Please get a flu shot

I think a lot of folks believe they get the flu the vaccines are supposed to protect them from, but instead get another 'version' of it. I know that's what happened to my dad and step mom. They were both in their 70's received both the pneumovax and seasonal flu shot, but both came down with some type of influenza anyway a few months later. My dad lapsed into pnuemonia, not one of the ones that vaccine protects you from, and died several weeks later after having his lungs turn to Swiss Cheese (doctor's description, not mine).
Now if you read this testimony, you'd say why bother getting any vaccinations for flu or pneumonia. We still do, my asthmatic daughter especially, but it could give some folks cause for concern. The vaccinations only protect you from the things they are designed to protect you from, not the ones they aren't. If your immune system meets up with one of the other nasties out there, you will get sick.

I may be mistaken, but I thought the pnuemovax vaccine was actually to prevent pneumonia and bactermia. Furthermore, theoretically, an immunocompentent individual should not need the vaccine. It's primary indications are for those with functional or mechanical asplenia, because it is an encapsulated organism.

Furthermore, the influenza vaccine is not always routinely available. Especially in densely populated regions like the East Coast. Therefore, you have to take into account accessibility. If the vacccine was more widely available, more people may fit into the category of wanting the vaccine. In general, I thought those who were more prone to the infection were triaged to recieve the vaccine first. This includes elderly, pediatric populations, immunocomprimised and healthcare workers. In general, I don't believe there is a contraindication to annual use, but I find it rather unneccessary. Taking into account the fact that immunology is so heavily dependent on genetics and HLA subtypes, the vaccine may not be neccessary for everyone.

I don't think it is totally productive to adovcate a widespread vaccine when it's formulation is based on prospective mutations in the viral genome.

leann: The use of pneumovax is being advocated because pneumococcal pneumonia is a frequent secondary infection in influenza. This is not just my recommendation. It is the recommendation of public health authorities, at least in many places.

The general feeling among public health officials is that widespread influenza vaccination is a good strategy. There is some argument about which groups should have priority if there is a shortage, but at this point the worry is that much vaccine will go unused, as happened last year, despite shortages early on. Thus people are being urged to get vaccinated. Some groups are more at risk from complications than others, but the objective is to build up herd immunity to slow spread and keep R0 as low as possible.

G in Indiana: Yes, you are right. To the extent vaccine makers have guessed wrong, they are not so protective and in fact their efficacy is only about 70%, so even if we guess right it isn't a guarantee by any means. But most data show it is a good public health measure. The pneumovax also has only some strains and doesn't guarantee. Yet I think on a population basis we are better off with as many people vaccinated as possible. This isn't a guarantee for any person but it is a help to the community.

This is an issue I have often wondered about. The article you've linked to states "Half of the mice given an ingredient from the regular flu shot survived infection with bird flu in the first experiment of its kind" but could you elaborate on how many mice would normally die of bird flu? Is it 100%? I'm not sure how clearly mouse tests translate to humans, but right now we have just just over half of humans dying of bird flu infections anyway. I do hope the seasonal flu vaccine is some kind of help, but the article isn't explaining to me what fact about these dozen tested mice makes the vaccine look helpful...?

BnG: Most of the mice would die from H5N1 when properly inoculated. These are experienced investigators so ou can assume they did it right. H5N1 aside, the seasonal vaccine is good for seasonal flu, which will be co-circulating even in a pandemic.

It seems normally, H5N1 kills animals in a way that frightens scientists, my impression from reading, over the years.

http://www.fluwikie.com/pmwiki.php?n=Science.AnimalsShownToBeInfectedWi…

(reveres, does "lethal" in this article mean they all died from it?)
http://www.nih.gov/news/pr/sep2006/niaid-11.htm ..."The safety of the vaccine viruses was evaluated in chickens and mice. In chickens, the H5N1 vaccine viruses were not lethal, while each of the three strains of the ?wild-type? (naturally occurring) H5N1 viruses were.

