White Coat Underground

As we ramped up for the H1N1 influenza pandemic last year, one of the worries expressed by the public and by the alternative medicine establishment was Guillain Barre Syndrome (GBS). As explained by neurologist Steven Novella, GBS is a serious auto-immune neurologic disease that causes weakness. It is often preceded by a relatively mild upper respiratory or gastrointestinal illness. In 1976, when a novel swine flu appeared and spread quickly through a military reservation in the U.S. This was a pattern seen in the 1918 pandemic, and the government moved to stem a potential serious pandemic. As it turned out, the pandemic fizzled, but the vaccine was associated with a bump in the incidence of GBS (10 excess cases per 1 million vaccinations).

Since that time, influenza vaccination has been associated with a small increase in GBS, approximately 1 case per million vaccinations. It’s not clear that this relationship is causal, but because of this history, it’s not just the altmed crowd who is interested in this question. The CDC and other agencies have taken an aggressive approach to monitoring the safety of the pandemic influenza vaccine including a possible associations with GBS. The CDC tasked its Emerging Infections Program (EIP) with active surveillance for problems. The EIP sought out cases of GBS through an extensive network of providers and calculated the risks associated with GBS and pandemic flu vaccination.

The preliminary results of this investigation were released this week in my favorite periodical, the Morbidity and Mortality Weekly Report. The CDC found an excess in GBS cases of 0.8 per million vaccinations, similar to previous (post-1976) years.  This is a low number, and correlation does not require causation, but it’s important to compare this small risk with the risk of influenza itself.  As the CDC summarized:

The 2009 H1N1 vaccine safety profile is similar to that for seasonal influenza vaccines, which have an excellent safety record. Vaccination remains the most effective method to prevent serious illness and death from 2009 H1N1 influenza infection; illness from the 2009 H1N1 influenza virus has been associated with a hospitalization rate of 222 per 1 million and a death rate of 9.7 per 1 million population.

This is good news.  In spite of the hype from the altmed industry, we managed to vaccinate a lot of folks and prevent a lot of flu, with very few significant adverse events.  

Comments

  1. #1 D. C. Sessions
    June 8, 2010

    Is the 0.8/1.0 per million in excess across the population or in comparison to people who actually got the flu?

  2. #2 SurgPA
    June 8, 2010

    @1

    “The CDC found an excess in GBS cases of 0.8 per million vaccinations, similar to previous (post-1976) years.”

    If you assume there is a certain background rate of GBS (vaccination is not the only cause/risk factor), then vaccinating the population causes an extra 0.8 cases per million people vaccinated.

  3. #3 D. C. Sessions
    June 8, 2010

    If you assume there is a certain background rate of GBS (vaccination is not the only cause/risk factor), then vaccinating the population causes an extra 0.8 cases per million people vaccinated.

    And presumably that background includes some incremental increase due to known risk factors, such as influenza infections. Given the rate of infection in the unvaccinated population vs. the rate of infection in the vaccinated population and the incremental risks of GBS for vaccination and infection, you might or might not come to a differential weighted risk of 0.8/million — it all depends on how the numbers were crunched.

    I don’t pretend to know that answer and didn’t find it on a cursory search. Thus the question.

  4. #4 Chuck
    June 8, 2010

    “vaccinate a lot of folks and prevent a lot of flu”

    A lot of folks being 28% of the US population (MMRW and census.gov) effectiveness of either HINI or seasonal influenza vaccine: Unknown.

  5. #5 D. C. Sessions
    June 8, 2010

    I think I’ll sit this one out. I’ve got some good salsa and sharp cheddar, who wants to bring the chips and beer?

  6. #6 Mu
    June 8, 2010

    I found a number of 1-2 per 100,000 per year for GBS incidence. As such an increase of 0.08 per 100,000 seems on the border of statistical significance.
    Cracker jacks anyone?

  7. #7 D. C. Sessions
    June 8, 2010

    Cracker jacks anyone?

    I gave up popcorn a long time ago, but I do wonder how that caramel coating would go with some chipotle powder mixed in.

    I’ve got chipotles on the brain since the peppers are yielding huge amounts of ripe fruit and I’m smoking the danged things as fast as I can with some of the mesquite I have growing here.

  8. #8 Chris
    June 9, 2010

    You know what makes popcorn really good: bacon. Use a bit of bacon fat instead of butter, add in some bacon bits and chives and you have yourself a very good companion to beer.

    Oooh, mesquite smoked chipoltes sound good!

    We once left Arizona with a box full of 60 pounds of mesquite chunks from my dad’s back yard. That provided the best barbecued burgers and chicken for a long while.

  9. #9 D. C. Sessions
    June 9, 2010

    Oooh, mesquite smoked chipoltes sound good!

    They’re pretty intense — mesquite smoke is a lot smokier than the usual pecan. A pinch of powder in eggs … aaaahhh.

    We once left Arizona with a box full of 60 pounds of mesquite chunks from my dad’s back yard. That provided the best barbecued burgers and chicken for a long while.

