'Tis the season (at least here in New England) for apple picking, county fairs, pumpkins, and a seasonal brew of recommendations, fulminations, recriminations, allegations and generalized befuddlement regarding the flu vaccine. What to do, this year, about flu?
Get vaccinated. That is, indeed, the punch line for most of us -- but the road to that conclusion runs anything but straight. Let's travel it together.
Among the road blocks, there are, for starters, the numerous theories -- highly loquacious in cyberspace -- that contend not only that flu vaccination is overtly dangerous, but that there is a systematic effort to delude the public about those dangers. Even those who are not convinced the Centers for Disease Control (CDC) is genocidal in its recommendation that everyone over six months of age be vaccinated are given pause by such allegations.
One good reason for this hesitation is that for a vaccine to do you any good, you need to get it while feeling fine. This is quite different from, say, an operation that is much more dangerous -- but easily justified by the obviously broken limb, plugged up gall bladder or occluded arteries. It can be hard to talk yourself into rolling up your sleeve and getting jabbed with a needle while feeling fine even if you are not particularly worried about a government conspiracy. With a little nudge from conspiracy theories, however unreliable the source, doubt can become insurmountable.
The truth, though, is that influenza vaccine is many times -- many times -- safer than the flu itself. That does not mean flu is a plague, nor that the vaccine is perfectly safe. Nothing in medicine and little in life is perfectly safe. Harm from the flu vaccine is possible, but a highly remote risk. For what it may be worth to make this personal, I readily accept that risk every year for myself, my wife and my children. I put the arms of my loved ones where my mouth is on this topic.
There are several reasons why the potential harms of flu vaccine may loom much larger in the imagination than they actually are. First, any adverse event -- an allergic reaction, the now exceedingly rare case of Guillain-Barré syndrome is amplified many orders of magnitude by repetition in the blogosphere. One case, appearing on 500,000 websites, exerts the influence of 500,000 cases.
But at least as important, we are generally blasé about risks that lack the intrigue of conspiracy. So, for instance, consider if flu infects one person in five, and kills one person per 10,000 infected. There is certainly a good chance you, if healthy, would not be among those who get the flu. There is a very good chance the majority of people you know would not get the flu, either. And you are very unlikely to know anyone who is killed by the flu.
But one infection per five means 60 million or so infections nationally. One death per 10,000 of these infections might be invisible in your circle of friends and family, but it would mean 6,000 deaths nationwide. This is consistent with a quite mild flu season in the U.S.
In contrast, the most dangerous flu vaccine in history -- the notorious swine flu debacle in 1976 -- was associated with 25 deaths. That's bad, but it is more than two orders of magnitude less bad than even a mild flu season.
I realize, despite the cold hard facts, that there is something about immunization that just makes people nervous. Consider this, though: Among the people and pundits who propagate this anxiety, there are very few who have ever experienced polio or smallpox. Vaccine apprehension is largely a luxury enjoyed by societies no longer ravaged by the dreadful diseases vaccines have helped prevent.
Perhaps a more legitimate roadblock is doubt about the effectiveness of the flu vaccine. It is certainly far from perfect, and the elderly -- who most need protection -- may need two inoculations to get it. But leaving aside some of the subtleties that complicate measuring vaccine effectiveness in real-world settings, and applying even a low level estimate of overall vaccine effectiveness, routine flu vaccination produces a decisive overall benefit compared to just taking our chances with the flu.
For those inclined to accentuate the potential harms of vaccination, there is also the need to satisfy basic demands of fairness to consider the possibility of unintended benefits. While immunization against influenza is really only intended to prevent flu and its complications, a recent study found a reduced risk of heart attack among vaccinees into the bargain. Honestly, I don't make too much of this association, and nor should you, but it does suggest that the conspiracy theorists may be willfully emptying their cups to call them half empty. If this theoretical benefit got a fraction of the attention of the theoretical harms, it would have been the talk of the water cooler all month.
Finally, we must recognize that when it comes to contagion, not one of us is an island. While true that the elderly most need protection and benefit least from vaccination, there is another way to protect our older loved ones: vaccinate ourselves and our children. People who can't get the flu can't transmit the flu to those most vulnerable to it and its complications.
Which brings us to the literal and figurative bottom line we began with at the top: get vaccinated.
