on the floor for a few hours because I couldn't get up, and that was with flu shots.

And it was also because I didn't know what a Flu Pre-pack was, but now I'm going to go get the stuff to make one up. Or more. One for each floor of this place. Multiple. And my friends now know to call every couple of days to make sure I'm alright.

I don't even know what to think about all this anymore, other than that commutes are evil in flu/cold time.

Dang, I sound old, but I'm not! Just apparently susceptible to crap.

Getting mine when Group Health of Western Washington says to; this state is late on the onset curve, and too early is as bad as too late. Even then, we're instituting special family rules about shower head and drinking glass management, since we've determined that those are the weak points in our disease transmission chain.

I've been telling my students that anyone who gives me the flu flunks the course.

We'll see how that goes.

I'm with JESR: my clinic has flu shot clinics for the high-risk group (I'm included: asthma) on 26 Oct and 1 Nov this year, with open clinics to follow.

Tracey @ #25, "We'll see how that goes"

That could reduce attendance, no?

Linkmeister @ 27: Yes, but if that means the sick students are staying home rather than coming and infecting Tracey and their classmates, then that should help halt the spread of the flu. Which is the objective here, if I'm not mistaken.

*Is* too early as bad as too late? I know it takes some time (a couple weeks, right?) to get to a high enough level of antibodies after the vaccination, and I know that the level falls off over time, but I didn't think it fell that far off over the course of a couple more months!

Anyone know if there's any reason to think the attenuated live spray-up-your-nose vaccine is any better or worse than the injection? (I got that one year, and found it more unpleasant in its own way than just getting a shot.)

I'll get my shot this weekend. Kaiser (mid-Atlantic region) is holding walk-in flu clinics for at-risk members this weekend and next.

Kaiser's mailing outlines who should get shot:

*Men and womene age 50 or older.

*Men and women with chronic health conditions such as asthma, diabetes, lung, heart, kidney, liver or blood problems, cancer, or impaired immune systems.

*Women who are pregnant during flu season, which can begin in early October and last as late as May.

*Health care workers.

*All children 6 months up to 18 years of age.

*Anyone living with someone in one of the above categories or with a child or teen.

Some of the area Kaiser medical centers are offering "drive-through" flu vaccine service.

On subsequent weekends, members who are not in one of the risk categories can stop by for a flu shot (if supplies last).

One thing handy Emergency Preparedness lists like the one Jim linked to often include is:

backup/reserve supplies of any medications you take on a regular basis

How are you supposed to get these? My insurance company won't authorize getting a month's supply of most of my meds more often than about once every 27 days. They go to considerable lengths not to *let* me stockpile.

Janet 30: Kaiser's mailing outlines who should get shot:

That's quite the massive purge you've outlined. If the Kaiser wants to shoot those people, we'll fight him all the way to Flanders!

*exit, singing "Over There"*

How are you supposed to get these? My insurance company won't authorize getting a month's supply of most of my meds more often than about once every 27 days. They go to considerable lengths not to *let* me stockpile.

In the past I have managed, over time, to build up a stockpile of sorts by being sure to order every 25-27 days. They give you a 30 day supply. The first month, you're three days ahead, second month, six days, third month, nine days, etc. In ten months, you'll have a thirty day supply by the time you are reoordering.

Obviously, this does not work for a new medicine right away, but for stuff you take regularly for a chronic condition, it is doable.

#33 In ten months, you'll have a thirty day supply by the time you are reoordering.

Then, when you get your new script, the fresh goes in your jump kit. You take the previous month's supply out of your jump kit and use that.

33: Fuck private healthcare! Welcome to my list of good reasons against it.

More generally, I wonder when this autumn's wave of Fresher's Flu is going to hit? A different institution this year, but presumably the dynamics are the same - a wave of kids from the four corners of the nation, and plenty of other places too, turning up in late September, and kissing a hell of a lot. Give it a couple of weeks for horizontal gene transfer and natural selection, and something horrible will be in the works.

