African-American Women, Menopause, and Hormone Therapy - The Facts

Menopause is a natural change in a women's life and this seems very clear to African American women. The Study of Women's Health Across the Nation (SWAN) found that African-American women view menopause more positively than white or Asian women. Although this is good news the bad news is, as a result, African American women may be less likely to discuss menopause related symptoms with their doctor. African American women should discuss their menopausal symptoms with their doctor- there is so much to know and so much has changed over the years for treating menopause especially the use of Hormone Therapy (HT).
The Women's Health Initiative and Hormone Therapy
The Women's Health Initiative (WHI), a 15-year study involving over 161,000 women that focuses on strategies for preventing heart disease, breast and colorectal cancer and fracture in postmenopausal women, has made some strong clinically valid claims about hormone therapy. Results from the WHI Trial found that Hormone Therapy (HT) which has long been the medical treatment of choice for managing menopausal symptoms could be harmful for women. The facts from the WHI study are very clear, HT is not for everyone. HT is linked to stroke, breast cancer and heart disease for some women. To empower women to make the right choices about HT and management of menopausal symptoms it is critical to understand what menopause is, it's symptoms, and treatment that can be used safely based on one's personal health history and risk status.
What is Menopause?
Menopause (also called the "change of life") is a normal part of a woman's aging. Menopause marks the time period when women are no longer able to conceive children. For some women the time it begins is usually at age 47, with the final menstrual period usually around age 51. However, some women experience it earlier. Menopause occurs over a period of time because the levels of a hormone called estrogen, which is produced by the ovaries, begin slowly decrease. Menopause is typically completed when a woman has not had a period for 12 months in a row.
Menopause will occur immediately, for example, if a woman has both ovaries removed (sometimes done as part of a hysterectomy). This is called "surgical" menopause. Another way women might enter menopause is if her ovaries are damaged by cancer treatment.
What are the Symptoms of Menopause?
The symptoms of menopause include:

• Hot flashes
• Night sweats, or perspiring excessively,
• Sleep difficulties
• Vaginal dryness.

Treating Menopause
Menopause is a natural process for women as they age and treating it is unique for each woman affected. Treatment can begin with a healthier lifestyle that includes, eating a healthy diet and exercising. Some women may not need any special treatment for menopause. But some women may have menopause symptoms that need treatment. Several treatments are available so it is best to talk about the treatments with your doctor so you can choose what's best for you. There is no one treatment that is good for all women. Sometimes menopause symptoms go away over time without treatment. Some women may consider alternative treatments or hormone therapy (HT). If a woman is considering HT it must be used properly, under the supervision of a doctor. Hormone therapy is the only therapy that is approved by the government for treating more difficult hot flashes and vaginal dryness. However, according to the WHI, hormone therapy should not be taken to prevent heart disease. These products are approved therapies for relief from moderate to severe hot flashes and symptoms. The Food and Drug Administration (FDA) recommends that hormone therapy be used at the lowest doses for the shortest duration needed to achieve treatment goals. Postmenopausal women who use or are considering using hormone therapy should discuss the possible benefits and risks to them with their physicians.
Estrogen-alone and Breast Cancer
Long-term use of hormone therapy (10 years or more) has been associated with a more than 50% increase in breast cancer risk among black women, states, Lynn Rosenberg, Sc.D., of the Slone Epidemiology Center at Boston University. Dr. Rosenberg reported in the Archives of Internal Medicine that previous studies included mainly white women, and few examined hormone use and breast cancer risk in black women specifically. The study included more than 23,000 black women ages 40 or older enrolled in the Black Women's Health Study, which started in 1995. Data on hormone use, breast cancer risk factors, and the occurrence of breast cancer were collected via questionnaires administered every two years through 2003.
Results of the Women's Health Initiative, reported in the Journal of the American Medical Association in 2004, indicated an 81% increase in breast cancer risk for women on long-term estrogen combined with progestin. The study found no increased risk associated with estrogen alone. Other studies, most notably the Million Women Study, which presented results in The Lancet in 2003, found an elevated breast cancer risk associated with estrogen alone as well.
Prior to the release of the latest findings, hormone therapy had been the common treatment in the United States for treating menopausal symptoms. It was believed that hormone therapy relieved hot flashes and vaginal dryness and prevented many postmenopausal conditions, such as osteoporosis and heart disease. However, in July 2002, the Women's Health released a report that hormone replacement therapy actually caused more health risks than benefits for women in the clinical trial. As a result doctors stopped routine prescriptions for HT treatment.
What Options Exist for Women?
There are safer options for treating heart disease, osteoporosis, and the symptoms of menopause. The options include:

