Respectful Insolence

Off to get my flu vaccine…

It’s about time.

My cancer center is finally offering the flu vaccine for its employees, and I’m off to go and get it. I’ll be sure to ask for extra thimerosal. Even though Jock Doubleday’s challenge seems to have disappeared, I’ll still do it in his honor.

This year, I’m particularly proud of my cancer center in that its leadership has made a stand by partnering with other health care institutions in the city and requiring the flu vaccine for employees who directly interact with patients. That means doctors, nurses, support staff, receptionists, pretty much everyone other than the lab rats working in the research section of the building. When we get our vaccine, we will be given a sticker to put on our employee ID. An employee can still refuse the flu vaccine, but that employee will not be given the ID sticker and, as a result, will be required to wear a mask any time he or she is in an area where patient care takes place and in patient waiting areas. It’s imperfect (personally, other than medical reasons, I see no reason why employees at a cancer center, where immunosuppressed patients are cared for, should not be required to be up on all their vaccinations, including the flu vaccine every year), but it’s a reasonable compromise between patient safety and personal freedom. I wish I could say I had something to do with this policy, but I didn’t. I did thank our cancer center director when I heard about it, though.

If I don’t return to the blog later today or sometime tomorrow, you’ll know that something horrible has happened to me as a result of the flu vaccine as a result of all that deadly mercury and killed virus. Of course, the likelihood of that is slim and none; the Insolence will resume later today or tomorrow as usual. The flu vaccine may not be as effective as we wish in some years, due to the nature of the influenza virus and the ever-shifting types of flu that circulate every year, but it is effective and it is safe. The benefits certainly outweigh the tiny risks. Even if we are too cavalier to protect ourselves and our own loved ones, we as health care professionals owe it to patients to take at least this minimal step to protect them.

It really is the least a health care professional should do during the flu season.

Comments

  1. #1 BA
    October 6, 2010

    I had mine last week. Unfortunately, I did not turn into the Hulk. Only a small bruise that lasted three days.

  2. #2 Todd W.
    October 6, 2010

    Got mine a few weeks ago. No bruise. No pain. But I do have this really neat pair of prehensile tentacles that grew out of my back.

  3. #3 Jojo
    October 6, 2010

    Thanks for the reminder. I just double checked my company’s schedule and marked the day on my calendar. Now to look into getting one for my wee beastie.

  4. #4 MikeMa
    October 6, 2010

    Local drug store is offering the shot. I will stop by on the way home one day this week.

  5. #5 Dangerous Bacon
    October 6, 2010

    Fools! You will all turn into newts.

    Good to see more hospitals requiring flu shots for their health care workers.

  6. #6 Composer99
    October 6, 2010

    I better check the provincial Ministry on when seasonal shots will be available here.

    Todd, I would hazard that your falling in with Great Old Ones like Cthulu has more to do with your tenatcles than a flu shot does. But hey, that’s just me.

  7. #7 bluedevilRA
    October 6, 2010

    I will be getting mine soon. Unfortunately, many of my friends in medical school refuse. They protest that it is not very effective, it carries the risk of dystonia (citing the Desiree Jennings case), and it can give you the flu. Despite proving that all of these claims are demonstrably false, they are not going for it. Paraphrasing Michael Shermer, smart people are amazingly able to convince themselves of dumb things.

    But we will get the last laugh. They will not have a choice during 3rd and 4th year (clinical rotations). Mandatory vaccinations! Science prevails, sort of. I would still prefer a world where people choose science over idiocy.

  8. #8 Pablo
    October 6, 2010

    Got mine yesterday. WITH thimerasol, too.

  9. #9 Seb30
    October 6, 2010

    @ 2 Todd

    You mean you look like something like this?
    http://www.wizards.com/dnd/images/eb_gallery/82152.jpg

    Maybe you meet a facetious Daelkyr :)

  10. #10 Todd W.
    October 6, 2010

    @Composer99

    No, no, no. The tentacles are totally the result of the flu vaccine. Sure, they just happened to coincide with my recent bouts of sleepwalking to the stone circle on the hilltop, but that, as I said, is just coincidence.

  11. #11 Todd W.
    October 6, 2010

    @Seb30

    Not quite as unfriendly-looking.

  12. #12 NJ
    October 6, 2010

    Todd @ 2:

    On first glance, I read that as “prehensile testacles”.

    Which would be an even more interesting side effect…

  13. #13 Matthew Cline
    October 6, 2010

    @Dangerous Bacon:

    Fools! You will all turn into newts.

    We got better.

    @bluedevilRA:

    Unfortunately, many of my friends in medical school refuse. They protest that it … can give you the flu.

    They think that the inactivated flu virus can give them the flu? Medical school students think this?

    @Todd W:

    Sure, they just happened to coincide with my recent bouts of sleepwalking to the stone circle on the hilltop, but that, as I said, is just coincidence.

