Flu update

Continuing my series from WhiteCoat Underground, here is the latest influenza update.

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While still widespread, numbers are finally starting to drop. I’m ready to drop myself. It’s been a terrible season—the worst I’ve ever seen. This is probably due, at least in part, to this year’s flu vaccine missing some unanticipated strains.

For those of you out there who don’t “believe in” flu shots, remember that vaccination isn’t a religion. The anti-vaccination forces are, however, rather cult-like. Here’s some info for you.


Influenza is a serious illness, and vaccination can prevent or reduce severity of illness. Partly as a response to some anti-vaccine nuttery, I think we should talk about this a little bit. But just a little. There is plenty of information available elsewhere. But at least a little summary.

Influenza is primarily a respiratory illness. When I see it in the clinic, it’s often fairly obvious…high fevers, muscle pain, dry cough, cold symptoms. It’s very unpleasant, at least for most people. For some, it’s deadly. Now, I’m not talking about “bird flu” or any other exotic disease. I’m talking about the “regular” flu that sweeps the globe yearly. In the North America, this happens in the winter, and death rates rise. Most flu deaths are due to either a severe case of influenza itself (as was probably the case during the 1918 pandemic) or because of complications, primarily pneumonia–the damaged lungs of flu victims are particularly susceptible to pneumonia.

Last month, a patient said to me, “Now, this will make sure I don’t get any flu or colds, right?”

“Um, no…this will help prevent you from getting some flus, and if you do get it, it will help prevent you from dying of it. It won’t do a thing for your colds.”

Everyone asks me if it will give them the flu, and the answer is a resounding “No!” It does cause your immune system to make antibodies to the flu virus, but it doesn’t give you any diseases. We give flu shots during cold and flu season…I can almost guarantee you will get sick at some point after the shot—but that isn’t in any way related to your vaccine.
But flu shots do the job they are supposed to do pretty well. The complex, global process of developing flu vaccines works. The New England Journal of Medicine just released a well-done study on the effect of flu shots on the elderly–the results are dramatic.

There is much written in the conspiracy-oriented corners of the blogosphere about the supposed ineffectiveness, danger, and God knows what else bad about flu shots.

It’s all bullshit.

There are legitimate questions to be asked about influenza vaccinations, about public health priorities, but these discussions should be based on data.

Statistics

Data is one of the points of contention among some of the conspiracy theorists. They loudly denounce the CDCs figures on flu mortality.

The CDC reports what is calls mortality due to pneumonia + influenza. This confuses people. It confused me. How do we know how many people are dying of influenza if the stats are mixed with pneumonia?

The answer is complicated–science is hard. That bothers some people–they think science should always be intuitive. Sorry.

A pretty complicated statistical analysis is applied to the available data. Since most cases of influenza aren’t actually tested, a certain amount of mathematical modeling must be used. (See BMJ 2006;332: 177-178 (21 January), and American Journal of Epidemiology 2006; 12:344-52.). These models have proven very successful. They make for boring reading, but I encourage you to give it a try.

Some would argue that excess winter deaths are simply “culling the herd”. If they wish to have that discussion, good luck, just don’t debate my mom…you’ll lose.

The bottom line is that flu shots save days lost from work, days of misery, and most of all they save lives. Get one every fall—thank me later.

Comments

  1. #1 Jason, Cincinnati
    March 22, 2008

    As a 33 year old healthy person who doesn’t work in health care or with children I choose not to bother getting vaccinated for the flu. Not due to any anti-vax nonsense, mind you, not having gotten the flu in a decade or so, it’s just lack of necessity.

  2. #2 LanceR
    March 22, 2008

    I used to feel the same way. I never get the flu, so why spend $25 for the flu shot?

    This year, I developed pneumonia trying to self-medicate the flu, and ended up in the hospital needing surgery to fix a collapsed lung. The scary part is how quickly I went downhill. I left work on a Tuesday, feeling a little bit under the weather. I went to the hospital on the following Monday. I probably should have gone on Friday, but I hate going to the doctor!

    Long story short, I got the pneumonia vaccine, and I will be getting the flu shot from now on.

  3. #3 Chuck
    March 22, 2008

    My daughter had both the flu and pneumonia vaccines fail in the same year. The last time anyone in my family had the flu or the flu vaccine was 9 years ago.

  4. #4 PalMD
    March 22, 2008

    Let me introduce everyone to Chuck. He is the anti-vax comic foil from WCU. He will help illustrate some of the common fallacies associated with anti-vaccination beliefs.

    The first one, above, represents not as much as a logical fallacy as an irrelevant anecdote.

    Stringing together anecdotes does not produce evidence.

    And wb Chuck. If you’re nice, I won’t shut you down.

  5. #5 Chuck
    March 22, 2008

    Thank you PalMD

    Your right, getting pneumonia and influenza after vaccination isn’t evidence of anything and FYI, you didn’t shut me down.

    If you are willing to be civil, so am I.

  6. #6 Chuck
    March 22, 2008

    Would you be willing to concede that the effectiveness of this year’s flu vaccine will make people question the necessity of getting the flu shot in the future?

    How are you going to counter that argument since the process of making the vaccine and choosing the strains hasn’t changed?

    All of the comments so far are “irrelevant anecdote” by your definition, but you point mine out because it is counter to your beliefs. I have no problems with that.

  7. #7 khan
    March 22, 2008

    Is there any progress being made on a new (faster) method to produce flu vaccine?

  8. #8 HCN
    March 22, 2008

    Is this the same “Chuck” from http://www.autismvox.com/ ?

  9. #9 PalMD
    March 23, 2008

    OK, the “feed the troll” continues only as long as it is educational.

    Would you be willing to concede that the effectiveness of this year’s flu vaccine will make people question the necessity of getting the flu shot in the future?

    Sure, I suppose. Non sequitur.

    How are you going to counter that argument since the process of making the vaccine and choosing the strains hasn’t changed?

    The method of vaccine development is quite good, but can always use improvement. It’s called “science”. The fact that this year stands out so sharply underlines the success of most previous years.

    All of the comments so far are “irrelevant anecdote” by your definition, but you point mine out because it is counter to your beliefs. I have no problems with that.

    My “anecdote” comment doesn’t have your name on it. All the stories are interesting, but you are right, they are not “data”.

  10. #10 Chuck
    March 23, 2008

    “The fact that this year stands out so sharply underlines the success of most previous years.”

    That is opinion, not science.

  11. #11 khan
    March 23, 2008

    Is there any progress being made on a quicker method of developing vaccines?

  12. #12 PalMD
    March 23, 2008

    I’m actually not sure. I’ll have to do some research on that.

    The current system is actually quite effective, but cumbersome. Tracking current viruses around the globe has worked very well, but it is vaccine production that holds things up. The use of chicken eggs to grow virus, and the need to produce millions of doses, is a relatively slow process, so when a new strain is found, there is no quick way to “adjust” the vaccine, or to produce a new one.

    There are other, non-vaccine, options being investigated.

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