Flu Vaccine For Everyone: When the Science Contradicts the Science

[Skeptic Ginger]

2005 Mortality due to Influenza in the United States—An Annualized Regression Approach Using Multiple-Cause Mortality Data

Quote:

Influenza is an important cause of mortality in temperate countries, but there is substantial controversy as to the total direct and indirect mortality burden imposed by influenza viruses. The authors have extracted multiple-cause death data from public-use data files for the United States from 1979 to 2001. The current research reevaluates attribution of deaths to influenza, by use of an annualized regression approach: comparing measures of excess deaths with measures of influenza virus prevalence by subtype over entire influenza seasons and attributing deaths to influenza by a regression model. This approach is more conservative in its assumptions than is earlier work, which used weekly regression models, or models based on fitting baselines, but it produces results consistent with these other methods, supporting the conclusion that influenza is an important cause of seasonal excess deaths. The regression model attributes an annual average of 41,400 (95% confidence interval: 27,100, 55,700) deaths to influenza over the period 1979–2001. The study also uses regional death data to investigate the effects of cold weather on annualized excess deaths. cause of death; influenza; linear regression; mortality; seasons; temperature; time series; United States

Here's are researchers using a different model which they believes is more conservative and still coming up with a substantial annual mortality figure, greater than the figures the CDC determined with their model.

Quote:

Following Thompson et al., we use the proportion of tested samples positive as a proxy for prevalence of each influenza subtype. Although this proportion is an imperfect measure of prevalence, we feel that it is the best influenza-specific measure available. The model of Thompson et al. makes use of weekly virus surveillance data, but these data have not been made available in the public domain.

It's a no brainer.

[kellyb]

Originally Posted by Skeptic Ginger

Who are these "people who study ..." and how do you know they don't know how to interpret the weekly influenza surveillance reports showing the % of ILI specimens that are positive for influenza?

You can cite all kinds of unrelated stuff about winter ILIs, none of it says experts aren't sure the influenza surveillance system isn't measuring the % of ILIs that are influenza cases circulating in the sampled population.

Uh, strawman?
I never said a chart like this:

http://www.cdc.gov/flu/weekly/weekly...3/WhoLab04.htm

...is difficult to understand.

Where it gets complicated is squaring it (and similar data) with ones like this on the same timeline:

http://www.cdc.gov/flu/weekly/weekly...13/bigpi04.htm

[kellyb]

Also:

Quote:

You can cite all kinds of unrelated stuff about winter ILIs

We were talking about RSV. Several back and forth replies were posted. It's not unrelated.

[Skeptic Ginger]

Originally Posted by kellyb

Uh, strawman?
I never said a chart like this:

http://www.cdc.gov/flu/weekly/weekly...3/WhoLab04.htm

...is difficult to understand.

Where it gets complicated is squaring it (and similar data) with ones like this on the same timeline:

http://www.cdc.gov/flu/weekly/weekly...13/bigpi04.htm

My point is the same and it is not a straw man. It doesn't matter how much RSV is in kids, or what % if ILIs are adenovirus. Because no one is confusing all ILIs with all flu cases.

Your CDC link says right on it, pneumonia AND influenza. It does not say influenza deaths. AND there is a correlating increase in influenza cases.

2012-2013 Influenza Season Week 4 ending January 26, 2013

Quote:

Synopsis:
During week 4 (January 20-26), influenza activity remained elevated in the United States, but decreased in some areas.

Viral Surveillance: Of 10,581 specimens tested and reported by collaborating laboratories, 2,701 (25.5%) were positive for influenza.
Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
Influenza-Associated Pediatric Deaths: Eight pediatric deaths were reported.
Influenza-Associated Hospitalizations: A cumulative rate for the season of 25.9 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported. Of all hospitalizations, more than 50% were among adults 65 years and older.
Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 4.2%; this is above the national baseline of 2.2%. All 10 regions reported ILI above region-specific baseline levels. Twenty-four states and New York City experienced high ILI activity; the District of Columbia and 13 states experienced moderate activity; 4 states experienced low activity; and 9 states experienced minimal activity.
Geographic Spread of Influenza: Forty-two states reported widespread geographic influenza activity; 7 states reported regional activity; the District of Columbia and one state reported local activity; Guam reported sporadic influenza activity, and Puerto Rico and the U.S. Virgin Islands did not report.

Laboratory-confirmed Influenza Hospitalizations Gee, what a coincidence this graph spike in flu correlates with the graph spike in P&I mortality for the same week in the same country.


I'm sorry but this discussion comes down to ignorance. Yes P&I deaths are reported. Yes when P&I deaths increase during winter during documented influenza outbreaks, it's an INDICATION a lot of those deaths are flu related.

Few people except in the lay media, in the lay public and people in this thread think the health care community is calling all P&I mortality flu deaths. It's an ignorant interpretation of what P&I deaths mean.