    Ia! Ia! Cthulhu fhtagn!

  14. #14 Vicki
    October 6, 2010

    @Todd: There are no coincidences. Clearly, the flu shot caused the sleepwalking. And the stone circle caused the influenza virus.

  15. #15 Orange Lantern
    October 6, 2010

    When we get our vaccine, we will be given a sticker to put on our employee ID. An employee can still refuse the flu vaccine, but that employee will not be given the ID sticker and, as a result, will be required to wear a mask any time he or she is in an area where patient care takes place and in patient waiting areas.

    My children’s hospital has the same exact policy. I love how institutions are taking the initiative on this.

  16. #16 Calli Arcale
    October 6, 2010

    Lucky you; I don’t get mine until Oct 21. (I’m a cheapskate, so I’m waiting until the company-sponsored flu clinic.) It will be the day after I’m scheduled to donate blood. Yay! :-D My eldest (the one on the spectrum) gets hers a week from Friday at her annual physical. Interestingly, last year I found that having ADD qualified her to get the H1N1 shots before others because it was a chronic disability. Fun! This year, of course, she’ll get it with everyone else. I still have to schedule the youngest for hers.

  17. #17 Pablo
    October 6, 2010

    When the wifey and I got our vaccines, we got a sticker that said, “I GOT IT, did you?” We stuck them on our son. He likes stickers.

    He was too young to get a flu shot at the grocery store, but will do it when he gets to the doctor in a couple of weeks.

  18. #18 MikeMa
    October 6, 2010

    @Dangerous Bacon,
    Could you make it a gecko? That little Geico ad-gecko makes a lot of money and needs some competition. I will need to practice an accent…

  19. #19 kittywhumpus
    October 6, 2010

    babywhumpus and I had our flu shots two weeks ago, and I do believe thimerosal was included.

    My husband has an appointment. For November. The quasi-public institution where I work used to hold free, walk-in flu clinics at various locations around campus, but this year, it’s by appointment due to their being over-run last year on their very first day (they ran out). This will mean that fewer people will get their flu shots, I think.

    This means I did not get my super-neat “Do it for the herd” sticker (complete with cow).

    p.s. Todd W., I saw the word “testicles”, too, which tells you something about my brain. It did make me laugh out loud, though, which was fun.

  20. #20 Prism
    October 6, 2010

    I’m glad you’re glad that you received the vaccine for free, but I think its a little weird that one would joke about the possibility of complications from a vaccine that has been shown to only “cure” last year’s two most prevalent flu strains…
    It’s strange how the flu manages to get more attention every winter than the world’s 10 big killers.

  21. #21 Todd W.
    October 6, 2010

    @NJ and kittywhumpus

    Well, such a mutation would definitely make me rather popular with certain segments of the population.

  22. #22 Joe T
    October 6, 2010

    Never got a flu shot before, but will be getting one this year at a local “Doc in a Box.” Last year 3/4 of the family had H1N1, or the “Swan Flu” as my youngest called it. It wasn’t the worst thing to ever happen, but it was no fun at all. Interestingly enough my eldest didn’t get it, which I take as proof that french fries provide immunity to H1N1.

  23. #23 Sid Offit
    October 6, 2010

    Good move Orac. The flu kills 36,000 people every year. I mean 24,000. I mean in some years as few as 3,300.

  24. #24 augustine
    October 6, 2010

    http://www.washingtonpost.com/wp-dyn/content/article/2005/10/22/AR2005102200042.html

    Healthy Skepticism
    A Shot of Fear
    Flu Death Risk Often Exaggerated; So Is Benefit of Vaccine

    “This series dissects health news to highlight some common study interpretation problems we see as physician-researchers and show how the research community, medical journals and the media can do better.”

  25. #25 Todd W.
    October 6, 2010

    Welcome back, Sid. You’ve been quiet so long, I thought maybe you succumbed to…I dunno…something.

    Of course, the only reason to vaccinate is to prevent deaths. No one cares about hospitalizations, complications/sequelae, missed work, missed school, outbreak/epidemic prevention, minimization of suffering. Nope. Deaths are the only endpoint we care about. Nailed it on the head, Sid. Well done.

  26. #26 Mephistopheles O'Brien
    October 6, 2010

    @Sid – Is it possible that immunosuppressed patients at, say, a cancer center might be more likely than most to both catch the flu and develop serious complications (up to and including death)? Or is it not important that a cancer surgeon not accidentally spread the disease to his patients (recalling that the contagious period starts before obvious symptoms)?

