Effect Measure

There’s no vaccine for the influenza subtype, H5N1, of most concern as the agent of the next pandemic but evidence exists that there is some cross-reactivity with existing seasonal vaccines (it’s not clear how much if any, but it might not take much) or that previous vaccination with seasonal vaccine produces a much quicker response to an H5N1 vaccine. Moreover there remains a substantial toll in morbidity and mortality from the seasonal influenza which the current vaccines are designed for. So strategies to encourage key populations to get the existing flu vaccine are of interest to public health officials. CDC just released results of a survey they did in 2004 about the different ways nursing homes (where influenza can spread rapidly with lethal effect) used to get their employees vaccinated. Here is the survey question and a summary of the answers:

Survey question: “Does (facility) do any of the following to encourage employees’ influenza vaccinations? Vaccinations recommended; vaccinations offered on site; vaccinations offered for free; staff incentives provided for vaccination; proof of vaccination (or contraindication) required as a condition of work/employment; furlough or patient restriction policy for employees developing influenza-like illness; none of the above.” Facilities could select all strategies that apply.

Results: In 2004, the majority (63%) of nursing homes reported <60% employees had received an influenza shot last influenza season. In 2004, nursing homes used different strategies to promote influenza vaccination among employees. Three of these strategies (offering free vaccinations, furloughing employees with influenza-like illness, and requiring proof of vaccination) were significantly associated with staff influenza vaccination rates >60%. Only 1% of surveyed facilities did not use at least one of the strategies. (CDC, Morbidity and Mortality Weekly Reports [MMWR])

Here’s a bar graph (because how would you know it was scientific if we didn’t show you a bar graph?):

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Comments

  1. #1 M. Randolph Kruger
    January 27, 2008

    Since I react so violently to flu vax I havent taken it for the last five years. The military used to have to put me up at the hospital each time they gave it to me. Now I did take the pneumovax and that was one of the more interesting ones. If you take it, do it on your Friday because by late afternoon your arm is going to be numb. But you know what? Not a sniffle, no colds, no nothing for the last three years. All thru this time though I havent gotten the flu either. I dont think I am immune or cleaner than anyone else, just dont get it.

    But here is one for you Revere… H5N1 comes down the trail at us. OSHA says for you to work in a known biohazardous environment that they have to provide equipment and training for you to be there. But if you are dealing with H3 or something else they dont? I guess its defined as a known condition with a high CFR rate and high kill pathogen.

    Dunno but thats kind of effed up isnt it.

  2. #2 speedwell
    January 28, 2008

    M. Kruger, the pneumovax? I wondered. In previous years, I received the seasonal flu shot but still got every little non-flu sniffle and coughed for days afterward. Then I went in for major surgery and got a shockingly infected kidney removed, and they gave me the pneumonia vaccine as a matter of course. Now this year everyone around me is miserable with what’s going around, and I’m standing tall and feeling like I keep dodging bullets. I thought it might have been due to my body finally being free of the bad infection and enabled to fight the colds and flu, but you may really have something there.

  3. #3 M. Randolph Kruger
    January 28, 2008

    Speedy-Well I consulted with my friend Revere way back what 2 years ago about getting it. He encouraged me to do both, but it wasnt medical advice. It was more like a strong suggestion. Since it took me a crapping six months to get over my last flu shot and I mean it started with the flu like crap, then the chest loaded up, then the throat and head and finally the already dripping shit nose was so full and inflamed that they were shooting epinephrine up it themselves (I couldnt) to get something that was open enough to move the air. They gave me something for the inflammation via a drip and I had a 103 fever for three days. It started higher but they got the circulating blankets out and kept it down.

    They thought it was malaria at first but I had to repeat to my military friends in the Base Hospital that they needed to get the OOD Doctor back in there else they might be going to a funeral. Mine! Finally a PA came in and took one look at me and said Holy Shit and sent me down for an Xray and then called the Doctor in.

    When he arrived I was in sad, sad shape. I was so far down the shitter that I couldnt even cough any more. No, no morphine even though it hurt. They were talking about the tube and machines and I said no to that. So the doc and I had a nice short talk. I told him that I needed to burn it out and load me up into a bath with magnesium salts (previous fix) and do it quick. So every three hours I was in a toasty little bath at 100 degrees. I had someone sneak some whiskey in and I took a couple of shots of that and some honey. On day 4 the fever broke and I was permanently off the flu shot in the military. Coughed for two months and I am talking about that industrial colored crap coming out. Orange, yellow, bloody funk. That was just from the shot.