I'll post this again, it seems to have been overlooked: Overview of Influenza Surveillance in the United States

Quote:

Five Categories of Influenza Surveillance
1. Viral Surveillance —Approximately 85 U.S. World Health Organization (WHO) Collaborating Laboratories and 60 National Respiratory and Enteric Virus Surveillance System (NREVSS) laboratories located throughout the United States participate in virologic surveillance for influenza. All state public health laboratories participate as U.S. WHO collaborating laboratories along with some city and county public health laboratories and some large tertiary care or academic medical centers. Most NREVSS laboratories participating in influenza surveillance are hospital laboratories. The U.S. WHO and NREVSS collaborating laboratories report the number of respiratory specimens tested and the number positive for influenza types A and B each week to CDC.

See that ^ VIRAL CULTURES!!!!!

Quote:

2. Outpatient Illness Surveillance —Information on patient visits to health care providers for influenza-like illness is collected through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet). ILINet consists of more than 2,700 outpatient healthcare providers in all 50 states, the District of Columbia and the U.S. Virgin Islands reporting more than 30 million patient visits each year. Each week, approximately 1,800 outpatient healthcare providers around the country report data to CDC on the total number of patients seen and the number of those patients with influenza-like illness (ILI) by age group (0-4 years, 5-24 years, 25-49 years, 50-64 years, and ≥ 65 years). For this system, ILI is defined as fever (temperature of 100°F [37.8°C] or greater) and a cough and/or a sore throat without a KNOWN cause other than influenza. Sites with electronic health records use an equivalent definition as determined by public health authorities.
The percentage of patient visits to healthcare providers for ILI reported each week is weighted on the basis of state population. This percentage is compared each week with the national baseline of 2.2%.

See that ^ reference to baseline ILIs. Now go back to the graph you linked to. Notice the epidemic baseline fluctuates throughout the year. Notice that in the winter when ALL cause ILIs are increased, the epidemic threshold is highest.

Quote:

ILI Activity Indicator Map: —Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, the District of Columbia, and New York City. Activity levels are based on the percent of outpatient visits in a jurisdiction due to ILI compared with the average percent of ILI visits that occur during weeks with little or no influenza virus circulation (non-influenza weeks).

See that ^ ILI compared with the average percent of ILI visits that occur during weeks with little or no influenza virus circulation. Yes, guess what, we know other virus outbreaks follow seasonal patterns, some overlapping influenza. THAT'S WHY YOU ALSO HAVE TO LOOK AT THE % OF POSITIVE CULTURES.

Quote:

3. Mortality Surveillance — Rapid tracking of influenza-associated deaths is done through two systems:
122 Cities Mortality Reporting System —Each week, the vital statistics offices of 122 cities across the United States report the total number of death certificates processed and the number of those for which pneumonia or influenza was listed as the underlying or contributing cause of death ... The seasonal baseline of P&I deaths is calculated using a periodic regression model that incorporates a robust regression procedure applied to data from the previous five years. An increase of 1.645 standard deviations above the seasonal baseline of P&I deaths is considered the “epidemic threshold,” i.e., the point at which the observed proportion of deaths attributed to pneumonia or influenza was significantly higher than would be expected at that time of the year in the absence of substantial influenza-related mortality.

See that ^ AT THIS TIME OF YEAR IN THE ABSENCE OF FLU. It doesn't say compared to the summer when flu is rare. It doesn't say all P&I deaths.

Quote:

4. Hospitalization Surveillance —Laboratory confirmed influenza-associated hospitalizations in children and adults are monitored through the Influenza Hospitalization Surveillance Network (FluSurv-NET).
Influenza Hospitalization Network (FluSurv-NET) —FluSurv-NET conducts surveillance for population-based, laboratory-confirmed influenza related hospitalizations in children (persons less than 18 years) and adults. The network covers over 80 counties in the 10 Emerging Infections Program (EIP) states (CA, CO, CT, GA, MD, MN, NM, NY, OR, and TN) and five additional states (IA, MI, OH, RI and UT). Cases are identified by reviewing hospital laboratory and admission databases and infection control logs for children and adults with a documented positive influenza test (viral culture, direct/indirect fluorescent antibody assay (DFA/IFA), reverse transcription-polymerase chain reaction (RT-PCR), or a rapid influenza diagnostic test (RIDT)) conducted as a part of routine patient care. FluSurv-NET estimated hospitalization rates are reported each week during the influenza season.

See that ^ LABORATORY CONFIRMED INFLUENZA. That's the very thing Jefferson and Doshi seem to think no one is looking at.

Quote:

5. Summary of the Geographic Spread of Influenza —State health departments report the estimated level of geographic spread of influenza activity in their states each week through the State and Territorial Epidemiologists Reports. States report geographic spread of influenza activity as no activity, sporadic, local, regional, or widespread. These levels are defined as follows:

You'll have to look at the link. The geographic spread is based 100% on LABORATORY CONFIRMED INFLUENZA.