• Follow a heart-healthy lifestyle- Women's risks of heart disease increase with age which can be right at the time menopause has begun. So follow a heart healthy lifestyle which includes not smoking, eating a variety of foods low in saturated fat and cholesterol, limiting salt and alcohol intake, maintaining a healthy weight, and being physically active. Sometimes, drugs also are needed to control high blood pressure, high blood cholesterol, or diabetes. For those who already have heart disease, adhere to your medications, maintain a healthier lifestyle and maintain your doctor appointments
• Keep your bones strong- The risk of osteoporosis increases as women get older. To help prevent osteoporosis, include calcium and vitamin D in your diet and make sure you get some exposure to sunlight to help the body make vitamin D. Also, do weight-bearing exercises. Osteoporosis is treated by stopping bone loss which women can indeed do through lifestyle changes and sometimes medication.
• Talk to Your Doctor about Alternatives Therapies for Treating Menopausal Symptoms- Alternative therapies can include botanical products that contain or act like estrogens. Examples of botanicals are soy and herbs, such as black cohosh. According to the WHI, research has stated conflicting results on the safety and effectiveness of botanical products. Lifestyle changes can offer some relief from hot flashes and other menopausal symptoms, especially those that are mildly to moderately bad. For instance, dress to avoid being too warm; reduce stress; avoid spicy foods, alcohol, and caffeine; get enough sleep; and be physically active.

Empowerment Points
Each woman should discuss her risk-benefit concern with her physician to make the best decision prior to starting HT. Every woman taking HT needs to routinely reevaluate her prescription with her physician and decide, based on individual risk factors and symptoms, to continue therapy or consider alternative treatments.

HIV/AIDS Facts You Can't Ignore

AIDS and African American Women

African American communities are feeling the damaging effect of an epidemic of AIDS and other sexually transmitted diseases (STDs). At issue is our lifestyle. Although a number of AIDS cases can be attributed to Injection Drug Use (IDU), too many of us – whether gay, straight, male or female – continue to have unprotected sex with multiple partners or people we barely know.

African Americans make up 13 percent of the population, yet we now account for 50% of all AIDS cases reported to the CDC from 1981 through 2005 The AIDS rate among Black women is four times as high as that among Latina and white women ^(6,1). According to the CDC’s June 2007 revised HIV/AIDS Surveillance Report ⁽¹⁾, Black women account for 66% of new AIDS cases among women while white and Latina women each account for 16% of new AIDS cases. Furthermore, Black women represented more than a third (35%) of AIDS Cases diagnosed among Blacks (women and men combined) in 2005, by comparison, white women represented only 15% of AIDS cases diagnosed among whites (men and women combined) ⁽⁶⁾. Sadly, Black teens (aged 13 – 19) accounted for 69% of new AIDS cases reported amongst all teens in 2005.” ⁽⁶⁾. Today Black women make up more than half of all women who have died of AIDS.

What is HIV?