  27. #27 bluedevilRA
    October 6, 2010

    Unfortunately, many share Sid’s ridiculous belief. The flu “only” kills a few thousand people a year (although sometimes much more than that). It mainly kills old people, except for the novel H1N1 last year. But then people like Bill Maher make more excuses. “It only killed young people who had underlying conditions. I am healthy because I eat right and exercise. It can’t touch me.” This sort of arrogance is foolish and dangerous. That is more or less what some of my med school friends express.

    @Matt, I should mention that we have not had immunology and infectious diseases yet. You would think it is common knowledge that the flu vaccine is inactivated, especially after the flu vaccination push last year, but not everyone pays attention to these things, even med students. If only SBM, RI, etc were required reading in medical school!

  28. #28 MikeMa
    October 6, 2010

    @Sid,
    Are the 3,300/24,000 deaths in Africa? I need to know whether we are ignoring them or we care about the victims.

    As for caring about victims, how do you feel about the whooping cough deaths in California? Okay with that outcome?

  29. #29 Sid Offit
    October 6, 2010

    As for caring about victims, how do you feel about the whooping cough deaths in California? Okay with that outcome?

    OK with? Care? What does that even mean. Do I control pertussis deaths in such a way that my being OK with them has any effect on their number? Do I have to get my adult pertussis shot or support mandatory vaccination to “care”? If that’s the case I’ll leave the caring to you.

    PS
    I just saw one of those flu stickers. Cute sheep.

  30. #30 Jarred C
    October 6, 2010

    Well, there you have it. Sid Offit does not care that people get sick or die from a vaccinated controlled virus.

  31. #31 Enkidu
    October 6, 2010

    Got mine last week at Walgreens. Didn’t even have to make an appointment, just popped in, got jabbed, and then left. Unfortunately no superpowers were gained by me either. Although I think all the mercury clogging my brain is to blame for the writer’s block I am suffering in regards to the manuscript I am working on.

    My daughter gets her flu shot tomorrow at the pedi. Now I have to get on my husband to get his…

  32. #32 Sid Offit
    October 6, 2010

    Is it possible that immunosuppressed patients at, say, a cancer center might be more likely than most to both catch the flu and develop serious complications (up to and including death)? Or is it not important that a cancer surgeon not accidentally spread the disease to his patients (recalling that the contagious period starts before obvious symptoms)?

    I don’t have a problem with a private hospital requiring employees to be vaccinated as a condition of employment. Just eliminate all constraints on employer choices regarding employees to be congruent. Seems odd however targeting the receptionist at a research facility. But hey it’s not my hospital.

  33. #33 Sock Puppet of the Great Satan
    October 6, 2010

    “Got mine a few weeks ago. No bruise. No pain. But I do have this really neat pair of prehensile tentacles that grew out of my back.”

    All hail Great Cthu-flu.

  34. #34 Orac
    October 6, 2010

    Seems odd however targeting the receptionist at a research facility.

    Receptionists who work in the clinics and at the main reception desk where the patients come in.

    This is not just a research facility. It’s a clinical cancer center combined with a research institute. We also have a very active bone marrow transplant program.

  35. #35 Todd W.
    October 6, 2010

    @SPotGS

    Gesundheit!

  36. #36 Vicki
    October 6, 2010

    @Prism:

    The vaccine does something much better than “curing”: it prevents disease. And it’s a relatively easy intervention: one injection a year, rather than significant dietary changes, or breaking an addiction to tobacco. Nor is anyone going to try to persuade you not to have a flu vaccine because [they think] they will enjoy sex more if you aren’t vaccinated.

    @Sid: You mean “in some years as many as 49,000 in the United States alone.”

    WHO estimates 3 to 5 million cases of serious illness, and 250,000-500,000 deaths, per year from seasonal flu.

  37. #37 Jean-Denis
    October 6, 2010

    but it’s a reasonable compromise between patient safety and personal freedom

    I disagree. The only reasonable compromise between patient safety and personal freedom, is to choose between the vaccine and working far from patients. For example cleaning Florida beaches. Say…

  38. #38 Orange Lantern
    October 6, 2010

    If anyone feels like visiting the “Vaccinate Your Baby” Facebook page (from Every Child By Two), there’s a little troll infestation to have fun with.

  39. #39 https://www.google.com/accounts/o8/id?id=AItOawmqD_mcUIrSfOTlK3iGVsnEDcZmI43srbI
    October 6, 2010

    In the US, influenza is estimated to be responsible for between 4,300 and 63,000 deaths a year, along with more than 90,000 hospitalizations for the primary diagnosis of influenza, hundreds of thousands more hospitalizations for which influenza was a complication/contributory factor, and billions of dollars in direct and indirect economic costs.

