Effect Measure

Flu deaths in children

The United States has an influenza surveillance system composed of five overlapping parts. You can get an overview of each here. In 2004 laboratory confirmed deaths from influenza in children (persons less than 18 years old) was made a notifiable cause of death by the states and through this we have been able to get a statistical snapshot of this most tragic kind of influenza mortality. There were 8 such deaths in four states reported this past week, occurring from February 1 to February 18, making the total for this flu season 17. Bacterial co-infection with Staph was seen in 10 of the 17 and four of the 10 were MRSA (a worrisome type of antibiotic resistance). And 8 of the 10 were older than age 12. Which reminds me of what the late Irving Selikoff, a renowned asbestos epidemiologist used to say: statistics are people with the tears wiped away:

Four years ago, Martin McGowan, 15, came home after trying out for his high school baseball team and slumped in front of the television. His mother, Diane McGowan thought it was unusual for her athletic teenage son.

“He just wasn’t his active self,” she said. “He usually reminded us of Tigger, bouncing all over the place.”

He went to bed that night complaining of flu-like symptoms.

“He had a temperature,” said McGowan of Nazareth, Pennsylvania. “It was 102. I knew the drill, give them ibuprofen or Motrin, give them something for the pain, and call the doctor the next day and see how it goes. That’s the normal case.”

That night, Martin vomited a couple of times, complained of pains in his legs and his lips were turning white. They rushed to the emergency room.

The doctors said he had the flu.

“Even at that point, I didn’t understand how sick my child was in the emergency room,” McGowan said. “Influenza doesn’t come across like that.”

The day before, Martin had gone running, which had irritated his leg muscles. The condition in his leg had developed into compartment syndrome, which limits blood circulation and causes leg pains. Doctors said he needed surgery as soon as possible.

While he was wheeled into the operating room, Martin turned to say: “Mom, don’t cry. It’s going to be OK.”

Martin died in the operating room.

“To hear that, it’s heart-wrenching,” his mother said. “The autopsy confirms it’s influenza, it rips your heart out.”

“He was a very healthy, active 15-year-old. He hadn’t been feeling well for one day. It hit him hard. It hit him like a lightning bolt. Within 15 hours, he was gone,” she said. (Madison Park, CNN)

Why Martin and not his classmates? We really don’t know. These terrible and swift deaths by young people are somewhat like the seemingly arbitrary but swift deaths of bird flu victims. There are millions of people exposed to the bird flu virus from infected poultry around the world, but lightning strikes only a tiny number. Why? Again, we don’t know. Would the current recommendation that he have a flu shot have saved him? We don’t know.

But I do know that I recommended my two youngest grandsons, who are both under the age of 2, get a flu shot (and one of them has, the other will when he sees the pediatrician next). That recommendation is based on what I know of the science.

But it is also based on the “grandpa factor.”

Comments

  1. #1 miso
    March 3, 2009

    Biota invent the first neuraminidase inhibitor, Relenza, but made the mistake of considering drug resistance more important than ease of use, the result was a compound, zanamivir, which wouldn’t work if swallowed, but which was practically irresistible to influenza. You’d reasonably expect to see a return on the pioneering research, and to use some of the profits to fund further R&D:
    = Try out a better inhaler because younger children couldn’t suck a consistent dose; old folk couldn’t follow the complex instructions of GSK’S Diskhaler.
    = Fund further trials of injection treatment following promising pre-clinical trials. Children younger than 7 years of age could have been treated with exact injected doses. Hospitalised patients with lung problems, or other complications could have been treated by I.V. Relenza for systemic infection.
    = Even work on the next generation drugs, LANI (long acting nuraminidase inhibitors), so called “Super Relenza”, many times more effective than normal Relenza; only one puff required for treatment or one week of prophylaxis. All this was in motion in the late 1990′s.

    Then U.S’s Gilead/Roche got a whiff of the potential profits, and saw Biota/GSK’s fatal mistake. Ignore resistance,… what’s needed is a pill. So an ex-Relenza researcher was recruited to fast track development of Tamiflu, intense clinical trials and a co-operative FDA saw Tamiflu released within months of a delayed Relenza.

    Earliest research found mutations that caused Tamiflu resistance but not Relenza resistance, however the inhaler simply couldn’t compete with a pill.

