As a person with Rheumatoid Arthritis (RA), I think a lot about my immune system. RA is an autoimmune condition, meaning that the immune system malfunctions and attacks healthy joints and tissues. The thought, “Why is my body attacking itself?” has gone through my head countless times in the 17 years since my diagnosis. As if that weren’t enough because the immune system is misdirecting its efforts, people with RA are more prone to infections.1 Furthermore, autoimmune conditions are often treated with immunosuppressant drugs. Since it is the immune system that is attacking healthy joints, tissues, and muscles, suppressing the immune system decreases the damage it can do to the body. The flipside is that the immune system exists to keep us healthy, so by suppressing it, we limit its ability to fight off germs and viruses. It is most certainly an RA catch-22.
With all of these factors at play, I think about my immune system far more than my healthy peers. Having RA and taking Orencia, an immunosuppressant, to treat it, I get sick more frequently than most of my peers, and I tend to stay sick longer.
Precautions for those on immunosuppressant drugs
As this is the case for most people taking immunosuppressants, experts recommend that people like me on immunosuppressant drugs receive annual flu shots.2 The rationale is that our bodies are less able to fight off the flu virus if we are exposed to it. However, that’s also the exact reason why many people with RA are wary of getting the flu shot. Many of us worry about introducing even a tiny amount of a virus into our systems, fearing that our bodies will be unable to defend ourselves from even the minor assault of a flu shot.
I have that fear each flu season, as I have indeed felt sick for a day or two after receiving the flu shot. Therefore, I’ve explored the issue and found there is a preponderance of research that indicates that introduction of “killed vaccines” into RA patients is safe and effective (the flu nasal spray, which contains a live virus, is not recommended for patients with autoimmune conditions).3 While the flu shot has made me sick, researchers argue that the flu makes one much sicker.4 Furthermore, the flu can cause severe health issues, such as pneumonia, in people with compromised immune systems.
The dilemma of getting the flu shot
With that knowledge, I opt for a flu shot each year, but I do so with hesitancy. This past flu season, my rheumatologist validated my concern. We had the following exchange at my fall appointment:
Doctor: “Have you had a flu shot?”
Me: “No, but I should get one, right?”
Doctor: “I’ve stopped telling people either way because it seems like every time I encourage a patient to get one they come back saying it made them sick. So now I just let people know it’s available in our office but I don’t push them to get it.”
I found this dialogue very refreshing. Too many doctors disregard their patients’ personal experience when it doesn’t conform to statistics (and I feel like I’m frequently an outlier when it comes to statistics). His honesty about and openness to patient self-reporting actually made me less hesitant about getting the flu shot. Somehow the validation of his acknowledgment that I could indeed get sick from the vaccine made me more willing to take this calculated risk.
Fast forward two months and the flu was unusually rampant. I work in a school, and some classrooms were half-empty due to so many confirmed cases of the flu. I did not have a reaction to this year’s vaccine, so I was feeling grateful I had opted for the flu shot. That was all the more the case when my four-year-old tested positive for flu. I snuggled and comforted him throughout the week he was sick, all the while crossing my fingers I wouldn’t contract his illness. I was also kicking myself that I had not gotten him a flu shot, worried that our entire family might come down with it. The value of the vaccine was rising in my book.
However, when I took my son for a re-check, the pediatrician said that the strain he had caught wasn’t covered by this year’s flu vaccine, and therefore wouldn’t have prevented it anyway. Of course, I’d heard that before, but having the direct experience with my child contracting a non-covered strain of the flu made me question the flu shot anew. Why risk introducing a tiny dose of a virus into my compromised immune system if it might not even be the same strain of virus that I come into contact with? Potentially I could have a bad reaction to the flu shot and still get the flu.
As my son and the scores of students at the school where I work all returned to their classrooms after their bouts of the flu, I was incredibly grateful that somehow, even with my malfunctioning and medically suppressed immune system, I had fended off the flu. Then my nose started running and my throat started itching. I hoped it was just the beginning of the allergy season. The next day, huddled under layers of covers in an attempt to ward off the chills racking my body, I took my temperature. With a reading of 101.5, a rarity for me as I usually don’t get fevers even when I have an infection, I knew I needed to see a doctor. A couple of hours later, I’d tested positive for the flu.
Lying on the doctor’s table, I felt frustrated all over again with the flu shot. However, the doctor told me it was a very good thing I’d had it, explaining that people who are vaccinated and then contract the flu tend to have milder symptoms and avoid the severe complications that can require hospitalization. It turns out the Centers for Disease Control agrees with him.5
The week that followed was awful. I was in bed for days, my body riddled with aches and chills. Any small task, such as taking a shower or heating up some soup, seemed to require a herculean effort. I thought about what the doctor had said and decided that if the flu could be even worse than what I was experiencing, then any decrease in symptoms was worth the risk of a reaction to the flu shot.
This flu season my opinion of the vaccine changed so often that following it was like watching a long volley in a tennis match. Yet, in the end, I am glad I had the vaccine, and I plan on getting it again next year. That being said, I can’t say I won’t have that same hesitancy and be likely of asking my doctor, “I should get one, right?”