Flu Shots

[eeyore1954]

Are flu shots just another money making gimmick? Do they protect only against previous years strains and are not effective against yet unknown strains? Is real influenza pretty rare and when most people say the got the flu the didn't have it and it was not something that would have been stopped by the shot.

[Katana]

Well, according to the Cochrane Database, which is an independent organization that compiles currently-available data and is considered the gold standard for evidence-based medicine, there isn't a lot of evidence to support routine flu vaccines.

Preventing flu among healthy adults:
Influenza vaccines are effective in reducing serologically confirmed cases of influenza. However, they are not as effective in reducing cases of clinical influenza and number of working days lost. Universal immunisation of healthy adults is not supported by the results of this review.

Preventing flu among elderly:
In long-term care facilities, where vaccination is most effective against complications, the aims of the vaccination campaign are fulfilled, at least in part. However, according to reliable evidence the usefulness of vaccines in the community is modest. The apparent high effectiveness of the vaccines in preventing death from all causes may reflect a baseline imbalance in health status and other systematic differences in the two groups of participants.

Preventing flu among patients with cystic fibrosis:
There is currently no evidence from randomised studies that influenza vaccine given to people with CF is of benefit to them. There remains a need for a well-constructed clinical study, that assesses the effectiveness of influenza vaccination on important clinical outcome measures.

Preventing flu among children:
Influenza vaccines are efficacious in children older than two years but little evidence is available for children under two. There was a marked difference between vaccine efficacy and effectiveness. That no safety comparisons could be carried out emphasizes the need for standardisation of methods and presentation of vaccine safety data in future studies. It was surprising to find only one study of inactivated vaccine in children under two years, given recent recommendations to vaccinate healthy children from six months old in the USA and Canada. If immunisation in children is to be recommended as public-health policy, large-scale studies assessing important outcomes and directly comparing vaccine types are urgently required.

Linky (http://www.mrw.interscience.wiley.com/cochrane/cochrane_search_fs.html?mode=startsearch&products=all&unitstatus=none&opt1=OR&Query2=&zones2=article-title&opt2=AND&Query3=&zones3=author&opt3=AND&Query4=&zones4=abstract&opt4=AND&Query5=&zones5=tables&FromYear=&ToYear=&Query1=influenza+vaccine&zones1=%28article-title%2Cabstract%2Ckeywords%29)

[Taffer]

Are flu shots just another money making gimmick?

Nope. Many people here can get them for free.

Do they protect only against previous years strains and are not effective against yet unknown strains?

They are developed based on previous strains, yes. Whether they are effective against current years really depends on how much the virus has changed. Viruses, especially Infuenza Viruses, mutate and evolve very quickly. However, that being said, mutations do not always impact immune factors. 'Flu' mutants which have different surface proteins will be less effectively (or not at all, depending on the change) targetted by any vaccination.

Is real influenza pretty rare and when most people say the got the flu the didn't have it and it was not something that would have been stopped by the shot.

Oh god yes. It's a peeve of mine, actually.

As Katana has pointed, it is not the most supported vaccination out there. However, that being said, for the you, elderly and especially the immunocompromised, it's not entirely silly to have them. Especially since they are free/cheap (at least here, dunno about elsewhere), don't harm, and could actually work (obviously depending on the strain). One major problem is you're not particularly likely to know if it has 'worked', since you wouldn't get sick!

(Yes, gross oversimplification I know.)

[Demigorgon]

Basicly, if you haven't had that particular strain before, yes it's worth it. Otherwise you've probably immunized yourself already if you've already had it. It just mutates to damn fast. Damn you evolution!

[Capsid]

Influenza does not mutate it reassorts.

[Bowser]

Influenza reassorts AND mutates AND recombines.

If you want to follow the progress of actual flu infections, the CDC has a good website. You can follow the wave across the country. Last year it started on the left coast and headed east. The posted CDC data tends to be a week or so behind.

http://www.cdc.gov/flu/weekly/fluactivity.htm

[Taffer]

Influenza reassorts AND mutates AND recombines.


Bowser has it. ;)

[Capsid]

I stand corrected.

[Luke T.]

I was given the flu shot every year for 20 years in the Navy. When I retired, I didn't go out and get the flu shot. That December, I got the flu. And I was a piece of raw meat to that bug. It was so bad, I ended up in the hospital. The admitting nurse in the ER said, "A lot of people come in here thinking they have the flu, but they don't have the flu. You have the flu. :)

Was not pleasant.

One shot I do believe in. The flu shot. I also believe in the pneumonia shot, probably more than the flu shot. I didn't even know there was such a thing until I got out of the Navy. Every year, I would get a cold and it would spread to my lungs and I would be hacking for weeks. Bent over double hacking. And on one occasion, coughing up blood.

I went to the Navy doc and he said I have asthma. He gives me an inhaler. As if every doctor in my life before then somewho missed that I had asthma. But hey, he's a doc, do what he says. So I use the inhaler and coughed like I have never coughed in my life. Then I noticed a whole bunch of my shipmates were carrying inhalers.

Freaking quack!

A corpsman who was on the ball got me some antibiotics and that was that.

Once I retired, I got this pneumonia shot my wife told me about, and its been six years since I have had that hacking.

[LibraryLady]

Bowser has it. ;)

I hope you feel better soon, Bowser.

I get the flu shot--it's free, I get it where I work, and I'm exposed to lots of coughing, sneezing people all day. It's worth it for me.

[skullerello]

I've never had a "flu-shot"; I lived in a tiny, geographically isolated area. I worked in a convenience store, and still never got sick. I wasn't exposed to a large number of the (U.S.) population, but, from over a cross-section of the entire state of Wisconsin; and, still, I never got sick.
But my friend Donna (who'd had a liver-transplant) always insisted that I should still get a "flu-shot" .
I'd known other folks who had gotten their flu-shots and, yet, still managed to get sick.
I deemed them all "weak-willed losers".
I continued to drink heavilly, and began instead, to chart my BM's.

[This Guy]

I was given the flu shot every year for 20 years in the Navy. When I retired, I didn't go out and get the flu shot. That December, I got the flu. [SNIP]

Nice to see there are other swabbies on here ;)

I got off active duty from the Navy in 1986, after about 12 years. Might have had a flu shot the first few years out, because I was working at a medical facility (honestly don't remember getting the shot, but it's likely they offered them free to us). But haven't had one for over 10 years now, and unless it passed unnoticed, I haven't had the flu once.

I used to hate getting the shot. It always wasted me. I'd have to go back home, and just crash for the rest of the day. By the next morning I'd be ok, but that night after the shot I was useless.

I keep thinking that as I get older, I should start taking them again. But figure I'll wait till I get a good case of the flu before I do.

[Mongrel]

Do they work - Evidence points that way.
Would I have it if offered - damn right.

I never had Flu until 2000\2001. New Years Eve so I was imbibing freely after I'd finished work and got light headed quicker than I would have expected. About 9PM I started to get a scratchy throat, I thoughtobviously that I was just getting a little dehydrated so alternated beers with juice for the rest of the night.

Next morning I surfaced into conciousness with the worst sore throat I'd ever had, muscle pains that felt like I'd been the victim of a brutal mugging, a feeling that my skin had been lightly sandpapered all over, a wracking cough and a fever high enough that my Pharmacist girlfriend was going to carry me to A&E.

Those symptoms lasted for about 5 days (the fever went down quickly with NSAIDs) and after that I was as weak as a kitten for another 6 or 7. I learnt two things from this;
Being off work for a couple of days means you haven't had Flu, it's just a cold.
If you're ever offered a Flu shot - take it

[Hydrogen Cyanide]

This evening during her violin lesson my daughter started to feel very tired and cruddy. Her eyes would start tearing for no apparent reason. In the car she insisted on having the heat on full blast.

When we got home she asked for more blankets because she could not get warm. I took her temperature and it was over 100 degrees F. And now her muscles hurt, lots.

So she now has the flu.

A couple of weeks ago she got her Tdap vaccine. I explained to her that this was new because pertussis was coming back, and it was very very bad and can cause death in very young children. I did tend to rant about my opinion on anti-vaxers.

Then later in the week her oldest brother got the influenza vaccine because he has a very severe heart disorder. The doctor even told me he worries more about the flu than pertussis with him (my oldest could not get the Tdap because he is 18 years old).

So now my daughter asked me twice this evening if she has the flu her brother was vaccinated for... and is it the one that causes death.

Oh, crud... I feel like a bad scaremongering parent right now.

I did tell her that the deaths are with older people and those with health problems (like her brother), not young healthy kids like herself.

I hope I'm right.... and I hope I don't get what she has.

[Fidelio]

At my age of 54 it matters not whether 'tis woo woo or not. (Anecdote follows)

Prior to getting flu shots I was in bed for around a week a year...what the bug was I have no way of knowing... (it ain't like the guys in the navy uniforms from the CDC come knocking on the door)

I haven't had that since. Therefore as I am too old to spend a week with one foot in the grave and the other on a banana peel, I choose the shots.
[/anecdote]

[rjh01]

I used to be sick for a couple of weeks every winter with the flu. Now work offers it to us for free. I take it and not been sick since. With one exception. I had not taken the flu shot that year.

[skeptigirl]

Influenza is not rare. CDC current flu activity as well as activity the past few years. (http://www.cdc.gov/flu/weekly/fluactivity.htm) The WHO, Europe, and a few other countries have similar report web sites.

The flu is a serious respiratory infection not a stomach infection as many believe. There are ~200 known respiratory pathogens and the flu represents only a small percentage. But it kills many more people than most the others. If you have a sudden onset of a high fever, headache, muscle aches, and by the next day have a sore throat and cough during flu outbreaks it is more likely the flu than not. If you have a scratchy throat and runny nose that turns into a cough and has a mild fever it is unlikely to be the flu.

A considerably large portion of public health money is spent by all modern countries monitoring and evaluating flu risk annually. This includes monitoring human and animal influenza disease. The virus' genetic drift (and shift when recombinant strains emerge) is continually determined by sampling the virus from animals and humans as outbreaks circle the globe following the endless winter.

Vaccine composition is determined by the WHO twice a year based on what is actually circulating. Vaccine strain viral cultures maintained by the WHO are then distributed to vaccine manufacturers from which they produce vaccine. There is a southern hemisphere and a northern hemisphere version with production set for the fall in each hemisphere. It contains 3 strains because adding more gets you the law of diminishing return. You get very little additional coverage for circulating strains by adding more than 3. The vaccine will change 1,2 or 3 of the strains it contains from year to year.

