Understanding Impact of the Flu on People with Lupus

Flu Season Vaccines 

During this flu season it is important to discuss getting vaccinated, particularly for vulnerable groups of people, like people with chronic illnesses. -File Photo

By Dr. Tamar Rubinstein, Pediatric Rheumatologist, Children's Hospital at Montefiore 

Bronx Voice 

January 19, 2024

NEW YORK - As we have reached the peak of flu season, it's time to discuss the importance of getting vaccinated, particularly for vulnerable groups of people, like people with chronic illnesses.

While flu can affect anyone, it is much more likely to lead to severe illness in people with chronic conditions. This is why if you or your child have a chronic medical condition, it is probable that your doctor will ask, “have you had a flu shot this season."

As a pediatric rheumatologist, taking care of kids and young adults with autoimmune and inflammatory conditions, where the conditions themselves and the medications we use to treat them can impact how sick people get from common infections, this is certainly one of the first questions I am asking my patients in clinic this week.

During the 2022-2023 flu season over 24,000 people were hospitalized in New York State. The weekly rate peaked the week of December 10th last year at just under 53,000 cases. The peak of the 2023-2024 flu season was estimated to come early January. And those of us working in hospitals are seeing this peak in action. According to the New York State Influenza Surveillance Report, the last week of December 2023 was the 6th straight week of high or widespread flu activity, with the number of people hospitalized steeply increasing from the previous weeks.

Likely the best protective measure that we have against severe flu, is the flu vaccine. Yet, uptake of the flu vaccine is less than optimal, sometimes because of myths or misconceptions around its risks and benefits.

One of the persistent concerns that exists in autoimmune and rheumatology patient communities is that vaccines, such as the flu vaccine, may lead to disease flares or worsening disease. Yet, there is very little evidence to show that this is the case, while there is good evidence to show that getting the flu can definitely make people more vulnerable to flares and worsening disease.

One of the most common rheumatologic conditions that affect kids in the Bronx is childhood-onset lupus - an autoimmune disorder where the body's immune system attacks the body's tissues and cells, leading to issues like fatigue, chronic joint inflammation and pain that can impact their daily living. Lupus in anyone, but especially in children, can cause permanent damage to almost any part or organ of the body. Unchecked, lupus can lead to permanent damage and even death. Controlling the condition is not just important to allow kids to have relief from pain and discomfort; it is crucial to ensure that long-term complications and damage do not develop and to make sure that kids with lupus can live long, healthy lives. This is why parents and doctors spend a lot of time and energy considering all the ways they can prevent kids with lupus from flaring. 

One important thing we can do to help protect these kids this season from getting serious flu infections AND from getting lupus flares, is by vaccinating them with the flu shot.

What else can we do to protect kids with lupus? We can work to vaccinate the people around them, as well. The more close contacts who are vaccinated against flu, the less likely people are to transmit the virus to the child.

The Centers for Disease Prevention and Control recommend that all people 6 months and older (with few exceptions) get vaccinated against influenza as early in the season as possible. And even though it’s January, it’s not too late to get vaccinated. Flu can linger as late as May, so any protection now is better than none. But the longer you wait in the season, the less benefit you get and the more likely you are to get the virus unprotected.

If you and your child got flu vaccines last year, you may wonder why you need to get them again this year. Each year different strains of flu circulate and the exact strains of flu the vaccine protects you from are different, based on the predictions of scientists who study viruses and their spread.

If you have questions about whether your child should get the flu vaccine, please discuss this with your doctor.  

For more information about lupus and the flu vaccine see: https://www.lupus.org/resources/get-your-annual-flu-shot. 

Wishing everyone a healthy and happy 2024.

Tamar Rubinstein, MD, MS, is a Pediatric Rheumatologist at Children's Hospital at Montefiore and an Assistant Professor of Pediatrics at our Albert Einstein College of Medicine.