DR. ROACH WRITES: If you haven’t gotten your influenza vaccine yet, it’s time to think about it. This year’s vaccine is similar to last year’s, but two of the components have been updated to match the strains that are circulating worldwide and expected to be epidemic in North America. In fact, this year’s decision on which specific types to include was delayed a month to get further information about a newer influenza virus. Nine different vaccines from five different manufacturers have been released by the Food and Drug Administration. All flu shots use only virus components and no live virus, so it is not possible to get the flu from a flu shot.

As in previous years, any flu vaccine is much better than none, but there are a few recommendations for specific people. In general, I recommend the quadrivalent vaccines, which provide protection against four strains. Most of the vaccines available in 2019-2020 are quadrivalent.

Men and women over 65 are recommended for high-dose vaccine, with double the amount of vaccine, and this year there is a quadrivalent high-dose vaccine (Fluzone High-Dose). An alternative would be the Fluad, which is a trivalent vaccine, with three components. This vaccine contains an adjuvant, which causes a more potent immune reaction than a standard vaccine.

People with egg allergies can receive any vaccine, according to expert groups, although there are vaccines made without using eggs (Flublok and Flucelvax). Don’t delay getting your vaccine for fear of egg allergy.

Two needle-free options are available: Afluria quadrivalent (given by a jet injector), and FluMist, which is a nasal live-attenuated vaccine. FluMist is indicated only in those up to 49 years old, and it has not been studied in the immunocompromised. The ACIP recommends against this vaccine for the immunocompromised and for their caregivers. The manufacturer notes that the supply of FluMist will be limited this year.

Last year the vaccine was just about 50% effective. It is still possible to get the flu despite vaccination. However, the vaccine lowers hospitalization rates, deaths in children and protects expectant mothers and their babies.


Getting vaccinated helps you, your family and neighbors, and your community.

DEAR DR. ROACH: I recently saw my doctor for some fatigue and lightheadedness, and my doctor ordered some tests. I’m concerned that the urine test showed trace positive for ketones, leukocyte esterase and protein. There were 3-5 white blood cells. My blood tests showed glucose of 90 and creatinine of 0.8. My doctor was not concerned, saying some fluctuations are normal, but I am worried this might be an early sign of kidney disease.

— J.

ANSWER: Ketones in the urine are present in high levels in people with uncontrolled diabetes. You clearly don’t have that. It’s also present in people who consume a large excess of alcohol. The body normally makes a small amount of ketones. I often see trace amounts in people who have fasted for a long time prior to blood testing.

People who deliberately avoid eating carbohydrates also may develop ketones in the urine. Urinary ketones are not a sign of kidney disease.

Trace protein can be a sign of early kidney disease, but again it is not uncommon to see in healthy people under certain circumstances. If you not only fasted but didn’t have much fluid before your lab test, then the urine can get very concentrated. The white cells and leukocyte esterase (an enzyme made by white cells) indicate mild inflammation of the bladder, possibly your body fighting off a urine infection.

Although I tend to agree with your doctor, it would be reasonable to retest the urine after eating and drinking normally. I do not agree with the lack of explanation.

* * *

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

Only subscribers are eligible to post comments. Please subscribe or login first for digital access. Here’s why.

Use the form below to reset your password. When you've submitted your account email, we will send an email with a reset code.