    You can go for several months with sixty pounds. I use the small branches (5-8 cm) sliced with a circular say to about 3-4 cm thick to pucks, then soak them in water [1] for a couple of days before putting them on a small oxygen-starved fire. Eventually they dry out and then they’re the charcoal, add more until the chilies at the other end of the smoker are dry.

    When I take baggies of the dried pods to work, I feel like I’m dealing to the cow-orkers.

    Bigger logs I mostly use for firewood in the winter. I have nine mature trees and that’s a lot of pruning.

    [1] They sink.

  10. #10 Mu
    June 9, 2010

    I grew up on sweet pop corn, and never really got the taste for salty. But I think I try the chipotle version (so I’m too lazy to smoke my own, peeling green chilies once a year is bad enough).

  11. #11 PalMD
    June 9, 2010

    I miss the Southwest. However, i don’t think any awesome green chilies or chipotles will prevent flu.

  12. #12 D. C. Sessions
    June 9, 2010

    However, i don’t think any awesome green chilies or chipotles will prevent flu.

    Agreed — but did you notice that the food talk was in lieu of feeding the troll?

    And although they don’t prevent flu, green chiles are loaded with vitamin C and are a dynamite natural decongestant. The C isn’t a wonder drug but nothing wrong with the nutritional value of capsicum fruits.

  13. #13 Mu
    June 9, 2010

    Pal, while green chilies do not prevent the flue, there’s clear evidence that green chili stew is preferable to chicken noodle soup for the treatment of symptoms (this statement has not been evaluated for evidence, only for taste).

  14. #14 Chris
    June 9, 2010

    D.C. Sessions:

    Bigger logs I mostly use for firewood in the winter. I have nine mature trees and that’s a lot of pruning.

    My dad did that until he found he was getting a bad reaction from the mesquite smoke (despite a good flu, it gets out). The volatile oils in the mesquite that makes stuff so good, reacts with my dad in a bad way (oh, and never smoke with apricot or almond wood because of the cyanide compounds it contains).

    By the way, I have not been sick in three years. This corresponds to the number of years I have received an annual influenza vaccine. I even got the H1N1 vaccine when it was available. Though it turns out I may not have needed it. I looked back at my extensive vaccine record (Army brat who has lived in South and Central America), and noticed that I the experimental flu shots I got as a college volunteer were both swine flu types (I made the doctor/research fill out my well worn vaccine record, he was kind of impressed with it because it included yellow fever, typhus and typhoid vaccines).

  15. #15 Chris
    June 9, 2010

    Another thought about flu and food: when we get a bug, we head down to our local Chinese restaurant for their hot and sour soup. That is really good for a sore throat and stuffy nose!

  16. #16 Luther Yount
    June 9, 2010

    I want everyone that reads this to stop for one minute. Do you know how many people actually die from influenza each year? Do you believe it is 36,000 like the CDC tells you? Now I want you to Google up “trends in pneumonia and influenza morbidity and mortality”, then go to page 11. There you will find the actual deaths caused by pneumonia, and influenza – Make sure you look at influenza stats alone. You will find that less than 900 people per year die from influenza. So how does the CDC get the 36,000+? They combine both influenza and pneumonia, but influeza is not a major cause of pneumonia. Do you still think the CDC has your best interest in mind? Remember, their job is to create vaccines for different causes – not to use a “common sense” approach for common cures…that would be to much like right.
    Luther Yount
    xx

  17. #17 Chris
    June 9, 2010

    On principal I ignore anyone who suggests we “Google” instead of using actual scientific evidence.

    Mr. Yount, you are being silly. If you want to know where the CDC gets its numbers, I suggest you actually read the references in the end of their documents. Much better than Google.

    One place they get information is from the county health department. Unfortunately, you live in a small county, and http://www.clarkhealth.net/ does not have as much information as larger counties, which also has a list of H1N1 diagnosis, reporting and test: http://www.kingcounty.gov/healthservices/health/preparedness/pandemicflu/swineflu/ProviderReporting.aspx.

    But Clark County should have a phone number for you to get information.

    To repeat: there is much better sources for information than “Google.”

  18. #18 Chris
    June 9, 2010

    My comment is in moderation. Mr. Yount, using Google instead of real scientific data is not suitable. If you read the actual CDC sites you will see that they report which ones have been tested for which influenza strain.

  19. #19 Chris
    June 9, 2010

    Some questions for Mr. Yount:

    1) Your email address too readily available. Are you getting lots of spam?

    2) You have your phone number listed. Are you getting lots of odd phone calls?

    3) Did your parents neglect to instruct you on internet identity safety prior to getting your computer? There are some seriously whacked out folks out there, and some have been known to stalk and injure folks who have been lax.

    4) Would you object if PalMD edited your comment to remove that identity information?

    5) Why are any preventable deaths from influenza acceptable to you?

  20. #20 Luther Yount
    June 9, 2010

    Chris,
    If you will note, using Google to locate “trends in pneumonia and influenza morbidity and mortality”, but trends in pneumonia and influenza morbidity and mortality is listed under the American Lung Assocination, and are the statistics of the ALA. Is this scientific data suitable?