Dr. David L. Katz; www.davidkatzmd.com
www.turnthetidefoundation.org
Follow David Katz, M.D. on Twitter: www.twitter.com/DrDavidKatz
Stephen Barrie, ND: Child Autism Epidemic Firmly Linked to Environment
Leo Galland, M.D.: 5 Supplements That Could Help Ward Off the Flu
Dr. Bob Sears: Flu Vaccines: Should They Be Mandatory For Health Care Professionals?
CDC - Seasonal Influenza (Flu) - Key Facts About Seasonal Flu Vaccine
Learn About Flu Shot -- the Influenza Vaccine -- and Its Side Effects
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A plug for a new website on the History of Vaccines found at http://www.historyofvaccines.org/
To shed some light on the history of these illnesses, and the development of vaccines to prevent them, The College of Physicians of Philadelphia has created The History of Vaccines, a website dedicated to exploring the role that immunization has played in the human experience and its continuing contributions to public health.
Well worthing looking at. It includes a History of Anti-vaccination Movements http://www.historyofvaccines.org/content/articles/history-anti-vaccination-movements On the Board of Advisors of this Philadelphia initiative are Dr. Stanley Plotkin, developer of the Rubella vaccine used worldwide and Dr. Paul Offit , co-inventor of the Rotateq rotavirus vaccine.
I look forward to you pointing out specific factual errors.
http://pediatrics.aappublications.org/cgi/content/abstract/126/5/e1018
Lay media report:
http://www.milwaukeenewsbuzz.com/?p=320557
It is impossible to know what you are trying to imply, exactly, by posting the above two links since you (strangely) provided zero interpretation or commentary. You seem to be supporting the assertion made by some that autism rates have not ‘really’ risen over the last 30 years. Please correct me if I am inaccurate in that characterization. In any case, I will point out…
1) The design of the small study by Dr. Maureen Durkin at the University of Wisconsin at Madison linked to above is in no way able to address or answer the comprehensive ‘big picture’ question of whether the large increase in the rate of autism that has been documented over the last 30 years is real, or not.
The OBJECTIVE of Dr. Durkin’s study: “The goal was to determine whether the increasing prevalence of autism, on the basis of educational data, in Wisconsin between 2002 and 2008 was uniform in all school districts or was greatest in districts with lower baseline (2002) prevalence.”
The METHODS of Dr. Durkin’s study: “Special education counts were obtained for all Wisconsin elementary school districts from 2002 through 2008. The annual prevalence of children being served under the autism category was calculated for each district, districts were grouped into 8 categories (octiles) according to their baseline prevalence, and prevalence trends were plotted according to octile.”
How about, simply, supplying a link to a study that was released that day on a topic that is heavily discussed on this thread. It's my way of saying "Hey everybody! Here's more information on the topic you are discussing. Perhaps this quantified study might be more useful than your anecdotal assessments or your continued parroting of claims made by others". That's about it.
3) And to all, please note ANB’s hysterical comment after the article (It begins with, “Thanks, Matt. That was a good summary of the evidence related to the so-called autism epidemic….”). What a blatant display of confirmation bias. ANB himself retells a fraction of the story to support his dug-in position and his ‘I am certain that I am correct’ views on the extremely complex subject of the epidemiology of autism. What a joke.
By the way, ANB does not work in medicine in any regard nor is he an epidemiologist or a medical scientist. ANB is merely a journalist from Milwaukee (with strong pro-vaccine views).
*Thomas R. Insel, MD
Chairman of the US Dept. of Health & Human Services, Interagency Autism Coordinating Committee (IACC). Insel is one of the nation's most prominent autism research coordinators.
*Philip J. Landrigan MD, MSc
Pediatrician and epidemiologist. Professor of Pediatrics and Preventive Medicine, and Director of the Children’s Environmental Health Center, Mount Sinai School of Medicine in NY. Dr. Landrigan has been a leader in developing and implementing the landmark NIH/HHS/EPA National Children’s Study (NCS), a 21-year prospective study of 100,000 American children, the largest study of children's health and he environment ever launched in the United States. http://www.iceh.org/pdfs/LDDI/LDDIStatement.pdf
*Craig Newschaffer, PhD
Professor of Epidemiology and Biostatistics at Drexel University School of Public Health in Philadelphia. Founder and former director of the Johns Hopkins Center for Autism and Developmental Disabilities Epidemiology. Newschaffer earned his master’s degree in health policy from Harvard University and his PhD in epidemiology from Johns Hopkins University. Dr. Newschaffer co-leads the NIH funded EARLI Study, a project studying a large cohort of mothers of children with autism at the start of subsequent pregnancies. This project is designed specifically to study pre-, peri- and neonatal autism risk factors and biomarkers.