The virus' lethality and complication rate are seriously underestimated by most people.

The vaccine is very safe compared to the risk from the disease.

It doesn't make you ill as many believe. There are placebo controlled studies showing that.

The vaccine is not the biggest money maker for drug companies which is one reason not enough is produced every year.

The current HPAI-H5N1 (bird flu) reminder that a deadly pandemic of influenza is cyclic and we have no means yet to stop it when it happens has renewed interest in potential profit therefore research has resumed in earnest among a few vaccine manufacturers.

A recent study (http://www.sciencedaily.com/releases/2006/10/061026185115.htm) published which analyzed the viral changes of regular flu over a few years indicated it remains the same as far as your immune system recognizing it for long stretches then a new version will emerge and rapidly become the dominant strain. This happened recently with H5N1 (http://www.promedmail.org/pls/askus/f?p=2400:1001:3124651568547661419::NO::F2400_P1001 _BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,35025) as well though the new version remains deadly and is not spreading among humans very efficiently just like the first version. Original article (http://www.pnas.org/cgi/content/abstract/0608157103v1?etoc) (BTW, there are several H5N1 strains that are not very dangerous and are worldwide. The deadly version emerged from the mild strains in 1997.)

Your vaccine will last anywhere from several months to a few years depending on your immune system but since you don't get a 'series' it doesn't last as long as say a tetanus vaccine. However it's a moot point since the virus will drift enough to appear as a new organism to your immune system every year or two anyway.

Oh, BTW, as an infectious disease practitioner, I get a flu shot and give one to my son every year.

[Dymanic]

Once I retired, I got this pneumonia shot my wife told me about, and its been six years since I have had that hacking.
If you were under 65 when you got the first pneumovax, you should get a booster after five years.

[jimtron]

(bump)

Any significant downsides to getting a flu shot?

[skeptigirl]

None that are evidence based.

[ChaoticLimbs]

I take medical advice from my doctor, not anonymous internet-people.
He went to school for that.

[skeptigirl]

I take medical advice from my doctor, not anonymous internet-people.
He went to school for that.So what is your point? That the medical providers in this forum somehow can't make a simple statement about the risks vs benefit of flu vaccinations?

I'd be careful if I were you about putting so much faith in your personal physician. I teach my patients that they should consider health care more of a buyer beware situation. The more you know about your medical care, the better you can determine together with your provider what the best course of care should be.

[Complexity]

I plan on getting a flu shot soon.

[JEROME DA GNOME]

Are vaccines stifling the progress of evolution?

[skeptigirl]

No, Jerome, unless you want evolution divorced from all technology. Are cars making us poorly adapted creatures? What about horses? Shoes? Houses? ........

[JEROME DA GNOME]

No, Jerome, unless you want evolution divorced from all technology. Are cars making us poorly adapted creatures? What about horses? Shoes? Houses? ........

Does not a flu vaccine; for the most part, just prevent the sickly from dying?

[skeptigirl]

No. It prevents healthy people from dying as well, it keeps young children out of the hospital, and some of those elderly people you speak of have plenty more to contribute to the world if they stick around longer.

And, you asked about evolution. Since the elderly are past reproduction, evolution is not going to be affected anyway.

[UnrepentantSinner]

(bump)

Any significant downsides to getting a flu shot?

I don't plan on getting one any time soon so it's my unbiased opinion that there are no down sides to getting a flu shot and, if you want to get one, you should.

[JEROME DA GNOME]

No. It prevents healthy people from dying as well, it keeps young children out of the hospital, and some of those elderly people you speak of have plenty more to contribute to the world if they stick around longer.

But mostly the sickly succumb. I found this: Flu-Related Deaths Up Sharply (http://www.cbsnews.com/stories/2003/01/07/health/main535605.shtml)

To the original point: Despite the advent of a vaccine four decades ago, flu-related deaths in the United States have risen dramatically since the 1970s...

Flu deaths have increased since the advent of the vaccine?
Maybe the distributors also believe that the vaccine mucks with evolution?



And, you asked about evolution. Since the elderly are past reproduction, evolution is not going to be affected anyway.

No, we have drugs that allow for the elderly to procreate. This goes to the same question. Should we use drugs to allow the elderly to have children? Is this stifling evolution?

[rjh01]

But mostly the sickly succumb. I found this: Flu-Related Deaths Up Sharply (http://www.cbsnews.com/stories/2003/01/07/health/main535605.shtml)

To the original point:

Flu deaths have increased since the advent of the vaccine?
Maybe the distributors also believe that the vaccine mucks with evolution?



I do not understand your point. The article you quoted explains it all.
The rising death toll is attributed largely to the nation's growing number of elderly people, who are especially vulnerable to the flu.

Only about 65 percent of older people get vaccinated, and the annual shots do not protect aging immune systems as well as they do younger ones.
In other words the death toll would have been even higher if the vaccine did not exist.

[Roboramma]

Are vaccines stifling the progress of evolution? Would that be a bad thing?

But to answer your question - no. All it does is change the selective pressures, just like any other change to the environment.

A flu vacine means the those who put their resources in to things other than preventing themselves from getting the flu, and fighting it when they've got it, are more likely to survive. Say there were a mutation that caused it's bearers to be more likely to be able to run fast, but also to have a slightly greater susceptibility to the flu. The vacine would remove a selective pressure against this mutation, and it might begin to spread through the population. Is that stifling evolution?

Such an idea isn't all that far fetched. Sickle-cell anemia and it's relationship to maleria is a good example of exactly what I'm talking about.

[sophia8]

No, we have drugs that allow for the elderly to procreate. This goes to the same question. Should we use drugs to allow the elderly to have children? Is this stifling evolution?
Wrong. In the case of women, no amount of "drugs" will let them pass on their genes once they are past the menopause; post-menopausal mothers have no eggs of their own and have to use donor eggs, which are invariably from healthy young women. Men can produce sperm and pass on their genes at any age; the only drug they are likely to need is Vl@gr@.

[Roboramma]

No, we have drugs that allow for the elderly to procreate. This goes to the same question. Should we use drugs to allow the elderly to have children? Is this stifling evolution? If we are making it easier for the elderly to procreate what sort of evolutionary outcomes would you expect to occur?
The only ones I would expect would be positive:
By making it possible for the elderly to procreate we change the selective landscape, and health in old age would be selected for. If people can reproduce longer, dying at sixty, rather than seventy, is suddenly selected against.
So, if anything, I would expect the outcome (long term obviously) of this to be evolution toward longer lifespans.

Again, how is that bad, exactly?

[Complexity]

What 'progress' of evolution?

[fls]

Women past menopause can still influence evolution if you take into consideration the Grandmother Hypothesis. The additional care provided by a grandmother could increase the chance of survival of her grandchildren and therefore the genes that they share.

Linda

[Michael Redman]

A money making scheme? It's primarily the government pushing flu shots. There's no money in it for them. Very little, if any, money in it for doctors and nurses who dispense it, and they're the other folks telling people to get them. If there was money in it for the manufacturers, there would be advertisement. I've never seen a commercial advertisement pushing flu shots.

[Michelle]

A money making scheme? It's primarily the government pushing flu shots. There's no money in it for them. Very little, if any, money in it for doctors and nurses who dispense it, and they're the other folks telling people to get them. If there was money in it for the manufacturers, there would be advertisement. I've never seen a commercial advertisement pushing flu shots.

Then it is obviously a scheme by the government to control your brain and make you blind to the great conspiracies they are leading while making you hate communists. :P

I'm getting mine monday... I don't like shots :boxedin: But I hate flus even more!

[kellyb]

It's being pushed because the same manufacturing facilities used to make the seasonal vaccines can be quickly converted to make birdflu vaccines in the event of a pandemic.
So a while back the WHO decided that the best way to save the world from birdflu would be to increase seasonal vaccine uptake by 75% in the developed world.
If people don't buy the seasonal flushots every year, then the manufacturers will withdraw from the market, close the plants, etc. and then we'll be up the proverbial creek without a paddle when we really need a gazillion doses of, say, an H5N1 vaccine.

Hence the CDC's ever-expanding recommendations which appear (and are, I'd argue..hi, skeptigirl. :)) rather bizarre on the surface, and strange things like this:
http://www.local6.com/spotlight/14350182/detail.html

Strip Club Offers Free Flu Shots

CASSELBERRY, Fla. -- An adult nightclub in Casselberry is offering free flu shots to Central Floridians.

Rachel's Gentlemen's Club launched a free flu shot service at the business located on Semoran Boulevard in Casselberry.

[JEROME DA GNOME]

I do not understand your point. The article you quoted explains it all.

In other words the death toll would have been even higher if the vaccine did not exist.

The article stated; according to the CDC, that flu deaths have increased fourfold since the introduction of the vaccine.

Fourfold is 4 times as many.

[JEROME DA GNOME]

A money making scheme? It's primarily the government pushing flu shots. There's no money in it for them. Very little, if any, money in it for doctors and nurses who dispense it, and they're the other folks telling people to get them. If there was money in it for the manufacturers, there would be advertisement. I've never seen a commercial advertisement pushing flu shots.

The governmnet advertises for the manufactures.

[Dymanic]

It's being pushed because the same manufacturing facilities used to make the seasonal vaccines can be quickly converted to make birdflu vaccines in the event of a pandemic.
The argument I've most often encountered is exactly the reverse: that the pandemic influenza threat is overstated (or even completely fabricated) in order to stimulate sales of seasonal flu vaccines -- an argument which (where it is permitted to do so) may be dismissed as conspiracy theory.

Your logic makes at least enough sense to deserve a closer look. What you are basically saying is that the consensus among a large community of infectious disease experts is that the best hope of marshalling an effective response to an influenza pandemic is a widespread program of vaccination. This consensus rests on the assumption that it is possible to formulate a vaccine capable of providing effective protection against an influenza virus (any influenza virus). Whether you believe that or not is irrelevant; you are (indirectly) arguing that they believe it. If you follow me so far, I wonder if you'd agree that if they believe that a vaccine can be effective against a pandemic influenza, it is very likely that they may also believe that a vaccine can be effective against seasonal influenza, and that while it may be true that stimulating sales of seasonal vaccines might be viewed as the most direct approach to the problem of limited vaccine production capacity (given the constraints of a system in which health care is profit-based), it logically follows that the same experts would also be very likely to view the practice as the most effective way of controlling seasonal influenza? As kind of a bonus?

