> SOUTHERN INDIANA — Over the past month I’ve had a TB test, a blood workup, a flu shot and a combination tetanus/whooping cough shot. I’ve never been particularly afraid of needles, but that’s a lot of jabbing.

As a kid it seemed every time I went to the doctor I ended up getting a shot of some kind. Now doctors are more inclined to write prescriptions. However, when we lived near Orlando we saw a physician who became known to us as “The Shot Doctor.” When you went to see him, no matter what was wrong with you, you could always count on getting some sort of injection. He had all these wooden boxes, packed with skinny glass hypodermic needles. You would walk into his office and before you knew it, one of them would be stuck in your rear.  

“You’ve got a cold, you need a shot.” “Headaches? A shot will clear that right up.”  “Flat feet? Drop your pants.”

My recent needle marathon took place because I had been dodging doctor  appointments. I had the blood workup the day before my doctor’s appointment (only about seven months late),  but I lucked out because they didn’t have the results ready for my appointment. So instead of the lecture, I got a nice phone call from a nurse instead.

I got a flu shot because I knew the doctor was going to ask me about it. Besides, seasonal influenza is a major public health hazard. Influenza in America typically results in about 200,000 hospitalizations and 36,000  fatalities annually. The flu season in Indiana starts around mid-fall, peaks in January and runs through the spring.

According to a study from New York’s Mount Sinai Medical College, the flu is more common in winter months because the virus is more stable and airborne longer when the weather is cold, dry and the humidity is lower, as it is in winter. By studying guinea pigs exposed to the virus, researchers found that influenza transmission was greatest at 41 degrees and decreased as the temperature rose, stopping completely at 86 degrees.

Also, the shorter winter days with less sunshine result in a decrease in the natural production of vitamin D, a substance important for immunity. Also in the winter months, due to bad weather, children often come into closer contact with each other, resulting in more opportunities to spread the virus, at school and home.

Of course, the best way to avoid the flu is the vaccine. Last year the U.S. Centers for Disease Control and Prevention (CDC), issued a new  recommendation that said everyone over the age of 6 months should be inoculated. Exceptions are people who have reacted badly to the vaccine in the past, people with an egg allergy, and those who have previously contracted Guillain-Barré syndrome after getting the shot. It’s best to get your vaccination early, because it takes almost 2 weeks to develop immunity.

In the 2010-2012 flu season, the CDC, estimated more than 120 million Americans received flu shots. That number however, only represents 49 percent of children and 41 percent of adults — meaning that more than half of Americans went unprotected. There are several reasons that Americans refuse flu vaccinations.

It’s been estimated that at least 10 percent of American adults have a significant phobia of needles and injections (technically termed  trypanophobia). The actual number is probably much greater since people with severe symptoms simply avoid medical treatment. Common phobia prevents a large number of Americans from getting an annual flu vaccination.

Needle phobia was recognized in 1994, when it was included as a diagnosis in the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual, (DSM-IV). Writing in the Journal of Family Practice, James G. Hamilton suggests that needle phobia is genetic and has evolutionary basis. He believes that our ancestors, who were able to avoid all sorts of punctures or stab wounds, had a significantly greater chance of survival. And that 80 percent of patients with needle phobia reported the same fear in a close relative.  

For people who suffer from needle phobia there are many treatments and alternatives that can be effective. The alternate use of nasal sprays or jet injectors which use air pressure rather than hypodermic needles is often suggested, acting anti-anxiety medications, the dental anesthetic nitrous oxide, topical anesthetics at the site of the needle stick and beta blockers have been found useful for people who faint. Laying down, with the legs elevated, often helps prevent loss of consciousness in people prone to fainting.

For more severe cases, psychological approaches such as psychotherapy, cognitive therapy, hypnosis and muscle relaxation training have been found helpful.

A growing group of parents refuse flu shots for their children because they believe that it causes autism. According to Jeff Dimond, a public affairs specialist at the CDC, this belief is usually based on an early, but generally discredited study that linked a vaccine preservative to autism.

Although the association was never proven, the substance in question was removed from all childhood vaccines and most flu shots. Celebrity activists,   like Jenny McCarthy, who claimed her son’s autism was caused by a childhood vaccination, have given this issue a lot of public traction. Despite the assertions of the CDC and scientific experts, one study showed that more than 24 percent of parents still give credence to McCarthy’s views on  vaccinations.  

Some people are frightened because they believe you can catch the flu from the vaccination. This comes from the belief that vaccinations still give you a mild case of the disease, so you can build up your immunity. Dimond says that you are only exposed to the dead virus, which cannot cause the disease.

Other refusers think that flu shots are not all that effective.The CDC reports that flu shots are typically between 70 and 90 percent effective at preventing influenza. However, a recent study at the University of Minnesota found that the shots were about 59 percent effective, somewhat less than the CDC claim. While the study had no conclusions regarding the elderly, they did find that the vaccine was 83 percent effective for young children. There is also some evidence that even in people who get sick with influenza, the vaccination reduces severity and the chance of complications.  

Finally some folks simply believe that you should always leave well enough alone.

A few days ago I was talking to a reasonable and intelligent professional, who told me that he never gets flu shots, even though they are free where he works and would only take a few minutes. He didn’t have any strong beliefs, a needle phobia, or any other logical reason. He just felt that since he never had the flu, why take a chance on unsetting the applecart.

I have to admit before my doctor convinced me, I felt exactly the same way. This line of thinking is based on the pessimistic philosophy that if anything can go wrong, it probably will, so why tempt fate. The only counter to this line of thinking is that the consequence of contracting influenza is likely to do much more harm than the vaccination ever could.

Social responsibility is another cogent argument for vaccinations. By having the shot you are also protecting other people you come in contact with, especially those who have weaker immune systems, like young children and the elderly. Think of it as your doctor avoidance program, one shot and you’re home free.

Terry L. Stawar, Ed.D., lives in Georgetown and is the CEO of LifeSpring the local community mental health center in Jeffersonville. He can be reached at tstawar@lifespr.com. Checkout his Welcome to Planet-Terry blog and podcast at www.planetterry.wordpress.com.