Flu Shots

[Beth]

It's kind of a weird situation, though, in that those who are most at risk are also the same people the vaccine doesn't even work in. (the very young and the very old).
And really, it's everyone who's being targeted now.

Remember this part of the recipe?

And then there's the CDC's version of the vaccine's effectiveness that they use to push it, which doesn't line up with reality.
And that's not cool, either.
And then there's the overblown figures on annual influenza deaths (36,000?)
http://www.bmj.com/cgi/content/full/331/7529/1412
And THAT's not cool, either.
So the whole shebang leaves a bad taste in my mouth.

Yeah, I agree. Not cool. As I said, the CDC does not have a lot of credibility with me. I kinda resent it. I'd like to be able to rely on their recommendations and not have to research stuff to the extent that I do.

Not that I have any better ideas myself on what to do about pandemic influenza, because you're right...eventually some new, bad flu virus will emerge, even though I personaly doubt it'll be H5N1. But eventually one will, and it'll be "a lot worse" than seasonal flu.
But still....

Oh, I agree with you regarding the kind of tactics you've posted about. Public trust is hard to regain and the loss of it has bad long-term consequences.

 

[fls]

It's kind of a weird situation, though, in that those who are most at risk are also the same people the vaccine doesn't even work in. (the very young and the very old).

Vaccine efficacy and effectiveness has been demonstrated in the old and the young in systematic reviews. The data on those less than 2 is arguably too sparse for separate analysis. Since complications are more severe in that age group, most places recommend that that group not be neglected while waiting for additional information. Effectiveness does decrease with extreme age, but it seems reasonable to continue helping the few for which it is effective.

And really, it's everyone who's being targeted now.

The emphasis continues to be on the high-risk groups.

And then there's the CDC's version of the vaccine's effectiveness that they use to push it, which doesn't line up with reality.
And that's not cool, either.
And then there's the overblown figures on annual influenza deaths (36,000?)
http://www.bmj.com/cgi/content/full/331/7529/1412
And THAT's not cool, either.
So the whole shebang leaves a bad taste in my mouth.

That is merely one person's opinion, and it seems to be someone who is unfamiliar with how to derive a reasonable figure. You would prefer that the CDC use a number it knows to be a gross underestimate instead of figuring out a way to get a more representative number?

Linda

 

[fls]

Almost everyone is part of the high risk group, though. Infants, children, parents, grandparents, etc, etc.

Huh? None of those are inclusive categories for high risk groups.

Ok. Let's break this down to it's most basic form.

Does the CDC contact the media and provide them with information to raise awareness about health related issues and motivate health behavior?

You are implying that they are making stuff up while everyone else stands idly by, in order to do so.

Linda

 

[robinson]

That isn't an answer.

 

[kellyb]

Huh? None of those are inclusive categories for high risk groups.

Are those groups not being targeted for increased vaccine uptake?

You are implying that they are making stuff up while everyone else stands idly by, in order to do so.

Linda

Is that a cryptic "Yes"?
(I'm thinking it is.)

 

[robinson]

Vaccine efficacy and effectiveness has been demonstrated in the old and the young in systematic reviews.

Link?

 

[kellyb]

Vaccine efficacy and effectiveness has been demonstrated in the old and the young in systematic reviews.

In the elderly, the same systematic reviews said a lot of it had to be due to selection bias, right?
Have you seen the new Simonsen study from a month or two ago?

The data on those less than 2 is arguably too sparse for separate analysis. Since complications are more severe in that age group, most places recommend that that group not be neglected while waiting for additional information.

Vaccinate all the babies now, figure out if it's safe and effective later.
Got it.

 

[Dymanic]

Have you seen the new Simonsen study from a month or two ago?

I have. But for balance, let's include the one by Nichol et al, which came out at about the same time, and indicated a 27% reduction in hospitalizations and a 48% reduction in mortality among vaccinated elderly.

 

[Skeptic Ginger]

Do they work - Evidence points that way.
Would I have it if offered - damn right.

I never had Flu until 2000\2001. New Years Eve so I was imbibing freely after I'd finished work and got light headed quicker than I would have expected. About 9PM I started to get a scratchy throat, I thoughtobviously that I was just getting a little dehydrated so alternated beers with juice for the rest of the night.