Similarly, the vaccine viruses were not lethal in mice, but the 1997 and 2004 strains of the wild-type H5N1 viruses were.

The 2003 strain of the H5N1 wild-type virus was not tested in mice because the researchers found that the virus was lethal in those animals only at very high doses.

Because the wild-type H5N1 viruses have been shown to replicate in animal lungs and brains, the researchers tested the ability of the 1997 and 2004 strains of the vaccine viruses to replicate in mice and ferrets as an additional safety measure In mice, the vaccine viruses replicated in the respiratory tract but did not spread to the animals? brains. In ferrets, the H5N1 vaccine viruses did not replicate in the lungs or the brain.

To evaluate the protective ability of the vaccines, the researchers gave the mice a single dose of vaccine virus via nose drops. All of these mice survived infection with the 1997 and 2004 H5N1 wild-type viruses, including two more recent strains of the H5N1 virus found circulating in Vietnam and Indonesia in 2005. Further, mice that received a second dose of vaccine 28 days after the initial inoculation demonstrated a stronger and more rapid immune response and almost complete protection from respiratory infection when exposed to the naturally occurring H5N1 viruses. Ferrets exhibited similar results when given two doses of the vaccine viruses.

It is impossible to predict how the H5N1 virus will evolve or which strain, if any, will cause an influenza pandemic. To be prepared, we need to select a vaccine capable of inducing an effective human immune response against a range of H5N1 viruses that may emerge in the future"...

One thing to add to my question above -- In Anthony Fauci's article "Seasonal and Pandemic Influenza Preparedness: Science and Countermeasures" [JID 2006:194 (Suppl 2)] he wrote "Since the currently circulating H5N1 virus continues to evolve by mutation, prepandemic vaccine production for the entire US population is not an optimal strategy. Nonetheless, it is important to develop the vaccine-manufacturing capacity to produce, within a reasonable period (46 months), 300 million doses of a vaccine that matches the virus strain..." He doesn't seem to think that the seasonal flu vaccine is helpful but the process of cranking out vaccines is helpful in that we want to learn how to make better vaccines and make them faster. He then says we need to work toward a universal flu vaccine.

BnG: Yes, that is what he is saying. But the evidence now suggests there might be some cross protection. How much, we don't know. It is plausible, biologically, but whether it happens is another issue. But it is good to be protected against seasonal influenza in any event, so it is a win-maybe win.

Thanks to both above. Well I for one will get a flu shot regardless. I had the flu several years ago and learned the difference between influenza and what people nonchalantly talk about when they say they had the flu yesterday. I tell them if they'd had the flu yesterday they wouldn't be here today and would probably still be recuperating two or three weeks from now. Gawd, the flu is the worst thing I have ever had, I had to be taken care of and I really did think I was going to die.

OK, I'm in the minority - I have never had, nor will I get, a flu shot. In my own defense, I haven't had the flu in at least 20 years, though I used to work in a community college in a crowded office and later in a small office where most of my co-workers had kids and were constantly bringing nasty bugs to work with them. Now I work alone, outside 7 days a week, a have very little contact with others. A bit of a hermit, perhaps, but a happy and healthy one. As to the myth that you can catch the flu from a flu shot - my father gets his shot faithfully each year and still occasionally gets a mild case of the flu anyway shortly thereafter; one of my suppliers got her shot this past Monday and had flu-like symptoms Tuesday through Friday. Have heard this same story before from friends and clients. May be coincidence, but I'll pass anyway, thank you very much.

cougar: They didn't have the flu. They have flu-like symptoms. It is a vaccine reaction that is not related to infection with influenza virus. This is a critical difference, so I wanted to be absolutely clear, hence this comment.

Revere: Is it true that once you have had the pneumovax you can't receive it again? I got one about 13 years ago (on my own initiative) after I had pneumonia, and realized there wasn't going to be anyone to take care of me if I got it again. I would get the pneumovax again, if the proscription isn't real. Many thanks.

