Case Teaching Notes for
“I Don’t Need a Flu Shot!”

Introduction / Background

This case study is a “clicker case.” It combines the use of student personal response systems (“clickers”) with case teaching methods and formats. The case is presented in class using a series of PowerPoint slides in parts, or stages. After each stage, students are asked to respond to questions (called “clicker questions”) posed by the instructor. In this way, students work their way through the material to understand, and solve, the problem presented in the case. Specifically designed for use in large introductory science classes, the method integrates lecture material, case scenario material, student discussion, (clicker) questions, clarification of the answers to those questions, more lecture, and data.

This case follows two college students, Ashley and Ryan, through a dialogue about the need for a flu shot. Ryan has many misconceptions about influenza that Ashley tries to clarify. Their discussion covers topics such as the stomach “flu,” the need for yearly vaccinations, and flu pandemics. While Ashley and Ryan are fictional characters, Ryan’s misconceptions are based upon questions asked by actual students in my introductory biology classes.

Objectives

• Recognize there is a difference between influenza and other conditions with flu-like symptoms.
• Understand that influenza can be a life-threatening disease that affects people of all ages.
• Explain why flu shots should be given annually.
• Understand how new strains of influenza arise.
• Recognize that a new flu pandemic can still occur.

Misconceptions

• The stomach flu or 24-hour flu is caused by an influenza virus.
• Antibiotics are effective against flu viruses.
• One can get the flu from a flu shot.
• Flu shots are effective for long periods of time.

Classroom Management

This case was written for a large section of an introductory biology course for both science majors and non-majors that uses personal response systems or “clickers.” In class, the instructor presents the case using a series of PowerPoint presentation slides punctuated by multiple choice questions which the students answer using their clickers.

The text of the case is found on the PowerPoint slides. There need not be any preparation on the part of the students before teaching this case. Since students read at different rates, caution is advised not to move too quickly through the text slides. As new concepts are introduced in the case, instructors should be prepared to stop and discuss these as appropriate. Students may volunteer information about their own experiences with influenza.

Teaching the Case

Slide 1, Slide 2, Slide 3, Slide 4, and Slide 5 introduce the case. The character of Ryan is a somewhat naive college student who does not feel he needs to get a flu shot. He wonders what good it would do anyway since he just got over the stomach flu. Ashley is Ryan’s girlfriend, who has taken it upon herself to convince Ryan that he needs to get vaccinated. Ryan also learns from Ashley that influenza can be deadly. Little does Ashley know at the start of their conversation that she will end up giving Ryan a biology lesson about the influenza virus, flu vaccines, and flu pandemics.

Slide 6 explains that the “real” flu, or influenza, is caused by a virus. The slide includes an unlabeled graphic of a virus. Depending on the background of the students, an instructor may wish to use this graphic to explain or review the general structure of a virus.

Slide 7 contains a chart courtesy of the U.S. Department of Health and Human Services. The chart is designed to help individuals determine if their symptoms are likely those of a cold or the flu. Fever, headaches, and aches are symptoms more consistent with influenza than with the common cold.

Slide 8 explains the difference between gastroenteritis (the stomach flu) and influenza. While vomiting and diarrhea may be symptoms of both conditions, gastroenteritis usually is short in duration, as implied by its nickname, “the 24-hour flu.”

Slide 9: Ryan finally understands that he didn’t have influenza, but he still doesn’t feel he needs a vaccination. He informs Ashley that if he gets the flu, he can just take antibiotics. Becoming ever more frustrated, Ashley explains to Ryan that antibiotics are not effective against viruses.

Slide 10, Clicker Question 1, is designed to test students’ understanding of the general concepts covered so far in the case. Depending on the responses, an instructor can choose to move on or some review might be appropriate.

Slide 11: Ryan is being stubborn about not getting a flu shot, and this time he uses his brother as an example. He states that his brother actually got the flu from a flu vaccination. Ashley corrects this misconception and explains that in rare cases one may have a reaction to the vaccine, but the reaction is not the flu.

Slide 12, Clicker Question 2, emphasizes that one is not at risk for getting the flu from a flu shot. This is a common misconception. This type of reaction may occur anytime something foreign enters the tissues. In rare cases, symptoms may resemble the flu, but these symptoms usually only last about one day. Depending on the background of the students and the amount of time allotted to this topic, an instructor may address how flu shots are made.

In Slide 13, Ryan asks that if he agrees to get a flu shot, will it offer long-lasting protection against the flu. Ashley now has to explain to Ryan about viral mutations and why one needs to get an influenza vaccine every year.

Slide 14 is a graphic illustrating viral mutations, or antigenic drift. If a virus mutates, a person will have little or no immunity to the changed virus. Instructors should use their own discretion to decide on the level of explanation that is appropriate for their class.