    OTOH I havent had the flu since. I took the P-vax after talking it over with Revere and then my doc..The doc wanted to shove another flu shot into me… I said anyone approaching me with a needle containing flu vax would have it stuck in a very inappropriate place be it woman or man. She said okay, okay and let it go. I havent been anything more than a little achey at times this year or the last. Not one snotty nose, no headaches, no fevers.

    I wonder though if the early vax’s gave me a major resistance to the bug. I know I got the first flu vax and then all of the subsequent ones until 98. After the 1976 mandatory Swine Flu vax that was given all the way up until 78 in the military I was fine. After that bio-debaucle was fielded I started reacting to the vaccines like you had shoved penicillin into me. I am allergic to penicillin. Might be connected somehow. The docs were astounded by my reaction to the bug vax. Across 20 years it got worse and worse, 91 and 92 were about the same but still bad. After that it was the clinic and the base hospital or red tagged for the next chopper out in 94 and 95. 98 though was the last one.

    Good to hear you are doing well Speedy, but you know I had the same feeling…Different somehow. Nose quit running except in the most coldest of weather and it was clear. Prior to that it was the constant green funkola that was present ever since about the 1980’s after being in and out of C. America. They have industrial grade bacteria there. But this is the one thing I can attribute it to. All the kids and wife got it and their noses cleared up. I suggested it to a friend at Fedex who had a perpetual asthma and chest congestion. It cleared her up enough to climb Mt. Ranier…go figure.

    I do recommend you talk to your doctor folks before taking this. Your arm is going to be dead for a day for sure and a little warm, headache and then better within 48 hours. WalGreens will give it to you in some states. Bout 100 bucks. About the cost of a doc in the box visit.

  4. #4 Monado in Toronto
    January 28, 2008

    One thing that the late Conservative government of Ontario did correctly was to throw open flu vaccine to everyone who wanted it. I just stroll to my local medical clinic (a slew of doctors, lab in the basement, etc.) and get one from the nurse on duty.

    They started by offering flu vaccine to kids and old people for free under the Ontario health insurance plan. Others could pay for it (about $25). But they rapidly progressed to Free for Everybody because one little flu vaccination saved so much lost employee time. I think it saves companies a billion every year. But that’s just a vaguely remembered factoid.

  5. #5 Melanie
    January 28, 2008

    Monado,

    This is in USD and the year is not given, but the round numbers sound right.

    Not only does the flu make people sick and miserable, but it hurts our pocket books too. Each year, up to 111 million workdays are lost because of influenza. And this costs American businesses more than $7 billion a year in sick days and lost productivity. (Noonan, David Newsweek, Nov. 6, 2000, Vol. 136 Issue 19, p56)

  6. #6 caia
    January 28, 2008

    Revere,

    I’ve heard that vaccines sometimes offer less, or less long-lasting, protection, than the antibodies from actually getting whatever illness. Is it possible that whatever cross-reactivity might exist would be greater if you actually got seasonal flu? Or would the vaccine be likely to be more effective because it features more strains?

    I’m not suggesting there’s any way to test that, or that anyone would choose to try to get seasonal flu instead of vaccine, I was just curious.

  7. #7 revere
    January 28, 2008

    caia: Yes, natural immunity could be (although isn’t always) stronger, since there may be more antigens in play and at higher levels. But you could also die from it or get really sick. And I mean really sick. Real flu is no picnic. It’s theoretically testable but we’ll need a pandemic first, and if the epidemiologists live through it and the data are collected it’s testable. Lots of things will be testable then. Too late.

  8. #8 caia
    January 29, 2008

    Well, right, untestable now. After it wouldn’t so much matter. Even then, there’d be huge confounders whether survivors knew whether they or the deceased had previously had the flu or just ILIs.

    I know I could get really sick from the flu, even if I’m young enough where dying from it would be a real surprise to everyone. I’m not looking to get it (ok, I haven’t gotten my flu shot yet this year, but nor have I been to the doctor since the summer), I was just wondering aloud.

  9. #9 bc
    January 29, 2008

    CAIA,

    If you’re the right age (2-49 yrs) and and good health, FluMist might be a good option for you. A live vaccine is more like a natural infection, but it won’t make you deathly ill like the flu can. (It can reproduce only in the lower temperature areas of the nostrils, not at body temperature.)

    If you’re older than 49 and in good health, you could try to persuade your care provider to give it to you off-label. (I’ve done that the past 3 years.)