    Citations: CDC. Estimates of deaths associated with seasonal influenza — United States, 1976–2007. MMWR Morb Mortal Wkly Rep. 2010 Aug 27;59:1057-1062.
    Thompson WW, Shay DK, Weintraub E, Brammer L, Bridges CB, Cox NJ, Fukuda K. Influenza-associated hospitalizations in the United States. JAMA. 2004;292:1333-1340.
    Molinari NA, Ortega-Sanchez IR, Messonnier ML, Thompson WW, Wortley PM, Weintraub E, Bridges CB.The annual impact of seasonal influenza in the US: measuring disease burden and costs. Vaccine. 2007;25:5086-5096.

    Sid you fracking moron, the receptionist sees EVERYONE. Including SICK PEOPLE. If he/she is sick and passes the illness along to SICK PEOPLE, then SICK PEOPLE get SICKER. And maybe DIE unnecessarily.

    I don’t apologize for the yelling. Seriously, you need to just shut the fuck up.

  40. #40 Dan Weber
    October 6, 2010

    I’m not sure if Auggie read the link it posted, but it (the article, not Auggie) is pretty even-handed. It points out how flu deaths may be both undercounted and overcounted, and the difficulty in ascertaining real data in such a field that is really really messy.

    Got my shot about a month ago. Kids are in the process of getting theirs (nasally).

  41. #41 Onkel Bob
    October 6, 2010

    The vaccine does something much better than “curing”: it prevents disease.

    As I understand it, the vaccine does neither. The intent of the vaccine is to lessen the symptoms should the recipient be exposed to the virus. One cannot be immunized against the flu the same as one is immunized against polio or smallpox.

    I’ll pass on it as I always have bad reactions to flu vaccines. It is odd because I’ve been stuck many times. (10 years in military, and in a readiness program, meant a cholera vaccine every 6 months, tetanus every year, and an assortment typhoid, flu, plague, yellow fever vaccines throughout my service.) I was required to get it last year and had the worst reaction to date.

    I’m an asocial bastard anyway so I avoid you mugs; and as the song goes, I’ve been mistreated, so I don’t mind dying :^)

  42. #42 Sid Offit
    October 6, 2010

    Sid you fracking moron

    Fracking? What is this, Battlestar Galactica?

    63,000 dead? Don’t see it in your citation.

    This report summarizes the results of these analyses, which found that, during 1976-2007, estimates of annual influenza-associated deaths from respiratory and circulatory causes (including pneumonia and influenza causes) ranged from 3,349 in 1986-87 to 48,614 in 2003-04. 49,000, the CDC said on Thursday.

  43. #43 dean
    October 6, 2010

    Folks seem to miss the fact that sid and auggie center the entire universe on themselves: kids get sick and/or die? it’s not them, so it doesn’t matter. elderly folks? same thing – to them, retirees are drags on society. that attitude makes it very easy for them to justify the time they spend on lies, distortions, and trolling.

  44. #44 gpmtrixie
    October 6, 2010

    Got mine on Monday at work (health insurance co – yes, evil insurance companies love vaccines!) and the 3 kiddos will get theirs before the end of October at the pediatricians’ office. My husband hides in our family herd with 80% coverage. He’s got the same attitude discussed in #7 above.

  45. #45 Todd W.
    October 6, 2010

    @Onkel Bob

    The vaccine does something much better than “curing”: it prevents disease.

    As I understand it, the vaccine does neither. The intent of the vaccine is to lessen the symptoms should the recipient be exposed to the virus.

    That’s not quite right. If there is an exact match, then immunizing can grant immunity. If there is only a partial match between the vaccine strain and the wild type, then symptoms may be minimized in severity, depending on how close the match is. So, it is possible to prevent at least some strains of influenza with the vaccine, while lessening the effects of others.

  46. #46 Vicki
    October 6, 2010

    @Onkel Bob:

    As I understand it (Orac can correct me if I’m wrong), one can be vaccinated against a specific flu virus. The problem is that there are a lot of different flu viruses, in part because the things mutate so fast. But the vaccine I’ll be getting in a couple of weeks will immunize against specific strains of flu, just as my polio vaccine immunized me against that virus.

    It doesn’t provide 100% protection, but neither do most other vaccines. But reducing the risk of illness to (say) 20% of what it would otherwise be is different from reducing the severity of the illness, without reducing the risk. If I don’t get the flu (whether because I’m immune or because I’m not exposed) I won’t pass it on; if I have the virus reproducing in my system but only mild symptoms, I can and likely will infect other people (as happens with adults who don’t realize they have whooping cough).

  47. #47 Prometheus
    October 6, 2010

    “Onkel Bob” claims:

    ” One cannot be immunized against the flu the same as one is immunized against polio or smallpox.”

    And your reason for believing this is…..?

    This is only correct to the extent that you will need another vaccination against influenza next year, and the year after that and… This is NOT because the influenza vaccine doesn’t give you long-lasting immunity, it’s because the influenza virus mutates rapidly.