HIV is the abbreviation for human immunodeficiency virus. HIV is the virus (infection) that causes AIDS (acquired immunodeficiency syndrome), a disease that can destroy one’s life. Human immunodeficiency virus infection occurs when infected cells in blood, semen, or other body fluids are spread from one person to another.
HIV infection attacks and breaks down the body’s immune system which normally produces white blood cells and antibodies that fight against viruses and bacteria. The infection-fighting cells are called CD4+T-cell lymphocytes. When the T-cell lymphocytes are destroyed, the body’s immune system is no longer able to effectively protect the body against diseases. The infected person is more open or susceptible to illnesses that usually do not affect healthy persons.

What is AIDS?

AIDS is a late stage of HIV infection, and is present when the body becomes overpowered by one or more opportunistic infections. These opportunistic infections ultimately cause death because the body cannot defend itself against them.

The AIDS definition developed by the CDC includes the following conditions:

• a person must be HIV positive, AND
• have a CD4 (T-cell) count below 200 OR one or more opportunistic infections.
  

A positive HIV test result does not mean that a person has AIDS. A diagnosis of AIDS is made by a physician using the above clinical criteria.

How Can You Become Infected?

Women, because of the structure of the female genital tract, run a higher risk of contracting the AIDS virus from a man than men do from women. That’s why the disease is increasingly transmitted through heterosexual activity and is claiming the lives of African American women at such an alarming rate. Common ways of acquiring HIV infection are:

• Having unprotected (without a condom) sex with someone who has HIV.
  
• Sharing needles and/or syringes used in IDU (injection drug use).
  
• A pregnant woman with HIV can give it to her baby during childbirth (this is now a much rarer occurrence given the fact that women can take medications before the birth to reduce the risk of transmission).
  
• Blood transfusions. Since 1985, however, people have seldom received HIV from an infusion of blood or blood-products because better safeguards are practiced against such occurrences.

Common Questions and Answers

• Can I become infected with HIV from "French" or open-mouth kissing?
  There is the potential for infection with blood during "French Kissing" if either partner has gum disease or there are other conditions when blood is present.
  
  
• Can I become infected with HIV from oral sex?
  It can happen, but not as likely as infection through anal or vaginal sex. Condoms and other health protective barriers should be used to prevent contact with body fluids.
  
  
• Can birth control pills prevent a person from getting HIV infection?
  No. Birth control pills do not protect against HIV infection or other STDs.
  
  
• I have anal sex with my boyfriend so I won’t get pregnant. Is this a safeguard against AIDS?
  No. Anal Intercourse with an infected partner is one of the most common ways that HIV is contracted. Anal sex is very risky whether you are male or female.
  

Empowerment Points

• AIDS is now the leading cause of death for African American women, aged 25 to 44 years of age.
  
  
• You can decrease your chances of infection with HIV and other STDs (sexually transmitted diseases) by using a latex condom correctly every time you have sex.
  
  
• Teenagers should learn that alcohol and drugs can cause them to make decisions and do things that can put them at risk for HIV, AIDS, and other STDs.
  
  
• AIDS is claiming and destroying the lives of millions of people. We need to be wise and informed about HIV, AIDS, and STDs for our own sakes and for those we care about.
  
  
• If you or your partner can’t or won’t discuss safe sex, then you should not have sex with that person. After all, it is your health and life at risk.

Hepatitis C

What is Hepatitis C?

The term “hepatitis” refers to the inflammation of the liver which is caused by viruses, toxic substances, or immune system abnormalities. You may have heard people talk about Hepatitis A, B, C etc; this refers to the infectious form of hepatitis which is caused by viruses. There are a number of viruses that cause hepatitis and the most well described forms of hepatitis include Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, and Hepatitis E.

Hepatitis C is a worldwide epidemic and there are approximately 170 million infected individuals. In the United States, about 4 million people have been infected with the virus. Hepatitis C is an important cause of chronic and often debilitating liver disease and accounts for an estimated 8,000-10,000 deaths each year in the United States.

Why is Hepatitis C An Important Medical Problem?