[JEROME DA GNOME]

The argument I've most often encountered is exactly the reverse: that the pandemic influenza threat is overstated (or even completely fabricated) in order to stimulate sales of seasonal flu vaccines -- an argument which (where it is permitted to do so) may be dismissed as conspiracy theory.

Your logic makes at least enough sense to deserve a closer look. What you are basically saying is that the consensus among a large community of infectious disease experts is that the best hope of marshalling an effective response to an influenza pandemic is a widespread program of vaccination. This consensus rests on the assumption that it is possible to formulate a vaccine capable of providing effective protection against an influenza virus (any influenza virus). Whether you believe that or not is irrelevant; you are (indirectly) arguing that they believe it. If you follow me so far, I wonder if you'd agree that if they believe that a vaccine can be effective against a pandemic influenza, it is very likely that they may also believe that a vaccine can be effective against seasonal influenza, and that while it may be true that stimulating sales of seasonal vaccines might be viewed as the most direct approach to the problem of limited vaccine production capacity (given the constraints of a system in which health care is profit-based), it logically follows that the same experts would also be very likely to view the practice as the most effective way of controlling seasonal influenza? As kind of a bonus?

I am beginning to think this should be moved to the CT section.

Are people/groups this calculating?

[kellyb]

I wonder if you'd agree that if they believe that a vaccine can be effective against a pandemic influenza, it is very likely that they may also believe that a vaccine can be effective against seasonal influenza, and that while it may be true that stimulating sales of seasonal vaccines might be viewed as the most direct approach to the problem of limited vaccine production capacity (given the constraints of a system in which health care is profit-based), it logically follows that the same experts would also be very likely to view the practice as the most effective way of controlling seasonal influenza? As kind of a bonus?

Well, flushots aren't particularly harmful, and they appear to have some small effectiveness, so it could easily be viewed as a win/win situation.
There's also a lot of research going into ways to make the vaccines more effective, which I think you'd agree is a good idea if the ultimate goal is to save lives, particularly in the event of a pandemic.

[Frost]

But mostly the sickly succumb. I found this:

To the original point:

Flu deaths have increased since the advent of the vaccine?
Maybe the distributors also believe that the vaccine mucks with evolution?





No, we have drugs that allow for the elderly to procreate. This goes to the same question. Should we use drugs to allow the elderly to have children? Is this stifling evolution?


Wouldn't sick days due to the flu be something worth preventing too?

[JEROME DA GNOME]

Well, flushots aren't particularly harmful, and they appear to have some small effectiveness, so it could easily be viewed as a win/win situation.
There's also a lot of research going into ways to make the vaccines more effective, which I think you'd agree is a good idea if the ultimate goal is to save lives, particularly in the event of a pandemic.

According to the CDC; since the introduction of the flu shot, flu deaths have increased by 4 times.

:jaw-dropp

4 times as many people have died each year since the flu shot began to be implemented.

I suggest a moratorium to see if the flu shot contributes to flu deaths.

[JEROME DA GNOME]

Wouldn't sick days due to the flu be something worth preventing too?

Sure, if it is proven to do that. The evidence thus far suggests that the flu shot may have contributed to a 4 times greater death rate due to the flu.

[kellyb]

Wouldn't sick days due to the flu be something worth preventing too?

From "Preventing Flu in Healthy Adults", that Katana mentioned earlier;

http://64.233.179.104/scholar?hl=en&lr=&q=cache:V2gTLPDN5TQJ:www.nuh.com.sg/x_apebm/CourseMaterials/5_Overview_Meta_UP/2_Article1.pdf+

Effect of vaccination on other outcomes
Six trials evaluated time off work, estimating that vaccination saved on average around 0.12 working days. This result was not statistically significant.



http://www.bmj.com/cgi/content/full/333/7574/912
The second problem is either the absence of evidence or the absence of convincing evidence on most of the effects at the centre of campaign objectives (table 2). In children under 2 years inactivated vaccines had the same field efficacy as placebo,8 and in healthy people under 65 vaccination did not affect hospital stay, time off work, or death from influenza and its complications

[Dymanic]

The evidence thus far suggests that the flu shot may have contributed to a 4 times greater death rate due to the flu.Statistics isn't really your strong suit, is it?

[kellyb]

Your logic makes at least enough sense to deserve a closer look.

Take a look. :)
(dug up links)
It's not my logic; it's just a fact.

http://www.pharmaceutical-business-review.com/article_feature.asp?guid=C4410902-FB92-4ADE-89F0-26BADA77D453

Ultimately, an improved vaccination coverage for the common seasonal influenza is a fundamental part of a strategy to enhance global preparedness for the anticipated avian influenza pandemic.

As part of its pandemic preparedness plan, designed to contain the threat posed by the avian H5N1 strain, the WHO clearly states that adequate manufacturing capacities for pandemic vaccines can best be achieved by increasing vaccination coverage during seasonal epidemics.

http://www.who.int/mediacentre/events/2005/03_WHO_Klaus_Stohr.pdf


Influenza pandemic vaccines: challenges
and opportunities

Influenza Pandemic Vaccines
Production capacity


Increase vaccination coverage of seasonal influenza
vaccine in developed countries to 75%

Now this part is my logic, but I wonder... how do you convince a whole, whole, whole bunch more people to start getting flushots?
What would be an effective way of getting 75% coverage in developed countries?

And I think that's what's up with this:



http://www.ama-assn.org/ama1/pub/upload/mm/36/2004_flu_nowak.pdf



“Recipe” that Fosters Higher Interest and
and Demand for Influenza Vaccine

1.Influenza’s arrival coincides with immunization “season” (i.e., when people can take action)

2.Dominant strain and/or initial cases of disease are:
–Associated with severe illness and/or outcomes
–Occur among people for whom influenza is not generally perceived to cause serious complications (e.g., children, healthy adults, healthy seniors)
–In cities and communities with significant media outlets (e.g., daily newspapers, major TV stations)

3.Medical experts and public health authorities publicly (e.g., via media) state concern and alarm (and predict dire outcomes)–and urge influenza vaccination.


4.The combination of ‘2’ and ‘3’ result in:
A.Significant media interest and attention
B.Framing of the flu season in terms that motivate behavior (e.g., as “very severe,” “more severe than last or past years,” “deadly”)

5.Continued reports (e.g., from health officials and media) that influenza is causing severe illness and/or affecting lots of people–helping foster the perception that many people are susceptible to a bad case of influenza.

6.Visible/tangible examples of the seriousness of the illness (e.g., pictures of children, families of those affected coming forward) and people getting vaccinated (the first to motivate, the latter to reinforce)


7.References to, and discussions, of pandemic influenza–along with continued reference to the importance of vaccination.
(emphasis mine)

That kinda threw me for a loop for a while and had me wondering exactly who the CDC worked for...but the idea that they're doing that to comply with the WHO objective of increasing vaccine uptake for the purpose of saving the world from birdflu makes sense to me.

[Ivor the Engineer]

Take a look. :)
(dug up links)
It's not my logic; it's just a fact.

http://www.pharmaceutical-business-review.com/article_feature.asp?guid=C4410902-FB92-4ADE-89F0-26BADA77D453

.



http://www.who.int/mediacentre/events/2005/03_WHO_Klaus_Stohr.pdf






Now this part is my logic, but I wonder... how do you convince a whole, whole, whole bunch more people to start getting flushots?
What would be an effective way of getting 75% coverage in developed countries?

And I think that's what's up with this:



http://www.ama-assn.org/ama1/pub/upload/mm/36/2004_flu_nowak.pdf



















(emphasis mine)

That kinda threw me for a loop for a while and had me wondering exactly who the CDC worked for...but the idea that they're doing that to comply with the WHO objective of increasing vaccine uptake for the purpose of saving the world from birdflu makes sense to me.

Hmmm. That sounds ethically dubious. A government agency frightening people to boost sales so the manufacturers don't close their plants down. I suppose the question is: Do the ends justify the means?

[Dymanic]

It's not my logic; it's just a fact.It's your interpretation of (one set of) facts. To be a bit pedantic.

The first of your links was to an article in a business journal. Not sure why you'd consider that relevant to evaluating whatever motivations WHO and CDC might have for promoting flu vaccines.

As for the second, if the quote: "the WHO clearly states that adequate manufacturing capacities for pandemic vaccines can best be achieved by increasing vaccination coverage during seasonal epidemics." appears anywhere, I'm danged if I can find it; I'm not sure if the formatting problems with that PDF are local to my system or what, but it's looking pretty mangled here. I'm able to resolve that it predicts the outcomes of increase vaccination coverage of seasonal influenza
vaccine in developed countries to 75% as:

Significant decrease in death and disease from seasonal influenza
Cost-effective reduction in health implications (cost-saving in some countries)
Increase in global vaccine production capacity by 60%

Which is pretty much what I said above.

As for the third, I think the reason the business about the "recipe" throws you for a loop is that you assume that it is intended to be prescriptive rather than descriptive; you are reading motivation into it. Speaking of a "recipe for disaster" doesn't necessarily imply a desire or an intent to try to cook one up. A clue is this statement: "A large component of consumer demand for flu vaccination is contingent upon things we can’t control"

The CDC doesn't have control over the virus, it doesn't have control over the media, it doesn't have control over individual physicians and care providers, and it doesn't have control over what every public health care person may say in front of a microphone. The article addresses the challenges of effective risk communication in the face of such uncontrollable factors, and basically concludes that people are going to believe what they're going to believe, and behave how they're going to behave, and there really isn't all that much you can do about it.

[robinson]

Considering the amount of time and effort required to gain approval for a medicine or drug, how can each years new flu vaccines possibly meet the safety and efficiency test before being used?

How can anyone even know if they are safe? And that the vaccine actually works? Where is the science to back up the claims made?

[robinson]

Take a look. :)
(dug up links)
It's not my logic; it's just a fact.

Wow. Wow. I'm not sure what to think. Can that be true?

[kellyb]

As for the second, if the quote: "the WHO clearly states that adequate manufacturing capacities for pandemic vaccines can best be achieved by increasing vaccination coverage during seasonal epidemics." appears anywhere, I'm danged if I can find it;

That's weird...
It's not a PDF.
Can you get to it through a google search?
http://www.google.com/search?hl=en&rls=GGLF%2CGGLF%3A2006-13%2CGGLF%3Aen&q=%22As+part+of+its+pandemic+preparedness+plan%2C+ designed+to+contain+the+threat+posed+by+the+avian+ H5N1+strain%2C+the+WHO+clearly+%22&btnG=Search


As for the third, I think the reason the business about the "recipe" throws you for a loop is that you assume that it is intended to be prescriptive rather than descriptive; you are reading motivation into it. Speaking of a "recipe for disaster" doesn't necessarily imply a desire or an intent to try to cook one up.