    Roche did some research published in 2002 The H274Y mutation in the influenza A/H1N1 neuraminidase active site following oseltamivir phosphate treatment leave virus severely compromised both in vitro and in vivo. (Antiviral Res. 2002 Aug;55(2):307-17 )which assured us “Virus carrying a H274Y mutation is unlikely to be of clinical consequence in man”. That’s the mutation that has rendered Tamiflu useless against influenza A, but has not made influenza A any less deadly in 2008-2009 influenza season . Similar resistance has also occurred when human victims of bird flu are treated with Tamiflu

    And what happened to Relenza R&D you ask? What happened to the expanded uses and expanded age range? You waited until Tamiflu stole Relenza’s oxygen, became a cash cow for Roche, Gilead, and Rumsfeld, until Tamiflu failed, to ask? Most of you still haven’t asked. And now your worried about “Flu deaths in children”?
    First time vaccination, which can be hit or miss anyway takes at least a month to protect a child, where as a thoroughly researched and developed Relenza had the potential to treat or protect a child immediately. What a wasted potential.

  2. #2 Ramneek
    March 3, 2009

    Why Martin and no other kids? Good question! Neither of my children are vaccinated (with anything) and while that really gets other people upset and worked up, its an informed and educated decision based on reality and not dogma. We live a very good lifestyle. Good organic foods, exercise, low stress, and try to minimize the effects of injury to the body naturally. When and if the boys get a fever, we let it run its course and we WATCH it closely so that the body can run its course and function like it was designed to do. I truly believe that “powerful” strains of viruses are more lethal becuase we, as human beings, can create an environment in our bodies that “help” viruses take a hold. Thats why other kids get sicker than our kids do. As a physician, I see it everyday. Here’s the CDC fact sheet on other (and forgotten) preventive measures with for seasonal Flu:
    http://www.cdc.gov/flu/protect/habits.htm

  3. #3 catgirl
    March 3, 2009

    Flu shots shouldn’t just be for children under 2. Everyone who is healthy enough to get one should do so. I’ve been getting them for the last 4 years, and not only am I avoiding this disease for myself, I am also preventing the spread of it to people who may be more vulnerable. Apparently, I could even be one of the vulnerable ones.

  4. #4 revere
    March 3, 2009

    catgirl: No, of course they are not just for chiildren. I get one every year. But this post was about pediatric flu deaths and they are an underimmunized group so it was an opportunity to promote it. I think the eviene is good that it protects adults under 65. People like me who are over 65 are a gray area with some conflicting data. Based on the basic science I get on anyway. It’s my immunologic version of Pascal’s wager.

  5. #5 Meyer
    March 3, 2009

    Ramneek,

    Your decision to not vaccinate your children is neither informed nor educated. The overwhelming evidence is that vaccination saves lives. Measles and haemophilus influenzae don’t care how organic your diet is.

  6. #6 Tom DVM
    March 3, 2009

    “The overwhelming evidence is that vaccination saves lives.”

    Meyer,

    Approx. 50% of those with university level health science degrees beg to differ with you.

    In my opinion, it is important to answer the question why…and I think the answer is in the suspect-quality of the research that has convinced you and the general public that influenza vaccine works.

    I don’t think anyone with training would avoid a vaccination program that works. I was born into the middle of a localized Polio outbreak and I know of no one who refused that vaccine.

  7. #7 paiwan
    March 3, 2009

    Meyer,

    Ramneek is talking about the good life style which is the best way to sustain health on long run. Not many parents are patient enough to take care of their children as “When and if the boys get a fever, we let it run its course and we WATCH it closely so that the body can run its course and function like it was designed to do.”

    Sometimes the quick fix way is damaging or weakening a person’s immunity foundation. It may help the parents feeling less guilty, or “Grandpa’s playful affection”.

    Nevertheless, if you are a traveler or working in a crowded office like my partner’s one where every day there is someone coughing in the office, then considering the flu shot perhaps is the short listed option.

    I personally take exercise regularly and intentionally exposed to sunshine everyday 10-20 minutes, and I am fine. Occasionally I had slight sore throat; I took that as an indicator to fine-tune my routine for more exercise and rest.