For many of them, it takes rather less than a couple of weeks to go from "kissing a hell of a lot" to "horizontal gene transfer".

Doctor Science (31):
...backup/reserve supplies of any medications you take on a regular basis...

How are you supposed to get these? My insurance company won't authorize getting a month's supply of most of my meds more often than about once every 27 days. They go to considerable lengths not to *let* me stockpile.

I paid out-of-pocket for the cheap blood-pressure meds ($10 for 90 days at Target) with a separate prescription from my helpful doctor. For the more expensive drugs, we conspired to make some well-timed dosage changes, so it only cost a couple of co-pays.

Joel Polowin #36: horizontal gene transfer

Now that's a euphemism I hadn't heard of before. heh.

Larry @ #19, you are correct in your surmise. The pharmacists here are perhaps a little extra tetchy right now. You might have heard that the national pharmacy licensing exam was compromised last year, by someone who paid students to tell him the questions that were on the exam so he could teach those questions in his prep workshop? That happened in my hometown.

Larry & Lila (19 & 39) Could there be some influence <koff> from the anti-vaccination groups? If you need to get the prescription, you'll be assumed to have given informed consent?

I'm another egg-allergic person here (I'm also potentially a high-risk measles exposure person as I have no immunity and that vaccine's also cultivated in eggs).

Is the Flu Mist (nasal spray) a viable option? I work in a K-8 school, have asthma, and live with someone who has regular Remicade infusions.

Arachne, #23, check with your doctor about getting a pneumovax. I get one every five years.

Janet, #30, I got my "come in and get your shot" mailer from Kaiser this week, too. But I can't stand as long as they require at the closest center that gives flu shots, so since I need to see my primary about this ear thing anyway, I'll just get my shot then.

Alex, #35, Georgetown has had norovirus already.

Back home, I'd be lining up for my free flu shot.

Over here, the NHS only provides flu shots for risk groups -- the rest have to go private. So some corporations will call up a private health provider to arrange vaccinations for their employees. And that is my job for the next couple of months. Fuck private healthcare, yeah! but temps need to eat, too.

Speaking of the NHS and "at risk" only -- how does one go about getting a flu shot in the UK if one is not in a high risk group oneself, but has several family members who are? I got my jab regularly in the local supermarket vaccination drives while I was in the US, but I have no idea how to go about getting it now I'm back in the UK, where they don't do it that way.

Mez @ #40, I don't think so. They already make you sign an informed consent document and indicate that you are not allergic to eggs.

A question about traveling during 'flu season for all you knowledgable folks. I live on the West Coast and will be visiting New England in mid-October. I'm "at-risk" due to upper-respistory weakness, but I'm worried about getting a 'flu shot - is it the same 'flu shot all over the country? Would a 'flu shot make me into some kind of carrier? Sorry if this is a dumb question.

Ingrid @46,

My understanding is you should get it ASAP, because it takes two weeks for your immune system to be fully ready to fight the flu after you get the shot. People in higher-risk groups in general are encouraged to get the shot early--there's been times supplies run out.

It is the same shot**.

I can guess why the shot could make you feel like a carrier. In the day or two after the shot, as your body reacts (notices the antigens*, creates antibodies), you can feel a bit like you're coming down with illness.

Since the flu shot is made of dead (inactivated) viruses, you're not infected, and you're not infectious, even if it feels that way.

--------
* anything that triggers the immune system into fighting an invader, for example patterns of molecules on the outside of bacteria or viruses. The immune system then creates antibodies designed to fight that specific antigen.

** many months earlier, researchers in China and elsewhere find flu strains that are likely to take off. The vaccine is made of what they think are the three most likely strains.

I admit that a flu shot can make you feel like crap.

I remember getting the Swine Flu shot way back when (the US military were the only people who got the shot, as it turned out). I had to stand watch that same night, and boy did I feel like I was going to die.

Ingrid @46 and Janet @41,

In the past few years there's also been the spray version of the vaccine. It contains live attenuated (weakened) virus*. Because it causes a real infection, that version is not recommended for people susceptible to complications from the flu (Table 1's footnotes details who that is).

