Guest: Dr. Adhi Sharma
Presenter: Neal Howard
Guest Bio: Adhi Sharma is Chief Medical Officer at South Nassau Communities Hospital, Oceanside, NY. Prior to joining South Nassau Communities Hospital in 2014, Dr. Adhi Sharma served at Progressive Emergency Physicians, where he was the chief operations officer responsible for strategic planning and operations; oversight and development of existing and future contracts, and contract negotiations with third party payers.

Segment overview: Dr. Adhi Sharma discusses the “Truth in Medicine” Poll that reveals that many people go to work even if they have the flu despite an awareness by an overwhelming majority that the flu virus is spread person to person.

Transcription
Health Professional Radio – How Flu Shots Work

Neal Howard: Hello and welcome to Health Professional Radio. Thank you for joining us today, I’m your host Neal Howard. It is the flu season and well, when you’ve got a flu, you don’t go to school, you don’t go to work, but what if you do? Our guest today is Dr. Adhi Sharma, Chief Medical Officer with South Nassau Communities Hospital and he’s here to discuss with us some of the misconceptions about the flu, the flu season, the flu shot, and what we can do to protect ourselves against the flu. Welcome to Health Professional Radio Dr. Sharma.

Dr. Adhi Sharma: Thank you Neal.

N: Thank you. Well, the flu season is upon us, are you a flu expert?

S: Flu expert, sure. Twenty years in the emergency department taking care of patients with the flu.

N: Now, have you always been affiliated with South Nassau Communities Hospital?

S: I joined South Nassau in 2014. Part of that, I was at other institutions.

N: Now, this poll of New Yorkers. Talk about this poll that specifically targets the flu.

S: So, we were interested to understand the people’s perspectives of the flu because with one thing to treat people who come seeking care but we don’t really understand what the perspective is amongst the population. And as we push for a population health strategy, education is probably critical. You don’t know where to do the education if you don’t know where the gaps and knowledge are.

N: Where you’ve identifying them gap, as far as information and education concerned?

S: We found 3 gaps in our flu poll that were really striking. One is that, people were going to work with the flu. And we weren’t surprised that, that was happening but it was important to understand the extent to that was occurring. And we found out around 33% of people are going to work with the flu, so that was a large number. The second area we found was that people still feel, almost half, people still thought the flu shot can give you the flu. And that myth is just never die down despite all the evidence to the contrary and that was an important element. And then third element was that people did not know you can get the flu twice in one season.

N: So some huge missed and misconceptions that basically perpetuate the flu from season to season, so let’s talk about this first one about people going to work. “Aw, just heard”, if you’ve got a flu, you don’t go to work. If you think you going to get the flu, you don’t go to work and you get a flu shot. So why are people going to work with the flu?

S: Our survey did not tell it into the why, but we do have some speculations and several reasons. One is, people can get a mild form of the flu. People who answered that they went to work with the flu, as we assume that they had knowledge if they had the flu one way or the other. Even they knew based on the previous experience where they were diagnosed with the flu or assuming they did not have a mild cold and thought that was a flu. We expected that they knew what flu meant. So, let’s assume that if you have a milder version of the flu, it can take away so bad, maybe you didn’t think you were that contagious as possible. The second is, people who don’t have sick time or people who have job insecurity may feel like, ‘I can’t miss a day at work because I’m at risk’. And third is, there may be some other socioeconomic stressors to people wherein which either they are taught growing up you toughed it out. You go to work, you don’t call in sick, and then you work at the kids that robust, or that simply they don’t want to set a bad example and depending upon what’s going on at work, or they simply they just too much going on at work and they can’t miss a day.

N: Did you find any difference between the amount of men and women that do that? I mean, sometimes we guys do things a little bit different. We’re a little less careful. Did you find that women reporting to work less with the flu than men?

S: Yes, we did find that. Women worked, more or less likely they go to work with the flu around 32% and on 39% from men and that was men over 50. So the largest group to go to work sick were men above the ages 50.

N: Work ethic especially when you are at that age group.

S: That is true. Job insecurity is a major concern because it’s harder to get equal employment after a certain age as easily as it is when you’re younger.

N: Absolutely. When it comes to people believing that the flu shot actually gives you the flu, explain to our listeners who most of our listeners are health professionals in one aspect or another. Anyway, how does the flu shot protect us from the flu?

S: The flu shot itself is made from a version of the virus that is killed, it’s inactive. Usually, a portion of the virus and that portion is what we called the “Endogenic Portion,” that’s the part of the virus that our body’s normal immune system would respond to. We take that portion and we put into a vaccine, we inoculate the patient, and those little proteins trigger an immune response in the patient. That immune response present in the bodies so that now when you get exposed to the flu virus, your body already knows and recognize it as a threat but your antibodies, which normally take a few days to a week to produce are already there because you got the vaccine. So now the antibodies attack the virus and either limit the illness to zero or at least give you a milder form of the illness because of viral replication is not going unchecked, as it would be in someone who didn’t have the vaccine or some natural immunity to the flu.