You can't be serious!
Nowak is the CDC's "Communicatons" director. He's a marketing guy. Before he went to work for the CDC he worked in advertising.

Look what they say next:

Influenza Immunization
Communication Challenges (2)

•Some component of success (i.e., higher demand for influenza vaccine) stems from media stories and information that create motivating (i.e., high) levels of concern and anxiety about influenza.
•Inducing worry, raised anxiety, and concern in people brings forth a number of issues and presents many dilemmas for health care professionals.

And can leave you searching for the
“Holy Grail” of Health Communication
(Lanardand Sandman, 2004)

The belief that you can inform and warn people, and get them to take appropriate actions or precautions with respect to a health threat or risk without actually making them anxious or concerned. (Remember the quiz?)
This is not possible. Rather. . .
“This is like breaking up with your boyfriend without hurting his feelings. It can’t be done.”

Not prescriptive my butt!

The article addresses the challenges of effective risk communication in the face of such uncontrollable factors, and basically concludes that people are going to believe what they're going to believe, and behave how they're going to behave, and there really isn't all that much you can do about it.

Yeah...you're left with sending media packets out and hoping that just scaring the snot out of people is effective.

[ExMinister]

So, would the medical practitioners here posting consider it worthwhile to spend $26 per flu shot to have an otherwise healthy family of four vaccinated, with small children, ages 4 and 5? It's definitely not free in our community. I'm considering it because we all had the flu back in 2003, my 8-month-old's turned into croup and pneumonia, he had to be hospitalized and almost didn't make it. This was serologically tested (type B, if I recall) influenza and we were all sicker than I can ever remember having been. But if the shots aren't all that effective, I hate to spend $26 per shot.

[Dymanic]

It's not a PDF.
Whatever. I'm willing to stipulate that the WHO is interested in increasing manufacturing capacities for flu vaccines as a preparedness measure against pandemic flu, and that this increases their interest in promoting seasonal vaccines. I just don't see this as their only motivation for doing so; they also believe in vaccination as an effective measure against seasonal influenza.

You can't be serious!I am completely serious. I know that you are quite attached to this document, and to a certain interpretation of it. Demand for flu vaccines can vary widely from one season to another. Understanding this fluctuation is a problem for a person with experience in marketing; hence, this evaluation:

"Vaccination demand, particularly among people who don’t routinely receive an annual influenza vaccination, is related to heightened concern, anxiety, and worry."

In other words (ignoring two categories: people who routinely get the vax, and people who never get the vax), demand is not based on critical thinking, scientific literacy, reasoned judgement, careful consideration of evidence, or anything like that; it's based on emotion. This is an observation, being made by someone with experience in making observations about what motivates demand for a product.

Look closely at these statements:

"Medical experts and public health authorities publicly (e.g., via media) state concern and alarm (and predict dire outcomes)–and urge influenza vaccination"

"Some component of success (i.e., higher demand for influenza vaccine) stems from media stories and information that create motivating (i.e., high) levels of concern and anxiety about influenza."

"The combination of ‘2’ and ‘3’ result in:
A.Significant media interest and attention"

These are descriptions of aspects of a process over which the WHO and the CDC have no control. The article's central theme reduces to: "You can't use science to persuade idiots; the threats they will take seriously will be those which the media selects for entertainment value".

[ExMinister]

Disregard above question, have found a place offering the shots for free. :) Even if they're just a little bit effective, they're probably worth getting if free. Having the flu was a wretched experience that I would definitely like to avoid repeating.

[kellyb]

"Medical experts and public health authorities publicly (e.g., via media) state concern and alarm (and predict dire outcomes)–and urge influenza vaccination"

These are descriptions of aspects of a process over which the WHO and the CDC have no control.

So after the CDC decides they need their spokespeople in the media stating concern and alarm, and predicting dire outcomes...and they end up in the news doing just that, it's a process they have no control over?
You don't think the CDC ever contacts the media with good stories that need to be told in the interest of health communication?

[JEROME DA GNOME]

So, would the medical practitioners here posting consider it worthwhile to spend $26 per flu shot to have an otherwise healthy family of four vaccinated, with small children, ages 4 and 5? It's definitely not free in our community. I'm considering it because we all had the flu back in 2003, my 8-month-old's turned into croup and pneumonia, he had to be hospitalized and almost didn't make it. This was serologically tested (type B, if I recall) influenza and we were all sicker than I can ever remember having been. But if the shots aren't all that effective, I hate to spend $26 per shot.

According to the CDC, flu deaths have increased by 4 times since the introduction of the flu shot.

There should be a moratorium until science determines if the flu shot is a factor in the increased flu deaths.

[JEROME DA GNOME]

Disregard above question, have found a place offering the shots for free. :) Even if they're just a little bit effective, they're probably worth getting if free. Having the flu was a wretched experience that I would definitely like to avoid repeating.

I doubt the shots are "free". Who is really paying for the shots?

[JEROME DA GNOME]

So after the CDC decides they need their spokespeople in the media stating concern and alarm, and predicting dire outcomes...and they end up in the news doing just that, it's a process they have no control over?
You don't think the CDC ever contacts the media with good stories that need to be told in the interest of health communication?

Drug companies do not lobby the governmnet!

You are outrageous!

:boggled:

[Dymanic]

You don't think the CDC ever contacts the media with good stories that need to be told in the interest of health communication?The CDC "serves as the national focus for developing and applying disease prevention and control, environmental health, and health promotion and health education activities designed to improve the health of the people of the United States."

With that mission statement in mind, what would you consider the ideal approach to communicating a threat, when a consensus among experts indicates that a threat exists?

[JEROME DA GNOME]

The CDC "serves as the national focus for developing and applying disease prevention and control, environmental health, and health promotion and health education activities designed to improve the health of the people of the United States."

With that mission statement in mind, what would you consider the ideal approach to communicating a threat, when a consensus among experts indicates that a threat exists?

Assuming that the CDC being a governmental organization is immune from the vast amounts of cash funneled into the governmnet by the manufacturers of the vaccine the implication of your question would be correct.

[kellyb]

With that mission statement in mind, what would you consider the ideal approach to communicating a threat, when a consensus among experts indicates that a threat exists?

Are you talking about birdflu here or seasonal flu?
I don't really see where you're going with this. Health marketing uses a variety of strategies.
Here are just a few:

(from their script suggestions page)
http://www.cdc.gov/healthmarketing/entertainment_education/tips/influenza.htm
Case Examples
1. A 70-year-old grandmother flies across the country to visit her family. After landing, she has a scratchy throat, coughs a little, and is tired and maybe even a little feverish, but she chalks it up to the long flight. At her daughter's house, she lies down. The daughter checks on her a bit later, and finds her burning with fever, with an intense headache and body aches. She is coughing and congested. The daughter calls a doctor who says the symptoms sound like influenza infection. Has the mother had a flu shot? No. The mother and daughter immediately go to the hospital emergency room where the diagnosis is acute bronchitis infection and pneumonia. The mother is hospitalized, antibiotics are administered, but her condition declines. She dies three days later.



http://www.cdc.gov/healthmarketing/basics.htm
A Health Marketing Example
The CDC develops a new rapid HIV testing kit that provides results in half the time of current tests. To efficiently market the new product, the testing kits are announced by the national media and medical journals. The CDC sends free samples of the new testing kits to each of the state health departments, who deliver them to local health departments, clinics and hospitals. Here is how the CDC used the marketing mix:
Product: new HIV testing kit; released by a credible research agency
Price: free for trial use
Place: widely and evenly distributed throughout states using state and local health departments
Promotion: national media publicizes to public; journals inform medical community



http://www.cdc.gov/healthmarketing/entertainment_education/index.htm

The media is a resource.
They also make little posters and stuff.


http://www.cdc.gov/flu/professionals/flugallery/2007-08/edumat_dad-baby.htm
http://www.cdc.gov/flu/professionals/flugallery/2007-08/edumat_mom-baby.htm
http://www.cdc.gov/flu/professionals/flugallery/2007-08/images/p_grandfather65_aa_180x240.gif
http://www.cdc.gov/flu/professionals/flugallery/2007-08/images/p_nurse_personal_5people_180x240.gif

[Ivor the Engineer]

Why don't they try honest(-ish) marketing?

Like saying:

"Guys, if we don't use enough flu vaccine the companies that make it for us are going to ramp down production and close their manufacturing plants. When pandemic flu arrives, a lot more people than usual will be at risk of serious or fatal illness and require a flu jab. Unless we have the capacity to treat them now, many more people will die in the future."

[kellyb]

I guess they think what they're doing now is more effective?
Plus, they do seem to really think that getting every man, woman and child (and infant now) to get a flu vaccine every year will save lots of lives from seasonal flu.
So since the "Do this or DIE" "message" is effective, why mess with perfection?
I also get the impression that there's a kind of almost religious-type "belief" in flu vaccines. People are slow to let go of old ideas about stuff. It's human nature.
Or something. I dunno.
Weird situation, for sure.

[Dymanic]

Are you talking about birdflu here or seasonal flu?
Let's say seasonal flu.

I don't really see where you're going with this.
You asked: "You don't think the CDC ever contacts the media with good stories that need to be told in the interest of health communication?" I'm asking whether you think it is proper for the CDC to do such a thing, or what sort of alternative you might propose.

Plus, they do seem to really think that getting every man, woman and child (and infant now) to get a flu vaccine every year will save lots of lives from seasonal flu.I think that's an important point. The conspiracy theorist might argue that they (which includes most physicians as well as public health officials) really don't think flu vaccines are effective, but promote the practice because they are all in Big Pharma's pockets. I'm glad that we agree on this.

I also get the impression that there's a kind of almost religious-type "belief" in flu vaccines.That sounds a lot like a familiar creationist argument. I think it's useful to make a distinction between subjective opinions and reasoned judgements. A frighteningly large number of people in Idiot America are unable to make this distinction. Since you aren't one of them, it's surprising to see you try to dismiss a consensus among public health care professionals as some mere quirk of human nature.