Quote:

The reported information answers the questions of where, when, and what influenza viruses are circulating. It can be used to determine if influenza activity is increasing or decreasing, but cannot be used to ascertain how many people have become ill with influenza during the influenza season.
The system consists of eight complementary surveillance components in five categories. These components include reports from more than 145 laboratories, 2,700 outpatient health care providers, vital statistics offices in 122 cities, research and health-care personnel at the FluSurv-NET sites, and influenza surveillance coordinators and state epidemiologists from all state, local and territorial health departments.

SEE THAT ^ WHAT A SURPRISE. I thought the CDC wasn't supposed to know that.

[kellyb]

You're link-dumping and bolding and highlighting and caps-locking stuff I already know, SG, which is kind of weird.

About this:

Quote:

Laboratory-confirmed Influenza Hospitalizations Gee, what a coincidence this graph spike in flu correlates with the graph spike in P&I mortality for the same week in the same country.

Look at this again:

http://www.cdc.gov/flu/weekly/weekly...3/WhoLab04.htm

Influenza incidence (as a % positive and most likely otherwise) is significantly down at the same time that the P&I mortality is spiking.

Also, do you still stand by what you said here?

Quote:

If you only looked at ILIs in kids under age 2, RSV would account for a large proportion of the specimens. But if you look at all ILIs, RSV will account a small % of the cases.

Quote:

RSV is an extremely important virus in sick kids under age 5. But that is a small fraction of all ILIs in all ages.

[Skeptic Ginger]

Originally Posted by kellyb

You're link-dumping and bolding and highlighting and caps-locking stuff I already know, SG, which is kind of weird.

Oh for pity's sake. It's ONE link! It specifically addresses your mistaken understanding of P&I mortality, which you appear to have ignored even when I spoon fed it. If you "know that stuff" then why are you applying it incorrectly?

Originally Posted by kellyb

About this:
Look at this again:
http://www.cdc.gov/flu/weekly/weekly...3/WhoLab04.htm
Influenza incidence (as a % positive and most likely otherwise) is significantly down at the same time that the P&I mortality is spiking.
Also, do you still stand by what you said here?

I absolutely stand by what I said, including the fact you don't understand what you are looking at.

The P&I mortality graph shows:

Quote:

9.4% of all deaths reported through the 122 Cities Mortality Reporting System were due to P&I. This percentage was above the epidemic threshold of 7.4% for week 4.

The flu breakdown bar graph shows:

Quote:

the number of respiratory specimens tested for influenza and the number positive by influenza virus type and influenza A virus subtype.

Those graphs are on grossly different scales as well as somewhat different reporting timelines, but more importantly THEY REPRESENT DIFFERENT POPULATIONS. The P&I graph is not the number of deaths in the ILI subset, it's the % of all deaths that are from P&I.

A minor issue is the flu cultures represent a delay because lab reports don't come in at the same rate as death reports. Next week the bars will be adjusted upward a bit on the cultures, as late reports are added.

But the key difference between P&I deaths, ILIs, and viral breakdown of the 25% (this week) of the ILIs that are influenza is they all represent different things. The largest proportion of the Jan P&I deaths are due to elderly fatalities. You would expect to see a sharper peak given the ILIs represent a different demographic than P&I mortality.

More importantly, this season so far, the elderly are being hit harder than younger demographics. Look again at this graph of culture confirmed influenza hospitalizations.. Again, it's a different time frame and scale. Notice the huge number of people over 65. That 25% of positive ILI specimens are not evenly distributed among age groups. A higher proportion of the ILIs within the P&I mortality are influenza than in the ILIs as a whole.



Take a look at this one showing ILI peaks for the last 10 flu seasons.
I could tell you without looking at the key that the grey line was the 2009-10 season, because flu peaked unusually early in the season Notice also that on this scale the graph much more closely follows the viral breakdown graph.

If you weren't trying to prove a falsehood I believe you would have seen that the two graphs correlate. The spike in P&I mortality is due in a large part to influenza mortality.

You need a better understanding of what you are comparing. The bottom line: You don't know how to interpret the data you are looking at.

[Skeptic Ginger]

Perhaps I need to dumb it down. If you look at all deaths, there are going to be more people over 65 in that subset.

If you only look at pediatric deaths, a breakdown in the cause of death is going to be different than the breakdown in deaths in people over 65.

If influenza causes a 10% spike in pediatric deaths, the number will be very small compared to a 10% spike in flu deaths in people over 65.

So if flu is causing more deaths in the pediatric demographic than average, the impact on the P&I numbers will be very minimal. That happened in 2009. If you only looked at the total deaths attributed to flu in 2009, and you can see this on the graph, there was not a huge impact on total P&I. But the impact on the younger demographic was clearly significant.

