Flu Shots, Influenza, & Lupus

Life with lupus means living with a weakened immune system. This is an added challenge during flu season, but a flu shot may help.

Influenza, or simply  the flu, is a seasonal disease that involves congestion, breathing difficulties, fever, aching joints, and nausea. It can linger for 2-3 days, and is caused by the influenza virus, which is highly contagious.

While many people are familiar with the symptoms of the flu, it is easy to underestimate. According to the Center for Disease Control (CDC), 80,000 people in the United States died from the flu in 2017 and another 900,000 were hospitalized.  

The flu shot helps the immune system recognize the flu virus and fight it. It is recommended that all people get a flu shot every year to keep themselves immunized. However, it is still possible to get sick even if you have had the shot. The CDC does an annual analysis of both the flu and the effectiveness of the vaccine.

Having the flu shot helps the body fight off the flu and any sickness is typically milder and shorter in duration.

Lupus and Flu

Systemic Lupus and other autoimmune diseases make people more susceptible to infections and more likely to experience complications of infections (such as pneumonia). This is due to 2 reasons:

1. Weak or improperly functioning immune systems
   • By definition, autoimmune diseases occur when the immune system misidentifies the body’s own tissues as foreign
2. Medications for lupus
   • Immunosuppressants are a common medication for the management of lupus. These medications work by decreasing the activity of the immune system

Because of these challenges, Lupus Warriors need more help protecting their body against invaders like bacteria and viruses. 

Can the flu shot trigger symptoms of lupus?

Flu shots administered via needle are created using versions of the influenza virus altered in such as way so that they are not infectious. The shot initiates the immune response to the virus without the risk of infection. 

However, this is NOT the case for nasal sprays that combat influenza. Nasal sprays, or live attenuated influenza vaccines (LAIV4), are not recommended for people with lupus because they rely on a weakened virus strand to generate the immune response. People with lupus, or other people with weak immune systems, are at risk of developing the infection even from this weakened version.

A 2006 study looked at the safety of the flu shot for people with lupus and people with RA. Half the participants, all of whom were in stable condition, received the flu shot while the control participants did not. The researchers followed the participants for a year. The researchers noted that the shot was well tolerated by all participants. And, those who received the flu shot experienced significantly fewer infections.

Additionally, the study “Autoimmune response following influenza vaccination in patients with autoimmune inflammatory rheumatic disease” looked at how 218 people with autoimmune inflammatory rheumatic disease (and people who were otherwise healthy) reacted to a normal H1N1 seasonal vaccine. The study didn’t identify any major safety concerns with the flu shot. The researchers did detect the production of autoantibodies in a small number of the participants but this increased production was temporary and only identified via blood test.

Are flu shots less effective for people with lupus?

“Studies of cell‐mediated immune responses to influenza vaccination in systemic lupus erythematosus” is a study that looked at people with lupus given an influenza shot, and compared their immune response to a control group of control participants. Lupus Warriors experienced a weaker immune response in general, and were less protected against the flu. This was true for both antibody production and for the activation of their white blood cells, known as cell-mediated responses. 

(You can read more about this study as described by the Lupus Foundation of America at Lupus.org)

What do doctors say?

For people suffering from autoimmune diseases, the protective benefits of the flu shot likely outweigh the risks.

Most doctors and the CDC recommend that people suffering from autoimmune diseases, including lupus (as well as the people around them who could infect them) get the flu shot and the pneumonia vaccine every year to protect them from the disease.

As with any health decision, work with your lupus treatment team to evaluate what is best for you. You should NOT get the flu shot if you:

• are pregnant
• have had an allergic reaction to the flu shot in the past

How do I keep from getting the flu?

No matter whether you can or can’t get the flu shot, you should definitely try to lower your risks of catching the flu in the first place. Try a few simple and common-sense steps to avoid getting sick this Fall:

•       Clean and disinfect your desk, room, or objects you often touch or come into contact with. They might harbor bacteria or viruses, such as the flu, and cleaning can make it much easier to avoid getting sick.
•       Wash your hands often with soap and water, or an alcohol-based hand rub. Washing hands regularly helps keep bacteria and viruses, such as the flu, from entering your body and making you sick.
•       Avoid being close to or touching people who are sick. Although you may want to comfort them or take care of them, #LupusWarriors are very vulnerable to catching illnesses from others, and will be hit harder. Protect yourself — they will understand.
•       Encourage people who live with you or come into close contact with you to get the flu shot (not the nasal spray). Even if you cannot receive the flu shot yourself, protecting them makes it less likely for them to catch the flu and pass it on to you — a win-win situation called herd immunity.

Looking to learn more?

There are many factsheets dedicated to this very topic, including an in-depth FAQ by Lupus.org. They also have a section highly recommending that people with lupus get their flu shots if possible.

The CDC has an entire website dedicated to the flu, including pages talking about prevention, symptoms, and treatment.