October 15, 2021 Influenza Vaccine and Diabetes

good afternoon or if you're calling from

the west coast good morning everyone uh

well thank you for being here my name is

brooks roach i am a diabetes education

specialist here at diabetes canada and i

would like to begin by acknowledging

that i am joining this webinar from the

traditional and unseated territory of

the makema people

and wherever you're joining or watching

from i will invite you to express

gratitude for the land on which we live

and to acknowledge the past inhabitants

of the indigenous lands that we call

canada

we are here today to talk about the

importance of influenza vaccines

specifically for people living with

diabetes we're joined by two wonderful

experts dr susie hoda who is an

infectious diseases specialist and an

epidemiologist at toronto's university

health network and associate professor

at the university of toronto thank you

susie for being here and we also have

mike boyvan who is a pharmacist

consultant with com farm so welcome and

sincerely thank you to you both

so the way that today is going to work

is our experts will be answering some

key questions they have been hearing

from patients and we'll also be taking

questions from you our viewers so some

questions have already been submitted

and you can feel free to ask any

questions that come up over the course

of the webinar by replying in the

comments below on facebook live

so we'll go ahead and dive right into

some some key questions that we've

received on

influenza vaccines and diabetes so dr

hoda we'll start with you and the first

question that i'd like to ask is if you

could provide us with sort of a basic

definition of influenza or the flu and

what symptoms to look out for

sure so what we commonly call the flu

refers to the influenza virus then this

is a virus that tends to infect our

upper and lower respiratory tracts and

when it does it can result in symptoms

like runny nose sore throat

nasal congestion a cough and fever and

you can also have sort of general

symptoms like muscle aches feeling

really tired and lousy sometimes even

some stomach symptoms you know

gastrointestinal upset diarrhea things

like that

um and most people will recover from

those symptoms within about seven maybe

10 days

but you can pass it on to other people

from starting from about a day before

when you start getting those symptoms to

about five days into your illness when

you have the most virus that you're

shedding and the way that you're able to

transmit it to people is through

expelling respiratory particles so

particles from your respiratory tract

that contain the virus while you're

infectious and people around you

who might get exposed to those particles

will inhale

and the other thing is you can also then

contaminate surfaces around you with the

virus um and then others who touch those

surfaces and then touch their nose or

eyes or mouths will then potentially

introduce it into their bodies and get

infected

so that's really how it works we we do

tend to see influenza viruses

circulate around a certain time of year

and that's usually between around

october november generally november till

about april or may

uh may would be very late actually it's

more more until the end of april and it

usually peaks around december late

december early january somewhere around

there

and it's often multiple different

strains or sort of subtypes of influenza

virus that are circulating at the same

time

and some will kind of predominate in a

certain season so there might be one

that really kind of takes over and tends

to cause most of the infections

but the virus itself is very capable of

changing and mutating and

that's one of the reasons why it's

really important to be getting influenza

vaccines on an annual basis because you

first of all don't get protection that's

offered for too long by a vaccine it

does kind of wane that immunity

but also you need to match the different

subtypes or strains that are within

the vaccine with what is circulating

that year

so so it is important to recognize there

are different strains of influenza

i'll say that in this past influenza

season or kind of respiratory virus

season we haven't seen a whole lot of

influenza actually globally we haven't

seen much influenza in the last 18 19

months

and i think that the theory is a lot of

that is because with the coven 19

pandemic

we've been using measures that are

common to reducing transmission of any

respiratory virus including covid so

things like all the masking we're doing

especially in indoor settings and

reducing our social contacts and keeping

physical distance and lockdowns that

we've experienced has really kind of

changed fundamentally

the epidemiology the numbers trends

everything that we see with influenza

but also other respiratory viruses and

so

that's been really helpful so that we

can respond to the pandemic

appropriately but it also does make us

recognize as we're

starting to release

society from some of those measures we

might see

influenza and other respiratory viruses

that we can't forget about that

circulate at the same time uh cropping

up so we really need to be prepared and

do what we can to prevent

uh you know the harms of influenza virus

this season

thank you doctor that that's really

helpful and i think a lot of people you

know i've heard this this sort of this

trend of maybe vaccine fatigue where

people have there's been so much time

and energy invested into the commitment

to get a covet 19 vaccine that this

feels like haven't i already done that

and and i think highlighting that

difference is really important um and i

think for a lot of viewers another

another point that that's frequently

raised and frequently asked is about the

relationship between influenza and

diabetes so could you speak to sort of

the change in risk factors if someone

lives with diabetes

absolutely so if you have any kind of

diabetes so that means type 1 type 2 or

even gestational diabetes you're

actually at risk

for having complications of influenza

infection so i already talked about what

symptoms are really common with a usual

influenza infection but

a proportion of people will actually