If influenza mortality is greatly increased among the elderly, like it is this year which has been documented both in culture confirmed fatalities and in culture confirmed hospitalizations, then you would expect to see a much bigger impact on the total P&I number. And that is exactly what we see.

Thus you have to know what the P&I graph is showing. The correlation with ILI is still there. And in 2009-10, the ILI number was more important as was the pediatric death rate. In 2012-13 the P&I spike is more important while the ILI numbers are also important. They are telling you different things.

[Skeptic Ginger]

OK, time to look at Jefferson's claims that turn up in his summaries. I already showed one "plain language summary" that did not say the same thing as the "findings".

In the same post I also noted Jefferson insisted on evidence of benefit while content to make assumptions about risk.

I'm not going to rehash those arguments. I've more than supported them with specific quotes, data and citations and I've not seen anything substantial refuting them.

Jefferson also makes a point of saying the reviewed RCTs were all subject to potential bias without testing that assertion again and again, based on a previous study. My half finished post on the 274 studies showing industry bias is still to be completed. I will get to that.

I've agreed the evidence the flu vaccine is less effective than past estimates has been cited. I don't agree the CDC has ignored this evidence and I await next year's ACIP to see what numbers for vaccine effectiveness they use. We switched to a new, stronger vaccine for seniors last flu season and the lack of effectiveness in the elderly is noted in multiple CDC advisories and documents. The lowered effectiveness of the seasonal vaccine in no way refutes the fact the vaccine benefit still outweighs vaccine risk, including for people with no identified risk factors. In addition, failing to prevent flu doesn't tell us if case severity was modified. So the number representing effectiveness would better be represented as a range, and in some years the risk of flu in healthy people can be quite high as it is with the 2009H1N1v strain.

Which brings us back to the Cochrane Reviews headed by Jefferson that supposedly show no measurable benefit in people with no identified risk factors. This finding remains irreconcilable with the fact the vaccine works sometimes in healthy people and sometimes healthy people experience influenza morbidity and mortality.

If you assume a falsely low morbidity and mortality for influenza, which I've shown evidence Jefferson may have done (for example, his claim we would need cultures when every flu agency uses cultures), it could affect one's interpretation of benefit.

That said, I'm going to address one of Jefferson's papers in the next post.

[Skeptic Ginger]

So here's a paper written by Jefferson that I think contains wrong and/or biased claims. It's seems odd to me, being a lowly nurse practitioner who has merely worked in the field on the front lines for 20+ years to be questioning a paper written by one of the leading experts in the field who publishes prestigious reviews of the research. But I can't deny what I see.

Dr Tom Jefferson - Influenzae Reviewer, Cochrane Acute Respiratory Infections Group and Cochrane Vaccines Field

Jefferson states in the Objective this is his assessment of the evidence.

Quote:

We start with what we see sometimes several times a year: influenza-like illness (“the flu”). The WHO defines influenza-like illness as “an acute respiratory infection with sudden onset characterised by fever >38°C and at least one of the following: headache, malaise, rigors and sweating, asthenia and at least one respiratory symptom such as rhinitis and pharyingitis”. We are all familiar with this illness but what most people are not told is that the influenza viruses only account for a minority (7-15%) of these episodes. ... This is possible because physicians and patients cannot tell influenza apart from ...

I don't know what sand this man's had his head in, but the paper was written in 2010 or later (going by the citations) and in the US at least we've been using rapid-in-the-clinic-flu-screening-tests for at least 5 years, on a regular basis. In 2009 so many cultures were sent to the CDC they exceeded their capacity to test. These were strictly specimens from patients already testing positive for influenza A using the rapid screens, and already confirmed as positive by the local county health departments.

Maybe a lot of nurses and docs in unrelated fields don't know the difference, but the majority of doctors and ED staff seeing patients with ILIs certainly do.

So the second bolded statement is blatantly false.

What about the first one? It's partly irrelevant. Yes, patients are often ignorant. I, for one, make an effort to educate patients about the flu all the time, and especially when I am giving flu vaccine. I believe other providers do as well. You want people to know the vaccine is only for influenza and all those other URIs (ILIs, ARIs) are not going to be affected by the vaccine. If you didn't tell people this they wouldn't understand why a flu vaccine matters, and that catching a cold didn't mean the vaccine failed.

What about the 7-15%? Well, if he is talking about during flu season, which is the only relevant number, then he's contradicting years of collected data that is specifically CULTURE CONFIRMED INFLUENZA. I more than substantiated that claim in my last page of posts.

So what's the deal? Why is he wrong? Because he clearly is. Did he cherry pick his data? Did he completely ignore the EU and CDC's weekly culture confirmed influenza? I can't figure it out. But I do know the evidence in all the culture confirmed data overwhelmingly demonstrates he is wrong. He doesn't cite the source of that 7-15% number.