    As a result, next year’s influenza virus will be different enough that your immunity to this year’s influenza virus won’t help….probably. In some cases, there is sufficient similarity between subsequent years’ influenza virus that last year’s vaccine will provide partial immunity.

    Nice try, “Onkel Bob” – back to Google U. for you!

    Prometheus

  48. #48 T. Bruce McNeely
    October 6, 2010

    As I understand it, the vaccine does neither. The intent of the vaccine is to lessen the symptoms should the recipient be exposed to the virus. One cannot be immunized against the flu the same as one is immunized against polio or smallpox.

    You understand it wrong. The flu vaccine prevents infection by the specific strain that it targets. A vaccine against H1N1 flu will prevent infection by H1N1 flu, not just “lessen the symptoms”. As such, it will prevent the recipient from spreading the virus to others. This is why flu vaccination needs to be repeated yearly, to act against the strain that is predicted (by case-monitoring and epidemiology) to be endemic in the coming year. These predictions, of course, cannot be exact, although they are getting better as the science improves. It is not effective against all influenza viruses. In that respect, it does differ from smallpox and polio.
    I understand your concern about reactions to the vaccine, however, I doubt that the reaction would be worse than actually getting even an uncomplicated case of influenza (chills, fever, prostration, cough and muscle pain lasting from 3 days to weeks).

  49. #49 T. Bruce McNeely
    October 6, 2010

    dean:

    You’ve nailed it.

  50. #50 Scott
    October 6, 2010

    [monotone] I feel perfectly fine. Everything is normal since my flu vaccine. Our Reptilian Overlords have not placed me under mind control. And the fires that keep happening around me have nothing to do with the lasers now emanating from my eyes. [/monotone]

    More seriously, I always get a pretty nasty ache/stiffness reaction when I get the flu vaccine (less so with others). Enough to limit my use of the arm for the next day or two. But it’s still better than getting the flu…

  51. #51 René Najera
    October 6, 2010

    I got mine yesterday, took a picture (which I posted to facebook and twitter), and had the nurse sign an affidavit that she indeed gave me the vaccine. I also recorded the lot number of the vial from where she took the vaccine. You never know when Sid or Augustus Infidelius will ask for – and I say this with all the sarcasm in the world – evidence.

  52. #53 MikeMa
    October 6, 2010

    Orac,
    I’m sure some of the intrepid researchers could get you some thimerosal to mix in with your tuna. You could then see which form of mercury, ethyl or methyl, lasts longer in your system.

  53. #54 W. Kevin Vicklund
    October 6, 2010

    Dear [cancer center director],

    Thank you for requiring your employees to receive the flu shot. I have Teh Allergies and am unable to receive said shot myself.

    Sincerely,

    Guy who works within walking distance of [cancer center]

  54. #55 James Sweet
    October 6, 2010

    Continuing W. Kevin Vicklund’s thought at #54, I recently opined that insurance companies should not be allowed to charge a co-pay for flu vaccinations. For many of us, the societal benefit of choosing to get the flu vaccine is even greater than the individual benefit. (i.e. at 31 with a healthy immune system, I’m extremely unlikely to die from the flu — but if I catch it, I might give it to somebody who will) I thought the point of a co-pay was to shift a small amount of the burden of a treatment onto the patient in order to adjust the patient’s cost-benefit tradeoff — but in the case of vaccination, you’d want to adjust it in the opposite direction, I would think.

  55. #56 Dangerous Bacon
    October 6, 2010

    Pablo: “When the wifey and I got our vaccines, we got a sticker that said, “I GOT IT, did you?”

    Sid and Augie have stickers too, only theirs has a picture of a virion on it*.

    *Cue claims of “I never get any infectious diseases, I’m healthy as a horse because I live right/avoid toxins/drink a gallon of colloidal silver daily”.
    Actually, engaging in frequent trollery might be postulated to have a protective effect, seeing as how the enhanced flow of bile in such folk could be antibacterial (if sufficient to counteract the effects of stress hormones). This could be the basis of a fascinating research study. Inoculate trolls with influenza virus and compare the outcome to non-trolls who are inoculated with the same virus after immunization. Control for confounding factors like differences in critical thinking capacity, and you’d have a winner that could at least be published in Medical Hypotheses.

  56. #57 Vicki
    October 6, 2010

    Dangerous Bacon: Can we do a study of whether troll behavior or lifespan is affected by gall bladder removal?

  57. #58 Antaeus Feldspar
    October 6, 2010

    “Onkel Bob” claims:

    ” One cannot be immunized against the flu the same as one is immunized against polio or smallpox.”

    And your reason for believing this is…..?

    I wonder if this might not be an honest confusion between flu and tetanus? I could be completely mistaken myself about this, but I thought the tetanus vaccine actually met Bob’s description: it cannot be applied proactively but it can be used to ameliorate symptoms after exposure.

    I could be completely wrong, in which case I welcome correction.