Our region was touted around the world as the leading edge of bird flu in the Americas. Our region provided and provides a lot of historical information needed to unravel the biology and sociology of pandemic flu.

Our region was told there was no H5N1 (LPAI) when there was. Our region is told there's no need to do emergency preparedness except cook birds.

Our region was the first to be "involved" by the federal agencies in pandemic flu operations, who did such a wonderful job at it that they complained on national radio about people "freaking out".

Our region only just received flu vaccine, nearly a month late. Our region must now pay more than twice as much for a shot as last year. (from $12 at Public Health to $25).

We may be the last gasp of yesterday but we are the future of actual public health response to disasters. Officially we are the health "frontier", which means we see what's coming and at a scale suitable for planning for the rest of the US. It's very unfortunate that so few want to learn.

Sorry but the following is not really "on thread" but I don't know how else to post it. It is really a question to Reveres. I also see it was already mentioned by G in Indiana in an earlier thread, but I didn't see any related replies (apologies if I missed them)
A group of scientists in Warwick, UK, are claiming a new type of vaccine that protects against *all* Flu subtypes.
http://news.bbc.co.uk/1/hi/health/5404184.stm
It is years off yet, but it still worries me (more so than gives me hope).
Summary from a layman (me):
In effect it is a flu virus weakened in many ways - with no ability to start to replicate itself inside a cell. However, as soon as another flu virus initiates replication the vaccine flu is very efficient at utilising the activated replication equipment - far more so than the other (read H5N1) virus - which it then outcompetes, both in the cell in question and (therefore) in the number of new cells infected. Presumably new cells infected by only the "vaccine" virus remain viable (but booby trapped for any subsequent invader) and the cycle continues - either dead-ending the invader, or delaying it (slash and burn tactics) enough for the body to fight it off.
Why does this worry me? It seems to me that the various mechanisms that recombine/reassort flu viruses could pass the superior replication from the vaccine to the invader.

We are always very careful that medicines are well tested enough that major side effects (death) are very unlikely (when compared with whatever is being treated!). Big Pharma looking to H5N1 as an excuse for immunity from the usual rules aside! I am not satisfied that ultra low frequency events that go beyond the usual (death of the patient) into the realms of causing or worsening epidemics/pandemics and so killing far more are treated with the even greater caution they warrant. In fact the mere fact that some countries permit large scale prophelactic antibiotic use in farm animals would seem to point to the law of unintended consequnces being an intentional blind spot if that isn't an oxymoron.
So, Revere(s) - would you know - is there likely to be any fundamental reason why the superior replication of the Warwick vaccine could not transfer to the flu strain it is fighting? For example, if the superior replication were not due to an improvement in the relevent RNA sequence, but just a side effect of the vaccine having far less genetic material and so quicker to copy, then it wouldn't transfer any benefit to any larger virus...
The answer (from Warwick) "We haven't seen it happen" would be particularly worrying, given the nature of ultra-low frequency events to elude demonstration in limited size trials.
Once again, apologies if any of the above is nonsense - I'm a physicist, not a medical person.

Just went for a flu vaccination last week.

There is a lesson to be derived from the experience. Specifically, this: under genuine pandemic conditions, expect a nearly instant and total system collapse.

The impromptu clinic we went to was an absolute carnival of disorganization, delay, and error. And this under perfectly calm conditions, administering the vaccine as a prophylactic measure, where there was no fear or panic involved, and where no one was sick, least of all the medical staff. People, including the staff, milled around in confusion. Patrons pushed in line. The elderly got their bone-simple Medicare paperwork hopelessly confused from the get-go. There were language barrier issues where the same point had to be explained repeatedly with only limited comprehension.

My wife and I came straight off the back end of that very disconcerting experience, and we immediately, jointly, and without further discussion amplified our own stocking and prep efforts fivefold. More food, more fuel, more water, more medicine, more masks. And a large order for pistol and shotgun ammunition. If people behave like that under non-pandemic conditions, that's all I need to know about how they would handle an actual pandemic.