Hepatitis C has the potential to be a very serious medical problem because most people who become infected carry the virus for the rest of their lives. Most of these individuals have some mild, chronic liver damage but fortunately do not feel ill. Approximately 20% of individuals infected with Hepatitis C have a much worse experience with the disease and go on to develop cirrhosis (scarring of the liver) and liver failure. A small percentage of these patients will also develop liver cancer. Without a doubt, Hepatitis C is an important medical disease which we should all be aware of.

How is Hepatitis C Spread From One Person to Another?

The Hepatitis C virus is found in the blood of persons who have the disease. The virus is spread in the infected blood and has primarily been seen in intravenous drug abusers and in individuals who received blood transfusions prior to 1992. Hepatitis C can be spread sexually, but this form of transmission is fairly rare.

Hepatitis C is not spread by sneezing, hugging, coughing, or other forms of “casual” contact.

Who is at High Risk For Being Infected With Hepatitis C?

Any one can become infected with Hepatitis C, but the following individuals are at particularly high risk:

• Individuals with a history of injection drug use.
• Individuals with a history of receiving blood transfusions or blood products prior to 1992.
• People who received an organ transplant prior to 1992.
• End stage kidney patients on chronic hemodialysis.
• Individuals with greater than one abnormal liver function test and no other obvious cause.
• Health care workers after an occupational exposure to Hepatitis C infected blood.
• Children born to Hepatitis C positive mothers.

Signs and Symptoms

Many individuals with chronic Hepatitis C have no symptoms of liver disease. Some of the symptoms that have been reported include:

1. Fatigue (extreme tiredness)
2. Mild abdominal discomfort
3. Decreased appetite
4. Nausea
5. Joint and muscle pains.

Medical Evaluation and Diagnosis

Many doctors routinely screen for Hepatitis C in patients who are considered at “high risk” for having the disease (please see the section “Who Is at Risk for Being Infected with Hepatitis C”). The screening consists of a simple blood test which looks for the presence of antibodies to the virus.

Sometimes, doctors test for the presence of Hepatitis C infection after routine tests of liver function remain persistently elevated. While the test for the presence of antibodies toward the Hepatitis C virus is usually the first step in terms of laboratory testing for the virus, there are more sophisticated blood tests that your doctor may order (if necessary).

If the test results reveal that you have been infected with the Hepatitis C virus, additional studies of your blood and even a liver biopsy may be needed to determine whether or not you are in need of medical treatment.

Treatment

In previous years, the treatment options available for treating chronic Hepatitis C were limited and the success rates were not very impressive. Things are a little better today, and researchers are actively looking for new and exciting approaches to treating this disease. The mainstay of treatment for chronic Hepatitis C at this time is a combination therapy using the anti-viral medications Interferon and Ribavirin. This combination of medications works effectively for about 30-40 out of every 100 people infected with the Hepatitis C virus.

It is important to note that these medications have significant side effects and some patients will not be able to tolerate them.

Side effects of Interferon include:

• flu-like symptoms
• depression with suicidal thoughts
• thyroid disease
• decreased white blood cells and platelets in the blood.

Side effects of Ribavirin include:

• anemia
• nausea
• and this medication can cause birth defects and should not be taken by pregnant women.

Prognosis

Overall, the majority of individuals infected with Hepatitis C do quite well and live a full, healthy life. Some individuals, however, will develop cirrhosis, liver failure, and/or liver cancer. If you have Hepatitis C, a thorough evaluation by your physician will help you to manage your disease effectively and devise the best treatment plan for you.

Empowerment Points

• Hepatitis C is a liver disease caused by a virus that is found in the blood.
• Most people who have Hepatitis C carry the virus with them for life.
• The majority of people with this disease do quite well, although they may have some mild, chronic liver disease.
• Approximately 20% of individuals will develop cirrhosis and serious liver disease.
• About 5% of Hepatitis C infected individuals will develop liver cancer.
• There is treatment for Hepatitis C with anti-viral medications.
• Remember, knowledge is power!