    I listed my name and phone number because I had an adverse effect from a flu shot in December 1996. I was admitted to the hospital on the late night hours of Dec 26th, 1996, and was misdiagnosed. On Jan 7th, 2007, I had Guillain-Barre syndrome (not diagnosed), another neurological disease, Transverse Myelitis (not known at the time), a blood staph infection (staphylococcus aureus but the exact type staph unknown), pneumonia, a temperature of 107.9, blood pressure of 44/0 by Doppler (would not register by cuff) internal bleeding (source unknown) and an EEG (brain scan) that showed no activity. I was did not receive either of the two treatments that can slow/stop the attack on the myelin sheath, plasmapheresis (plasma exchange) or IVIg (intravenious immuneoglobulin). It was 3:00AM and the doctors told my wife to make arrangements for a post-mortem. But she did not make those arrangements. Instead she called our pastor at 5:00AM, and when he arrived, my family members and a few close friends that were there circled my bed and prayed for a miracle. I was spared by the grace of God. I was in a rehab center for 4 months and as I continued out-patient therapy another 4 months learning to walk again. At the end of my therapy I could walk approx 300 feet with hand loop crutches. From there it has been self therapy. I have severe nerve axonal damage, which means my nerve cells are damaged. My nerve cells do not function properly, and as a result the chemical acetylcholine is not released by the neurotransmitters, and the muscles must function without the help of the nerves. So the muscles support themselves and become fatigued easily as a result.

    I list my name and phone number because maybe there is someone that has GBS or CIDP (chronic inflammatory demyelinating polyneuropathy) that may need answers or help…and after researching this disease for more than 10 years, I feel that I could probably help anyone that may have a problem with these diseases.
    Luther Yount
    xxx xxx xxxx

  21. #21 Chris
    June 9, 2010

    You really do not have a clue. If you have real data, present it. Otherwise, you are just posting as a naive internet newb if you think someone is going to call you up for information.

    Though you might get some nice offers from Nigeria.

  22. #22 Shay
    June 9, 2010

    Chris@15 — kimche works, too.

  23. #23 Chris
    June 9, 2010

    Shay, I have heard that kimche works. Though I am really not fond of the taste. I don’t like curry or cilantro either.

    Though tomorrow I will be making a middle-eastern dish of cauliflower, chicken, pine nuts and rice that has lots of garlic, allspice and a cucumber/garlic/mint yogurt sauce. That should help keep bugs away.

    (I have to make it tomorrow instead of the previously planned Friday because son is coming home from college a day early… we call him “Vampire Boy” because he is tall, thin, blond and hates garlic, but does not sparkle… wait, yes it does, when he smiles… so Friday he is getting a very well marinated London Broil)

  24. #24 D. C. Sessions
    June 10, 2010

    Shay, I have heard that kimche works. Though I am really not fond of the taste. I don’t like curry or cilantro either.

    Check out Thai hot and sour soup. My favorite, actually.

  25. #25 Shay
    June 10, 2010

    Chris: I am married to Vampire Boy’s evil twin. Perhaps we can maroon them on their own garlic-free island?

    (how can anyone not like kimche’s taste? What’s not to like about well-rotted cabbage, garlic and hot peppers?)

  26. #26 Chris
    June 10, 2010

    :-)

  27. #27 JustaTech
    June 11, 2010

    In my area it’s all about the pho (pronounced phu), the Vietnamese noodle soup. Incredibly cheap, huge servings, and some of the best broth ever. I find it much more effective than American-style chicken noodle soup, and that’s before you add chili sauce.

  28. #28 PalMD
    June 11, 2010

    Had a great bowl of Pho yesterday for lunch. Cost me about 126 bucks. 6 for the soup, 120 for the traffic ticket.

  29. #29 Chris
    June 11, 2010

    Ouch!

  30. #30 Shay
    June 12, 2010

    ooh, JustaTech, now I want some pho. Pity the only Vietnamese restaurant for fifty miles closed last year.

  31. #31 Chris
    June 12, 2010

    Whoa! Where do you live? I thought that the Vietnamese had settled every corner of the USA.

    Though, I live in the Pacific Northwest. There are so many pho places, that some of the Vietnamese branched into the other culinary heritage: French baking. And it was a wonderful little shop (unfortunately it got too big and went strictly wholesale, now I buy the bread at my local Safeway).

  32. #32 James Pannozzi
    June 13, 2010

    Wow interesting post! PalMD see, you CAN write coherently when you’re not doing a Dr. PalMd – Mr. Hyde rant against Homeopathy.

    Guilliane-Barre’ is interesting etiologically and in several other ways.

    Any thoughts on whether FDR really had Guillaine-Barre’ instead of polio? Some MD and PhD experts published a paper not too long ago giving some considerations that this might have been the case.
    Retrospective diagnosis, obviously – still, interesting. Aspects of the progression of paralysis… curious.

    Of course, massive political incorrectness to say so, given the “march of dimes” campaign and all the rest.

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