  58. #59 JohnV
    October 6, 2010

    @sid

    “Seems odd however targeting the receptionist at a research facility. But hey it’s not my hospital.”

    What, at your hospital is there a transporter that beams people from the parking lot to the examination rooms, thus bypassing receptionists?

  59. #60 Robert S.
    October 6, 2010

    Feldspar @58 Yup, totally wrong. Unless by “the same” you mean that knocking out all human infections wont get rid of the disease in the wild as Clostridium tetani lives in soil, not just humans. Oh, and go get your combined Diphtheria, Pertussis and Tetanus vaccine.

  60. #61 Chris
    October 6, 2010

    Robert, then why is getting a tetanus booster suggested after possible exposure? (I got my Td booster five years ago, I plan to get the Tdap as soon as I get over my cold)

  61. #62 Calli Arcale
    October 6, 2010

    Because tetanus is one of those things that’s really really really nasty if it starts showing symptoms. The best treatment really is not getting it in the first place, so if doctors are concerned you may have been exposed (e.g. a deep puncture wound from a used pitchfork or something), they will tend to be aggressive in making sure you don’t get tetanus. In general, if they’re not absolutely sure you’re current on your vaccination, if you’ve had the right kind of wound they’ll recommend a booster as a sort of post-exposure prophylaxis. It provides only partial protection, however, as tetanus can develop faster than tetanus immunity. Antibiotics can be used to kill the Clostrium tetani, but as they aren’t actually what’s causing the disease, this doesn’t cure tetanus. It just stops it getting worse. For a cure, you need to eliminate the extremely potent toxin which they’ve produced. (The anti-vaxxers sometimes like to call mercury the most toxic substance, but tetanospasmin is much, much worse, and it takes only a tiny amount to kill a healthy adult.) To do this, tetanus immunoglobulin is administered — this does not make you immune (it’s not a vaccine) but provides passive immunity by injecting the same sorts of antibodies your body would be cranking out if it were immune. They deactivate the toxin.

    In the meantime, the doctors’ main job is to keep you alive, and this is a real challenge because the spasms can become so severe they prevent breathing. Wikipedia has a great description of treatment for severe tetanus. (Mild tetanus treatment consists mostly of things to try and keep it becoming severe tetanus.) Muscle relaxants and sedatives will be given; in extreme cases, curare (another poison!) will be used to completely paralyze the patient, who is then placed on a ventilator. A tracheotomy may be required to maintain the airway. The patient’s blood pressure and body temperature will fluctuate wildly and require constant management. The imunoglobulin will be injected into the spinal column. The patient must also be fed; all of these spasms exert a tremendous caloric demand yet the patient can’t eat. So the patient has to be fed intravenously or through a tube in the stomach. We’re talking ICU here. And you may be hospitalized for a month, may have permanent damage, and there’s still a decent chance of death even with these heroic measures.

    So yeah, doctors will often give a tetanus shot to people suspected of tetanus exposure, since it can be really REALLY nasty, but your survival odds are way better if you’ve kept your tetanus vaccination current. And since it’s not realistically possible to avoid all potential tetanus exposure, pretty much everybody should get vaccinated unless they can’t handle the vaccine itself.

  62. #63 fcc
    October 7, 2010

    “It really is the least a health care professional should do during the flu season.”

    I’ll go further; as a husband of a health care professional, I am obligated to maintain the same vaccination schedule as my wife, not only in deference to her calling, but in recognition that my relationship to her can, should I be negligent, place her patients at risk. Herd immunity is a real thing, it is measurable, and so is social responsibility.

  63. #64 Prometheus
    October 7, 2010

    Master Feldspar comments:

    “I thought the tetanus vaccine actually met Bob’s description: it cannot be applied proactively but it can be used to ameliorate symptoms after exposure.”

    Actually, the prophylactic dose of tetanus vaccine given after tetanus-prone injuries (and, to be frank, often given after any laceration) is to “cover” you if your immunity had waned (or if you hadn’t received your primary series of tetanus vaccine). The “T” in DTaP, Td, etc. is for “tetanus” – it’s part of routine childhood vaccinations.

    In reality, you don’t need a tetanus vaccine “booster” after a penetrating injury if you’ve had one within ten years. however, many Emergency Depts. will give one regardless, just to be sure.

    Tetanus vaccine is directed against the toxin – tetanospasmin – made by the bacteria Clostridium tetani (under anaerobic conditions). C. tetani is a common soil bacteria.

    One “fun fact” for anti-vaccinationistas – who often opine that it is preferable to attain immunity “naturally” – is that even a life-threatening infection with C. tetani doesn’t produce enough toxin to stimulate an immune response. So, after spending a couple of unpleasant weeks chemically paralysed and mechanically ventilated (standard treatment for tetanus), you still aren’t immune to tetanus toxin. Only the vaccine can give you immunity.