Do you perhaps have some of the "good research data" as to why the H1N1 shot is any more risky than the seasonal flu shot that you have gotten for the past 15-20 years?
"Putting it in the mix with the 2010 Seasonal Flu Shot is wrong on so many levels"
Why? It's just another influenza A subtype.
What happened last year was the emergence of a new form of H1N1 in March/April. It was different enough that the H1N1 contained in the trivalent vaccine for 2009-2010 wouldn't be effective. A new vaccine was made that only used 2009 H1N1, in addition to the regular 2009-2010 seasonal vaccine.
This year, the H1N1 strains doing the infecting are (as expected) the same as last years 2009 H1N1 virus --- so that's the H1N1 component. A bit surprisingly based on past pandemic experience other virus strains (H3N2 and influenza B) are now also infecting. So the trivalent vaccine for 2010-2011 contains 2009 H1N1, a new H3N2 strain and the same influenza B strain as last year.
To the extent that it isn't H1N1 doing the infecting, it will be a deadlier year for the elderly. Last year trhey were protected because many had exposure, before 1957, to flu that was similar to 2009 H1N1. That isn't the case with the new H3N2.
Due to the failure of the supposed "pandemic" of last year, we see a trend developing that is similar to last year. In Europe, Govt health services are trying to rid themselves of last year's massive miscalculated amounts of swine flue, by offering the jabs for free. And like last year, nobody falls for the hype.
http://www.bmj.com/content/339/bmj.b3461.extract
This records last years swine flue fiasco.
As for European government's giving flu shots for free, that makes sense. What doesn't make sense on this version of planet earth is a claim that they are using left over monovalent 2009 H1N1 vaccine. They would be giving away free seasonal influenza vaccine containing the three vaccine strains chosen for 2010-2011.
Quote from my post:
"This records last years swine flue fiasco."
What's the "failure"? It didn't kill enough people? That's the "failure"?
Kaviraj, why don't you show us some reliable source of information as to what strains of flu are currently circulating in different parts of the world.
No, it was the failure of the authorities to analyze the data that was sitting in front of them the whole time. They had accurate data from Australia that the flu season would be mild. They ignored it, and instilled panic anyways.
That is a failure.
A new study done by C.S. Mott Children's Hospital shows that for parents, vaccine and medicine safety are the most important topics in children health research.
1. 89% vaccine safety
2. 88% medication safety
http://www.huffingtonpost.com/kim-stagliano/89-of-parents-rank-vaccin_b_759305.html
Safety is the primary concern with vaccines and no parent wants to take risks with their child's health.
How does one define most? And how do you know that "most" who have done their homework agree with you?
"A new study done by C.S. Mott Children's Hospital shows that for parents, vaccine and medicine safety are the most important topics in children health research"
Yes. And almost every vaccine proponent here will also agree with that poll that vaccine safety is certainly important. But the poll failed to ask important questions to qualify that initial response. The important followups would be "Do you think vaccines are currently safe?" or "Do you think vaccines are currently unsafe?" That poll says nothing about whether parents are actually questioning vaccine safety.
1 No they are not safe and entirely experimental.
2. Yes they are entirely unsafe, because of their experimental nature.
It sounds like the author here is painting with broad strokes and thus minimizing the very strong argument against vaccines (or at least most). I would like to strongly say that no one should get vaccinated without spending at least 6 hours of reading on the subject. Look at both sides, fine. But read the arguments against vaccinating well. Take the time. You can't take the shot back.
Money is being made. This isn't an altruistic system that cares for your well being. It just doesn't. Individual doctors may care, but the system has been corrupted and the doctor's education has been corrupted. Look at what other countries do. Think outside of the box.
ONE place to start, and there are so many, would be www.mercola.com because he has various articles that are easy to read and will LINK you to other articles so you can start researching.
Our immune systems are very smart. Playing around with it is serious business.
