Should I Get a Flu Shot?

The flu (influenza virus infection) can be a very serious illness, especially for someone with cancer. The flu is not the sniffles, sore throat, or an upset stomach that goes away in a few days. The flu often causes fever, body aches, tiredness, and a cough that can last for weeks. As many as 1 in 5 Americans gets the flu each year, and on average more than 200,000 a year are put in the hospital because of it.

The number of people who get the flu varies widely from year to year. Annual deaths linked to influenza ranged from a low of 3,000 to a high of 49,000 over a 30-year period. New strains of influenza crop up fairly often, which is why flu outbreaks are watched and reported.

What do adults with cancer (and those who have had cancer) need to know?

Cancer patients and survivors are more likely to have serious problems if they get the flu. They are more likely to end up in the hospital or even die from these problems. Getting the flu shot early in the flu season can help reduce the risk of the flu and its complications.

Since 2010, the CDC experts have recommended that everyone age 6 months or older get a flu shot every year—unless there’s a good reason not to get it. For instance, anyone who is very sick or getting cancer treatment should talk to their cancer doctor before they get a flu shot.

It’s best to get the vaccine as soon as it’s available, or before December. Flu season is when people are more likely to be exposed to influenza. In the US this is usually from October to May, peaking in January and February, but it can start earlier.

I have had cancer in the past, but I have no signs of cancer now. Is the flu still dangerous for me?

Yes. If you have had cancer, you might have a higher risk of serious problems if you get the flu, even if you are cancer-free now.

Are cancer patients and survivors more likely to get the flu than others?

No one knows for sure if cancer patients and survivors are more likely than others to become infected with flu. But they are at greater risk for having serious problems from the flu. Even if cancer patients have the same risk of getting the flu, once they get any type of flu they are at higher risk of complications.

Should I get the 2012-2013 flu vaccine even if I got the flu shot last year?

Yes. The flu vaccine is evaluated each year and changed as needed to protect against the flu viruses that look like they will cause the most illness. The 2012-2013 flu vaccine helps protect against 3 different types of flu virus, 2 of which are different from last year’s vaccine.

What can I do to protect myself from the flu?

The best way to keep from getting the flu is to get the vaccine. For extra protection, encourage everyone in your household older than 6 months to get the flu shot, too. This lessens their chance of illness, and lowers the risk they will bring the flu home to you.

All types of flu are spread the same way. Even if you haven’t yet had the vaccine, there are things you and others can do to help prevent the spread of flu viruses and many other germs.

• Wash your hands often. Use soap and warm water or alcohol-based cleaners or wipes.
• Do not touch your eyes or nose. Keep your fingers away from your mouth.
• Cover your mouth and nose with a tissue when you cough or sneeze. Then throw the tissue in the trash and wash your hands.
• Try to stay away from sick people. At least 6 feet is thought to be a safe distance (except for chickenpox and tuberculosis, which can travel on air currents).
• Try to stay away from small children who spend their days in group settings like daycare or school—germs spread easily in these places.
• Be ready just in case you do get sick. Have the things you may need at home (food, tissues, hand cleaners, medicines for cough and fever, and so on) so that you don’t have to go out to get them.
• Take care of yourself. Follow public health advice about outbreaks, like school closings and avoiding crowds.
• Certain strains of flu affect mainly pigs, but can be passed from pigs to humans. Avoid close contact with pigs, and stay away from swine barns if you go to a fair.

In some cases, prescription flu medicines and anti-viral drugs can be used to try to prevent the flu in someone who has just been near someone with it. They can also be used to treat people who have been recently infected. (See the sections, “Can the flu be treated if I already have symptoms?” and “When should cancer patients and survivors get anti-viral drugs to prevent the flu?”)

What else can I do to be prepared?

Make plans with your doctor ahead of time about what to do if you get sick. Talk with your doctor about:

• What symptoms should prompt a call to the doctor
• Whether you should get anti-viral medicine if you get flu
• How to get a prescription for anti-viral medicine quickly if you need it
• Making sure your vaccines are up to date

Keep a written record of these important facts in a place you can find them quickly:

• The type of cancer you have or have had
• Cancer treatments you have had and when you had them
• The name and contact information for your doctor
• A complete list of medicines you are taking

What about patients who are getting cancer treatment?