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I make sure that my 12-year-old son who has asthma gets a flu shot each year. This might be the first year in five years that I could afford a shot for him at the public health nurse without it being a hardship. When you're well-below the poverty level, $15 for a flu shot is a lot. I've never had a flu shot, and can't see much point in getting one. If I purchased a flu shot for each member of my family, it would cost $60, and even with an improved financial situation, I can't afford that. So I'll continue to get one just for him.

I'm with cougar on this one. Through experience and learning I don't trust vaccinations. I prefer to look after my immune system by eating and sleeping well, going easy on the poisons and minimising stress. This protects me against a whole host of illnesses, not just flu. If I'm spreading germs around it's germs acquired by colleagues who come into work choked with whatever, blow their nose, leave the snot rag on their desk and touch everything without washing their hands then ask me to come fix their computer. Thanks very much. I don't see any concern for my health in this. Just as well I'm robust. And yes, I wash my hands before I go do anything else and on the rare occasions I get sick I don't go into work and share it.

I realize H5N1 is a novel virus that everyone will be susceptible to, but so was H1N1. Sooner or later everyone would have been exposed to it and it didn't cause extinction. It makes sense that a healthy immune system was what made the difference between falling foul of it and brushing it off. I can see the benefit of the smallpox vaccine, but flu jabs don't eradicate flu. If a universal vaccine that eradicates all flu is found I might consider it. But at this point I won't take a shot every year to protect the health of others who won't do the basics to look after their own health (and the health of others).

Flu shots are mandatory in the military and for 13 long years I was relegated to sick call, the dorm, and one hell of a case of pneumonia every season. I could set my watch by it. I get the shot, I would get feverish, then the snotty nose, the runny buns, then pneumonia. I amazed the docs because I always got sick and still got another flu at about springtime every year.

I continued taking it when I got out until I finally said enough is enough and quit taking it. That was two years ago. Since then I havent gotten so much as a cold. Revere and I discussed the pneumovax and yep boys and girls I took that yesterday and I feel fine. I will steer clear of the flu shot for obvious reasons. But thats just me. I can also safely say that I am unusual (no kidding) but you guys might not be. So take both and hope that the strain is a near match or regrettably you might have G in I's situation. You might have it anyway. It wont help against H5N1 too terribly much but it might slow it down and thats the key to surviving it. Slow the cytokine storm and your own body will whip it in a couple of days.

Its all about choice folks. I have made the choice to prepare for H5, but not take the flu shot. I dont know if I would take the coming H5 one either for fear that it might swack me. Time will tell on all fronts. Dont bitch if you get sick though. I would like for there to be a post up in March where Revere can tally the totals of who got sick. Remember to be honest.

Ralph: The Warwick "vaccine" story is really a very old idea. Many RNA viruses have Defective Interfering mutants that can't replicate without the helper wild type. This has been know at least since the 1970s, maybe earlier. There are a variety of problems with the idea but it is worth exploring and several groups are doing it. This particular press release had to do with this guy's start up looking for venture capital. It is nothing imminent and certainly not a breakthrough. It is basically hype at this point. The idea is interesting (but not new) but it will be years before anything comes of it if it ever does.

Dizzy: You might want to read G of Indiana's comments about what the flu can be like. It is no fun, even regular seasonal flu. So you can take your chances but that's what you'll be doing.

marquer, Jude: Sigh.

An associate of mine never fails to point out that seasonal influenza vaccinations should be universal. If they were, there would be the financial impetus to build the capacity to manufacture enough flu vaccine to vaccinate everybody when the pandemic happens. A reasonable point, I think, and reason enough to get your "flu" shot.Go to your local health department, make a small donation, and get your shot. both you and your LPHA will be better off for it.