But in addition, if the 85% of ILIs are mostly mild (excluding in infants), then it's not relevant anyway. So 85% of the time you have an ILI that won't be serious? Is that a reason not to get a vaccine for the 7-15% that could be serious? Of course not!

I can only take this paper a bit at a time. I'm going to have a beer now.

[kellyb]

Quote:

A minor issue is the flu cultures represent a delay because lab reports don't come in at the same rate as death reports. Next week the bars will be adjusted upward a bit on the cultures, as late reports are added.

For this chart?
http://www.cdc.gov/flu/weekly/weekly...3/WhoLab04.htm
Are you sure?

Quote:

Look again at this graph of culture confirmed influenza hospitalizations.. Again, it's a different time frame and scale.

I'm pretty sure they're showing the cumulative seasonal hospitalizations, too.

Quote:

Notice also that on this scale the graph much more closely follows the viral breakdown graph.

That's my point. Influenza/ILI incidence is down, and yet P&I mortality (and culture-confirmed flu hospitalizations? Hard to tell, in the case that it's cumulative) is up/increasing.

Quote:

If you weren't trying to prove a falsehood I believe you would have seen that the two graphs correlate.

WTF? lol.

Quote:

The spike in P&I mortality is due in a large part to influenza mortality.

So, how do you square that claim with this:


http://www.cdc.gov/surveillance/nrev...atl-trend.html

...and the decreasing incidence of culture confirmed flu?

Quote:

So if flu is causing more deaths in the pediatric demographic than average, the impact on the P&I numbers will be very minimal. That happened in 2009. If you only looked at the total deaths attributed to flu in 2009, and you can see this on the graph, there was not a huge impact on total P&I. But the impact on the younger demographic was clearly significant.

Actually, a lot (most?) of that was the 50-64 yo age group.

[Skeptic Ginger]

Originally Posted by kellyb

...
That's my point. Influenza/ILI incidence is down, and yet P&I mortality (and culture-confirmed flu hospitalizations? Hard to tell, in the case that it's cumulative) is up/increasing.....

Did you friggin miss the down tick on the P&I chart?

[Estellea]

Originally Posted by Skeptic Ginger

Claiming it isn't a reliable indicator and your other posts suggest you don't understand what ILIs are an indicator of.

ILIs are used as indicators of flu activity and no, not a reliable indicator given the numerous other respiratory pathogens co-circulating. It is only fairly recently that sentinel sites with standardised antigen-based testing has been implemented in the U.S. and some EU countries that lend a clearer picture of the burden of flu activity. ILIs are still being used however as per your own links, I suggest you read them more thoroughly. ILIs are also used by state and local public health departments to estimate flu activity.

Quote:

BTW, I'm curious if you can find a record of a significant ILI spike that wasn't accompanied by a significant increase in influenza positive cultures. And I've not looked at Kelly's links yet, but RSV surveillance as well as other viral culture % are also reported during the year. I can check the local lab any time of the year for a breakdown of what they are finding.
U of WA Virology lab reports

RSV doesn't tend to show a spike in ILIs like flu does because the majority of the population turning up with ILI symptoms are only a small segment of the population. OTOH, they represent a lot of the viral cultures because sick infants get cultured. The U of WA lab tests all the specimens from the Children's Hospital nearby, as well as a lot of other cultures any of us order in the community.

You probably want to take a look at your own state's data given that RSV absolutely shows peaks and almost consistently, exceeding influenza activity each year. On one hand you say that outpatient ILIs are a small proportion tested yet you use these as representative of flu burden. You're not even consistent with your own data presented.

Este

[Estellea]

Originally Posted by Skeptic Ginger

This is the post discussing Jefferson's claim. I was wrong, it was on page 1.

Sigh, so time consuming to deal with a couple legit experts with illegit beliefs. But, I guess that's why I started the thread. Take this as a partial reply, because if I don't post part of it, I may never finish it.

The Debate About Flu ShotsIt's an outright lie. He might be conflating what the public and news media confuse for flu, but not the health care community. The more I read from Jefferson, the more I think he's full of his own confirmation bias when it comes dismissing the morbidity and mortality of influenza. I can't find any other explanation for his claims.

Your own confirmation bias precludes you from understanding the weaknesses of influenza epidemiology. Jefferson is undoubtedly arrogant and speaks outside the scope of his work at times. However, that is a separate issue than what he and his co-authors have reported in the Cochrane reviews of influenza vaccine effectiveness. Just yesterday a neighbour informed me that one of her children is ill and her physician informed her that it "was probably flu" but no need to bring him in to be tested since that or any other respiratory illness was treated the same. Why don't you stick to the reviews as per your own OP.

Quote:

Yeah, and people think the "stomach flu" is what we're talking about. So what? Health care providers are not the ones making this mistake, at least not on the nurse practitioner/physician level.

Another strawman noted and moving on.

