Ask Dr. Mike: Do I Need to Get Vaccinated Every Year?

Meet internal medicine physician Michael Cirigliano, affectionately known as “Dr. Mike” to not only his 2,000 patients, who love his unfussy brilliance, tenacity, humor, and warmth (he’s a hugger!), but also to viewers of FOX 29’s Good Day Philadelphia, where he’s been a long-time contributor. For 32 years, he’s been on the faculty at Penn, where he trained, and he’s been named a Philadelphia magazine Top Doc every year since 2008. Starting today, he’s our in-house doc for the questions you’ve been itching (perhaps literally) to ask a medical expert who’ll answer in words you actually understand. Got a doozy for him? Ask Dr. Mike at lbrzyski@phillymag.com.

Hey, Dr. Mike! Everyone’s sick — and now there’s a “super flu” in the mix. But some people still swear they “never get sick.” So let’s put it together: Does everybody need a flu shot every year, even if they think they’re the exception?
The flu shot saves lives! That’s why it’s universally recommended, unless you have an allergy to it. All humans get viruses, and viruses like to spread and mutate — and fast. People might say, “Well, Dr. Mike, I got my flu shot and I still got the flu!” They don’t realize that the shot doesn’t prevent you from getting the flu but it reduces your risk — by 30 to 4o percent — of ending up in a hospital on a ventilator because of it. (The new variant this season — subclade K — is pretty potent. I’ve seen patients who are really sick from it.) Besides, data shows that if you get a flu shot year after year, you’re simply more protected, and that’s especially true of the elderly, young people, and those who are immunocompromised.

What about the people who claim they don’t ever get the flu?
To that I say, “I guess you’re an alien!” Seriously though, I operate according to this quote: “In God we trust. Everyone else, show me the data.” If the data shows vaccinations save lives and are safe and effective, then get vaccinated. We have to hang our hat on something. Or else, it’s entropy.

If the benefits of the shot are so clear, what’s with the vaccine hesitancy that’s gotten everyone yelling at each other?
There’s a tremendous amount of misinformation out there and a lot of conspiracy theories when it comes to pharmaceuticals, all of which has been amplified by rhetoric linking immunizations to autism and health issues. So, that’s part of what’s been fueling the contention. I want to remind people that, thanks to vaccines, we don’t really see cases of smallpox or polio anymore. Case in point: Decades ago, when I first started working at Penn, we had two iron-lung machines stored in the basement that were once used to help polio patients breathe. Luckily, vaccines were created and those machines were no longer needed. I’ve never seen a case of polio in my 35-year career.

Still, vaccines aren’t always risk-free, right?
Look, if you give an intervention to 100,000 people, are some of them going to have a negative event? Yes. Getting vaccinated comes down to risk-benefit ratio — every choice in life does. I tell my patients, “You drove to my office in a car. There was a chance you’d get in an accident, but you chose to visit me because the benefit outweighed the risk.” To me, the choice is a no-brainer: Get the flu shot.

What about the COVID booster?
I believe it should be given initially in life, when a baby is six months old. After that, it depends on what risk factors the person has. If you’re healthy and 40 years old, I don’t think getting the booster is necessary.

In my adult practice, I generally reserve the annual COVID booster to the elderly, cancer patients, pregnant individuals, those who are immunosuppressed, and people living with someone who is high-risk. For most patients now, COVID has morphed into a bad cold — the virus has changed over time, and basically everyone on the planet has had COVID and/or gotten the vaccine. It’s not like the beginning of the pandemic where nobody had immunity — that was a whole different ballgame. Also, we now have medication for COVID, like Paxlovid, which can help prevent symptoms from getting worse. One thing’s for sure: If there’s anything we’ve learned from the pandemic, it’s “If you’re sick, stay the hell home!”

Preach! Everyone’s immune system operates at a different strength level. Just because the symptoms of your cold or illness aren’t terrible doesn’t mean someone else’s cold symptoms won’t put them in bed for a week.
Exactly. So when you’re sick, you’ve got to be mindful of your risk of others. Just the other day, I advised three patients who are sick with RSV or COVID not to attend family gatherings because of who they told me would be there. If you’re sick and want to attend the gathering, you’re responsible to ask: Will Grandma Jones, who is getting cancer treatment, be there? What about newborns? I’m not trying to be patients’ personal Oppenheimer and destroy plans, but we all have to consider the impact our sickness might have on people who are vulnerable.

Just last month, the CDC’s vaccine advisory panel changed the guidance for newborn hepatitis B vaccination to a decision-based model. It has sparked a lot of controversy and anxiety …
I vehemently disagree with the guideline changes! The test that is used to determine if a pregnant person has hepatitis B is not 100-percent accurate. So if mom tests negative, but actually does have hepB, the newborn can be born with it. Contracting hepB early in life can be extremely dangerous; there’s almost a 90-percent chance of developing cirrhosis and liver cancer, and dying from it, down the road.

A big misconception in this context is that people think hepB is transmitted only through IV drugs or sexual activity. But it can actually be cross-transmitted in other ways, like sharing toothbrushes or nail clippers. Half to two-thirds of people who have hepB don’t even know they have it, so the potential for household contact puts others at risk, especially children.

What’s the biggest takeaway from all this vaccine talk?
A good thing that has come from the debates is that patients are now talking with their healthcare providers about what they’re hearing. This is great, because we’re the best people to help patients make informed choices. I’ve never said to a patient, “It’s my way or the highway.” My job is to give you advice. With immunizations, I love to remind people that America is the land of the free and home of the brave: You’re free to make decisions based on your beliefs — and you also may be brave based on some of those decisions. If you’re an adult and you don’t want a vaccine, that’s your choice. But remember: When little Johnny or little Susie don’t get a say in the matter of their own health, it’s a fait accompli.