Jude,

Nearly all local health departments will provide your high-risk child, and probably your family members, with a flu shot if you cannot afford to pay, asking you to pay what you can afford.

Try calling before you go, to find out if they can accommodate you.

G in Indiana: I'm sorry for your loss.

I remember reading, although it was quite awhile ago now so the specifics escape me, that flu vaccination doen't work as well for the elderly. They're at particular risk for succumbing to the flu or pneumonia due to weak immune systems, but those weak immune systems mean (somebody found, IIRC) they're much less likely to develop antibody protection when they receive the vaccine.

This raised the question of who should get flu vaccines, including to protect the elderly. IOW, would the elderly be better served if other people they came in contact with were vaccinated? (It might have been at Peter Sandman's site, but I'm just guessing.)

Last year I turned down a flu vaccination, even though I qualify to get one. Since there was a shortage, I didn't want to be taking one some baby or grandparent needed more. This year, I may get it. We'll see.

Btw, Revere: how do you get diagnosed with the flu, anyway? I'm pretty sure I had it... fever of 102.2 when I went to the ER (because I had a sore neck too, and they'd warned of meningitis at my college), the cough, felt badly for weeks. But despite the way it passed among friends, and despite how we all clearly had the exact same thing, we each got our own "infection" diagnosis. My friend who was delirious with fever when friends dragged her to the ER got "lung infection". I got "upper respiratory infection", even though none of those I'd had before or since gave me a fever that broke with sweating, and I'd had my share of awful coughs that knocked me flat.

It makes me think the flu is more common than people think it is.

Revere: thanks for the clarification; still, it doesn't change my mind. No flu shot.
Dizzy: Good point on maintaining a healthy immune system - eat right AND get your sleep. How many folks do both???

Revere, I would like your opinion regarding the research at the University of Warwick led by Nigel Dimmock on a "protecting virus" vaccination, based on deleting about 80% of the RNA of one of the 8 individual segments of single stranded RNA. The press release in Medical News Today suggested that all of the preliminary work has been published in peer reviewed journals. While intra-nasal administration of the vaccine was mentioned, the specific species of animal involved was not clear. It does not appear that any human testing has been performed at this point. Do you have any additional information on this research and what do you think of this approach?

scientist: I've had a couple of requests about this, so I'll probably post on it this week. Yes, there have been publications in peer reviewed journals. As I said above in a comment, Defective Interfering viruses have been known and worked on for a long time, at last 30 years that I know of and probably more. There are a variety of problems in using them for a vaccine. There is nothing much new in this press release (note they are trying to raise venture capital) and nothing in the offing for years. But the science is interesting so it's worth a post, I guess.

A "healthy immune system" might not prevent individual "extinction". In 1918-1919, and now, with H5N1, something about the viruses, and, having a robust immune response, seems to be why the young and healthy died. "Cytokine storm"?

"graph of the 1918 flu looks more like a misshapen W, with an astonishing middle peak reflecting that it was most fatal to perfectly healthy adults in their 20s and 30s."

WHO graphs, by age, show most of the H5N1 deaths are in their teens, twenties, and thirties...

Got the pneumovax previously, need to get the flu vax. Reveres, any pre-pandemic thoughts on shot vs flumist?

caia: I think you can only know for sure when a sample of it is sent to a laboratory. Physicians do that sometimes.
Every year we have a Big Flu Measure Project in the Netherlands and Belgium. I can see there what A and Be influenza viruses are sent to a laboratory and are taken up in the statistics.

crf, many people think they are healthy when they're not. I know a lot of people who drink too much caffeine and alcohol, live on refined carbs (aka pure sugar), don't do any exercise and are pretty stressed at work. They look fine and function as normal, but catch every bug around.

I think there are obvious reasons why people who had just fought a 4 year war or were at home stressing and grieving for those who did battle might have had a depressed immune system. Did the W curve stats come from countries involved in the war or from every country?