  8. #8 revere
    March 3, 2009

    Tom, paiwan: I happen to agree with Meyer on this. Tom, since you don’t know the literature I don’t know how you can pontificate about it. paiwan, there is no good evidence that exercise and what Ramneek personally thinks today is a good diet will be effective in preventing someone from getting the flu. It may be a good thing in itself, but let’s stick to the subject. If Ramneek doesn’t want to vaccinate his children, that’s his privilege, although he is free riding on the herd immunity provided by those who do. This is a typical anti-vaxer position, and while I think there are questions about the efficacy of flu vaccination in certain age groups (like mine), the data for most people are pretty good and even for the over 65 there are solid, although sometimes conflicting but scant data. In general, I think Tom and Ramneek are taking a know-nothing stance that is not defensible.

  9. #9 Tom DVM
    March 3, 2009

    Revere

    I guess myself and Ramneek and about 50% of the healthcare community will have to agree to disagree with you…for now.

    When I see data, using well-established scientific norms, that provide proof that the primitive influenza vaccine, in use today actually works…then I will sing like a jaybird…from the rooftops.

    But you have not provided any to this point…and epidemiological screening tests of the same quality that led to a doubling of alcohol consumption by young people because an industry epidemiologist said it was so…isn’t going to wash.

    I would like to see double-blind quality tests using the well-established protocol following health professionals personal choice which doesn’t put anyone at risk…

    …and they can only decide someone has had influenza when they have acute and convalescent titres…not because someone did a half-assed physical examination and concluded they had influenza.

    I am still waiting…patiently.

  10. #10 pft
    March 4, 2009

    Funny how the same agency that can not regulate food safety is so trusted when it comes to the safety of vaccines. They seem to rely on VAERS to identify problems after marketing begins and do not do any testing on their own, just review the manufacturers tests.

    FDA and the CDC manage VAERS where an adverse event that may be associated with any vaccine is reported. However, many events that might be associated with vaccines go unreported since the problem with vaccines given to very young children is that there are a lot of background adverse events occurring in the first years of life and a reaction thought to be due to a vaccine may actually have been from something else, or a reaction caused by the vaccine could be excluded for the same reason.

    And then there is autism. Fact is, autism and other childhood disorders have increased along with increasing vaccine use. Just like temperatures have increased with mans CO2 use. This is not conclusive of course. There is no conclusive evidence vaccines cause these disorders, but really, how hard are they looking. It may be that some have decided that vaccines are still beneficial despite the increases in these disorders, and do not want to muddy the water, so funding for such research is limited. This is the same issue with climate science as some scientists say even if they are wrong, so what, reducing consumption of fossil fuels is a good thing.

    I believe CDC, another discredited agency, is involved in which projects receive government funding but in 2005, an IOM panel condemned CDC for its “lack of transparency” in vaccine-autism research. The only scientists who seem to suggest there is no issue and that the science is settled are those with ties to the vaccine industry.

    This study suggests a possible link.

    http://www.drugs.com/clinical_trials/infant-vaccines-produce-autism-new-primate-study-university-pittsburgh-scientists-4323.html

    Dr. Bernadine Healy former direct of the NIH says the science is not settled, of course, she is linked to Big Oil scientists who deny global warming, and is a Republican(as wikipedia takes care to point out). But then, what industry benefits from establishing a link of vaccines to autism and how is that a party issue. Bush pushed HPV vaccines on immigrants and was a big supporter of the vaccine industry.

  11. #11 g336
    March 4, 2009

    Revere, I have to disagree with the “they’re your children…” approach.

    Children aren’t property.

    Parents have an obligation to feed them, protect them, and so on. Parents don’t have a right to put their childrens’ lives at risk in service of a delusional ideology. Whether it’s withholding vaccines or putting sick kids in Christian Science hospitals where they’ll be prayed over and denied all medications including painkillers: either way, that’s child abuse, neglect, or endangerment.

  12. #12 Ramneek
    March 4, 2009

    Mr. Meyer. Contrary to your comment, my decision was indeed educated and an elightened one. Do pathogens care how I care for my body or how my children care for their bodies..ABSOLUTELY! I can flood you with literature on the relationship between stress, toxicity, and trauma and sickness and immunomodulation. There is no shortage of quality literature on the matter. If your lifestyle doesn’t matter then why don’t ALL of us die from Hemophilus or measels? My kids have had varicella, hand foot mouth, whooping cough, influenza, sinusitis, and otitis. BECAUSE we live in the manner that we do dedicated to wellness (just like we were taught in medical shcool) the boys’ ability to ward off infection is remarkable.