Heart Disease

What Is Heart Disease?

“Heart Disease” is a term that can refer to a variety of ailments ranging from heart attacks, chest pain (angina), congestive heart failure (CHF), arrhythmias (irregular, fast, or slow heart beat), and etc. For the purposes of this article, we will discuss Coronary Artery Disease (CAD) which is the number one killer of both men and women in the United States.

What Is Coronary Artery Disease?

CAD is caused by the progressive thickening of the inside walls of the coronary arteries, the small blood vessels that supply blood to the heart muscle. This thickening, referred to as arteriosclerosis, narrows the space through which blood can flow and decreases the supply of oxygen and nutrients to the heart. A heart attack occurs when there is complete blockage of blood flow to a portion of the heart muscle.

Heart Disease and African American Women

According to noted cardiologist Dr. Richard Allen Williams, “heart disease has long been considered a disorder which principally affects men in our society; consideration of the occurrence of heart attacks in females has been largely been an afterthought.”

We now know that every woman should be concerned about heart disease. It is the number one killer of American women and it is estimated that 370,000 women in the United States die from heart disease each year.

Dr. Williams notes that African American women are especially affected by CAD in a negative manner. They have a higher mortality and morbidity than African American men and White women under the age of 55. In the age group 25-44, African American women have 2.5 times the coronary heart disease mortality risk of white women.

Symptoms

• The symptoms of CAD vary from individual to individual. Symptoms can include:
• Chest pain (angina)
• Shortness of breath with exertion (may be an early sign of CAD).
• Chest heaviness, tightness, or pressure.

Are You At Risk?

Risk factors are habits or traits that make a person more likely to develop a disease. The more risk factors you have, the greater your risk for development of disease. Heart disease risk factors include:

• Cigarette smoking
• High Blood Pressure
• High Cholesterol
• Overweight
• Physical Inactivity
• Diabetes
• Family history of heart disease

Dr. Williams points out that cigarette smoking and obesity represent risk factors which have been documented to increase cardiovascular disease in black women. Diabetes is of particular concern in black women as a risk factor; the death rate among black diabetics is 2.5 times higher that in diabetic whites.

What Can I Do?

Making lifestyle changes to reduce your risk factors for heart disease is one of the best thing you can do to improve the “health” of your heart. Consider taking the following steps:

• Make an appointment with your doctor for a physical exam (if you have not had one recently).
• Discuss your risk factors for heart disease with your doctor.
• Make a plan to reduce any risk factors that you may have.
• Continue (or start) to get regular aerobic exercise.
• Eat a sensible, balanced diet.

Hair and Scalp Dehydration (HSD)

Dry Environments will cause your hair to dry out.
Many African Americans suffer from hair and scalp dehydration during the winter months. Have you ever noticed how dry and “ashy” your hands and feet are in the winter or during whether changes? Well there is a reason for these changes: the air is so dry that moisture is pulled from whatever is moist- in this case your skin, and your hair and scalp are suffering right along with the rest of the body. Under such circumstances, Hair and Scalp Dehydration can develop. HSD is a developed disorder that occurs when the hair and scalp is depleted of its natural moisture. This occurs in two ways: first, lack of the appropriate natural moisture to offset the sudden change in the climate or the environment that the hair and scalp is exposed to; second, using hair products that have a high pH, high protein, or high alcohol content. In extreme cases HDS will cause chronic scalp itch and flakes and hair breakage. During the winter months your hair goes through several traumatic and dehydrating dry changes in the course of a single day. You may have never thought about this, but if you live in a part of the country or world where the air is always dry or the winters are cold and dry, your hair and scalp has suffered from a form of HSD.
The Average Winter Day can Cause Winter Hair and Scalp Dehydration.