The flu shot is recommended for most people with cancer. People often have weak immune systems during cancer treatment. For them, the flu can lead to serious, even life-threatening problems. People getting cancer treatment with radiation or drugs (chemotherapy) are at high risk for problems if they get the flu.

Many people with cancer worry that the flu shot will make them sick or react with other medicines they are taking. Talk to your cancer doctor about this—he or she knows your situation best. Find out if you should get the shot and when is the best time to get it. If your doctor agrees, get your flu shot in the early fall, at least before December.

Some people do get mild symptoms, such as a low-grade fever or achy muscles, after a flu shot. These symptoms are caused by the immune system’s response to the flu shot and should go away in a day or so. The flu shot cannot cause the flu.

The CDC recommends that people who live with or care for a person at high risk for flu-related problems get the vaccine. This means that if you are being treated for cancer, your family members, caregivers, and children at home should get the flu shot, too.

Remember that a few people who are allergic to chicken eggs might have an allergic reaction to flu shots. Talk with your doctor about your reactions to eggs and any other allergies you have before you get the flu shot.

What types of flu vaccines are recommended for people with cancer?

Cancer patients do have to be careful about the type of flu vaccine they get. There are 2 main forms of flu vaccines:

• Live vaccines are made of weakened live virus and given as a nasal spray—which people with cancer should NOT get.
• Inactivated vaccines are made of dead virus. They are given as shots or injections. This includes the new intradermal flu vaccine (see below).

People with cancer should get the inactivated flu shots, NOT the nasal spray. Even a very weak live virus might cause illness in a person with immune system damage from cancer treatment. Family members of a person with cancer can safely get the nasal spray unless the patient needs extra protection from germs. For example, household members should not get the nasal spray if a family member recently got a stem cell or bone marrow transplant or is getting high-dose chemotherapy.

What about the new intradermal flu shot?

This vaccine was approved in 2011 for people ages 18 to 64. A much smaller needle is used to inject the vaccine into the skin instead of the muscle. It takes less vaccine to produce the same effect, so there’s less liquid to inject. Like the other flu shots, this vaccine is made from inactivated (dead) virus. It’s an option for adults with cancer who are 64 and younger.

What about the high-dose flu shot for people 65 and older?

Approved in late 2009, Fluzone High-Dose^® is a new flu shot made for people who are 65 years of age and older. Immune defenses become weaker with age, which can lessen the body’s immune response after a flu shot. This means the standard flu vaccine may not work as well in older people.

The higher-dose vaccine is designed to boost immune response to better protect against flu. Even though the immune response looks better on lab tests, it is not yet certain that this vaccine will prevent more influenza. Studies are still being done.

Because the high-dose shot is an inactivated vaccine, most people with cancer can get it. If you are 65 or older, ask your doctor if this is something you want to try.

When should cancer patients and survivors get anti-viral drugs to prevent the flu?

If you have been within 6 feet of someone known or suspected to have the flu, and you:

• Have had cancer treatment like chemo or radiation within the last month

OR

• Have a blood or lymph cancer (such as leukemia, lymphoma, or myeloma)

Call your doctor right away. Your doctor may give you anti-viral drugs to help keep you from getting the flu.

Can the flu be treated if I already have symptoms?

Prescription flu medicines like Tamiflu^® and Relenza^® can be used to treat and prevent swine flu as well as seasonal flu.

Other prescription anti-viral drugs can also be used. They work by keeping the virus from reproducing in your body. They can make the flu symptoms milder and can help you feel better faster. They can also help keep the infection from causing severe problems. Anti-viral drugs work best if they are started within 2 days after getting sick, so don’t wait.

If you are a cancer patient or survivor, and you think you have the flu, follow these steps:

• Contact your health care provider and follow his or her instructions.
• Stay home and away from others as much as possible to keep from making them sick. Avoid public activities like work, school, travel, shopping, social events, and public gatherings. Stay home for at least 24 hours after your fever is gone (without the use of fever-reducing drugs). Only go out to get medical care or other things you must have.
• If you need to go to the doctor, emergency room, or any other health care facility, cover your mouth and nose with a face mask if you can. If not, cover your mouth and nose with a tissue when you cough or sneeze. Let the staff know right away that you are there because you think you may have the flu.