Let's say a bunch of people agree with you and all decide not to vaccinate against the flu. Then doesn't the "box" become not vaccinating and thinking outside of the box would be vaccinating?
"Our immune systems are very smart. Playing around with it is serious business. "
I'm going to go out on a limb and say that you don't actually know how our immune systems work at all. Our immune systems aren't smart, but they do know how to learn. There are two ways it can learn. The first is to get an infection and with that infection comes all the risks associated with getting that particular disease. The second is to get a vaccine. That vaccine teaches your immune system, sometimes more efficiently than an infection itself, how to respond to that particular pathogen. That vaccination doesn't carry with it the same risks of disease that an actual pathogenic infection does.
Just out of curiosity, how does one "play around with the immune system."
And as place to start --- mercola? Are you crazy? The place to start is always with sites such as cdc.gov or www.flu.gov (for the US) or www.phac.gc.ca (for Canada) or Why? Because if you want to get educated, you need to know the fundamentals and you won't learn them from vaccination opponents web sites. Only after you've worked through the fundamentals, should you then look elsewhere. Web sites of vaccination opponent, almost by definition, aren't about the fundamentals of vaccines and viruses. Go look at them later.
And even for vaccination opponent website, mercola is really nuts.
Or you could assume that experts in virology,immunology,vaccine effectiveness and vaccine safety know what they are talking about and simply get vaccinated.
Your concept of "free?" astonishes me every time. Someone is paying Sheldon. Most likely from a tax, most likely from taxpayers that have vaccine injured children.
Also
I find it funny that a person like you who tells people to bow down to the great and mighty Orak is offering advice where to find experts on the issue.
Also
I was troubled to read on the CDC website regarding their interpretation of the risks of aluminum. They say humans are at a greater risk of ingestion of aluminum than the IM injections from vaccines. This is a completely contradictory statement based on research.
ATSDR – Agency For Toxic Substances and Disease Registry
“Gastrointestinal absorption of aluminum is low, generally in the range of 0.1–0.4% in humans, although absorption of particularly bioavailable forms such as aluminum citrate may be on the order of 0.5–5%”
http://www.atsdr.cdc.gov/toxprofiles/tp22.html#bookmark07
The CDC contradicts itself.
Pharmaceuticals make money from flu shots when they sell them.
I'm sure you have some evidence of that. Oh nevermind, I forgot, you just KNOW it.
Drum roll............................
The answer is obvious ---- they are the ones who don't get sick.
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There's a great powerpoint presentation from the CDC dated August 30, 2010. It includes a discussion of the disease, the varying death rates (in years when H3N2 predominates there are 2.7 times more deaths than when H1N1 or Influenza B dominates). There's a discussion of the recent Hutterite colony study showing that vaccinating some protects others and even an explanation of blood levels. You don't need a scientific or medical background to understand it. A lot of great information.
www.bt.cdc.gov/coca/ppt/HHSCDCFlu_083010.pdf
As a result, I was forbidden by my doctors to never accept vaccinations of any kind, especially not the ones containing live strains.
I am now 38, vaccine-free except for tetanus which was a requirement for international travel, and except for a bout of dengue fever I battled with while in the Carribean, I am hardly ever sick. As a kid, I roughed and tumbled and cut and scraped myself, probably put things in my mouth I should not have and did all sort of unsavory things (hello dog food for a snack) yet I am still standing. This year again, I find myself having to explain why I will not get vaccinated. For the same reason I do not take pills of any sort (that included antibiotics) unless I absolutely must (as with the Dengue fever). But then again, I must be a little bit different, what with the huge amount of chemo drugs that were pumped into me as a child. Viruses probably look at me and go "heck no!"... So my personal belief is that one can live without being vaccinated. But then again, I am not a frail 95 year old with emphysema. So it all beats me really.
However, your risk of death and other co-morbidities from disease increases greatly without vaccination, especially if there is no one vaccinated around you.
Just out of curiosity, what pills did you have to take for Dengue fever? There is no actual treatment for the disease so I assume the treatment was simply palliative (i.e. tylenol or something for pain).
http://www.guardian.co.uk/lifeandstyle/wordofmouth/2010/oct/29/cold-comfort-balm
it stuck me once again that americans seem to have a lot less aceptance and tolerance for being ill generally.
every snivel most be made extinct.