Lets start with a cold winter morning. Most of us keep our house nice and toasty (dry heat) then we go outside (dry cold) to get in the car and turn on the heater (dry heat). We get to work and walk (dry cold) inside the warm building (dry heat). That is five different drying situations that your hair just went through. In my clinic, I hear women complain about dry hair, scalp itch and flakes more during the winter months than any other time of the year. The reason for this phenomenon is because of the dehydrating changes that the scalp and hair goes through on the average winter day.
One of my more current studies shows that one cause for HSD is what I have coined as transition weather. This is the time of year between seasons, like at the end of winter and the beginning of spring. During this transitional time, we may experience cold mornings and warm evenings.

Ways to prevent Hair and Scalp Dehydration (HSD)
Simple changes making big differences.
The key is to be prepared; most of us will use lotion on our body during the dry months and never make the connection to our hair and scalp. Your hair and scalp, like your skin, benefits from adding moisture. Changes like dry flaking and itching scalp will cause some to use dandruff shampoos. Others with dry brittle hair often turn to moisturizing shampoos. Neither of these specialty shampoos are helpful, and will actually cause HDS to become more chronic.
Changes you can take to avoid HDS

1. Deep moisture condition your hair twice a week.
   
2. Apply a small amount of moisturizer each day to your hair
   
3. In extreme cases and coarse hair textures, after applying moisture, apply oil on top to seal in the hydration.
   
4. Stay away from shampoos that have fillers, such as moisturizing shampoos, because they cause a filmy build-up that can be drying
   
5. Only use clarifying shampoos that have a pH between 4.5 to 5.5, the hair and scalp’s natural pH.
   
6. Apply oil not grease to your scalp

Grow Natural or Go Straight?

At the start of each New Year, many black women ask this very question; "should I grow natural or go straight?"
Most black women have a naturally kinky hair type, a feature that we were born with. However, many black women have resolved to change this natural trait. For many years, there has been a growing difference of opinion as to why some women want to change the natural state of their hair and whether this is right or wrong. In an effort to solve this dilemma, I will discuss some of the most common explanations.

For decades, many black women have been forced to choose sides in a metaphorical battle between kinky and straight hair types. Whether we recognize it or not, black women are divided into two sides: one side which we shall call the "Natural Hair Movement" and the other side which we shall call "Unnatural, Straight Hair Movement." Within these two groups, there are a plethora of reasons for choosing to stay natural or go straight. For instance, some in the natural hair movement say "to be black is to be natural and we should not change and conform to the look of another race." Others, choosing to stay natural proclaim, "If I straighten my hair, it will fall out." These are just two examples of the variety of reasons for choosing to go natural.

On the other hand, an overwhelming percentage of the members of the unnatural, straight hair movement, exclaim, "I wear my hair straight because I don't like my hair natural!" as they cover their mouths saying, "Oops, did I say that out loud?"
Many black women are forced to make the choice: natural or straight? There seems to be an easy answer: just do what you want and you will be happy. Unfortunately, this state of blissfulness is short lived.
Many women whom I have counseled about their hair ask this same question: "should I stay natural or should I go straight?" My answer is always the same. "Yes." And no, I am not riding both sides of the fence. I truly believe that, regardless of the reason, it is and should always be a women's choice to wear her hair kinky or straight. With that being said, I also believe that once she has made her choice, she should act responsibly. In other words, if a choice is to be made, a woman should accept the responsibility of her choice by caring for her hair accordingly. Never make a choice that you are not willing to care for.
Unfortunately, at some point most sisters find themselves unhappy with their choice no matter whether they chose natural or straight..

The reasons for this despondency are that many women:

1. Don't understand the choice that they have made
2. Don't understand how to manage the choice that they have made
3. Don't understand how to properly care for the choice that they have made

Let's take a look at the two choices… Natural and then Straight.
Natural Hair
We were born with natural hair (hence the term: natural), however we still don't understand our natural hair. Natural hair requires "care steps" to be taken in order to manage the spiral tresses.

