Mike the Mad Biologist

The Political Failure of Annual Influenza

One of the few predictable statistics in American public health is that between 35,000-40,000 people will die every year from ‘ordinary’ influenza. Most of these deaths are preventable. Yet we do nothing.

In the U.S., influenza kills approximately the same number of people every year as breast cancer does. But unlike breast cancer, we don’t need to run, walk, jump, pogostick, or unicycle for the ‘cure.’ All we need to do is vaccinate enough of the appropriate people. It’s that simple.

An effective influenza vaccination policy would involve the mass vaccination of those most likely to transmit influenza: children aged 5-18. Yet our public health response to the annual equivalent of twelve 9/11s is miserable. We can’t even successfully vaccinate a high-risk group, children under 24 months old (italics mine):

Beginning with the 2004–05 influenza season, the Advisory Committee on Immunization Practices (ACIP) recommended that all children aged 6–23 months receive influenza vaccinations annually. Other children recommended to receive influenza vaccinations include those aged 6 months–18 years who have certain high-risk medical conditions, those on chronic aspirin therapy, those who are household contacts of persons at high risk for influenza complications, and, since 2006, all children aged 24–59 months. Previously unvaccinated children aged <9 years need 2 doses administered at least 1 month apart to be considered fully vaccinated. This report assesses influenza vaccination coverage among children aged 6--23 months during the 2005--06 influenza season by using data from six immunization information system (IIS) sentinel sites. The findings demonstrate that vaccination coverage with 1 or more doses varied widely (range: 6.6% to 60.4%) among sites, with coverage increasing from the preceding influenza season in four of the six sites. However, <23% of children in five of the sites were fully vaccinated, underscoring the need for increased measures to improve the proportion of children who are fully vaccinated.

This is a complete failure of the basic function of government to protect the life and health of the weakest among us.

Influenza also affects other public health issues, such as antibiotic resistance. About half of those who die from influenza are ‘finished off’ by a secondary bacterial infection (Streptococcus pneumoniae). While most hospitalized influenza patients don’t die (thankfully), many have secondary bacterial infections requiring antibiotic therapy. This antibiotic use could be greatly reduced if the number of influenza cases were greatly lowered.

How seriously can any of our bioterrorism or biopreparedness measures be taken when we can’t even do this right, let alone adopt an effective vaccination strategy.

When are we get serious about the clear and present biological threat of annual influenza? Would a stupid ribbon help?

Comments

  1. #1 Ken Hirsch
    March 27, 2007

    BMJ: Are US flu death figures more PR than science?

    36,000 or 20,000 or 8,000 or 1,348?

  2. #2 Crow
    March 27, 2007

    Ken,

    The argument above amounts to

    1. Falling doesnt kill people, the impact is what kills people.

    2. Therefore falling isn’t dangerous.

    -Crow

  3. #3 Steven
    March 27, 2007

    Great post Mike.

    I will be in some virology lectures tomorrow, well actually today. In 9 hrs. :-D. We did some in Introduction to Microbiology but hopefully it will go into more detail now in Semester B.

  4. #4 Mike the Mad Biologist
    March 27, 2007

    Ken,

    several points to consider:

    1) the history of infectious disease surveillance has almost always underestimated the number of infectious disease deaths (e.g., nosocomial infections)

    2) most bacteriologists think that there is almost always a viral infection that co-occurs with severe bacterial pneumonia (whether the virus is the primary causative agent is a separate issue). I think some of the 40,000 deaths per year attributed to bacterial pneumonia should be reclassified as influenza deaths (an aside: I deal with bacterial infections for a living, so my professional interests should dictate that I would want to play down the role of viruses. Just something to consider…)

    3) Following on #2, some apparent bacterial infections (i.e., S. pneumoniae or H. influenzae have been isolated from sputum) often resolve with antiviral therapy. In addition, these infections appear to ‘look like’ viral infections when you use diagnostics like C reactive protein or procloclastin.

    So, no, I don’t think 36,000 is an overestimate (and if it were ‘only’ 20,000, that still ‘beats’ AIDS/HIV). But with a lot of cheap, rapid diagnostics coming on line, we’ll get much better numbers.

  5. #5 King Aardvark
    March 28, 2007

    In Ontario we have free flu shots for anybody – literally anyone can show up and get one during the annual flu shot campaigns. The effectiveness has been somewhat hit or miss; a year or two ago I remember that the vaccine wasn’t particularly effective since the strain had mutated a fair amount since the vaccine was prepared, but all in all, most people are happy with the program.

  6. #6 Larry
    March 28, 2007

    I worked in the immunization branch at the health dept in san francisco, and can tell you that one issue that came up time and time again is parents’ fear of vaccines. The anti-immunization campaigns are effectively scaring parents away from life-saving vaccines for their children.

    I won’t go into the issues here, a simple google search will illustrate for you how large a presence the anti-vax kooks have. Have a look around, and imagine you’re a busy young parent with no medical background, wanting to do what’s best for your kid. There’s a lot of dangerous (mis)information out there.

  7. #7 bitkisel ürünler
    May 12, 2009

    will be in some virology lectures tomorrow, well actually today. In 9 hrs. :-D. We did some in Introduction to Microbiology but hopefully it will go into more detail now in Semester B.