Vaccines usually aren't as good. The issue is whether they are good enough. With flu vaccine and healthy children and adults --- the answer is a definite yes. The flu vaccine is very effective in protecting against the actual flu in those populations. The real problem comes with vaccinating the elderly --- where the great majority of deaths due to flu occur. The evidence is that current flu vaccines don't work well in the elderly because they don't have strong immune systems to react to the flu vaccine.
New vaccines are being introduced this flu season for the elderly. They've been introduced based on their ability to have a higher proportion of the elderly get good levels of antibodies in the blood. Tests to prove they actually prevent more cases of flu are underway. Not surprisingly, they cause more short term (but not more long term) adverse events. There's Fluzone HD, available in the US this year, which has 60ug of each vaccine strain instead of the normal 15ug. In Europe, there's Intanza/FluID where there's 15ug of each strain compared to 9ug in each strain of regular Intanza/FluID.
Vaccines don't have to be as good as natural infection --- just good enough.
Second (and 3rd, 4th, etc) exposures to the same virus have a quicker response because the body produces memory B-cells following the first exposure. It's like having a template in the library. The general immune cells do the initial fighting and specialists have much less lag time because of the memory cells.
The reason doctors say "immunity is immunity" is that the number of B cells doesn't matter that much (for healthy people) as long as they are present. Also, the manner of the first exposure is not important. With a vaccine, there is a much smaller exposure, but as long as there is an immune response, those B cells are present. If I am vaccinated against the flu, there's a good chance my body will fight it off before I become a threat to the elderly or immune-compromised.
The only way I see a conclusion would be for certain communities to have health care freedom to live and move within their own circle, while another community contained themselves within their own borders and all vaccinated. This would be a huge experiment and then the outcome over a century could decide which community was healthier and less susceptible to epidemic contagious disease. This hypothetical world is just an idea because I see no resolution to the constant bickering.
The other side does not have evidence however, merely a collection of anecdotes (including VAERS, which is NOT definitive evidence) and unevidenced opinion garnered from antivaccine websites.
http://www.huffingtonpost.com/dana-ullman/the-questionable-efficacy_b_311621.html
I ask because your conclusion goes against the expected result for the upcoming flu season. As you know, the vaccine strains for 2010-2011 were determined last February. From then to now, there's been continued world wide surveillance of the infecting strains. For 2010-2011, the mix of H1N1, H3N2 and Influenza B in the US and Canada isn't obvious. But we do know the antigenic similarity to the vaccine strains. For H1N1, it is a continuing near perfect antigenic match. The same for the new H3N2. That's what you would expect for new or relatively new variations of influenza. Influenza B is only an 88% match.
As to your blog entry, the 2009 H1N1 flu wasn't as bad as it could have been because those most at risk, the elderly, were largely immune. If they hadn't been immune, it would have been truly dreadful. And perhaps you are unaware that in terms of those under 65, it was a much worse year. One study that measured the virulence of 2009 H1N1 in terms of years of life lost, found that it was more dangerous than merely looking at lives lost. See http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/mar2310years.html
He likes posting snippets of unevidenced opinion, and never comes back to explain why when he is called on it.
http://www.wellnessresources.com/health/articles/the_narrow_scope_of_flu_vaccine_usefulness
The article contains embedded links to several studies. They're difficult to see since they aren't placed in bold type.
Lesourd B. Nutrition: a major factor influencing immunity in the elderly. J Nutr Health Aging. 2004 August 8(1):28-37.
Service de Gerontologie Clinique, Hopital Nord du CHU de Clermont-Ferrand, Route de Chateaugay, B.P. 56, 63118 Cebazat, France.
Copy and paste that information in the Google search box, and you get this link:
http://www.ophsource.org/periodicals/ophtha/medline/record/MDLN.14730365
Easy, isn't it?
Hey, I offered as much proof as you did.
The experts current view is that autism is a strongly genetic condition that has environmental factors. But the environmental factors are those that occur before birth. It is only a minority view from groups such as UC Davis MIND institute that believes that what happens after a child is born can cause autism.
And the MIND group's views on vaccines and autism? Infants and pregnant women should not get vaccines containing thimerosal. In practice, that means they should get single dose flu shots. If there is a strong family history of immune problems or the infant has persistent infections, talk to the doctor before vaccination. Otherwise, they don't have a criticism of the vaccine schedule.