Este

[Estellea]

Originally Posted by Skeptic Ginger

2005 Mortality due to Influenza in the United States—An Annualized Regression Approach Using Multiple-Cause Mortality Data

Here's are researchers using a different model which they believes is more conservative and still coming up with a substantial annual mortality figure, greater than the figures the CDC determined with their model.

It's a no brainer.

Yea, it's a no brainer to see how a model using an estmate of an estimate is going to be rubbish. It's not even consistent with the CDC's own influenza-related mortalities from the same time frame. Please actually read the paper before trying to bash someone with it. Do you really believe that because an author says it's reliable that it is? Talk about confirmation bias.

Este

[Estellea]

Originally Posted by Skeptic Ginger

OK, time to look at Jefferson's claims that turn up in his summaries. I already showed one "plain language summary" that did not say the same thing as the "findings".

No you didn't; you merely asserted that.

Quote:

In the same post I also noted Jefferson insisted on evidence of benefit while content to make assumptions about risk.

I'm not going to rehash those arguments. I've more than supported them with specific quotes, data and citations and I've not seen anything substantial refuting them.

Sorry but you haven't shown a single piece of evidence that refutes Jefferson's vaccine reviews and don't forget, Osterholm et al. found the same thing.

Quote:

Jefferson also makes a point of saying the reviewed RCTs were all subject to potential bias without testing that assertion again and again, based on a previous study. My half finished post on the 274 studies showing industry bias is still to be completed. I will get to that.

You posted the link yourself to the review of study bias and influenza vaccines. That was also observed by Osterholm et al. and oh look, here's one about the 'healthy vaccinee effect'.

Quote:

I've agreed the evidence the flu vaccine is less effective than past estimates has been cited. I don't agree the CDC has ignored this evidence and I await next year's ACIP to see what numbers for vaccine effectiveness they use. We switched to a new, stronger vaccine for seniors last flu season and the lack of effectiveness in the elderly is noted in multiple CDC advisories and documents. The lowered effectiveness of the seasonal vaccine in no way refutes the fact the vaccine benefit still outweighs vaccine risk, including for people with no identified risk factors. In addition, failing to prevent flu doesn't tell us if case severity was modified. So the number representing effectiveness would better be represented as a range, and in some years the risk of flu in healthy people can be quite high as it is with the 2009H1N1v strain.

What does most of this have to do with the fact that vaccines used for decades do not perform as well as claimed and policy based upon those faulty claims? And you do realise that now a universal U.S. policy has been implemented, we won't ever see proper trials to demonstrate vaccine effectiveness don't you?

Quote:

Which brings us back to the Cochrane Reviews headed by Jefferson that supposedly show no measurable benefit in people with no identified risk factors. This finding remains irreconcilable with the fact the vaccine works sometimes in healthy people and sometimes healthy people experience influenza morbidity and mortality.

Then produce the studies that the Cochrane review should have considered based upon their grading system.

Quote:

If you assume a falsely low morbidity and mortality for influenza, which I've shown evidence Jefferson may have done (for example, his claim we would need cultures when every flu agency uses cultures), it could affect one's interpretation of benefit.

You presented a talk he gave. What about the methods in the reviews themselves? You haven't presented any refuting evidence.

Quote:

That said, I'm going to address one of Jefferson's papers in the next post.

Thank goodness.

Este

[kellyb]

Quote:

And you do realise that now a universal U.S. policy has been implemented, we won't ever see proper trials to demonstrate vaccine effectiveness don't you?

While that's definitely true in N America, couldn't good RCT (etc) data still come out of Europe?

[Estellea]

Originally Posted by kellyb

While that's definitely true in N America, couldn't good RCT (etc) data still come out of Europe?

It could but the external validity isn't good due to differences in vaccines, circulating strains and healthcare structure just to name a few.

Este

[kellyb]

RSV stuff, so we're all on the same page as this discussion advances:


http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Abstract

Quote:

A total of 608 healthy elderly patients and 540 high-risk adults were enrolled in prospective surveillance, and 1388 hospitalized patients were enrolled. A total of 2514 illnesses were evaluated. RSV infection was identified in 102 patients in the prospective cohorts and 142 hospitalized patients, and influenza A was diagnosed in 44 patients in the prospective cohorts and 154 hospitalized patients. RSV infection developed annually in 3 to 7 percent of healthy elderly patients and in 4 to 10 percent of high-risk adults. Among healthy elderly patients, RSV infection generated fewer office visits than influenza; however, the use of health care services by high-risk adults was similar in the two groups. In the hospitalized cohort, RSV infection and influenza A resulted in similar lengths of stay, rates of use of intensive care (15 percent and 12 percent, respectively), and mortality (8 percent and 7 percent, respectively). On the basis of the diagnostic codes of the International Classification of Diseases, 9th Revision, Clinical Modification at discharge, RSV infection accounted for 10.6 percent of hospitalizations for pneumonia, 11.4 percent for chronic obstructive pulmonary disease, 5.4 percent for congestive heart failure, and 7.2 percent for asthma.
CONCLUSIONS:
RSV infection is an important illness in elderly and high-risk adults, with a disease burden similar to that of nonpandemic influenza A in a population in which the prevalence of vaccination for influenza is high. An effective RSV vaccine may offer benefits for these adults.
Copyright 2005 Massachusetts Medical Society.