[Beth]

I guess they think what they're doing now is more effective?
Plus, they do seem to really think that getting every man, woman and child (and infant now) to get a flu vaccine every year will save lots of lives from seasonal flu.
So since the "Do this or DIE" "message" is effective, why mess with perfection?
I also get the impression that there's a kind of almost religious-type "belief" in flu vaccines. People are slow to let go of old ideas about stuff. It's human nature.
Or something. I dunno.
Weird situation, for sure.

The problem I see with this sort of marketing approach is that it degrades the credibility of the CDC. It's essentially crying wolf falsely and everyone knows the moral of that story. I have little respect for the CDC these days and almost all of their loss of crediblity in my eyes comes as a result of their public advisory messages and policy recommendations in regard to vaccinations.

[Segnosaur]

The article stated; according to the CDC, that flu deaths have increased fourfold since the introduction of the vaccine.

Fourfold is 4 times as many.

But the article already explained the problems:

- The total number of deaths may be higher, but then there are also more people alive, and they are living longer (and flu tends to affect older people more). For example, lets say you had a town of 100 people in the 70s. Lets say 10% of the people there MIGHT die from the flu, and a vaccine is brought in that will save half the deaths. As a result, 5 people die, 5 are saved. Twenty years later, the population of the town has doubled. 10% of the people might still die from the flu (total of 20 people)... Vaccines are still 50% effective. As a result, 10 people will die, 10 will be saved. The vaccine has saved people (in fact, more people than before), but because there are simply more people around more people die.

- the article you referred to also pointed out that many people in high risk groups simply aren't taking the vaccine. Can't blame the vaccine if you're not taking the shot.

[Segnosaur]

(bump)

Any significant downsides to getting a flu shot?
Don't think there's anything that significant. There is the cost (even if you get the shot for 'free', the government still charges you for it through your taxes). And, since most flu vaccines use eggs for incubation, people with an allergy to eggs might have a bad reaction to it.

[robinson]

Does anyone have any actual information about how Flu shots are made each year? Where do they get the "new" flu from to make the vaccines? How do they test them to make sure they are safe? That they actually work?

Solid scientific information about the manufacturing process. the safety and efficiency testing, would go a long way towards encouraging skeptical people to get the vaccines. It seems the problem is a lot of people are skeptical of the value of getting a shot.

If somebody is skeptical of a claim, evidence is one of the best ways to convince people to change their minds. Spurious claims and sketchy evidence, or worse, wild claims and fear mongering, don't do anything except further more skepticism about the validity of a claim.

How hard would it be to simply publish the scientific facts, along with the evidence for these facts, rather than keep claiming something is true?

So, does anyone actually have any facts about Flu vaccines? In regards to the main issues that are questioned by skeptics?

[fls]

I think I have less trouble trusting the ACIP because rather than picturing them as nameless corporate drones, some of them are people I worked with (my residency research was on vaccine policy) and whose opinions are highly respected for a reason. Plus I've served on various public health/advisory committees and so have first-hand experience with the kind of discussions that take place.

ETA: I've never seen anything remotely as 'calculating' as Kelly has proposed. The kind of people that are drawn to serve on these committees tend to be from the opposite end of the spectrum (usually at least a few raised as idealist hippie types (myself included ;)).

However, if the CDC is untrustworthy, what about policy from other countries (http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/07vol33/acs-07/index_e.html)?

Linda

[kellyb]

Hmm...I just jumped over to the WHO site, and it looks like it's a different branch of the CDC (not the ACIP) doing the brainstorming here...

http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_2004_3.pdf


Vaccines for pandemic influenza
Informal meeting of WHO, influenza vaccine manufacturers,
national licensing agencies, and government representatives
on influenza pandemic vaccines
SUMMARY REPORT
11–12 November 2004
Geneva, Switzerland

The American representative is:

Members of the WHO Global Influenza Surveillance Network:
Dr Nancy Cox
Director, WHO Collaborating Centre for Surveillance, Epidemiology and Control of
Influenza; Chief, Influenza Branch, Viral Disease Division
Centers for Disease Control and Prevention
Atlanta, Georgia USA

So she's way up in the WHO and the CDC.

And some of the highlights of the meeting:

Increased vaccination coverage during seasonal epidemics should be
recognized as the best long-term strategy for ensuring an adequate
manufacturing base for pandemic vaccines; national policies should seek to
improve vaccination coverage of groups at high risk of complications during
seasonal epidemics

Roles and responsibilities. Concerning roles and responsibilities, governments
were urged to provide a better environment for the development of influenza
vaccines in general, most notably by increasing the uptake of seasonal vaccines,
when this conforms with national health priorities. It was up to countries with
resources and manufacturing capacity to prepare the stage for responding to what
would unquestionably be a global threat.

Health officials and industry executives were in full agreement that increased use
of vaccines for seasonal epidemics represents the best long-term strategy for
increasing manufacturing capacity for pandemic vaccines.


These efforts went hand-in-hand with campaigns to improve uptake of seasonal
vaccine; several countries (Canada, Switzerland, the UK, and the USA) reported
impressive progress in this regard.

Yeah...I bet they did.

At this point industry stepped up and got to make their requests:

Partnerships needed in specific areas. Industry identified five main areas in
which public-private partnerships were needed to move the process forward: (1)
development of the seed vaccine and registration of a mock-up product, (2)
expansion of production capacities, (3) assurance of adequate supplies and
equitable distribution, (4) acceleration of time to market, and (5) assurance of
liability protection.


(2) Expanded capacity. Vaccine formulation – antigen content, adjuvants,
immunogenicity, and dose schedule – would ultimately influence the number of
doses available. Furthermore, increased uptake of seasonal vaccines would
profoundly expand global manufacturing capacity. This could be achieved
through government policies aimed at meeting WHO recommendations and
targets for seasonal vaccine coverage in high risk groups in countries where
influenza vaccination is part of national priorities for combating infectious
diseases.

(3) Supplies and distribution. Industry was keenly aware of the problem of
inadequate supply and inequitable distribution. Again, increased uptake of
seasonal vaccines was the best long-term strategy for increasing overall capacity.


Here's another one



http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_05_8-EN.pdf

2. Increase the supply of influenza vaccines
– Find ways to bridge the gap between current vaccine production capacity and
the expected demand during a pandemic
Ways must be found to ensure that countries without domestic manufacturing
capacity will have access to affordable vaccines in adequate quantities. Several
approaches are being pursued, including antigen sparing strategies, technology
transfer, and cell-culture and recombinant vaccine development. Increasing the
demand for seasonal vaccines expands overall manufacturing capacity. The
comparative effectiveness and implementation costs for the various approaches
have not been reviewed. An action plan, with specific recommendations for
countries with and without vaccine production capacity, is urgently required.

Increasing demand for influenza vaccines????

How in the world do you do that, I wonder....

Enhance utilization of seasonal influenza vaccines in high risk groups, in line
with WHO targets (50% coverage in 2006 and 75% in 2010)
Achievement of this goal requires global leadership in assessing and
communicating progress in influenza coverage in countries having national policies
for influenza vaccination and, elsewhere, in vulnerable groups. Other activities
include the development of recommendations to augment vaccine coverage in
target groups, support for the implementation of national vaccination programmes,
and the acquisition of better epidemiological and economic data on the burden of
seasonal influenza in developing countries.

So...
They were shooting for 50% by 2006 (last year)...and 75% by 2010...so we've got a ways to go with this whole thing, still, I think...

[fls]

I guess what I don't understand is why it is unreasonable to improve vaccination coverage in high risk groups - so much so that suggesting it's a good idea for more elderly people be vaccinated than unvaccinated becomes evidence of conspiracy?

Linda

[kellyb]

Most of the US is targeted for flu vaccination now.


What do you thnk about the "7 step recipe"?
Do you agree with Dymanic; it's simply a description of something the CDC has no control over?

[Beth]

You know Kelly, your posts do show evidence of a conscious plan to increase vaccination coverage. But I'm not entirely sure it's a 'bad thing'. Basically, the risk of an new pandemic flu is strain in real enough. They've happened in the past, it's pretty much a sure thing that it will occur again, it's a matter of when, not if. It makes sense to figure out how to make sure the manufacting and distribution facilities are in place to respond quickly and effectively to such an event and doing it the way they are makes sense economically, not just for vaccine manufacturers, but also for the general public.

While I don't like the scare tactics, as long as the vaccines remain optional I don't have a problem with the strategy of increasing demand for seasonal vaccines, particularly when they are targeting those who are most at risk.

[fls]

Most of the US is targeted for flu vaccination now.

But the 'targeting' and goals are really just directed at the high risk groups - trying to improve coverage to greater than 50% in the elderly, for example, where it will provide the most benefit.

What do you thnk about the "7 step recipe"?
Do you agree with Dymanic; it's simply a description of something the CDC has no control over?

It was clearly descriptive. Some parts would make no sense if read as prescriptive.

Linda

[kellyb]

While I don't like the scare tactics, as long as the vaccines remain optional I don't have a problem with the strategy of increasing demand for seasonal vaccines, particularly when they are targeting those who are most at risk.

It's kind of a weird situation, though, in that those who are most at risk are also the same people the vaccine doesn't even work in. (the very young and the very old).
And really, it's everyone who's being targeted now.

Remember this part of the recipe?

2.Dominant strain and/or initial cases of disease are:
–Associated with severe illness and/or outcomes
–Occur among people for whom influenza is not generally perceived to cause serious complications (e.g., children, healthy adults, healthy seniors)

And then there's the CDC's version of the vaccine's effectiveness that they use to push it, which doesn't line up with reality.
And that's not cool, either.
And then there's the overblown figures on annual influenza deaths (36,000?)
http://www.bmj.com/cgi/content/full/331/7529/1412
And THAT's not cool, either.
So the whole shebang leaves a bad taste in my mouth.

Not that I have any better ideas myself on what to do about pandemic influenza, because you're right...eventually some new, bad flu virus will emerge, even though I personaly doubt it'll be H5N1. But eventually one will, and it'll be "a lot worse" than seasonal flu.
But still....

[kellyb]

But the 'targeting' and goals are really just directed at the high risk groups -

Almost everyone is part of the high risk group, though. Infants, children, parents, grandparents, etc, etc.

It was clearly descriptive. Some parts would make no sense if read as prescriptive.

Linda

Ok. Let's break this down to it's most basic form.

Does the CDC contact the media and provide them with information to raise awareness about health related issues and motivate health behavior?