    In my family practice, I advocate vaccinations for many. Some learn that I don’t hail from that school of thought. I have an obligation to my children and my patients, however, if someone wants to live life without fear and exist in a more enlightened paradigm, I feel it’s far from uneducated or uninformed. Try it…you might be amazed at what your body is capable of. Health doesn’t originate from a vaccine…in fact…if your NOT HEALTHY, vaccines can be contraindicated. Contrary to g336′s comment, this paradigm requires my wife and I to be even more responsible, more diligent, be mindful parents, and not just trust blindly that a pill, powder, or potion will make our children healthy. Our choice is not a whimsical one, we take our routine to health and wellness on a daily basis, VERY SERIOUSLY!! We reap the benefits from it. I bet very few of you can relate firsthand what real health is.

  13. #13 Interrobang
    March 4, 2009

    If your lifestyle doesn’t matter then why don’t ALL of us die from Hemophilus or measels?

    Because if Hib and measles were universally fatal to humans, neither organism would have a host in which it could reproduce and it would itself go extinct, which kind of puts an upward boundary on its ability to kill its hosts. I’m not a doctor or even a scientist, and I don’t have anything resembling a formal medical or scientific education, and even I know that. If you can’t grasp biology to that basic level, you’ve got no bloody business making medical decisions for anybody.

    My kids have had varicella, hand foot mouth, whooping cough, influenza, sinusitis, and otitis.

    Considering that at least three of those things are vaccine-preventable to a greater or lesser degree, and considering that varicella causes shingles in older people (so the best course of action is never to be exposed to it in the first place); and considering that pertussis is often fatal; and considering that all of those diseases are positively miserable; and considering that sinusitis often doesn’t resolve completely without antibiotics (it’s possible to have a low-grade, nearly asymptomatic sinusitis for months at a time), you’re a bad parent to have willingly allowed your children to contract these diseases (when they’re preventable) and a worse one for not treating them.

    That’s your choice, but on the other hand, I think your local Children’s Aid ought to know about you.

  14. #14 Lea
    March 4, 2009

    Holy cow Interrobang, you have no right to say what you did in that last sentence. (of course revere will disagree).

    Free choice still exists (for now) Ramneek, and I’m with you on what you’ve said. My Chiropractor, bless his big Mormon butt, last month basically reamed my behind for refusing to use his office pen. He went off the deep end about me being overly concerned over germs and how I needed to do this and that. (it was a month ago so I don’t remember everything he said).

    I’m not here to start an argument either revere so please keep your ill-temper away from me simply because I don’t agree with you on this.

  15. #15 M.Randolph Kruger
    March 4, 2009

    Webster also covered this flu vax thing from his ABC interview… If the flu vaccines that were being used by the Chinese on both humans and chickens was good, (Which the ChiComs asserted for both), then “Why are we seeing so much flu? ” But then it opens up the can of worms. Does shitty vaccine cause superbugs?

    As for the old peoples vaccinations, yeah it does apparently keep them alive. But I think Tom is asserting that the reason we get flu vaccinations is as a preventative pretty much worthless. It might just keep you alive long enough in severe cases of a non seasonal flu? No way they can make that statement. Creatures like H5, H7, H3, that might have picked up some gnarly pieces of RNA somewhere open the door for a real hummer of a case.

    Webster is brilliant on flu of all types. I think he knows more than most people on it, but each time it takes a turn for seasonal or novel worse we have little or no resistance to it. The flub up last season with the worthless vax was evidenced and it apparently, maybe, could learn from the vax what not to make for the next outbreak as it mutates. Flu is here to stay. Vaccinations…? Personal choice but the others aren’t. Your kids are criminals by condition if you don’t want them vaccinated. My kid couldnt get into Bama until she proved she had taken a flu shot… Pure unmitigated bullshit is what that is. Might do a little for a flu but not much..The funny part? They gave her the previous seasons flu vax… Worthless-but still 20 bucks at Walgreens.

    Be it the Thimerosal or personal preference then you have to look at it for what it is… A big maybe….A big stinging bee and a moving target. You get stung, you get ill. If you get ill your body is STILL the only think that turns on the virus and kills it and maybe the patterns in the vax is matched with the bug. Ever read Webster on how many times in a DAY that he believes flu mutates ? The vax is nothing more than an educated guess and quite a few of these people who took it last year got ill. Maybe they were a little better off, maybe not for having taken it. That should be the real test.