also have complications which include

typically bronchitis

or

pneumonia so a lower respiratory tract

infection that's more serious and quite

often does result in hospitalization

or things like middle ear infections um

sinus infections

and the other thing that it's really

relevant is uh kind of a less recognized

complication of influenza infection

that's especially important for those

with diabetes is you can have heart

attacks or strokes related to your

infection

so it can precipitate that um so there

is a connection between heart disease

and cardiovascular uh health and

wellness and influenza infection

so that's an important relationship to

recognize

on the matter of sort of complications

of influenza infection very rarely

people will actually suffer from really

serious consequences of influenza

including things like inflammation of

the brain or the lining of the brain

or things like inflammation of the heart

muscle itself or the lining of the heart

muscle so

these are really important things to

know about they happen uncommonly but

but again if if there's a way to prevent

it that's that's kind of where my mind

goes what can we do to try and prevent

that and that's what we're going to be

talking about today

one other thing to keep in mind sort of

a final relationship between diabetes

and influenza

would be if you had diabetes and you got

an influenza infection it could actually

make it very difficult to control your

blood sugars partly because any

infection will then you know increase

your blood sugar levels

commonly but the other part is uh

characteristic of influenza is that

people lose their appetite sometimes and

so it can be a little bit hard to you

know gauge insulin levels and you might

run a less a risk of

hypoglycemia as well during the

infection

thank you and so recognizing that inner

connection

that you've just highlighted next

question is going to go to to you mike

and that's

if you can explain the the sort of added

importance uh and effectiveness of

immunization if someone lives with

diabetes

and in addition to that as we've seen

over the past say 18 months um

are there any other strategies in

addition to a vaccination to reduce the

spread of influence influenza or these

related viruses

that's a great question

so dr hoda really touched on it already

is that we've seen so little influenza

through globally over the last few years

so we know the strategies that we're

using for kova 19 are working to reduce

the risk of a lot of these respiratory

types of infections

but the key thing is as we relax these

measures there's going to be potential

issues that we see so people said well

why did i bother get the flu shot last

year when there's so little circulating

why don't i just wait and see if it

comes back well first and foremost it

takes at least two weeks for the vaccine

to actually get enough levels of

protection within the body so if you

wait for the flu to circle in your

community it could be too late and this

is especially important for people like

you who have diabetes who are much

higher risk of these complications that

dr hoda qualified

what you may not know is that five to

ten percent of adults globally and

twenty to thirty percent of children are

infected in a typical year with

influenza

a lot of the healthy people recover

without any issues at all but people

like patients with diabetes or some of

our older patients are higher risk of

complications including heart attack or

stroke

pneumonia hospitalization and we know

that influenza will kill a portion of

our population every year and this is

why it's so important to protect our

patients

what you also may not know is that here

in canada pneumonia and influenza or the

flu is amongst the top 10 causes of

death that we see every year so this is

something that's really important for

you to take care of yourself if you're

focusing on your diabetes to keep

healthy this is a key thing that you can

do to actually help keep yourself

healthy and out of hospital

now if you're looking at ways to to talk

and protect yourself we we talk about

the flu and i think that one of the most

effective ways if you do not want to get

the flu just like if you do not want to

get coca-19 the best strategy is to get

the vaccine

now we hear every year when people say

well the vaccine doesn't necessarily

work every year and you'll see it in the

media sometimes we'll say well the

vaccine is only 50 affected

to let you know how this works is that

the world health organization every year

tries to think of which vaccines are

going to be i'm sorry which viruses are

going to be circulating with influenza

every single year and they do this in

may march april may to predict what's

going to happen on our flu season here

in the fall sometimes they're perfect

and the vaccine has very high efficacy

and sometimes they're not as good in

terms of the way that the vaccines end

up working but the key thing is is that

even when the vaccine is not a perfect

match we know it keeps people out of

hospitals and reduces a risk of death so

it's so important that one of the key

things that you do is get that vaccine

every year now brooks you were asking

about what other measures you can end up

using like everything that we're doing

for cover 19

masking seems to work washing your hands

staying away from people that could be

ill staying home when you're sick or

anyone else in your family sick will

reduce the risk of spreading the flu

within your communities once we go back

to normal

thank you mike and i think you know the

point you make about the that delayed

onset or if someone is waiting to see if

there is a flu outbreak um it's almost

like waiting to see if there's a flood

before you flood proof your home it's

once once the signs are there uh you're

gonna wish you had had protected

yourself in advance

um our next question is gonna be to both

of you and it's that you know that

there's been a lot of discussion around

a well-founded discussion on getting the

copic 19 vaccine distributed to

different age groups

and i'm wondering if you could share

some thoughts on who is eligible and who

should get the influenza vaccine based

on age based on demographics where

someone lives