N: Once you get the flu, do you just let it run its course or are there drugs to help you out once you do have it?

S: We fortunately have antivirus specifically for influenza virus. The recommendation, we saw a lot of the these and that during H1N1 in 2000 and 2010. And what happened there is we started to see a little bit resistance. So, the recommendations are, unless you’re in a special class, the elderly, the very young, or people without the medical immune compromise conditions, such as the diabetes or medications that may suppress the immune system, etcetera. We don’t recommend treatment as a routine method managing the flu.

N: Okay. So just let it run its course?

S: For most cases, yes.

N: What percentage of cases would you say that the course ends in a fatality?

S: We see about 30,000 cases of the flu with mortality on our annual basis in the United States. While we can get projections on how can people actually have the flu, we don’t have the total denominator. But figure there’s millions of cases of flu, so the fatality rate fortunately is low, but it’s probably around 3%.
N: When we’re getting a flu vaccine at our local store that’s offering them at this huge discounts free, are we getting a shotgun type of vaccine that’s going to take care of this flu, that flu, and the other flu? Or are we getting something that as you say is going to lessen the effects of some of these other more … strains?

S: That’s a great question Neal. So, flu is around 24/7/365. We talk about flu season but the virus are around. The difference is it’s active in other parts of the world. When it’s winter in South America, that’s when their flu season is. Based upon that winter in South America, scientists in Europe are trying to predict what flu virus strains are going to be prevalent in the Northern Hemisphere during the Northern Hemisphere’s winter, right? Based on the predictive model, they tried to create what’s called it’s either a Trivalent or a Quadrivalent vaccines. So that means you took 3 virus strains or 4 virus strains. So that the shot you get, most likely, they could be either one of the 3 and 4 strain versions contains a vaccine component to more than one type of flu. So there’s flu A, there’s flu B, they’ve certain mandated in H1N1 vaccines just to prevent future pandemics and then the fourth one will have another variation of what they think maybe another possible strain of the flu. So when we say you get the flu twice it’s because every flu season commonly, there’s a flu strain A and a flu strain B with subspecies within that and stereotypes within that. And then, you can get the A and be sick with the flu in December and then in February you can get flu strain B and be sick again and you will already have the flu twice. If you get a vaccine, the vaccine keeps seen has some reason why accuracy that year, and this year’s vaccine actually has pretty good accuracy, consistency at this point. You won’t get A or B, because you have been protected against both.

N: So basically, if folks are getting flu shots, they’re protecting themselves in some degree against the flu that’s out there anyway and it gets folks who maybe showing to up to work for whatever reason who have the flu. Even those who have had a flu shot and have a mild form because they did get a flu shot. So if no one’s getting the flu shot, then I guess we are really, really in for pandemic I supposed and not going to be a good situation at all.

S: That’s true. Fortunately, we still have the majority of people going out and getting flu shots, that’s the good news. The bad news is that majority from our survey with 57% versus 42%, so it’s not an overwhelming majority. And there is this concept I’ve heard immunity, which we demonstrate with small path, we eliminated the disease from the population. So even if you never got immunized, you are not risk for it because the disease doesn’t exist anymore. So if everybody were immunized, then the flu season would be really nothing. We would not even talk about it much because the number of people who will get just sick will be so low that it would be the exception of the rule.

N: So as we wrap up, let’s talk about the folks that never get a flu shot. Is it just a matter of time before they get the flu? And can they carry the flu and be a symptomatic?

S: So, yes and yes. Most people who don’t get flu shots are either refusing the flu shot because they just don’t get sick and there are some people out there like that and we all know them. So they think, ‘I don’t need a shot.’ And they’re probably right, their immune system is as such that they don’t need a shot. That again is the exception of the rule. If you don’t have one of those super immune systems, then you’ll probably going to catch the flu at some point unless you’re a hermit in a cave somewhere away from all of mankind during the flu season.

N: Where can our listeners go and get more information about South Nassau Communities Hospitals and the flu in general?

S: So, if they go to www.southnassau.org/main/flu, they will be able to get education on the flu. So if they were on the main website, www.southnassau.org, they can find the flu link and as the survey results as well as a lot of information from one of our lead in Texas disease persons on the flu.

N: Great. Well, it’s been a pleasure talking with you this morning.

S: Thank you Neal, likewise.

N: You’ve been listening in the Health Professional Radio with Dr. Adhi Sharma, Chief Medical Officer of South Nassau Communities Hospital, discussing the flu and clearing up some misconceptions. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm, you can listen in on SoundCloud, and subscribe to this podcast on iTunes.

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