What happened with the vaccine that was "supposed" to be on the market by now:

http://cdn.intechopen.com/pdfs/24399...and_future.pdf

Quote:

MEDI-559, now developed by
Medimmune, has been demonstrated to elicit an approximately 4-fold increase in antiRSV antibodies in 44% of previously RSV-naïve patients that received a first vaccine dose
(Karron et al, 2005). The results also showed that protective immunity was achieved in a
majority of RSV-naïve vaccine recipients. Unfortunately, MEDI-559 shows some genetic
and phenotypic instabilities necessitating further improvement of this vaccine candidate
(Karron et al, 2005; Murata, 2009).

Quote:

Many different approaches are currently applied to develop a safe and
effective vaccine, although only a limited number of vaccine candidates are actually under
clinical evaluation. The two most advanced candidate vaccines are MEDI-559 and MEDI-
534, currently in phaseI/II of clinical development. However, approval of the first RSV
vaccine is not expected before the end of this decade.

Some older (and the new) P&I mortality charts:

1998-2002:
http://www.cdc.gov/flu/weekly/weekly...bigpi01-02.gif

2001-2005:
http://www.cdc.gov/flu/weekly/weekly...umary04-05.gif

2005-2009:
http://www.cdc.gov/flu/weekly/weekly...gpiSummary.htm

2008-2013:
http://www.cdc.gov/flu/weekly/weekly...13/bigpi04.htm

Which is all very interesting to compare with these:
http://depts.washington.edu/rspvirus/respiratory.htm

[Skeptic Ginger]

Originally Posted by Estellea

ILIs are used as indicators of flu activity and no, not a reliable indicator given the numerous other respiratory pathogens co-circulating.

You've provided no evidence for the bolded claim, only assertion and a misunderstanding of graphs you are looking at.

Originally Posted by Estellea

It is only fairly recently that sentinel sites with standardised antigen-based testing has been implemented in the U.S. and some EU countries that lend a clearer picture of the burden of flu activity.

You'd have to research the EU's surveillance system for their timeline. I've been looking at those flu culture proportions for more than a decade. In-office flu screening tests are a more recent development (if you call 5+ years recent). But not the sentinel culture monitoring in the US. And now that we have wider use of in-office flu tests, they correlate with past data.

1999-2000 surveillance data.

Quote:

From October 1999 through May 2000, WHO and NREVSS laboratories tested 92,403 respiratory specimens for influenza and 13,773 (15%) were positive by viral isolation or antigen testing.

In that same summary:

Quote:

Whether the higher-than-expected percentage of P&I deaths was due to influenza activity, respiratory illness due to some other pathogen, or reporting changes in the 122 Cities Mortality Reporting System is unknown. Because of changes in the reporting case definition that occurred just prior to the start of the 1999-2000 season, the current increase in P&I mortality should be interpreted with caution.

Of course you don't believe we actually understand that.

The WHO has had a formal sentinel flu monitoring system in place since 1952. They sample specimens from worldwide sites and culture them to monitor the shifting and drifting genetics of circulating strains.
WHO Interim Global Epidemiological Surveillance Standards for Influenza (July 2012)

Quote:

The Global Influenza Surveillance and Response System (GISRS)1, previously known as the Global Influenza Surveillance Network (GISN), has been performing influenza virological surveillance since 1952. This network has played a critical role in developing our current understanding of global influenza virus circulation.

Originally Posted by Estellea

ILIs are still being used however as per your own links, I suggest you read them more thoroughly. ILIs are also used by state and local public health departments to estimate flu activity.

I've not seen any evidence in this thread from you or kellyb showing ILI spikes above epidemic threshold that didn't have an influenza component. You showed graphs of viral spikes, but you don't understand what you are looking at.

Originally Posted by Estellea

You probably want to take a look at your own state's data given that RSV absolutely shows peaks and almost consistently, exceeding influenza activity each year. ...
Este

You, like kelly, are misunderstanding how to compare two different data sets. Just like P&I are not derived from the same data set as ILIs, neither are the viral cultures you two are looking at derived from the same set.

Take kelly's link: "Weekly laboratory test result data" showing RSV. That is not the same data set as ILIs or the ILI surveillance where a subset of ILI specimens are tested for influenza.

I don't know how else to explain it to you, neither of you seems interested in actually understanding why you are making the mistake you are making.

A subset of viral cultures ordered by doctors on patients that are more seriously ill is not the same subset as the sentinel surveillance of ILI specimens.