what what

what prioritizes an individual

sure so maybe i'll get started and make

please feel free to jump in

in my opinion everybody should get the

influenza vaccine and here in ontario at

least in many provinces it's funded to

be available to everybody but in

particular i'd recommend those who are

at risk for having complications related

to co to not covenanting to influenza

infections so that does include diabetes

there's a whole long list of health

conditions um that actually do put

people at risk heart disease liver

disease

also age is important so if you're over

the age of 65 or or if you're a child

you're at a higher risk of complications

of infection so

these are the kinds of

risk factors there are other things as

well that are important to consider so

if you are a caregiver you live in a

household with somebody who's at risk

for severe complications of influenza

you should also get vaccinated or if you

live in an institution like a long-term

care home or or in a sort of more

congregate type setting then it would

also be important to protect yourself so

i'll i'll start there and might have

other comments about what yeah and

that's a great point i think one of the

key things is as as you mentioned

everybody over the age of six months

should be getting the vaccine the key

groups are the really young and the

really old they tend to be some of the

people of the highest risk of

complications so the kiddos that we see

and they were sending off to school that

we're worried about that we can't yet

vaccinate against cover 19 we can't

vaccinate them against influenza we can

we can protect them at this key point so

this is a key group that you can look at

but also from our older patients anyone

over the age of 65 there are different

vaccine options that are available for

our individual people that are over the

age of 65 experts recommend that they

get a high dose influenza vaccine so if

you're over the age of 65 i would

encourage you to get that vaccine

in many provinces this will be paid for

by the government's plan so strongly

encourage you to get the highest one and

may reduce your overall risk but one of

the key groups that i focus on are the

young and healthy people and we've seen

this with cobia 19 and we've seen this

with influence in the past is that i'm

young i'm healthy i don't need to worry

about i'm going to be fine if i get the

flu and the odds are you're probably

right you'll probably be sick but you'll

probably recover completely the

fundamental issue thing issue thing is

two things one thing is that if you get

sick with influenza there's a good

chance that you're going to be sick on

your back for up to seven days most

people recover as i mentioned within

seven to 14 days but seven days you can

be out of commission

so if you're a young person you're young

and you're healthy and you're feeling

great

the problem is is that you can miss

seven days of work or seven days of

school and this could be a significant

issue if you're trying to in university

or in high school or if you're working

at a part-time job or a full-time job

you may be going without that pay

the most important thing though we see

is that you have an important thing

about reducing the amount of

transmission in the community

i would hate to be a young person who's

young and healthy but then to give it to

my grandmother and then i'm running into

somebody or to give it to somebody with

diabetes and they end up getting really

sick with it so anything that we can do

as a group to actually reduce the

overall risk i think is very important

yeah i wanted to actually maybe expand a

little on that because i think that's

that's such a key point you know we get

vaccinated against influenza to protect

ourselves but also to protect society

right so there really two goals there

and you know for the individual

especially if you're at risk it can

reduce your risk of hospitalization by a

third

if you get vaccinated and especially if

you're older it's it's got much more

effect

but it also reduces a risk of death and

particularly in people with at-risk

conditions um but in terms of the

society as a whole

you know we have to think too about

what's been happening with this pandemic

and our healthcare system is very

vulnerable right now you know we've got

shortages of healthcare workers um

people are quite fatigued and uh and and

the healthcare system is

uh not as resilient in terms of

dealing with additional you know

preventable illnesses and so you know if

hospitals start to fill up not just with

influenza but also covet and other

respiratory viruses then it makes it

very difficult for us to provide the

kind of care that we need for everything

else as well so you know these are

important societal

considerations as well as as you make

your decision about getting vaccinated

yeah that's a great point one of the key

things that i focus on is that we see in

our patients with type 2 diabetes there

are many of these patients that are over

the age of 65

and one of my key worries that i see is

that you know when some people say well

i'm older or something happens to me

it's not the end of the world the

problem with influenza is there's many

patients that will end up getting it

that actually don't end up dying from it

but end up having permanent disability

from it so if you get hospitalized or if

you get a severe case and it leads to

damage in your lungs all it does is it

increases your overall level of frailty

so by increasing your frailty you may

not be able to live as independent as

you were before some of these people

never recovered to the way they were

before and this is such a simple measure

that you can end up doing by getting

this flu shot every year you can reduce

your risk of this happening to you and

that's the last thing i want to see to

happen to any of you or to any of your

family

members yeah thank you both that's those

are really really important points and i

think you know that that idea is it's

not necessarily for us it's for those

around us and that vaccination just does

not necessarily stop uh transmission um

there's a point that was that i see

raised in in the comments coming in from