    I’m not aware of any studies showing that tetanus vaccination after inocculation with C. tetani in the absence of pre-existing partial immunity (i.e. after having had at least one previous tetanus vaccine dose) is able to prevent tetanus. Since most “tetanus-prone” wounds won’t result in clinical tetanus, this would be a difficult hypothesis to test.

    Rabies is the only vaccine I am aware of that is typically given only after exposure, but that is because the rabies virus replicates very slowly, spreading along the peripheral nerves from the inocculation site to the brain. Once symptoms develop – from two weeks to several months after inocculation – the fatality rate, even with the best of modern medical treatment, is reported to be about 92%. Survivors – the few that exist – typically have significant brain damage.

    People who are likely to come in contact with rabid animals will sometimes get the rabies vaccine prior to exposure, but that is the rare exception.

    Prometheus

  64. #65 Todd W.
    October 7, 2010

    @Prometheus

    So, after spending a couple of unpleasant weeks chemically paralysed and mechanically ventilated (standard treatment for tetanus), you still aren’t immune to tetanus toxin.

    Don’t forget parenteral nutrition, which contains the dreaded aluminum (in fact, significantly more by the end of treatment than is found in vaccines) and is injected straight into the bloodstream.

  65. #66 Sid Offit
    October 7, 2010

    @ Calli Arcale

    Do you have any empirical data showing the tetanus booster is efficacious in an emergency situation

  66. #67 Dangerous Bacon
    October 7, 2010

    Sid: “Do you have any empirical data showing the tetanus booster is efficacious in an emergency situation”

    Of course, Sid. Observation and experience alone have taught practitioners that with emergency tetanus prophylaxis in people who’ve been inadequately immunized, protection against development of the disease is excellent. One may also observe that dramatic declines in overall tetanus cases and notably in neonatal tetanus have occurred since the vaccine came into use. There’s your empirical evidence.

    (Hint to Sid: look up the meaning of “empirical”) :)

  67. #68 Sid Offit
    October 7, 2010

    @Bacon

    In other words,the answer is no.

  68. #69 Sid Offit
    October 7, 2010

    @Bacon

    Hint to Sid: look up the meaning of “empirical”)

    http://en.wikipedia.org/wiki/Empirical
    “empirical” in science may be synonymous with “experimental.” In this sense, an empirical result is an experimental observation.

  69. #70 Chris
    October 7, 2010

    I love it that Sid likes the 20% chance of death from tetanus, and that is even with being on a ventilator for a while.

  70. #71 Sid Offit
    October 7, 2010

    Avoiding the question are we? Seems ER docs are practicing neither science nor evidence-based medicine but rather vaccine-based medicine.

  71. #72 Scott
    October 7, 2010

    And the failed troll apparently fails to even read the page he himself links to.

    Empirical data is data that is produced by an experiment or observation.

  72. #73 Science Mom
    October 7, 2010

    Avoiding the question are we? Seems ER docs are practicing neither science nor evidence-based medicine but rather vaccine-based medicine.

    It would help you considerably if you understood the pathogenesis of tetanus and post-exposure prophylaxis and what it does. Blimey, if it’s not written in crayon, you don’t seem to be able to follow along.

  73. #74 Todd W.
    October 7, 2010

    Guys, Sid is trying to show that he learned something from RI. He wants a link to actual evidence that giving tetanus vaccine as a prohpylaxis post-exposure is effective. Now, he doesn’t specify effective for what. Td is only recommended if the individual’s vaccination status is unknown or is out of date. The purpose is to help the individual produce antibodies to minimize spread of the bacteria or re-infection. It’s not given to stop that particular infection.

    Antibiotics are administered to quickly kill tetanus bacteria in the patient, and tetanus immune globulin is administered as an antitoxin to neutralize the circulating tetanospasmin. The vaccine is more or less icing on the cake, as it were.

  74. #75 Chris
    October 7, 2010

    Obviously Sid thinks tetanospasmin is not as bad as “teh ebil toxins” in the vaccine, because it all natural!

  75. #76 Dangerous Bacon
    October 7, 2010

    You know, Sid, it’s one thing to be caught out using a word you doesn’t understand. It’s worse to pretend you knew and use a doctored quote for support.

    Wikipedia starts out by defining “empirical” as follows:

    “The word empirical denotes information gained by means of observation, experience, or experiment.”

    What Sid quoted was part of a sentence under the subheading “Variations”. The full line reads as follows: “In a second sense “empirical” in science may be synonymous with “experimental.”” (italics added to highlight the missing portion)

    Shame, shame on you Sid for truncating a sentence in an attempt to cover your flub. What would Jay Gordon (alleged truncation victim) think?

