Flu: the gift that keeps on giving

There is a good Canadian Press by Michael Macdonald about the often long time it takes to make a full recovery from flu. A full blown case of classical influenza can really lay you low for days or weeks. People often report never having felt so sick. But once you are "recovered" and back to work or your daily activities you aren't necessarily fully recovered:

Marga Cugnet thought she knew what she was in for when she came down with swine flu last October.

But the health administrator from Weyburn, Sask., said she was annoyed and somewhat dejected when the potent H1N1 virus left her with lingering symptoms that did not let up until earlier this month.

That's five months of suffering through a hacking, post-flu cough and bouts of fatigue.

"I never went anywhere without having a bag of cough drops with me because I would just get into a coughing spell that wouldn't stop," said Cugnet, the 56-year-old vice-president of primary health with the Sun Country Health Region.

"I knew it could take months to go away, but I didn't think it would last that long." (Michael Macdonald, Canadian Press)

It's not just a hacking cough, either. Months of enervation for some, moderate fatigue for others and not being as robust as before for many isn't uncommon. These aren't people who wound up in the hospital but people who suffered through the flu at home. The cost in lost work and productivity when a sizable fraction of the population is affected (Canadian public health authorities are estimating 10% to 30%) is staggering. And with pandemic flu the age distribution gets shifted to the left, with younger people who are working most affected.

There are a lot of bad diseases out there, but in terms of the sheer number of previously healthy people who can have their daily lives affected for a significant period, flu gets my respect.

The majority of cases (although not all) can be prevented by vaccination, especially in the younger age groups. That's why governments push vaccination. I'm not so sure why many people resist it or don't take the trouble to get it.

Maybe because they've never had a case of full-blown flu.

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There is no reason why a flu blogger-epidemiologist-physician's family should be immune to flu in the community. And it appears my family is not. My daughter has had a cough for the last few days and Friday night was suddenly seized by nausea, vomiting and fever. Her HMO's urgent care directed her…
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When I was little, I was vaccinated for the things that were recommended at the time: polio, measles, German measles (rubella), diptheria, tetanus, whooping cough (pertussis). I had the mumps and chicken pox when I was little, and was re-vaccinated for measles before college (because the late 60's…

People have different reasons for not wanting it and it's better not to dismiss peoples with educated reasons for not wanting a vaccination - http://www.guardian.co.uk/world/2009/aug/18/nurses-swine-flu-vaccine-sa…
The article concentrates on nurses reaction but I know many (but not all by any means) doctors who have chosen not to have the vaccine; I presume most of them have had flu at some stage; I also presume they know more than politicians who tend to have different motivations for actions.

Hand Gel Man: You are correct that people have many different reasons for not wanting to get vaccinated but not many are educated or rational reasons (there are valid contraindications and religious reasons, but they don't apply to most people who don't get the vaccine). I am a doctor and I can tell you most doctors and nurses who don't get the vaccine or advise their patients to take a pass are not in the least educated about it or know anything about the literature on efficacy. They are just lay people in that regard.

To Hand Gel Man: I would hope that a doctor is paying attention to news about the limits of flu vaccination, in particular, that vaccines do not protect you from future flu viruses while an actual case of the flu will, to some extent. My daughter's pediatrician told me that she believes children who never have the flu may be at risk later in their lives, and I've read recent research that backs her up. It is a calculated risk, but not an uneducated decision. Also, the nurses are on to something. Every time I get a flu shot, I'm laid low for a day with a rapid fever, and no other symptoms. This phenomenon has to be addressed.

OK, at this stage it may be good to point out that the US and Europe took slightly different approaches to the development of H1N1 vaccines - both fast-tracked but the US took a slightly more cautious approach.
Doctors I know do not object to the vaccine on religious grounds - but would find the suggestion rather amusing - we tend to be less religious here in comparison to US!
Their reservations are more scientific:
vaccines are put through tests to ensure their safety,
drug companies exert enough influence to ensure that those procedures are not excessive,
if you short-cut those safety measures how can you ensure safety?
Here in Europe there are other questions emerging - http://www.guardian.co.uk/world/2010/jan/11/swine-flu-h1n1-vaccine-euro…

For years I refused to get a flu shot, until about 10 years ago. After enduring the previous winter catching several upper respiratory viruses, and one that led to secondary bacterial sinusitis, I decided it was worth a shot (pun intended) to receive the free flu vax provided by my employer. Not surprisingly, my anecdotal experience proved them extremely effective.
So this fall, along with my family, we received the seasonal flu vaccine during the first week of October. We planned to get the Swine as soon as it became available.
Well, on Oct. 11, we were "swined". It was HORRIBLE, especially for me. The kids were only sick for a couple of days, but it took almost 3 weeks for me to fully recuperate. I can't stress strongly enough that it's worth every penny to get the vax.
The government often gets criticizes for blowing this out of proportion, but I disagree. Had they truly been on the ball, the H1N1 vaccine should have been available much sooner.

A few comments about flu vax. Vitamin D is effective at preventing flu.
5000 iu a day. Www.vitamindcouncil.org
Doctors don't widely know this because of drug
companies and because of ignorance of the
scientific basis of Koch's postulates.
Another issue with vaxes is: do vaccines contain
epitopes in common with human self peptides?
Viruses may display such sequences as a cloaking
strategy, and there's some evidence for that.
If so, raising such immune surveillance against
one's own body might weaken this important
function of the IS and lead to arthritis, cancer,
among others.
The point I am making is don't pretend that
vaxes are proven safe, and that vitamins are
quackery (as doctors said for 90 years), unless
you want a job at NIOC.
(National Institute of Obama Care)

By John brookes (not verified) on 30 Mar 2010 #permalink

Two points. (1) Do we yet know whether one vaccination for this flu suffices, for older persons, or whether two vaccinations, as with seasonal flus, is more likely to provide immunity equivalent to that from one vaccination in a younger person? (2) And do we yet know whether two vaccinations in fact suffice for small children?

Paula: For our age, we don't know how effective it is. Probably some but not as much as for the younger folks. On the other hand, we don't seem to be getting this one much. The Australians say one shot is enough for the tykes. We'll know better in a year when more data are analyzed.

why is there no statisitcs of how many of those that test
positive or present with ILI had been vaccinated ?
Very easy, just ask them.
A small representative sample of some thousand would
already be useful.
They must have a reason to keep this secret.

Why are folks here (anon, brookes, hand gel etc.) so suspicious of any public health campaign designed to help us? If anything, I think the development of the H1N1 vaccine was too slow. What is the NIOC? Is this a new institute of the NIH? And what does health care reform have anything to do with the flu?

If you don't want to get vaccinated that's fine - let's hope you have health insurance to cover your medical/hospital costs when you do get the flu....

Australia is actually giving two shots to kids between four and ten -- both the same dose as an adult shot. It isn't that popular with the four year old ...