facebook so it's to consider it more as

a an individual as a vessel that could

could

could pose harm to others and that's

that's why it's so important

um so with that uh making reference to

questions coming in via social media

we're going to open it up to questions

and uh the first question that we have

that's been submitted is

uh

and this for context at the time that

this webinar is being recorded there are

some discussions taking place at the

provincial uh federal level around a

third shot

of the covet 19 vaccine

specifically for folks who are immuno

compromised so the question is would a

third shot for kovitz 19 if it is

approved

have any impact on getting the yearly

flu shot

so i i guess i could uh start off with

that um there is some work that's being

done to kind of review right now what

the implications are of sort of

co-administration of different vaccines

and

you know right now we don't have any

evidence that if you got your third shot

of a covet 19 vaccine and you had to get

your influenza vaccine shortly after

that that there would be a problem that

there would be any interference between

them but to be cautious the

recommendation remains that if you get a

dose of your covet 19 vaccine you should

wait 28 days

before you get another vaccine so that's

what we would prefer to see happen

if there's some emergent reason for this

would be unlikely for an influenza

vaccine but say another vaccine to be to

be given in a shorter time frame than

that that can be done you do have to

speak with your health care provider to

understand the risks and benefits but it

can be done but yeah yeah i don't think

it's going to interfere it's not going

to cause a problem you can wait a little

bit to get your influenza vaccine if you

do indeed need to get a third dose of a

covet 19 vaccine

okay thank you

the next question that's been submitted

is

kind of just an operational one and it's

when will the influenza vaccine be

available this year

makes you happy inside that's always a

really great question it all depends

every public health unit in in the

province is quite different so we see

some variances in terms of when they get

actually in

to primary care providers so to your

local pharmacies you're a local family

physician or public health to be able to

administer them so the key thing is that

we know with people diabetes you're on

medication so your best bet is just to

connect with your pharmacist um they are

there all the time they will be able to

tell you exactly when they're getting

their flu shots in and we'll know that

probably by middle of october but it

varies every year so you'll have to just

double check with them and they'll be

able to let you know

we have a we have another question that

is regarding uh if vaccination is

effective at stopping transmission so

i'm wondering if you folks could could

speak a bit to that and i think that

that leads into uh a question around

debunking some common misconceptions

around vaccination so um

i'll leave that with with you folks if

one of you would like to take that on

around the effect on transmissibility

that vaccination has

do you want me to take a stab yeah go go

for it i'm starting with that yeah i

mean so i think um you know it really

depends on how the effects or the

outcomes are measured in different

studies of different vaccines just how

much we can comment on this and for

influenza i think we know that

transmission can occur and we're seeing

this with a lot of different viruses

um

and and it's not necessarily completely

prevented by vaccination but when you

think about you know even a moderate lee

effective vaccine like what we have with

seasonal influenza vaccines preventing

infections from occurring say 40 to 60

percent of the time if that's what the

you know a certain year's

vaccine effectiveness is

that reduces the opportunities so in a

way it does still have some impact on

the risk of sort of community

transmission of infection so if enough

people get vaccinated it will have an

impact so it's a bit of a hard thing to

explain i guess um but that's it's it's

about having

uh a community-wide effect but for the

individual yes you may still

get infected because it's not 100

uh effective at stopping symptomatic

infections from happening and yes you

may transmit onto others if that occurs

so

you know i think that's kind of the

bottom line the other thing i'd say is

again we focus so much on the

transmission piece on the symptomatic

infection piece and i think the covenant

19 experiences helped us to learn that

sometimes you have to keep your eye on

what's truly important and that's the

really severe illnesses and you know the

risk of hospitalization like i said

being reduced by a third

with influenza vaccination that's an

important outcome the risk of death

being reduced as well and by up to 25

from heart disease and stroke in those

uh with diabetes in particular with

influenza vaccination like we're getting

some pretty good data out there that it

does make a difference um so i i think

that that counters that whole question

um and the relevance of whether we

should focus on transmission yeah and

the other thing that you can focus on is

the way we look at vaccination is it's

protecting you on the inside so you can

actually inhale in virus a respiratory

virus it can get and it can grow in your

nose and you may be able to spill some

of this virus out but if that virus is

to get into your respiratory tract or as

they get into your body having the in

the the antibodies from the vaccine can

protect you so it can reduce your risk

of transmission can reduce your risk of

really severe outcomes so it's a key

focus so everybody says well if you're

still going to be able to transmit do i

still need the vaccine of course because

we want to protect you and we want to

protect everyone around you

yeah exactly

yeah that's a great point um we have

another question that is um

from from a viewer who has uh lada or

latent autoimmune diabetes in adults

and this person's wondering if they

should consider getting a third covid19

shot if it becomes available

yeah right now that's not one of the

approved indications among the group of

individuals were considered as immune