[JEROME DA GNOME]

But the article already explained the problems:

- The total number of deaths may be higher, but then there are also more people alive, and they are living longer (and flu tends to affect older people more). For example, lets say you had a town of 100 people in the 70s. Lets say 10% of the people there MIGHT die from the flu, and a vaccine is brought in that will save half the deaths. As a result, 5 people die, 5 are saved. Twenty years later, the population of the town has doubled. 10% of the people might still die from the flu (total of 20 people)... Vaccines are still 50% effective. As a result, 10 people will die, 10 will be saved. The vaccine has saved people (in fact, more people than before), but because there are simply more people around more people die.

- the article you referred to also pointed out that many people in high risk groups simply aren't taking the vaccine. Can't blame the vaccine if you're not taking the shot.

Those are all speculative reasons. This is why I propose a moratorium to determine if the flu shot does or does not contribute to flu death.

[Beth]

It's kind of a weird situation, though, in that those who are most at risk are also the same people the vaccine doesn't even work in. (the very young and the very old).
And really, it's everyone who's being targeted now.

Remember this part of the recipe?

And then there's the CDC's version of the vaccine's effectiveness that they use to push it, which doesn't line up with reality.
And that's not cool, either.
And then there's the overblown figures on annual influenza deaths (36,000?)
http://www.bmj.com/cgi/content/full/331/7529/1412
And THAT's not cool, either.
So the whole shebang leaves a bad taste in my mouth. Yeah, I agree. Not cool. As I said, the CDC does not have a lot of credibility with me. I kinda resent it. I'd like to be able to rely on their recommendations and not have to research stuff to the extent that I do.

Not that I have any better ideas myself on what to do about pandemic influenza, because you're right...eventually some new, bad flu virus will emerge, even though I personaly doubt it'll be H5N1. But eventually one will, and it'll be "a lot worse" than seasonal flu.
But still....

Oh, I agree with you regarding the kind of tactics you've posted about. Public trust is hard to regain and the loss of it has bad long-term consequences.

[fls]

It's kind of a weird situation, though, in that those who are most at risk are also the same people the vaccine doesn't even work in. (the very young and the very old).

Vaccine efficacy and effectiveness has been demonstrated in the old and the young in systematic reviews. The data on those less than 2 is arguably too sparse for separate analysis. Since complications are more severe in that age group, most places recommend that that group not be neglected while waiting for additional information. Effectiveness does decrease with extreme age, but it seems reasonable to continue helping the few for which it is effective.

And really, it's everyone who's being targeted now.

The emphasis continues to be on the high-risk groups.

And then there's the CDC's version of the vaccine's effectiveness that they use to push it, which doesn't line up with reality.
And that's not cool, either.
And then there's the overblown figures on annual influenza deaths (36,000?)
http://www.bmj.com/cgi/content/full/331/7529/1412
And THAT's not cool, either.
So the whole shebang leaves a bad taste in my mouth.

That is merely one person's opinion, and it seems to be someone who is unfamiliar with how to derive a reasonable figure. You would prefer that the CDC use a number it knows to be a gross underestimate instead of figuring out a way to get a more representative number?

Linda

[fls]

Almost everyone is part of the high risk group, though. Infants, children, parents, grandparents, etc, etc.

Huh? None of those are inclusive categories for high risk groups.

Ok. Let's break this down to it's most basic form.

Does the CDC contact the media and provide them with information to raise awareness about health related issues and motivate health behavior?

You are implying that they are making stuff up while everyone else stands idly by, in order to do so.

Linda

[robinson]

That isn't an answer.

[kellyb]

Huh? None of those are inclusive categories for high risk groups.
Are those groups not being targeted for increased vaccine uptake?

You are implying that they are making stuff up while everyone else stands idly by, in order to do so.

Linda
Is that a cryptic "Yes"?
(I'm thinking it is.)

[robinson]

Vaccine efficacy and effectiveness has been demonstrated in the old and the young in systematic reviews.

Link?

[kellyb]

Vaccine efficacy and effectiveness has been demonstrated in the old and the young in systematic reviews.
In the elderly, the same systematic reviews said a lot of it had to be due to selection bias, right?
Have you seen the new Simonsen study from a month or two ago?

The data on those less than 2 is arguably too sparse for separate analysis. Since complications are more severe in that age group, most places recommend that that group not be neglected while waiting for additional information.
Vaccinate all the babies now, figure out if it's safe and effective later.
Got it.

[Dymanic]

Have you seen the new Simonsen study from a month or two ago?I have. But for balance, let's include the one by Nichol et al (http://content.nejm.org/cgi/content/full/357/14/1373), which came out at about the same time, and indicated a 27% reduction in hospitalizations and a 48% reduction in mortality among vaccinated elderly.

[skeptigirl]

Do they work - Evidence points that way.
Would I have it if offered - damn right.

I never had Flu until 2000\2001. New Years Eve so I was imbibing freely after I'd finished work and got light headed quicker than I would have expected. About 9PM I started to get a scratchy throat, I thoughtobviously that I was just getting a little dehydrated so alternated beers with juice for the rest of the night.

Next morning I surfaced into conciousness with the worst sore throat I'd ever had, muscle pains that felt like I'd been the victim of a brutal mugging, a feeling that my skin had been lightly sandpapered all over, a wracking cough and a fever high enough that my Pharmacist girlfriend was going to carry me to A&E.

Those symptoms lasted for about 5 days (the fever went down quickly with NSAIDs) and after that I was as weak as a kitten for another 6 or 7. I learnt two things from this;
Being off work for a couple of days means you haven't had Flu, it's just a cold.
If you're ever offered a Flu shot - take itCould have been influenza but without a lab test one can't be sure. But your point is correct in that many cases of influenza are quite severe.

Characteristics of influenza: known flu cases around sudden onset high fever headache muscle aches bronchial cough

The influenza virus infects cilia cells in your trachea, whereas many other upper respiratory viruses infect the cells lining the pharynx. Influenza virus can also infect cells lining the lower airways and the alveoli (lung) in some cases. Despite the image of influenza being a minor illness, it is one of the deadliest infections on the planet.

The vaccine is practically painless, quick, cheap and by far the benefit outweighs any extremely rare risk from the vaccine. The main risk is a serious allergic reaction and in 17 years giving a couple thousand flu shots a year I have never seen a single allergic reaction. I have even vaccinated two people with a severe egg allergy using a special protocol and neither reacted.

One person in 17 years had temporary brachial nerve inflammation for several months. It has not recurred and he continues to get flu shots every year. I have not had a single other significant reaction reported to me from my patients.

In adults, placebo controlled double blind prospective studies have failed to find anything other than a mild sore arm as a reaction to a flu shot yet the myth the shots make you ill persist. In children very mild fever and malaise can occur but it is not common.

[skeptigirl]

....They are developed based on previous strains, yes. Whether they are effective against current years really depends on how much the virus has changed. Viruses, especially Infuenza Viruses, mutate and evolve very quickly. However, that being said, mutations do not always impact immune factors. 'Flu' mutants which have different surface proteins will be less effectively (or not at all, depending on the change) targetted by any vaccination...The strains included in each years' vaccine are determined by the WHO every 6 months. Samples of circulating virus are continually collected from 'sentinel' sites during influenza seasons in countries all over the world. The genetic changes are continually monitored. Based on the sampling, the WHO makes recommendations and provides the vaccine strains for manufacturers. In the Northern hemisphere in summer the strains are determined and in the Southern hemisphere in their summer the southern strains are determined. Then everyone produces the same vaccine for that year in that hemisphere. Only when significant genetic changes in circulating virus occur after the vaccine production has begun is there a mismatch. And even in those years the vaccine still offers reasonable protection.

The research on the effectiveness has already been well covered here. Sadly a couple members of our forum have latched on to some initial studies which found little difference in death rates in the elderly since introduction of large scale flu vaccine programs. A fair amount of research after those particular studies consistently found clinical benefits in influenza vaccine programs. I was interested in those initial studies and appreciate that they were brought up in the discussions we have had here. If the science wasn't supporting flu vaccinations it would be time to reconsider them.

However, it is time to move on. Look at the research in its entirety and not the cherry picked studies favoring either side. I have reviewed as much of the research as anyone here and I am confident the vaccine benefit is tremendous and the risk minuscule. I have also seen the studies on the outcomes from influenza itself. This is, like I said, one of the deadliest and probably the most underestimated infections on the planet.

Risk perception is a funny thing. If millions of people get infected but the fatality rate is 1-2%, we don't perceive the threat. It's easy to think those people who died were not like us. If a few hundred get infected and 90% die, that disease is incredibly feared. Yet the math might easily show your risk of dying is greater from the first infection because the odds of getting it are so much higher. That is what happens with influenza. But the years when a greater number of young, otherwise healthy people die from influenza are only recognized in hindsight. And once that happens, it's too late for the vaccine to prevent the deaths.

[kellyb]

I have. But for balance, let's include the one by Nichol et al (http://content.nejm.org/cgi/content/full/357/14/1373), which came out at about the same time, and indicated a 27% reduction in hospitalizations and a 48% reduction in mortality among vaccinated elderly.


So...it was another 50% reduction in all cause mortality?


http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/oct0907elderly.html

Simonsen and colleagues also write that since 1968, flu has accounted for an average of about 5% of all winter deaths in older people. Yet the results of cohort studies have prompted claims that flu vaccination reduces the risk of winter death from any cause by about 50% for community-dwelling people older than 65. "That influenza vaccination can prevent ten times as many deaths as the disease itself causes is not plausible," say Simonsen et al.

So, would you agree that there appears to be something very, very wrong with studies like the Nichol one?

[Dymanic]

So, would you agree that there appears to be something very, very wrong with studies like the Nichol one?
I'll concede the possibility -- if you'll concede the possibility that there may be something very wrong with Simonsen's numbers. Are you aware that his method of estimating excess mortality due to influenza is not universally accepted?

[kellyb]

I'll concede the possibility -- if you'll concede the possibility that there may be something very wrong with Simonsen's numbers. Are you aware that his method of estimating excess mortality due to influenza is not universally accepted?

Yes.

But the point that the flu doesn't cause anywhere near 50% of winter mortalities in the elderly, so any study that finds that flu vaccination reduces mortality by 50% has to be suffering from some kind of bias so severe it's basically worthless...that point is solid.

[Frost]

Correct me if I'm wrong, but aren't flu shots made from a killed virus? How in the world would a killed virus cause disease/death?