Slide 15, Clicker Question 3, tests the students’ understanding of why new flu vaccines need to be made every year. Vaccines are developed against specific strains of the flu; they will have limited effectiveness against a strain that mutates or undergoes antigenic drift.

Slide 16 and Slide 17: Ryan has heard about the “Swine flu” and a pandemic. Ashley describes for Ryan what a pandemic is all about. Pandemic flu is virulent human flu that causes a global outbreak, or pandemic, of serious illness. Because there is little natural immunity, the disease can spread easily from person to person.

Slide 18 provides a link to a short video. In this video, a survivor of a pandemic flu (the Asian flu) shares her experience. This adds a degree of personalization to the topic.

Slide 19 and Slide 20 are graphics showing a public health poster and a photo of a makeshift hospital ward during the time of the 1918 flu pandemic. An unusually high proportion of casualties were found among young adults, ages 20–40 (the age of many college students).

Slide 21 tells the story of two immigrants whose children perished during the 1918 flu pandemic.

Slide 22, Clicker Question 4, asks students to form a hypothesis about why one of the individuals in the story told on the previous slides did not get sick with the flu. Instructors can also use this question to point out that the flu shot had not yet been developed (the first influenza vaccine in the United States became available in 1945) and that the purpose of wearing gauze over the nose and mouth was to prevent one from spreading the virus.

Slide 23 re-emphasizes that there was a high mortality rate among young adults during this pandemic.

Slide 24, Clicker Question 5, is a factual question that reviews information presented about the 1918 flu pandemic.

Slide 25 and Slide 26: Ashley tells Ryan about two other flu pandemics and the emergence of new influenza strains in recent decades including the present.

Slide 27: The World Health Organization declares an H1N1 flu pandemic in 2009.

Slides 28–32 explain why the H1N1 flu is sometimes called a “Swine flu.” Slide 29, Slide 30, Slide 31, and Slide 32 contain graphics illustrating how flu strains can be transmitted between species (antigenic shift). Instructors should use their own discretion to decide upon an appropriate level of explanation for their class.

Slide 33, Clicker Question 6, is a factual question about the Swine flu, re-emphasizing one way that new strains of the flu appear.

Slide 34: Ryan is finally ready for his flu shot, but insists that it better work on the current strains. Ashley explains that making a new vaccine takes time.

Slide 35 is a chart showing the production timeline of a new vaccine. This chart summarizes more detailed information that can be found on a Sanofi Pasteur website (listed at the end of these teaching notes).

Slide 36, Clicker Question 7, is a factual question that reviews information presented about flu vaccines.

Slide 37 and Slide 38 explain steps that students can take to reduce their risk of getting the flu. Slide 38 shows the cover of a free brochure available from the United States Centers for Disease Control and Prevention (CDC).

Slide 39, Clicker Question 8, is a factual question that reviews information presented about flu pandemics.

Slide 40, Clicker Question 9, asks students to apply their knowledge and understanding of flu pandemics to predict a situation where a new pandemic may arise.

Slide 41: Ashley’s former boyfriend, Ryan, performs poorly on his biology exam. He blames the stomach flu.

Answer Key

Answers to the questions posed in the case study are provided in a separate answer key to the case. Those answers are password-protected. To access the answers for this case, go to the key. You will be prompted for a username and password. If you have not yet registered with us, you can see whether you are eligible for an account by reviewing our password policy and then apply online or write to answerkey@sciencecases.org.

References

Supporting Material

Pandemic Influenza Storybook: Personal Recollections from Survivors, Families, and Friends. Story of Beth Hines.

http://www.pandemicflu.gov/storybook/stories/1957/hines/index.html

This is one of many personal stories about flu pandemics available at http://www.pandemicflu.gov/storybook/index.html. Instructors can browse the site and use other resources as appropriate.

Websites

All of the following sites were last accessed at time of publication, January 19, 2010.

Sanofi Pasteur, Inc., The Vaccines Division of Sanofi-Aventis Group. Influenza vaccine timeline.

http://www.influenza.com/Index.cfm?FA=Science_History_6

Detailed information about the vaccine production timeline.

Centers for Disease Control and Prevention. Seasonal influenza (flu).

http://www.cdc.gov/flu/

National Institutes of Health. Influenza.

http://health.nih.gov/topic/Influenza

National Institutes of Health. Medline Plus. Flu.

http://www.nlm.nih.gov/medlineplus/flu.html

National Institutes of Health. National Institute of Allergy and Infectious Diseases (NIAID). Flu (Influenza).

http://www3.niaid.nih.gov/topics/Flu/Research/basic/

U.S. Department of Health & Human Services. Flu.gov: Know what to do about the flu.

http://www.flu.gov/

One-stop access to U.S. Government H1N1, avian and pandemic flu information.

Slide Credits

Date Posted: February 2, 2010.

Copyright © 1999–2010 by the National Center for Case Study Teaching in Science.  Please see our usage guidelines, which outline our policy concerning permissible reproduction of this work.