compromised and where there's enough

data that

we feel it's important to give a third

dose at this time and the rationale for

that is not so much thinking boosters

but thinking that recognizing that some

severely immune compromised people

actually don't have enough of a of an

immune response in the first place when

they get the the two series the series

of two doses and so a third one seems to

augment that response and and that's

really the rationale behind it so we do

have to be a little cautious with the

language we use we haven't seen that yet

with certain groups um people with

autoimmune diseases for example

what's very interesting with it too as

well is that the coca-19 vaccines have

been quite different and unique whereas

in some conditions where we see very

poor responses to vaccines so patients

that have had chronic kidney disease

don't respond well to some vaccines but

seem to respond really really well to

the kova 19 vaccine so as we get more

and more of this information i think we

can make better and more specific

recommendations for our patients but as

dr hoda mentioned we know that patients

who are on immunosuppressive therapy so

patients that have ra

rheumatoid arthritis psoriatic arthritis

and they're using biologic therapies

those patients are at higher risk of not

having enough antibodies coming from the

vaccine so those ones are typically

prioritized for that third dose at this

point but that may change and so as we

know as more things will change we'll

learn more so for you i would just wait

and see there's nothing really at this

point but we may have more information

for you a month from now two months from

now or a few months from now

we have another question and and this is

sort of a down the road looking down the

road and it's uh regarding what measures

have been taken to protect people

uh if mrna vaccines start to cause

delayed immune system responses like

diabetes so i suppose the question is

around um what what preparations if any

uh do you folks know of that have been

been made for for longer term potential

implications of current vaccination

that's an interesting question actually

and i think if i understand it correctly

it's talking about how would we even

know if there is a signal and how would

we respond to it right

so after any new vaccine therapeutic is

on the market there's always some

post-marketing surveillance that occurs

and i think there's an especially

important big focus on that with the

cove 19 vaccines because

of the magnitude of the vaccination

effort that is going on right like mass

vaccination at a level we've never done

before but also new technologies behind

some of the vaccines that we're using et

cetera et cetera and so the clinical

trials that originally were used to help

with getting authorization for these

vaccines are still ongoing you know the

participants are still a part of a

follow-up

proto follow-up uh in the protocol and

you know we should be getting some

longer-term data on what are the risks

of developing a problem like diabetes or

an autoimmune disorder for example

or anything else any other signal that

might emerge longer term after having

any of these vaccines

that's one way we get it the other thing

is that there's ongoing like i said just

i guess broad post

marketing surveillance that's occurring

in which adverse events or any data on

that is being recorded and collected and

it will be analyzed over time to make

sure that you know from a big society

perspective in real life we're getting

those signals as well

in terms of how we respond to it i think

it's again just the healthcare system

has to be prepared for all the demands

that might come from this pandemic and

that includes people who've suffered

from long-term consequences of covet

infection itself which we're still

learning about and there's some

interesting data coming out on that on

the magnitude of what that could look

like within you know ontario and canada

and also

you know some of the therapeutics that

are being used as well as the vaccines

that are out there so

so yeah we just have to be prepared for

for what those consequences would be

yeah i think one thing to jump in on

this one brooks is that i'm what i'm

really concerned about and what i've

seen over the last year to year and a

half especially in patients with

diabetes is that we're seeing people

forego the regular care that they've

actually had so some of these people

have

stopped some of their medications or

haven't really been managing their

diabetes as well because they haven't

been able to have access to their

diabetes educators their family

physicians as easily and i'm really

worried about what that impact will have

over the long term like we talked a

little bit about the link between

cardiovascular disease or heart disease

and people that don't get their flu shot

so if you get the flu that puts you at

higher risk but if we don't control your

diabetes this can put you at higher risk

of complications as well so your heart

your kidneys your eyes your feet all

those can be affected so you know what

although a lot of people are worried

about what is going to be the impact of

vaccines

my my primary basis of all the vaccines

we we have and dr hoda you can jump in

is that i've never seen data showing

that we see any prolonged adverse

effects or side effects six months after

so

side effects that occur six months eight

months a year afterwards typically we

see this shortly after immunizations and

i'm confident in terms of what we're

doing is that we're immunizing so many

people side effects that we may have

never seen

never came up in any of the trials we're

seeing now because once you give this to

a thousand people 2 000 people we're

giving it to millions of people millions

and millions and millions of people so

even the smallest signals can actually

show up on some of the bases so am i

worried about things developing in in

the long term probably not but we're

hoping that you know if anything this

comes up we'll identify them and we'll

address them just like any other issue

yeah

we have another question this is

regarding the the influenza vaccine for

the coming flu season so 2021 to 2022.