[Puppycow]

I'd be careful if I were you about putting so much faith in your personal physician.

I've run into doctors that said things I found hard to believe. One prescribed me antibiotics and told me I could stop taking taking them as soon as I felt better, my immune system would finish off the rest. I went to get my prescription filled and the pharmacist said I need to take them all without fail. That one doctor was the only one I ever heard that from. All others have said you have to take them all without fail.

[skeptigirl]

According to the CDC; since the introduction of the flu shot, flu deaths have increased by 4 times.

:jaw-dropp

4 times as many people have died each year since the flu shot began to be implemented.

I suggest a moratorium to see if the flu shot contributes to flu deaths.Jerome, unless you cite a source so we can see if we agree with your interpretation of the facts, no one in this forum is likely to believe what you post.

[skeptigirl]

Take a look. :) (dug up links)
It's not my logic; it's just a fact......
That kinda threw me for a loop for a while and had me wondering exactly who the CDC worked for...but the idea that they're doing that to comply with the WHO objective of increasing vaccine uptake for the purpose of saving the world from birdflu makes sense to me.If you think the threat of pandemic flu has anything to do with the current market for flu vaccine, you'd be wrong. I get an occasional question if the vaccine would cover bird flu mostly from people who already know the answer is no. Also, out of sight, out of mind. Bird flu is simply not on the flu vaccine patient's mind right now.

[skeptigirl]

Hmmm. That sounds ethically dubious. A government agency frightening people to boost sales so the manufacturers don't close their plants down. I suppose the question is: Do the ends justify the means?What nonsense. You guys are finding links that are irrelevant to the real world. I am in the real world. I am vaccinating the same people I vaccinate every year. Nothing has changed except there is a lot of vaccine this year.

[Ivor the Engineer]

What nonsense. You guys are finding links that are irrelevant to the real world. I am in the real world. I am vaccinating the same people I vaccinate every year. Nothing has changed except there is a lot of vaccine this year.

No, it is not nonsense at all. It is basic supply and demand. Companies with shareholders are not going to waste money scaling up production facilities and making bucket loads of flu vaccine unless they have a market for it. So how is the demand for flu vaccination being grown?

It would seem by promoting it as more effective than it actually is and making flu sound like it's set to become the next plague. Nice to see those in public health communications have learned something from alternative medicine.

I still don't see why they could not appeal to peoples' rational mind, and explain why having a large manufacturing base for flu vaccine will be essential if many deaths are to be avoided from a future pandemic.

It is rather ironic that you, of all people, should be supportive of a marketing campaign which aims to motivate people by appealing to their irrational mind.

[fls]

Are those groups not being targeted for increased vaccine uptake?

Not by any reasonable use of the word 'targeted'.

Is that a cryptic "Yes"?
(I'm thinking it is.)

I'm sorry. I thought that was a "does a bear poop in the woods" type question.

Yes. The mission of the CDC is to promote health which includes providing the media with information to raise awareness about health related issues and motivate health behavior.

Linda

[Acleron]

The benefits of flu vaccination appear unclear.

The most recent Skeptics Guide to the Universe podcast features an interview with Dr Mark Crislip, an infectious diseases specialist. He debunked many myths about the flu vaccine and concluded it was safe and effective.

However the Lancet Infectious Diseases (http://www.docguide.com/news/content.nsf/news/852571020057CCF685257362004B9807)has a recently published paper calling into doubt the benefits of vaccination for the over 65's. This group is the main focus of many vaccination programs, certainly in the UK.

Sorry the link is not directly to the Lancet

[fls]

In the elderly, the same systematic reviews said a lot of it had to be due to selection bias, right?
Have you seen the new Simonsen study from a month or two ago?

No. They concluded the vaccines were effective and added there may be some effect from selection bias (i.e. healthy vacinee bias). Studies that have specifically looked at this selection issue (such as the Nichols study) find that adjustments in group characteristics do account for this bias, and that the measured affect is fairly robust.

Yes. The Simonsen study shows that comparing apples and oranges on the basis of colour shows greater differences than comparing them on the basis of 'fruit'. It shows that the portion of deaths related to influenza in a study population should not be assumed to be comparable to the portion of deaths related to influenza in the general population. While it may be reasonable to expect to find that about 5 percent of deaths in an average time period are due to influenza in a sample drawn from a general population, it is not reasonable to assume that 5 percent of deaths during a virulent influenza outbreak drawn from a sample of the frail elderly will be found to be due to influenza. And that the number of excess deaths is sensitive to the method used to measure excess deaths.

Vaccinate all the babies now, figure out if it's safe and effective later.
Got it.

That's the point of expert review. There aren't simple answers to questions such as how much confidence we need before acting - the answer depends on the details. We already have information about safety and effectiveness in babies, and knowledgeable and experienced people have weighed these issues and provided an opinion, which includes the recommendation that better information should continue to be obtained.

Linda

[fls]

Link?

The links are in the reference I provided here (http://forums.randi.org/showthread.php?postid=3090340#post3090340).

Linda

[fls]

So, would you agree that there appears to be something very, very wrong with studies like the Nichol one?

No. It simply shows that studies like the Nichol one are necessary. And that randomized clinical trials would provide useful information. Careful attention must be paid to the validity of generalization.

There are several types of selection bias that are relevant. The first is that of the healthy-vacinee - people who get vaccines are different in important ways from those who don't in ways that will influence outcomes. Another type of selection bias is that of the population from which the sample is selected. And this is of more relevance to external validity and generalizing the study conclusions to a larger population.

Linda

[Ivor the Engineer]

For those who can't be bothered to search:

Ref. 17 in Linda's link:

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=16437500&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

BACKGROUND: In children and adults the consequences of influenza are mainly absences from school and work, however the risk of complications is greatest in children and people over 65 years old. OBJECTIVES: To appraise all comparative studies evaluating the effects of influenza vaccines in healthy children; assess vaccine efficacy (prevention of confirmed influenza) and effectiveness (prevention of influenza-like illness) and document adverse events associated with receiving influenza vaccines. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2005); OLD MEDLINE (1966 to 1969); MEDLINE (1969 to December 2004); EMBASE (1974 to December 2004); Biological Abstracts (1969 to December 2004); and Science Citation Index (1974 to December 2004). We wrote to vaccine manufacturers and a number of corresponding authors of studies in the review. SELECTION CRITERIA: Any randomised controlled trials (RCTs), cohort and case-control studies of any influenza vaccine in healthy children under 16 years old. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. MAIN RESULTS: Fifty-one studies involving 263,987 children were included. Seventeen papers were translated from Russian. Fourteen RCTs and 11 cohort studies were included in the analysis of vaccine efficacy and effectiveness. From RCTs, live vaccines showed an efficacy of 79% (95% confidence interval (CI) 48% to 92%) and an effectiveness of 33% (95% CI 28% to 38%) in children older than two years compared with placebo or no intervention. Inactivated vaccines had a lower efficacy of 59% (95% CI 41% to 71%) than live vaccines but similar effectiveness: 36% (95% CI 24% to 46%). In children under two, the efficacy of inactivated vaccine was similar to placebo. Thirty-four reports containing safety outcomes were included, 22 including live vaccines, 8 inactivated vaccines and 4 both types. The most commonly presented short-term outcomes were temperature and local reactions. The variability in design of studies and presentation of data was such that meta-analysis of safety outcome data was not feasible. AUTHORS' CONCLUSIONS: Influenza vaccines are efficacious in children older than two years but little evidence is available for children under two. There was a marked difference between vaccine efficacy and effectiveness. That no safety comparisons could be carried out emphasizes the need for standardisation of methods and presentation of vaccine safety data in future studies. It was surprising to find only one study of inactivated vaccine in children under two years, given recent recommendations to vaccinate healthy children from six months old in the USA and Canada. If immunisation in children is to be recommended as public-health policy, large-scale studies assessing important outcomes and directly comparing vaccine types are urgently required.

Ref. 18:

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17259870&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

BACKGROUND: Two systematic reviews evaluating influenza vaccine efficacy in healthy children have recently been published. Although quantitative summary estimates were similar, authors' conclusions were quite contrasting. We carried out another meta-analysis reevaluating study inclusion criteria and using metaregression techniques in addition to sensitivity and subgroups analyses to evaluate potential sources of heterogeneity of efficacy estimates, including methodologic quality of studies. METHODS: Only randomized clinical studies assessing the efficacy of influenza vaccine in healthy children/adolescents (age < or =18 years) for preventing naturally occurring influenza and/or acute otitis media cases were included. Summary estimates of effect were obtained using a random effects model. The methodologic quality of each study was assessed using 3 systems: Chalmers scale, Jadad scale and Schulz components (randomization, allocation concealment and double-blinding). RESULTS: The overall vaccination efficacy was 36% (95% confidence interval: 31-40%) against clinically diagnosed illnesses (evaluated by 19 randomized clinical studies for a total of 247,517 children); 67% (51-78%) against laboratory-confirmed cases (18 trials, n = 8574); and 51% (21-70%) against acute otitis media (11 trials, n = 11,349). Significant sources of between-study heterogeneity were participants' age and study quality both directly correlated with the efficacy. When the analysis was performed excluding USSR studies, the overall efficacy of the vaccine in preventing clinical cases substantially increased (from 36% to 61%). CONCLUSIONS: These findings may indicate that the vaccine efficacy might be greater than the overall estimates. Although no safety and cost considerations are addressed in this analysis, the present findings support vaccination as a possible option for the prevention of influenza in healthy children and adolescents.

Ref. 19:

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=15780733&ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

We conducted a meta-analysis of 13 randomised clinical trials evaluating the efficacy of influenza vaccine in healthy children. Against culture-confirmed influenza the overall efficacy was 74% (95% confidence interval, CI, 57%-84%), 65% for inactivated and 80% for live-attenuated vaccine. Corresponding figures were 59% (95% CI 43%-71%), 63% and 54% for serologically-confirmed influenza, and 33% (95% CI 29%-36%), 33% and 34% for clinical illness. Influenza vaccine is effective in preventing laboratory-confirmed and clinical influenza in healthy children, with no clear difference between inactivated and live-attenuated vaccine. Data on infants and younger children were too scanty to allow separate assessment.