    BUT… As Webster has pointed out… Shitty vax is just that and it shouldnt be used. We got rid of Smallpox because of vaccinations, we got rid of polio in the US because of vax. They both worked because the bugs are effectively gone. Its also reasonable to assume that these bugs will be back and stronger at some later date. But will it be because we used vax and it evolved around it or will it be because of a natural evolution?

    Wont see any studies done that prove the prior at the drug companies Revere. To do so would prove Toms case and set the world on its ear. It also creates a dilemma. If we dont vax and something comes down the pike at us (polio), the time in motion to do a national vax program is in the months if not years to get everyone. Even the H5N1 planning is flawed as it will take a year or better to get everyone vaxed. By then the bug will have mutated away…again.

    My bro had polio and it screwed him up badly. 10th grade education level from brain damage, withered right arm, post polio syndrome. He is a wreck so you have to vax for some things I think, perhaps maybe not others.

    You are in the dilemma too Revere… If this kid had a flu shot can you unequivocably say he would be alive today? Nope is the answer to that I am sure. …. But it cant hurt either right? It does if we vax ourselves into MRSA and superflu’s… Are WE creating the problem and the cure each time we do?

    Anyone want to talk about the anthrax vax given to the troops and how messed up some are from it? Now there’s a vax that didnt work.

  16. #16 Ramneek
    March 4, 2009

    Oh Interrobang, so nice to meet you too! Lets start with pathogenic organisms in and around you. Pathogens are everpresent!! I’m fairly certain that if we cultured everyone’s blood on this blog or ran ELISA’s or RASTs we’d find evidence of pathogenicity and prevalence of the microbes in question. Once again, we coexist with these organisms in a delicate balance and its up to us to manage their existence. Of course, how we choose to manage them is a matter of choice.

    I am not in the business of making medical decisions for anyone. I advise, guide, test, image, and otherwise dispense healthcare responsibly, ethically, and in a manner congruent with the oath and degrees conferred upon me. My patients make their own decisions with my help and if they don’t like what I say or suggest, they are welcome to ask someone else without any ill will on my part. I’m a conservative practitioner, not a bully.

    You’re obviously referencing varicella, pertussis, and influenza as preventable. You’re WRONG! There is no guarantee that any child won’t contract an illness by having had received its inoculum. In fact, in all of those cases, vaccinated children suffered the illness alongside my children. Here’s the great part, my children were cleared to go back to school sooner than any of the others. In fact, the two children who often showed up to school with processed poptarts, soda, sugary kool-aid, and candy bars were the last to come back to school. Tell me their immune systems were working at potential?! So are the parents of all the vaccinated children that contract diseases deserving of your report to ‘childrens aid’? By the way, in the US we call it DHS if you’re interested in reporting me!

    To iron our your last wrinkled thought about me not rendering care to my children, let me be clear: I don’t know where you contrived the idea that I didn’t have my little ones take a course of antibiotics or undergo an adenoidectomy, or apply a topical to soothe the skin, or manage a cough with some pharmacotherapy? I’m conservative Interrodong not stupid. Your delusions about me not “treating” my kids is misplaced and inappropriate. Furthermore, I take umbrage with your suggestion that I need to be reported to “childrens aid”. Tread lightly and speak not of what you DON’T KNOW!

  17. #17 paiwan
    March 4, 2009

    Oh, this is going to be a great Blog, and again it has allowed the debates from two seemingly opposite professional opinions.

    I’ve appreciated Ramneek’s authentic disclosure about his/her viewpoint; to me that people who has engaged his life with personal service is an ethical stance. I am a layman in medicine and a marine biologist. At my age of 59, I now place the ongoing life style as my leverage area for fine-tuning. As the life style has to encompass the physical, mental and perhaps the value system of my own; the well-being should be interpreted as an ultimately poised state of personal health.

    It has taken a year to be used to this kind of debate; the tone sometimes is too strong for an Asian like me. Nevertheless, Revere has convinced me that this is America, full freedom of expression. Thanks for the inputs and the dedicated debates.

  18. #18 revere
    March 4, 2009

    Ramneek: I’m not clear. Are you saying you don’t vaccinate your children for any disease?