um and it's it's simply what what is new

with this vaccine or did we know that

information yet as as mentioned you

mentioned mike it comes from the world

health organization in the in the spring

um are we are you folks aware of of what

specifically how it's composed or i

suppose within that question is that

something that folks really need to

um dive into the details of

yeah i mean so it's it's funny every

year uh in our occupational health and

safety department we'd have this you

know discussion before flu season before

we ramped up for our campaign to

immunize and get all excited

the question that people always waited

for is what's in the flu vaccines that

we're giving out this year and when you

think about it it's kind of irrelevant

in a way you know it's really just

it's what

has been decided is most likely to be um

circulating based on what circulated in

other parts of the world during their

seasons which are kind of the flip of

our seasons you know the southern

hemisphere and temperate regions where

it circulates all year round

um so the cdc did release it i i haven't

seen it i was scouring our nasty

statement and um and for whatever reason

they i couldn't pick it out as easily

but i know that we end up having the

same constituents as within the u.s

typically correct me if i'm wrong mike

but that's right that's what i know um

so there are two different types of

vaccines that are out there there are

ones that are grown within eggs so

they're egg-based vaccines and then

there are some that are more cell or

recombinant of different technologies

used to make those vaccines and the

components are slightly different but

they always have two of the influenza a

subtypes in them and depending on if you

have a vaccine that is what we call

trivalent so it has three strains within

it um that it covers three strains

within it or quadrivalent so it covers

for four

um you would either have one or two of

the b strains

subtypes that are that are in there so

um in the egg base this year it's a

victoria h1n1 if this is relevant to

anybody uh the a cambodia h3n2

and the b washington uh victoria lineage

and b uh phuket yamagata lineage and

that's the ones i mean we typically do

give out more of the egg-based vaccines

um there's a slight difference in what's

offered in the

other type of vaccines this year

and i think that's been a really key

issue is that we have we used to back in

the day like if you look at me i have a

lot of gray hair now and it's been

around for a while like we had one

vaccine for everybody whether you were

six months or you were 85 it was one

vaccine for everybody the fundamental

issue now is we have lots of different

vaccine options so first and foremost

there is if you're worried about needles

and you're under the age of 50 there and

you're 17 to 50 you can consider getting

the flu flu mist if it's available this

year it's actually a message you can use

inside the nose it is an effective

vaccine and you wouldn't have to get

poked with a needle

we have vaccines that are specifically

designed for kids underneath the age of

two we have vaccines that are specific

designed for patients over the age of 65

and then the new technology is dr hoda

mentioned these are ones from cells so

they never touched an egg so these ones

for patients although all vaccines seem

to be okay patients with flu egg

allergies these ones are especially safe

for those individuals so the key thing

is there's lots of different vaccine

choices you can end up using out of all

of the ones that are mentioned the key

thing here is that if you're over the

age of 65 consider a high dose influenza

vaccine that has three times or four

times excuse me the amount of the of the

antigens or the amount of the stuff that

we're developing the antibodies to in

that so it really helps older people

that tend to have a weaker immune system

but for every other person take the

first flu shot you're offered doesn't

matter which one all of these are going

to offer good protection for you

that's really interesting and i think

for our viewers i'll highlight two

really interesting points from that

answer which was fantastic and first is

that there are a lot of different types

and mediums media through which you can

get this vaccine if you're if you're

needle averse you can get it via a mist

you know if you if you have an egg

allergy there are ways to circumvent

that that challenge so there are um it's

been made very easy to become vaccinated

is the the key point there and uh you

know it should be

take advantage of that if it's if if you

can um can i just add one thing to that

and one of the key things that we see a

lot with um with vaccines is that people

will never they don't normally want to

mention to healthcare providers that

they're they're scared about needles or

they don't like the pain of their

vaccines we have lots of options that we

can end up using that if you need to get

a needle we can reduce the pain from

that without a problem at all the key

thing is that you have to bring it up to

the attention of the people that are

giving you the vaccine they'll work with

you we have creams we have things that

can end up helping you we'll barely feel

the needle that's going in will make you

much more comfortable and it's just a

matter of bringing up and we can do our

best to end up helping those out

yeah thanks mike i i think the other

point that i found really interesting

and

it's when folks talk about uh you know

the question arises what's in the the

flu vaccine or you know how is this

being developed and uh susie the point

you raised about it actually being a

kind of a rolling

collection of data from whether it's the

southern hemisphere or more temperate

regions around the equator we're dealing

with a sample size of potentially

billions of people so this is you know

as much as the the criticism can be

lobbed as mentioned earlier if it's only

let's say 40 to 60 effective um that's

still on the scale of billions of people

you know and we're basing this on

on uh this this really constant and

