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ASK THE DOCTOR: Is my mother too old for the flu vaccine?

My 89-year-old mother has dementia and I wonder if this, as well as her age, makes the flu vaccine inadvisable. Would the vaccine itself make her ill?

Name and address supplied.

First of all, it’s a myth that the flu vaccine can make you ill. I urge your mother to have the jab.

Without it, the influenza virus can be fatal, with complications leading to death most common in the frail elderly and those weakened by other conditions.

The need for vaccination is particularly pressing this winter following a major outbreak in Australia affecting 170,000 people — more than double the normal number — and where a reported 72 people have died. We are forewarned by their experience as the virus spreads across the globe to the northern hemisphere as we enter winter.

A number of misconceptions surrounding the flu vaccine have led to concerns about its safety and whether it is suitable for everyone. The first is that the vaccine contains strains of the flu. This is correct but, crucially, these strains of the virus are dead and do not, as some believe, cause infection.

It’s a myth that the flu vaccine can make you ill – without it, the influenza virus can be fatal

When these are injected, the immune system examines the chemistry of these viruses and makes immune proteins called antibodies that give a degree of protection against any incoming viruses of the same type.

As part of this immune response there can be some other symptoms such as mild fever and sore muscles, but these should resolve within a day or two.

The second mistake people make is confusing regular viral symptoms with those of flu. The vaccine is given at the very time of year when many types of respiratory virus are circulating.

So the coincidence of receiving a flu vaccine and then becoming ill from one of those viruses — which in many cases cause similar symptoms to influenza, albeit less severely — is not uncommon.

Similarly, if somebody in the early stages of influenza sneezes near me and I inhale the virus, I will start to incubate it. If I subsequently have a vaccine but become ill shortly afterwards, I will blame the vaccine, forgetting that prior exposure to the flu.

But the vaccine does not cause flu. Side-effects and complications are limited to the injection site where you may get temporary pain or aching, or potential allergy to components of the vaccine.

This includes traces of egg protein and of antibiotics such as neomycin or gentamicin. That’s why the only groups that should avoid the vaccine are those with allergies to these ingredients.

The vaccine should be given first and foremost to frail individuals, including your mother, but I would encourage everyone to get vaccinated — especially if you are in an at-risk group.

NHS guidelines recommend the vaccine for everyone over 65, pregnant women, people with chronic illnesses such as diabetes and asthma, as well as those working in healthcare.

I have already had my flu vaccine this year, as I do every year.

The best evidence I’ve seen that these injections, usually given in October, are effective, was research published in the prestigious New England Journal of Medicine. Seven thousand volunteers were given the flu vaccine or a placebo and monitored for three months. The group receiving the vaccine took 40 per cent fewer days off work in that period.

In short, the vaccine is our best defence against flu and it is not unsafe for your mother to have it.

My adult daughter has rheumatoid arthritis and has been prescribed teriparatide injections to make her bones grow. Can you tell me about this, as I didn’t realise bones could grow as you got older?

A. E. Thomas, Barry, Wales.

Rheumatoid arthritis (RA) is a chronic inflammatory disease caused by the immune system attacking the joints and other organs (in fact many doctors now talk about rheumatoid ‘disease’ rather than merely focusing on the arthritis aspect).

Your question about your daughter’s bones ‘growing’ relates to the effect RA can have beyond the joints themselves. Bone is a living, dynamic tissue — with cells called osteoclasts breaking down old bone and osteoblasts making new bone. If this balance is disrupted as a result of age, lack of oestrogen or lack of weight-bearing exercise, it can lead to osteoporosis-weakened bones.

Almost everyone with RA will lose bone, both due to the inactivity imposed by severe joint pain and the inflammatory process itself. On top of that, many people with severe RA will be taking steroids (usually prednisolone) as part of their treatment, which are anti-inflammatory but which further increase the risk of bone loss and osteoporosis.

Rheumatoid arthritis (RA) is a chronic inflammatory disease caused by the immune system attacking the joints and other organs

Rheumatoid arthritis (RA) is a chronic inflammatory disease caused by the immune system attacking the joints and other organs

To prevent this, patients are prescribed teriparatide injections (also called Forsteo) once daily —this is the treatment your daughter is having.

It is the only medication that works by stimulating bone formation; all other treatments work by reducing bone reabsorption. It is however, expensive, costing more than £500 a month, and is therefore reserved for only the most severe cases of osteoporosis.

Forsteo is a synthetic form of parathyroid hormone, a natural hormone released from the parathyroid glands in the neck that has a pivotal role in calcium metabolism. Bone is a ‘calcium bank’ for the body, and parathyroid hormone helps activate the osteoclasts to extract calcium from these stores when the amount circulating in the blood is too low. Forsteo also stimulates the osteoblasts to build bone.

I very much hope that the treatment your daughter has been prescribed, including the methotrexate you mention in your longer letter — which helps reduce the immune system’s attack on the bones — will have reduced the risk of bone loss and pushed the RA into remission, and that a good quality of life has been restored.

By the way . . . Calling children obese will save lives

It is difficult talking to the parents of obese children about their size, not least because all too often they, too, are overweight, and nothing is gained if the discussion feels like an attack on them.

But that doesn’t mean we should avoid confronting difficult or painful issues. However, this week Public Health England has issued new guidance advising healthcare professionals to avoid using the term obese when talking to parents: instead, doctors and nurses should talk about the importance of a ‘healthier lifestyle’.

When I heard this it had a damaging effect on my health and wellbeing, as my blood pressure soared. If using the word obese hurts feelings, it’s because it opens a conversation into a deadly serious subject, and making deviations into gentle Public Health England-derived terminology is hardly likely to help.

Imagine the situation: ‘I went to see the nurse today about Mimi being so out of breath on the stairs, and after she weighed her the nurse told me that Mimi needs to achieve healthier weight status, so that’s OK then’. This achieves nothing.

The only guidelines that those of us caring for patients need are enshrined in the four pillars of medical ethics. Autonomy — allow patients, once informed, to do as they decide, it is their responsibility. Beneficence: be kind but give all of the relevant facts, with straight-talking. Non-maleficence: do not be nasty about it — avoid being accusatory. Justice: be fair, but tell them how it is and advise about all available recommended resources that might be helpful.

Obesity is where someone is so fat it will have a negative effect on their health: you are obese when you are 20 per cent heavier than you should be. Public Health England is well aware of the fact that an astonishing third of children between the ages of two and 15 are obese, doubling their risk of an early death and giving them a seven times greater chance of type 2 diabetes.

Beating about the bush to let people off lightly and enable them to avoid the truth is unethical and downright irresponsible. What is Public Health England up to?


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