  19. #19 Ramneek
    March 4, 2009

    Yes Revere, that is correct. I actually had every intention of vaccinating on an alternate schedule as put out and supported by the American Academy of Family Physicians and American Academy of Pediatrics alike. Ultimately, my own research, inquisition, and influence from my own conservative roots/lifestyle (Ayurveda) brought me to the present. Let me also suggest that I am not opposed to vaccinating should I feel it is the ONLY form of protection/management.

  20. #20 revere
    March 4, 2009

    Ramneek: So you are an antivaxer. You don’t vaccinate your children at all. And you claim you have scientific evidence that MMR doesn’t protect, polio vaccination doesn’t protect (I lived through polio epidemics, but maybe I was imagining it), that smallpox vaccine doesn’t protect, that DPT doesn’t protect. Is this what you are telling me?

  21. #21 paiwan
    March 4, 2009

    Ramneek,

    I am in marine shrimp research; I have used the same concept that you have to my shrimp breeding and production. In fact, I have attained better result than ultra-clean hygiene method. As I review the theory; shrimp lives in water body where the viruses are all there-no way to flee. Marine viruses have confirmed the ambivalent to the ecosystem; they regulate and destroy and induce the immunity programming of organism. Lately, the human medicine also indicates that babies rely on a little dirt to induce their immunity development. A shocking example is the parasite worm for children is helping the children- preventing the ongoing asthma and allergic sickness.

    I have no doubt to apply for my shrimp. The dilemma for me to whether I will advise my son to do for my grand-child (I am expecting soon.);-)

    Since I know that you are pro-Ayuveda; may I know if you are a vegan? If yes, how you can reconcile the need of DHA of seafood which is important to prevent Alzheimer’s and dementia?

  22. #22 Ramneek
    March 4, 2009

    Revere: No, I have never said that any of those vaccines don’t protect. They do offer protection. I never said I have scientific evidence that speaks to them not protecting. I stated that I have scientific evidence that speaks to the correlation of lifestyle augmentation and mortality/morbidity as it relates to communicable diseases. I don’t believe vaccinations are the “gold standard” or the only form of protection. Most of my patients vaccinate and I support them. Some of my patients push and ask questions about safety, efficacy, alternatives, and sometimes they ask what I do personally. I don’t like to talk about it too much because I don’t want the perception out there that Dr. Ramneek says you don’t need vaccines. That’s not what I’m about.

    The patients that are committed to living a lifestyle that embodies the ideals of wellness and prevention…I support their decision to be nonvaxers. As with any medical decision, it comes with risks and responsibilities. They have the right to make those choices. I counsel them on those risks…what to look for if you child gets sick, visiting the physician (me) sooner than most..so on, so forth…

    As an aside, Revere, I do mission work once a year in impoverished communities. I have rendered health care in countries like India and Haiti. I have seen the miracles of what drugs and vaccinations can do. Those people don’t have water or food, let alone clean water or food. I am a proponent…just not a “carte blanche” proponent.

    Paiwan: Interesting research! I am not a vegan. I am an omnivore. We eat mostly organic food and drink clean reverse osmosis water. PLENTY of fresh fruits and vegetables. We supplement our diets with plenty of DHA/EPA. Wherever and whenever possible, I use botannicals, vitamins, and minerals from from third party tested nutriceutical companies. I consult a ND and a DC from time to time and when need be, we intervene with drugs and/or surgery…hasn’t happened very often!

  23. #23 da
    March 4, 2009

    The seasonal influenza-related deaths that I’m aware of in my part of the world all seem to be related to secondary infections, primarily from Staph aureus, with a mix of MRSA and MSSA. The fact that the deaths occur among previously healthy individuals is alarming. Another disturbing trend, based on an admittedly small sample size, is that the deaths seem to predominantly involve influenza B–disturbing because of the vaccine mismatches for B that we’ve seen in the last two years.

    I certainly am in favor of (and do my best to practice) what would be considered a healthy lifestyle, partly under the assumption that it improves one’s immune system. But I’m also strongly in favor of hedging one’s bets by getting an annual flu shot. It’s not so much the risk of increased mortality that motivates me as much as the prospect of being incapacitated for a week or so; I hate run-of-the-mill URI’s, so I’ll happily subject myself to an annual jab of assorted hemagglutinin and neuraminidase molecules.