Of course I could be wrong but I'm willing to take my chances. I don't recall ever having the flu (maybe once as a teenager?) and if I did it couldn't have been that bad. I really believe a cytokine storm is the product of a malfunctioning immune system. For some reason some people succumbed to it in 1918/19 and some didn't.

It occurred to me that perhaps the people in Indonesia, although they have less wealth in the way of material goods, actually eat natural organic foods, get exercise through their work, breathe fresh air and don't stress about life the way we do. Maybe that's why it's not running rampant and no inapparent infection has been found. I don't know if people develop antibodies if viruses just bounce off them. The 'developed' nations are in trouble if there's any truth in that.

Dizzy: I'd like to confirm your view of Indonesian life.
But there's not much awareness on environment issues, the air is filled with benzene flavours from motor vehicles; there is redtape if one wants to build a smoking factory but that's not definitely preventing it to be built or blocking the risks it brings to a healthy life, and they are smoking the lungs out of their bodies by the use of kretek cigarettes.
The poor are eating rice and sambal and not much more than that, there's a lot of administration that replaced the sweating jobs and they have their own concerns in life that are stressfull. Only in some regions they don't express these feelings and their smiling is a social way of covering things up. Because, to a foreigner, it's not your business. But I think you were joking to us in that part of your theory.

As for the rest of your post, I'm as interested in the answers as you are, and I am with you about the influence stress (wartime) can have on the immune system. Even the passive way of experiencing war has a correlation with the percentage of born boys or girls. So that's about living cells and cell fusion (and hormones), and of course it's quite another cell process but viral infections IMHO will attach to one and not to one another. When I was 23 I caught all viruses that were coming along that year: all influenzas and colds, and I became quite depressive of it.
I thought it would never stop again. But when you'd interview me about it I really don't know what made me vulnerable at that time. I had a healthy life, good food, not too much stress, enough excercise, not too many contacts in general. As long as the research on this is in the category of Prevention, it won't raise too much funds I guess.

It's curious how a possible pandemic is about the only issue in the Prevention category to be relatively seriously invested in (but not enough as a lot more research could be done and could have been done by now).

The worst and maybe the only real case of the flu I have ever had was from the vaccination I got on entering Basic Training in 1968. It was bad enough that I have been leery of government sponsored vaccinations since. I am not by any means anti modern health care or science, but it will still take a lot to motivate me. Say the start of a "pandemic"?

Tom: You didn't get the flu from the vaccination. It was a killed virus vaccine. You may well have had a vaccine reaction, which has "flu like" symptoms. But I guarantee you it is still a lot better than a full blown case of influenza, which is something you don't want and probably have not had. Many flu cases are asymptomatic, so you may have had it at other times in a mild or inapparent fashion, but "real" flu is not forgettable or comparable to "a bad flu."

shouldn't we stop producing H3N2 vaccine and use the capacities to produce prepandemic H5N1-vaccine instead ?

anon: No. H3N2 is a very bad disease and we will surely suffer an outbreak this year. We cannot ignore it. It is a major public health problem. Making a probably weakly effective (at best) H5N1 vaccine when H5N1 may never happen would be extremely foolish.

http://www.washingtonfreepress.org/70/fluVaccineMissingTheMark.htm

82 million US.people are vaccinated per year against flu
15% of US-people get flu each year
36000 deaths per year
25% of vaccinations are effective

so 82million vaccinations save 2500 lifes per year in USA.

assuming a probability of only 2% per year (as the mortality-bonds suggest)
for a H5N1 pandemic worse than 1918, that's an expectation value of
at least 40000 deaths per year.
Assume the CFR is 2.5% as in 1918, suppose the prepandemic vaccine
has a 10% chance of protection, that's an estimated 1000 of saved
lifes per year.

That ignores the discussion about side-effects which
would only be 10% with panflu-vaccine.
And this assumes 1918 as worst case.

It's not so easy to decide...

The clear decision pro H3N2 suggests, that you and the authorities don't consider the threat as big
as I had thought :-)