Next morning I surfaced into conciousness with the worst sore throat I'd ever had, muscle pains that felt like I'd been the victim of a brutal mugging, a feeling that my skin had been lightly sandpapered all over, a wracking cough and a fever high enough that my Pharmacist girlfriend was going to carry me to A&E.

Those symptoms lasted for about 5 days (the fever went down quickly with NSAIDs) and after that I was as weak as a kitten for another 6 or 7. I learnt two things from this;
Being off work for a couple of days means you haven't had Flu, it's just a cold.
If you're ever offered a Flu shot - take it

Could have been influenza but without a lab test one can't be sure. But your point is correct in that many cases of influenza are quite severe.

Characteristics of influenza:

• known flu cases around
• sudden onset
• high fever
• headache
• muscle aches
• bronchial cough

The influenza virus infects cilia cells in your trachea, whereas many other upper respiratory viruses infect the cells lining the pharynx. Influenza virus can also infect cells lining the lower airways and the alveoli (lung) in some cases. Despite the image of influenza being a minor illness, it is one of the deadliest infections on the planet.

The vaccine is practically painless, quick, cheap and by far the benefit outweighs any extremely rare risk from the vaccine. The main risk is a serious allergic reaction and in 17 years giving a couple thousand flu shots a year I have never seen a single allergic reaction. I have even vaccinated two people with a severe egg allergy using a special protocol and neither reacted.

One person in 17 years had temporary brachial nerve inflammation for several months. It has not recurred and he continues to get flu shots every year. I have not had a single other significant reaction reported to me from my patients.

In adults, placebo controlled double blind prospective studies have failed to find anything other than a mild sore arm as a reaction to a flu shot yet the myth the shots make you ill persist. In children very mild fever and malaise can occur but it is not common.

 

[Skeptic Ginger]

....They are developed based on previous strains, yes. Whether they are effective against current years really depends on how much the virus has changed. Viruses, especially Infuenza Viruses, mutate and evolve very quickly. However, that being said, mutations do not always impact immune factors. 'Flu' mutants which have different surface proteins will be less effectively (or not at all, depending on the change) targetted by any vaccination...

The strains included in each years' vaccine are determined by the WHO every 6 months. Samples of circulating virus are continually collected from 'sentinel' sites during influenza seasons in countries all over the world. The genetic changes are continually monitored. Based on the sampling, the WHO makes recommendations and provides the vaccine strains for manufacturers. In the Northern hemisphere in summer the strains are determined and in the Southern hemisphere in their summer the southern strains are determined. Then everyone produces the same vaccine for that year in that hemisphere. Only when significant genetic changes in circulating virus occur after the vaccine production has begun is there a mismatch. And even in those years the vaccine still offers reasonable protection.

The research on the effectiveness has already been well covered here. Sadly a couple members of our forum have latched on to some initial studies which found little difference in death rates in the elderly since introduction of large scale flu vaccine programs. A fair amount of research after those particular studies consistently found clinical benefits in influenza vaccine programs. I was interested in those initial studies and appreciate that they were brought up in the discussions we have had here. If the science wasn't supporting flu vaccinations it would be time to reconsider them.

However, it is time to move on. Look at the research in its entirety and not the cherry picked studies favoring either side. I have reviewed as much of the research as anyone here and I am confident the vaccine benefit is tremendous and the risk minuscule. I have also seen the studies on the outcomes from influenza itself. This is, like I said, one of the deadliest and probably the most underestimated infections on the planet.

Risk perception is a funny thing. If millions of people get infected but the fatality rate is 1-2%, we don't perceive the threat. It's easy to think those people who died were not like us. If a few hundred get infected and 90% die, that disease is incredibly feared. Yet the math might easily show your risk of dying is greater from the first infection because the odds of getting it are so much higher. That is what happens with influenza. But the years when a greater number of young, otherwise healthy people die from influenza are only recognized in hindsight. And once that happens, it's too late for the vaccine to prevent the deaths.

 

[kellyb]

I have. But for balance, let's include the one by Nichol et al, which came out at about the same time, and indicated a 27% reduction in hospitalizations and a 48% reduction in mortality among vaccinated elderly.