What are the symptoms of flu?

Common symptoms of the flu include:

• Fever
• Cough
• Sore throat
• Runny or stuffy nose
• Body aches
• Headache
• Chills
• Fatigue (tiredness)

A few people may have vomiting and diarrhea as well. But other people may have the flu, and only have a cough, sore throat, or stuffy head with mild fever or even no fever. Still others have fever and aches or chills with few other symptoms.

Many doctors offer quick tests that use a sample from your nose or throat to find out if you have the flu. The tests work best if they are done within a day or 2 of the time symptoms start.

What else do I need to know?

Flu vaccines cause the body to make antibodies that protect it against influenza virus infection. It takes up to 2 weeks after the shot for the body to do this. This is why you should get the flu shot as soon as you can—so your body has time to form the protection you need.

Keep in mind that you CANNOT count on any former immunizations, including last year’s flu vaccine or the 2009 H1N1 flu vaccine to protect you against this year’s flu.

People with cancer should talk to their cancer doctors about getting the 2012 flu vaccine. People who live with or care for people with cancer, including health care workers, should also get the vaccine.

In most people, flu is a limited illness that is not life-threatening. But the flu can be serious in people with cancer. Make it a priority to get your flu vaccine.

To learn more

More information from your American Cancer Society

Here is more information you might find helpful. You also can order free copies of our documents from our toll-free number, 1-800-227-2345, or read them on our Web site, www.cancer.org.

Infections in People With Cancer

After Diagnosis: A Guide for Patients and Families (also in Spanish)

Coping With Cancer in Everyday Life (also in Spanish)

National organizations and Web sites*

Centers for Disease Control and Prevention (CDC)
Toll-free number: 1-800-232-4636 (1-800-CDC-INFO)
Web site: www.cdc.gov/cancer/flu/#1

Has information on flu and flu vaccines for people with cancer.

Web site: www.cdc.gov

Has up-to-date information on influenza and flu vaccines, including side effects and which types can be used for people with serious illness.

No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call us at 1-800-227-2345 or visit www.cancer.org.

References

Centers for Disease Control and Prevention (CDC). Cancer, the flu, and you: what cancer patients, survivors, and caregivers should know about the flu. Accessed at www.cdc.gov/cancer/flu/#1 on August 21, 2012.

Centers for Disease Control and Prevention (CDC). Estimating Seasonal Influenza-Associated Deaths in the United States: CDC Study Confirms Variability of Flu. Accessed at www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm on August 21, 2012.

Centers for Disease Control and Prevention (CDC). Intradermal influenza (flu) vaccine. Accessed at www.cdc.gov/flu/protect/vaccine/qa_intradermal-vaccine.htm on August 21, 2012.

Centers for Disease Control and Prevention (CDC). Key Facts about Influenza and Flu Vaccine. Accessed at www.cdc.gov/flu/keyfacts.htm on August 21, 2012.

Centers for Disease Control and Prevention (CDC). Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP) — United States, 2012–13 Influenza Season. MMWR. 2012;61(32);613-618. Accessed at www.cdc.gov/mmwr/preview/mmwrhtml/mm6132a3.htm?s_cid=mm6132a3_w on August 21, 2012.

Centers for Disease Control and Prevention (CDC). Seasonal Flu Vaccine. Accessed at www.cdc.gov/flu/about/qa/fluvaccine.htm on August 21, 2012.

Fiore AE, Fry A, Shay D, et al; Centers for Disease Control and Prevention (CDC). Antiviral agents for the treatment and chemoprophylaxis of influenza — recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60(1):1-24. Accessed at www.cdc.gov/mmwr/preview/mmwrhtml/rr6001a1.htm?s_cid=rr6001a1_w on August 21, 2012.

Fiore AE, Uyeki TM, Broder K, Finelli L, et al; Centers for Disease Control and Prevention (CDC). Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Recomm Rep. 2010;59(RR-8):1-62. Accessed at www.cdc.gov/mmwr/preview/mmwrhtml/rr5908a1.htm?s_cid=rr5908a1_w on August 21, 2012.