Ref. 67:

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17167134&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

BACKGROUND: The efficacy of influenza vaccines may decline during years when the circulating viruses have antigenically drifted from those included in the vaccine. METHODS: We carried out a randomized, double-blind, placebo-controlled trial of inactivated and live attenuated influenza vaccines in healthy adults during the 2004-2005 influenza season and estimated both absolute and relative efficacies. RESULTS: A total of 1247 persons were vaccinated between October and December 2004. Influenza activity in Michigan began in January 2005 with the circulation of an antigenically drifted type A (H3N2) virus, the A/California/07/2004-like strain, and of type B viruses from two lineages. The absolute efficacy of the inactivated vaccine against both types of virus was 77% (95% confidence interval [CI], 37 to 92) as measured by isolating the virus in cell culture, 75% (95% CI, 42 to 90) as measured by either isolating the virus in cell culture or identifying it through real-time polymerase chain reaction, and 67% (95% CI, 16 to 87) as measured by either isolating the virus or observing a rise in the serum antibody titer. The absolute efficacies of the live attenuated vaccine were 57% (95% CI, -3 to 82), 48% (95% CI, -7 to 74), and 30% (95% CI, -57 to 67), respectively. The difference in efficacy between the two vaccines appeared to be related mainly to reduced protection of the live attenuated vaccine against type B viruses. CONCLUSIONS: In the 2004-2005 season, in which most circulating viruses were dissimilar to those included in the vaccine, the inactivated vaccine was efficacious in preventing laboratory-confirmed symptomatic illnesses from influenza in healthy adults. The live attenuated vaccine also prevented influenza illnesses but was less efficacious. (ClinicalTrials.gov number, NCT00133523.) 2006 Massachusetts Medical Society

Ref. 68:

During the 2003-2004 influenza season, we conducted a case-control study of influenza vaccine effectiveness (VE) among Colorado residents aged 50-64 years. Cases (n=330) were identified from laboratory-confirmed influenza reports to the Colorado Department of Public Health and Environment (CDPHE). Controls (n=1055) were recruited by random-digit dial telephone survey. VE was 60% (43-72%) and 48% (21-66%) among those without and with high-risk medical conditions, respectively. VE was 90% (68-97%) and 36% (0-63%) against influenza-related hospitalization for persons without and with high-risk conditions, respectively.

ETA: Ref. 52:

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17443504&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

BACKGROUND: Different types of influenza vaccines are currently produced world-wide. Healthy adults are at present targeted only in North America. Despite the publication of a large number of clinical trials, there is still substantial uncertainty about the clinical effectiveness of influenza vaccines and this has a negative impact on their acceptance and uptake. OBJECTIVES: To identify, retrieve and assess all studies evaluating the effects (efficacy, effectiveness and harms) of vaccines against influenza in healthy adults. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2005) which contains the Cochrane Acute Respiratory Infections Group trials register; MEDLINE (January 1966 to January 2006); and EMBASE (1990 to January 2006). We wrote to vaccine manufacturers and first or corresponding authors of studies in the review. SELECTION CRITERIA: Any randomised or quasi-randomised studies comparing influenza vaccines in humans with placebo, no intervention. Live, attenuated, or killed vaccines or fractions of them administered by any route, irrespective of antigenic configuration were assessed. Only studies assessing protection from exposure to naturally occurring influenza in healthy individuals aged 16 to 65 years were considered. Comparative non-randomised studies were included if they assessed evidence of the possible association between influenza vaccines and serious harms. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. MAIN RESULTS: Forty-eight reports were included: 38 (57 sub-studies) were clinical trials providing data about effectiveness, efficacy and harms of influenza vaccines and involved 66,248 people; 8 were comparative non-randomised studies and tested the association of the vaccines with serious harms; 2 were reports of harms which could not be introduced in the data analysis.Inactivated parenteral vaccines were 30% effective (95% CI 17% to 41%) against influenza-like illness, and 80% (95% CI 56% to 91%) efficacious against influenza when the vaccine matched the circulating strain and circulation was high, but decreased to 50% (95% CI 27% to 65%) when it did not. Excluding the studies of the 1968 to 1969 pandemic, effectiveness was 15% (95% CI 9% to 22%) and efficacy was 73% (95% CI 53% to 84%). Vaccination had a modest effect on time off work, but there was insufficient evidence to draw conclusions on hospital admissions or complication rates. Inactivated vaccines caused local tenderness and soreness and erythema. Spray vaccines had more modest performance. Monovalent whole-virion vaccines matching circulating viruses had high efficacy (VE 93%, 95% CI 69% to 98%) and effectiveness (VE 66%, 95% CI 51% to 77%) against the 1968 to 1969 pandemic. AUTHORS' CONCLUSIONS: Influenza vaccines are effective in reducing cases of influenza, especially when the content predicts accurately circulating types and circulation is high. However, they are less effective in reducing cases of influenza-like illness and have a modest impact on working days lost. There is insufficient evidence to assess their impact on complications. Whole-virion monovalent vaccines may perform best in a pandemic.

[Professor Yaffle]

How close are we to developing a universal flu vaccine? Is it a strong possibility, or just some slightly promising research that has been Daily Mailed:

http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=425227&in_page_id=1774

[fls]

The benefits of flu vaccination appear unclear.

The most recent Skeptics Guide to the Universe podcast features an interview with Dr Mark Crislip, an infectious diseases specialist. He debunked many myths about the flu vaccine and concluded it was safe and effective.

However the Lancet Infectious Diseases (http://www.docguide.com/news/content.nsf/news/852571020057CCF685257362004B9807)has a recently published paper calling into doubt the benefits of vaccination for the over 65's. This group is the main focus of many vaccination programs, certainly in the UK.

Sorry the link is not directly to the Lancet

It's not really calling into doubt the benefits, but rather the extent of the benefit if that makes sense. The link that Kelly provided earlier does a better job of summarizing the paper, I think.

http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/oct0907elderly.html

There is a fairly consistent reduction in mortality of 40 to 50 percent in various studies. The question becomes in what way are those excess deaths related to influenza?

Are they simply related to characteristics of people who are vaccinated vs. those who aren't - the healthy-vacinee selection? That is, have we simply found a way to divide people into groups at higher and lower risk of death for other reasons? Studies taking that into consideration (such as the Nichol study) don't find evidence of this effect, and if it were present wouldn't account for much.

Do they simply reflect the combination of an effective vaccine and the expected number of influenza-related deaths in the general population? I think Simonsen is directing his complaint at the assumption, and I think it is a valid complaint. The expected number of influenza-related deaths in the relevant population is much lower (he mentions 5 percent). This suggests that what happens during the study is much different from what happens in the general population. Some of these differences are obvious - studies showing this difference focus only on the highest risk period where influenza-related deaths are a higher proportion of all deaths. And the study populations are also at a higher risk of their death being related to influenza. So these studies will over-estimate the magnitude of the impact if applied directly to a general population. If you want a better estimate, you need studies that more directly answer that question. The question is whether trying to obtain the answer to that question with RCT's is ethical given that the answer wouldn't change the current recommendations nor the direction of current research towards more immunogenic vaccines and use of anti-viral drugs.

Linda

[JEROME DA GNOME]

Jerome, unless you cite a source so we can see if we agree with your interpretation of the facts, no one in this forum is likely to believe what you post.

I did earlier in the thread. I was reiterating the point.

[kellyb]

Is this correct or incorrect?

http://archinte.ama-assn.org/cgi/content/full/165/3/265#IOI40800T1



UNADJUSTED NUMBERS OF SEASONAL EXCESS DEATHS, 1968 TO 2001
Excess all-cause mortality was only a small portion of the approximately 500 000 deaths that occur annually among the elderly during winter months, never exceeding 10%

Also..I remember this from a few years ago, when Chiron had the contamination issues and we had a huge national shortage of flu vaccines. It was supposed to be the deadliest circulating flu virus in recent years...

Our results have obvious implications for influenza vaccination policy. For the 2004-2005 season, we face a severe influenza vaccine shortage that will likely result in lower coverage among the elderly, and the effect of this shortfall on mortality is a matter of great interest.37 The present findings, and those of at least 1 other study,35 indicate that the shortage will have little impact, perhaps owing to disparities in vaccination rates33-34 and possibly vaccine failure due to immune senescence.38 Other cohort studies suggest that the shortage will have a tremendous impact on mortality among the elderly.13-19,36 Either way, this vast disconnect between conclusions from different studies must be sorted out.

Who ended up being right there?

And just for fun:

http://www.thelancet.com/journals/lancet/article/PIIS0140673605678841/fulltext


We believe that the vaccine effectiveness estimates derived from cohort studies reporting on mortality, for example, are—literally—unbelievably large. Jefferson and colleagues compile cohort study results for prevention of death from all causes, and find a vaccine effectiveness of 47% in community-dwelling elderly people. But because the periods during which the underlying cohort studies record mortality typically include the entire winter season, this estimate implies that influenza is involved in about half of all winter deaths among elderly people, which in turn would mean that influenza is the leading contributing factor to winter mortality in this age-group. This figure is in stark contrast to the finding from our excess-mortality study, which showed that influenza is associated with an average of about 5% of all winter deaths in this age-group.

[kellyb]

In the elderly, the same systematic reviews said a lot of it had to be due to selection bias, right?

No. They concluded the vaccines were effective and added there may be some effect from selection bias (i.e. healthy vacinee bias).


You answered "no" and then went on to explain how the answer is "yes".

Here's what they said:


http://www.thelancet.com/journals/lancet/article/PIIS0140673605673394/fulltext


We think the residual heterogeneity could be the result of the unpredictable nature of the spread of influenza and influenza-like illness and the bias caused by the non-randomised nature of our evidence base. The findings of the cohort studies that we included are likely to have been affected to a varying degree by selection bias;

A further example of the potential effect of such bias is the apparently counterintuitive effectiveness of the vaccines in elderly individuals living in the community. In this population, the vaccines are apparently ineffective in the prevention of influenza, influenza-like illness, pneumonia, hospital admissions, or deaths from any respiratory disease, but are effective in the prevention of hospital admission for influenza and pneumonia and in the prevention of deaths from all causes. That such differences are the result of a baseline imbalance in health status and other systematic differences in the two groups of participants cannot be discounted. Evidence from randomised controlled trials, in which bias is reduced to a minimum, is scant and badly reported. Unfortunately, because of the global recommendations on influenza vaccination, placebo-controlled trials, which could clarify the effects of influenza vaccines in individuals, are no longer possible on ethical grounds.

[dudalb]

The Anti Vaccination woo amazes me because so many people buy into it who should really,really,know better.
Some are diving by paranoia against that all purpose villian "big