expert collection of of data that's

that's coming in from all over the world

so um it's really worth noting that

that's such a powerful concerted effort

um

on that note there's a follow-up

question that just came in and it's

would or could there be a missed form of

the vaccine for cova 19

i think there are some people who've

been trying to work on intranasal

vaccines for covid19 i don't know a lot

of details about it but there is a

theoretical benefit of getting to the

right kinds of cells by

administering the vaccine directly to

the the nasal passage

but i don't think any of them are close

yet to coming

you know going through clinical trials

and going through the entire process

but maybe one day

yeah and it's it's an exciting

notion from a theoretical basis because

we're worried about with these

respiratory viruses the virus gets into

the nose it can grow in the nose and you

could potentially transmit it but if we

push that vaccine right into those

passages and touching on those tissues

we may be offered some great protection

for us so that may be a potential for

boosters moving forward but we're not

sure as of yet and i haven't seen

anything that it will be a month from

now two months from now or potentially a

year from now we'll get more information

as as they do more testing

we have a question um from a parent uh

apparently

someone with

with diabetes and they say my 15 year

old son

won't get the covert back cover 19

vaccine he has been watching the news

and and saw that it causes heart

inflammation in males his age

he said i already have diabetes i don't

need

another a health another heart problem i

don't need a heart problem

so the question is

do do you know the percentage of uh

you know of uh intersectionality in risk

for for young males but i think most

importantly is the second question how

can i encourage him to get it

can i just jump in really quickly on

that one before we'll let dr hoda take

the heavy lifting on it there was a

paper that was published in the new

england journal of medicine just a few

years ago looking at what are the

potential side effects of using an mrna

vaccine so this would be the pfizer

pfizer biontec and the madonna vaccines

that we have here in canada

versus if the person had cover 19

infection

the data is actually showing that a

patient is at risk of heart inflammation

if at about three to four times higher

risk if they had covered 19 than if they

have the vaccine

so for a young male who actually has

diabetes who's at already risk of

actually getting a heart condition

because of his diabetes i'd be very very

concerned from that key component

the fundamental issue is and i've had

many many conversations with people that

i'm unrelated to not family members not

direct patients of mine that just want

to ask questions so from a parent

perspective i find it's very hard for a

lot of parents because it seems like

that you're just pushing on a 15 year

old or 16 year old telling them what to

do the key thing for them is to try to

find a health care provider that they

work with so this could be an educator

from their perspective they could be

their pharmacist a family physician a

nurse educator or a dietitian

endocrinologist that they see on a

regular basis to actually have a

conversation about why they should end

up having it

i i can tell you i have kids that are in

that age group um i feel very

comfortable that my kids are protected i

feel it actually provides me some relief

that they are and it's the biggest thing

that we can end up doing to help us all

get back to somewhat normal life again

yeah i actually don't really have a lot

to add to it i mean you can look at what

our surveillance data over time here and

internationally has shown and yes there

have been cases of heart inflammation or

inflammation in the lining of the heart

after particularly after the mrna type

vaccines

however i think that you know that's

just one source of information and the

study that mike referred to is really

really it was a game-changing study in

many ways because it really did show

comparatively what the risk is

um based on vaccination and based on not

getting vaccinated uh especially if

you're in an area of higher prevalence

or you know as we go through the

different waves of covet 19 and so i do

think that you know

the risk of not getting vaccinated is is

much higher than the risk of any of

those kinds of rare but serious outcomes

uh after vaccination um and i do also

wholeheartedly agree with talking to

somebody independent and who you feel

like you can trust about this who would

be knowledgeable in the area so talking

to your family doctor or you know there

are a whole slew of different people who

would be very happy to provide that kind

of advice um and it just changes the

dynamic of the discussion altogether so

really would encourage that especially

as school started up and you know your

opportunities of being in close contact

with people is going up through the

through the fall it's it's an important

time to be having that talk

yeah the other thing is that i can tell

you from the work that i've done with

vaccine hesitancy people that are

worried about vaccines in general

is

the minds can be changed over a period

of time it doesn't have to be today all

of a sudden something can end up

happening where it could be changed so

it's really about not closing the door

to the discussion we really want that if

he's not ready at this point

get him to think about it talk to other

people but he may be ready in a month or

so and if that happens you know what

we'll part the gates for him and make

sure that he gets protected when he's

ready for that so don't close down the

discussion we'll work with him if he

needs that help

yeah

thank you folks um we we have a question

from someone who lives with fibromyalgia

i think her question is would that be be

considered as an autoimmune disease like

ra rheumatoid arthritis that could

qualify for a third copa 19 vaccine and

i'll i'll sort of take a shot at this