So...it was another 50% reduction in all cause mortality?


http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/oct0907elderly.html

Simonsen and colleagues also write that since 1968, flu has accounted for an average of about 5% of all winter deaths in older people. Yet the results of cohort studies have prompted claims that flu vaccination reduces the risk of winter death from any cause by about 50% for community-dwelling people older than 65. "That influenza vaccination can prevent ten times as many deaths as the disease itself causes is not plausible," say Simonsen et al.

So, would you agree that there appears to be something very, very wrong with studies like the Nichol one?

 

[Dymanic]

So, would you agree that there appears to be something very, very wrong with studies like the Nichol one?

I'll concede the possibility -- if you'll concede the possibility that there may be something very wrong with Simonsen's numbers. Are you aware that his method of estimating excess mortality due to influenza is not universally accepted?

 

[kellyb]

I'll concede the possibility -- if you'll concede the possibility that there may be something very wrong with Simonsen's numbers. Are you aware that his method of estimating excess mortality due to influenza is not universally accepted?

Yes.

But the point that the flu doesn't cause anywhere near 50% of winter mortalities in the elderly, so any study that finds that flu vaccination reduces mortality by 50% has to be suffering from some kind of bias so severe it's basically worthless...that point is solid.

 

[Frost]

Correct me if I'm wrong, but aren't flu shots made from a killed virus? How in the world would a killed virus cause disease/death?

 

[Puppycow]

I'd be careful if I were you about putting so much faith in your personal physician.

I've run into doctors that said things I found hard to believe. One prescribed me antibiotics and told me I could stop taking taking them as soon as I felt better, my immune system would finish off the rest. I went to get my prescription filled and the pharmacist said I need to take them all without fail. That one doctor was the only one I ever heard that from. All others have said you have to take them all without fail.

 

[Skeptic Ginger]

According to the CDC; since the introduction of the flu shot, flu deaths have increased by 4 times.



4 times as many people have died each year since the flu shot began to be implemented.

I suggest a moratorium to see if the flu shot contributes to flu deaths.

Jerome, unless you cite a source so we can see if we agree with your interpretation of the facts, no one in this forum is likely to believe what you post.

 

[Skeptic Ginger]

Take a look. (dug up links)
It's not my logic; it's just a fact......
That kinda threw me for a loop for a while and had me wondering exactly who the CDC worked for...but the idea that they're doing that to comply with the WHO objective of increasing vaccine uptake for the purpose of saving the world from birdflu makes sense to me.

If you think the threat of pandemic flu has anything to do with the current market for flu vaccine, you'd be wrong. I get an occasional question if the vaccine would cover bird flu mostly from people who already know the answer is no. Also, out of sight, out of mind. Bird flu is simply not on the flu vaccine patient's mind right now.

 

[Skeptic Ginger]

Hmmm. That sounds ethically dubious. A government agency frightening people to boost sales so the manufacturers don't close their plants down. I suppose the question is: Do the ends justify the means?

What nonsense. You guys are finding links that are irrelevant to the real world. I am in the real world. I am vaccinating the same people I vaccinate every year. Nothing has changed except there is a lot of vaccine this year.

 

[Ivor the Engineer]

What nonsense. You guys are finding links that are irrelevant to the real world. I am in the real world. I am vaccinating the same people I vaccinate every year. Nothing has changed except there is a lot of vaccine this year.

No, it is not nonsense at all. It is basic supply and demand. Companies with shareholders are not going to waste money scaling up production facilities and making bucket loads of flu vaccine unless they have a market for it. So how is the demand for flu vaccination being grown?

It would seem by promoting it as more effective than it actually is and making flu sound like it's set to become the next plague. Nice to see those in public health communications have learned something from alternative medicine.

I still don't see why they could not appeal to peoples' rational mind, and explain why having a large manufacturing base for flu vaccine will be essential if many deaths are to be avoided from a future pandemic.

It is rather ironic that you, of all people, should be supportive of a marketing campaign which aims to motivate people by appealing to their irrational mind.

 

[fls]

Are those groups not being targeted for increased vaccine uptake?

Not by any reasonable use of the word 'targeted'.

Is that a cryptic "Yes"?
(I'm thinking it is.)

I'm sorry. I thought that was a "does a bear poop in the woods" type question.

Yes. The mission of the CDC is to promote health which includes providing the media with information to raise awareness about health related issues and motivate health behavior.

Linda