1. You must cleanse and clarify with shampoo and stabilize with a protein and moisturizing conditioner, at least weekly, so that your scalp won't be prone to disorders and your hair won't become polluted.
2. You must moisturize your natural hair each day in order to prevent a dehydrated hair and scalp.
3. You must groom your natural hair each day so that your natural hair will not web together or matt, even if you have locks or twist styles.
   

Straight Hair
Many women choose the option to mechanically or chemically straighten their hair. While this is a very viable option, many women forget that their hair is not naturally straight, causing so many of them to suffer with hair loss and other problems. Remember, when you change your hair from kinky to straight, you must protect and preserve it by following some simple rules:

Pressed/ Flat Ironed Hair

1. Only use heated tools on clean and conditioned hair.
2. Always use a moisturizer when straightening your kinky hair.
3. Only use one heated tool when straightening your kinky hair.
4. Always monitor the heated tool, ensuring that the temperature stays below 300 degrees.
5. Oil your hair and scalp, as needed, in order to seal in moisture.

Relaxed hair

1. Never relax damaged hair or receive a relaxer if your scalp is damaged.
2. Never allow less than 8 to 10 weeks time between relaxers.
3. "Wet Set" your hair and stay, heated tools your last choice in styling
   
4. When choosing heated tools, also always monitor the heated tool ensuring that the temperature stays below 300 degrees.
5. Moisturize your hair to prevent hair dehydration.
6. Oil your hair and scalp, as needed, in order to seal in moisture.

At the end of the day, we will always have strong opinions about black women and their hair, but the choice is yours. Just remember: God made your hair and God makes no mistakes. Learn to respect and love your hair in its natural state, before you alter it.

The Flu

It's that time of year again when you may be concerned about getting the flu, a contagious respiratory illness caused by influenza viruses. Each year, you may find yourself wondering if this is the year you will get the flu, or if you had it last year, you wonder if you will get it again this year? You may also wonder if you should get vaccinated against getting the flu. Well, to help answer your questions you should start with understanding your risk for complications from the flu. According to the Centers for Disease Control, every year in the United States:

• 5% to 20% of the population gets the flu;
• more than 200,000 people are hospitalized from flu complications, and;
• 36,000 people die from flu.

These facts make it critical to understand your risk for serious problems if you get the flu. Certain groups of the population are at higher risk.
Who Should Get a Flu Shot, and When?
According to the CDC, the following groups of individuals should be vaccinated:

1. People at high risk for complications from the flu, including:
   • Children aged 6 months until their 5th birthday,
   • Pregnant women,
   • People 50 years of age and older,
   • People of any age with certain chronic medical conditions, and
   • People who live in nursing homes and other long term care facilities.
2. People who live with or care for those at high risk for complications from flu, including:
   • Household contacts of persons at high risk for complications from the flu
   • Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)
   • Health care workers.
3. Anyone who wants to decrease their risk of influenza.
   

Who Should Not be Vaccinated?
The CDC advises that the following individuals should not get a flu shot before talking to their doctors:
People who have a severe allergy to chicken eggs.
Those who have had a severe reaction to the flu shot in the past.
People who previously developed Guillan-Barre syndrome (GBS) within 6 weeks after getting the flu shot.
Children less than 6 months of age (influenza vaccine is not approved for use in this age group).
People who have a moderate or severe illness with a fever should wait to get vaccinated until their symptoms subside.
Types of Flu Vaccinations
There are two types of vaccines:

• The "flu shot" - an inactivated vaccine (containing killed virus) that is given with a needle.
• The nasal-spray flu vaccine - a vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for "Live Attenuated Influenza Vaccine"). LAIV is approved for use in healthy people 5 years to 49 years of age who are not pregnant.

Empowerment Points
The flu vaccination is the most effective way to prevent the flu. Talk to your doctor about your need for a flu vaccination today.