and if i miss anything please feel free

to fill it in but but essentially

i would refer you in those cases to

check your provincial health ministry uh

the information they're putting out

and i'm also going to make a note that

for diabetes canada to to share any and

all updates that come in when it

pertains to a third covenanting vaccine

for uh immunocompromised individuals um

so again because there is some

variability on timelines right now and

on different jurisdictions i don't want

to give you a wrong answer but um keep

you know keep stay following our pages

and i'll do my best to to get that

information distributed as soon as it's

out there but also stay tuned with your

provincial or territorial ministry

um so folks i think that's that's all

for questions that have been submitted

on facebook and i want to want to thank

you all for for submitting your

questions and um there's obviously a lot

of a lot of thought going into this a

lot of curiosity so it means a lot to

have you here asking

um and i'll have i'll pose one final

question to uh our guests and that's

sort of if you have anything you'd like

to add at this point uh or specifically

if there are any common misconceptions

that you would like to address i'd like

to be that chance now

i'll throw out one misconception i this

happens uh this comes up i think every

time i talk about the the vaccine and

people often think that you can get

influenza from the influence of vaccines

and you absolutely cannot if they're not

designed to do that and the vast

majority of the vaccines that we do give

for influenza are inactivated uh

vaccines they they don't contain sort of

live virus there is the exception is

that flu mist vaccine the intranasal

spray that we talked about that does

contain

the live uh a live form of the vaccine

and why it's not recommended for people

who are immune compromised or pregnant

um

and there are a number of sort of

parameters around who could receive that

for that reason

but you cannot get influenza infection

from these vaccines you might feel a

little bit lousy um the day of the day

after maybe a couple of days after you

get your shot

and this is really just a sign again

that your immune system is reacting

appropriately to the vaccine so you

might get a little bit of fever or

chills you might feel muscle aches you

might be tired

that's not influenza it's your body

doing the right thing and trying to uh

mount a good immune response

one thing i want to add that i've heard

with copenhagen vaccine we have also

heard with influenza and vaccines in

general is that people are saying that

there's no safety measures that these

vaccines are just big pharma is pushing

them through we have incredible

standards here in canada and in the us

and in different regions of the world

for the way that vaccines are approved

we have less tolerance they're much more

scrutinized than a standard medication

out on the market and the reason why is

we're giving them to healthier people so

we have to be very very careful from

that standpoint

all the vaccines the processes go

through from health canada whether it

was kova 19 people say how could they

approve it so quickly the reason why is

they approved the vaccine for cover 19

so quickly is so many people are

affected we ended up getting data fairly

quickly and because it was a pandemic we

did all the safety measures in a very

short period of time because we had so

many vaccines that were being

administered

none of the the and then the steps were

actually compromised all the same safety

standards and even today we're still

doing the safety standards to make sure

these vaccines are safe over the long

term that's why we can find some of

these rare side effects to make sure

that these are safe over the long term

so regardless of which vaccine you

receive all of them have gone through

the same safety standards so i would

encourage you not to worry about

thinking that these are got onto the

market they're experimental drugs these

are highly tested pharma

pharmacotherapies or vaccines that can

actually end up helping to protect you

and keep your family safe

yeah thank you both that that's that's

really uh

i think it's powerful to hear that

information coming from from both you

with the expertise that you have so so

thank you um

before we wrap up i'd like to take a

moment to tell you folks how diabetes

canada is helping to support canadians

impacted by diabetes

especially and including during uh the

flu season and as the pandemic continues

um so you can feel free to visit our

website or our social media to stay up

to date on our work and on resources

that we're putting out

and i also see a question regarding

would we consider doing media blurbs on

the impact of not getting coveted

vaccines when a person has family or

relatives with with diabetes um and the

short answer is i think that's that's a

really impactful uh way of framing it so

i'm going to uh

i'm going to mention that uh

to to our team we have a great team and

i think it's really you know super

important to give people resources that

can help to to frame things coming from

from an expert body so um

thank you for raising that question um

to access these sort of resources and

for specific direction

i would recommend you can feel free to

call our helpline at 1-800 banting or to

email info diabetes.ta for any questions

and we'll do our best to help

so uh with that i want to say a huge

thank you to to our guests uh dr suzy

hoda and mike coyvan so uh means a lot

to have you here and have you uh sharing

such a you know investing a lot of your

time and energy into in to providing the

best answers you can

to to our guests thank you as well uh

please don't hesitate to reach out and

uh i personally i i found this to be

such a valuable webinar i hope the same

is true for you as a viewer and that's

been helpful and please feel free to

contact us for any further information

for any questions or to be connected to

our experts so thank you very much and

and take care everyone

thanks so much thank you