    Apparently Sid will only accept the value of tetanus vaccine if we round up a group of people without prior tetanus immunization, expose them all to tetanus and give only half of them emergency prophylaxis that includes the vaccine. This study is highly unlikely ever to be approved for ethical reasons, but maybe Sid (plus other antivaxers who support a study comparing autism rates in vaccinated and unvaccinated children) will volunteer themselves as research subjects. An attack of tetanus would be a small price to pay for the opportunity of showing up them arrogant scientists, right Sid?

  76. #77 augustine
    October 8, 2010

    And how do you plan to get that thimerosal mercury out of your body? Harmlessly via your metabolism?

  77. #78 Prometheus
    October 8, 2010

    “Sid Offit” asks if there have been any studies showing that tetanus prophylaxis – as practised in most modern ED’s – is effective.

    The short answer is “no”. That sort of study – on humans – would be grossly unethical. What we do know is that after tetanus prophylaxis was introduced in the 1920’s (and widely used during WW II), the incidence of tetanus following penetrating trauma dropped to nearly zero. In fact, it is only seen when tetanus prophylaxis is not done.

    Now, that’s not a randomised, double-blind, placebo-controlled clinical trial, but it should be good enough, given that even “mild” tetanus has a 10% fatality rate – even with modern treatment. Giving an additional dose of tetanus vaccine – which has a less than 1 in 10 million fatality rate – seems like pretty cheap insurance.

    A study I’d like to see – that would certainly have to be done on animals – would be if the tetanus vaccine can prevent tetanus if it is given immediately after inocculation in an animal that has no previous immunity. With the number of unvaccinated children out there, this might have some real clinical relevance.

    “Augustine” asks:

    “And how do you plan to get that thimerosal mercury out of your body? Harmlessly via your metabolism?”

    Short answer: “yes”. Even the oft-quoted (but rarely understood) Burbacher et al study of methyl- and ethyl-mercury showed that less ethyl-mercury was retained in the body and that it was excreted faster than methyl-mercury.

    Therefore, if you’re going to panic over 25 mcg (or less) of ethyl-mercury, you should definitely stay away from the larger fish, like tuna, swordfish, pike, etc., which contain comparable amounts of methyl-mercury.

    The reality is that there isn’t any data supporting the claim that thimerosal in doses like those contained in pre-2000 children’s vaccines (or in post-1900 vaccines of any kind) causes any sort of disease or injury except in those very few people who are allergic to it.

    If “Sid” or “Augie” had any such data, I’m sure they would have trotted it out by now rather than suffer the “slings and arrows” of ridicule and humiliation. Since they lack data, all they can do is try to make witty comments (and fail miserably).

    Prometheus

  78. #79 Sid Offit
    October 8, 2010

    “Sid Offit” asks if there have been any studies showing that tetanus prophylaxis – as practised in most modern ED’s – is effective.

    That’s not what Sid asks. Sid understands there is evidence regarding the efficacy of the TIG. But Sid is puzzled as to why a booster is given along with that TIG and is asking for any empirical data, even a rational appearing in print, to explain why a tetanus booster should be administered in addition to the TIG.

  79. #80 Chemmomo
    October 8, 2010

    Sid – re “empirical”

    I think you meant to ask whether Bacon et all had any statistical evidence about whether the tetanus vaccination has any efficacy in emergent situations.

    Empirical refers to what is observed experimentally. We use the word to distinguish that type of evidence (observed) from say a mathematical proof, which is derived from theory.

    We can describe some evidence as “empirical,” but that doesn’t mean all evidence is empirical, or that everything that is empirical is evidence. An anecdote is empircal – but it’s not evidence.

  80. #81 sheldon101
    October 8, 2010

    I live in Ontario where flu shots are free to anyone over the age of 6 months who resides in the province. One of the benefits of that policy has been a sharp downturn in the number of prescriptions for antibiotics during flu season.

    Last year’s H1N1 shot used AS03 (adjuvanted) shot with only 25% of the antigen. It got approved on an emergency basis. This year it isn’t being offered. Nor have any of the high dose vaccines for the elderly.

    However, Intanza has been approved. It uses a really, really short needle that goes into the skin. Perhaps next year they will have approved the high dose version for the elderly.

  81. #82 ababa
    October 22, 2010

    Jock’s challenge may have disappeared, but anti-vaxers are still using it. Just this week a local antivaxers posted this (obviously in a heavily moderated “natural living” area:

    “Years ago I read that the ingredients aren’t safe to drink, so why are they safe to be injected?”

    Obviously she is referring to Jock’s challenge, even though she is purposely avoiding a direct reference so it can’t be easily validated. She knows about Jock, she brought him up a few months ago and was promptly shot down as how deceptive he was by people that did a basic search. She does that all the time, posts vague “I heard” or “I remember reading somewhere”, which is plenty to scare some of the undecided.

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