Here's a CDC science paper summarizing the differences between the live virus (LAIV) and attenuated virus (TIV) vaccines. In the "side effects" summary they say that the LAIV did increase asthma symtoms in one study of small children, and that there haven't been studies that could show safety in other at-risk groups. Without additional data LAIV can't be used in those groups.

People who get FluMist shed viruses for about 8 days. They're generally not infectious. However, researchers don't have data on how these shed viruses could affect vulnerable immunosuppressed people (people being protected, such as after a transplant), so in that case people in contact with them must have TIV instead. LAIV is fine for people who come in contact with other at-risk groups, the paper says.

---------
The virus has the same antigens as the regular virus, but it's engineered to reproduce well at 60F/15C (for mass production) but not at 98F/38-39C (lower airway temperatures). That way it infects nasal tissues (and the immune system makes antibodies) but doesn't infect the lungs.

Julia Jones: I know carers can get the flu jab on the NHS because they spend lots of time in close proximity to high-risk people -- might as well ask your GP.

If not, start shopping around. Some Boots stores are holding flu clinics (England only), but I'm not sure how much it costs. Somewhere between £10-20, though.

In the past I've not bothered to get a flu shot, because (aside from some special cases, such as a doctor in the early 90s trying to make me fit the BMI) I'm pretty resistant to bugs.

But then last year some unusually virulent creeping crud went around the department, and my boss and I both were knocked out of commission for most of a month. It was definitely viral but wasn't all that flu-like. That said, between that and allergy to cigarette smoke (not good on a college campus, but I'm a glutton for punishment) my doctor insisted I get a flu shot early this year.

At least they have weekly flu clinics on campus.

Went to the Safeway pharmacy to get my month's prescription refills today, and they were having a flu shot clinic. Free if you have Medicare Plan B (which I do). So... I've now gotten it over with. Would've gotten one next week at my regular doctor visit, but hey, I'm high enough risk that the sooner the better.

Arachne @ 23: Bainbridge? (Or, as my friend over in Kingston calls it, just to give me a bad time for living here, "Braindead.")

Marilee #42 - I'll definitely have to talk to my doctor about that.

glinda #52 - Yep. Hi!

glinda & Arachne, I figured that was it. We lived on Whidbey at Oak Harbor and then in Edmonds while Dad's ship was nominally stationed at Bremerton.

Tlönista @50: Thanks. At that price it's probably worth paying it to be able to get it done as a walk-in close to work or at the weekend rather than having to take the afternoon off work to see my GP and argue about whether I fit the criteria.

My Georgia-based company seems to be advertising free flu shots as usual. I assume there's no script required here because the people administering them aren't pharmacists.

#24, JESR - Your shower head is a vector? Elaborate, please?

Hah! Read this, thought "Hmm, should see about asking my GP where to get a flu shot", and that very second received a mail from my boss's office informing me that there will be company-funded voluntary flu shots next Wednesday. Very decent idea, that. If anything would have come in the way of me getting a flu shot it would have been the hassle involved in finding out where to go, when to go, how to get the time off etc--now it turns out the sum total of hassle was clicking "Yes" in the voting option of a mail.

My big thing with the flu shot is the darn mercury, namely the thimerosol preservative. I hear that the FluMist nasal spray does not have it.

There's a nice list of links on pediatric flu vaccines and preservatives, including FDA stuff out there. Sure, not much mercury in a single shot. There are folks who feel that multiple immunizations in close time proximity added up to autism though.

You may have to ask around a bit, but apparently you can get a thimerosol-free flu shot, and for kids and pregnant women, its especially recommended. Allegedly the type of mercury in thimerosol differs from the type in your "small can of tuna fish" (the "how could this be dangerous, it's the same as" object), in that it is a type more likely to build up in the brain.

Sid, the Science Kid, gets a flu shot

Got my H1N1 shot today because I'm in the group with chronic pulmonary inflammation -- still waiting for the campus health center to get the regular flu shots.