A huge increase in RSV does not cause a huge increase in total ILIs because infants make up a small proportion of the total ILIs. ILI rates and RSV rates are simply not derived from the same sub-population of patients.

A perfect example of this was seen in the 2009-10 influenza pandemic when there were large increases in the pediatric and young adult flu mortality but not in the elderly. There also was not an accompanying large spike in ILIs. More than a few people just didn't get it. How was it a serious flu pandemic if the mortality rate didn't spike? It did spike, in a smaller demographic than the entire population.

Compare that to this season where the elderly are being hit especially hard by influenza. There's a sharp spike in ILIs and a spike in P&I mortality. A larger proportion of the population is experiencing the effects of influenza.

In 20 years I've never seen an ILI spike above the epidemic threshold in the winter that didn't have a substantial influenza component. Yes, there are plenty of ILIs that are not influenza. And of all the people with ILIs, the majority typically don't have influenza. Those elevated rates of ILIs are built in to the epidemic threshold which is higher in the winter.

Every september-october in the US we see a community spike in URIs (upper respiratory infections) that are not due to influenza. It happens when the kids go back to school. Most of those illnesses are not included in the ILI reports because most of those people do not have a fever >101F, nor do the bulk of them seek medical treatment.

But even if the ILI threshold is exceeded when influenza is not circulating, it doesn't negate the usefulness of monitoring ILIs. Your whole premise is that we count all ILIs as flu cases AND WE DON'T DO THAT! For whatever reason, you and kellyb can't seem to let go of that misinformation.

Predicting the Epidemic Sizes of Influenza A/H1N1, A/H3N2, and B: A Statistical Method

Quote:

Early circulation of one influenza strain is associated with a reduced total incidence of the other strains, consistent with the presence of interference between subtypes. Routine ILI and virologic surveillance data can be combined using this new method to predict the relative size of each influenza strain's epidemic by following the change in incidence of a given strain in the context of the incidence of cocirculating strains.

I.e. ILI data is useful. Imagine that.

[Skeptic Ginger]

Originally Posted by kellyb

RSV stuff, so we're all on the same page as this discussion advances:

http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Abstract

From your link:

Quote:

with a disease burden similar to that of nonpandemic influenza A in a population in which the prevalence of vaccination for influenza is high.

IOW, they specifically looked at cultures when influenza rates were low. You can't then extrapolate from that and say RSV in the elderly has the same morbidity as influenza. But go ahead, keep confusing data sets if it makes you happy.

Originally Posted by kellyb

What happened with the vaccine that was "supposed" to be on the market by now:

http://cdn.intechopen.com/pdfs/24399...and_future.pdf

And this is relevant to the thread, how?

Originally Posted by kellyb

Some older (and the new) P&I mortality charts:

1998-2002:
http://www.cdc.gov/flu/weekly/weekly...bigpi01-02.gif

2001-2005:
http://www.cdc.gov/flu/weekly/weekly...umary04-05.gif

2005-2009:
http://www.cdc.gov/flu/weekly/weekly...gpiSummary.htm

2008-2013:
http://www.cdc.gov/flu/weekly/weekly...13/bigpi04.htm

Which is all very interesting to compare with these:
http://depts.washington.edu/rspvirus/respiratory.htm

Like I said, keep on confusing what you are looking at if it makes you happy. I have addressed this at length twice now.


How about getting back to the facts here:

ILI rates above epidemic threshold correlate with epidemic influenza during winter.

ILI rates are a good indicator, useful in deciding empirically (meaning based on symptoms, not labs) when to put a patient coming into the clinic with ILI symptoms on an anti-viral drug.

No one in flu research or in the CDC believe ILIs or P&I mortality represent a direct count of influenza burden.

Just because Jefferson claims the CDC does that, does not make it so.


So what is your beef here? Because frankly with the exception of your misunderstanding of the graphs you are looking at, I don't don't see the problem.

You have not submitted any evidence that the CDC tells or implies to the public all ILIs and P&I mortality are caused by flu. All you've done is shown you don't get what the numbers you are looking at mean.

[Skeptic Ginger]

Originally Posted by Estellea

It could but the external validity isn't good due to differences in vaccines, circulating strains and healthcare structure just to name a few.

Este

What evidence do you have that the circulating flu strains are substantially different within the northern hemisphere between continents during the same flu season?

While some strains emerge locally thus vary temporarily (like the 2009H1N1v when it first emerged in Mexico) or are confined to small regions due to great efforts (like the HPAI H5N1 which remains confined at the moment) the majority of what circulates are the same strains across the n or s hemispheres during a single epidemic.

But not only that, the strains are closely monitored and genetic drift is well documented in real time.

And some of the vaccines differ, but not all of them.

[Skeptic Ginger]

Originally Posted by Estellea

Your own confirmation bias precludes you from understanding the weaknesses of influenza epidemiology.

Or yours does.

Originally Posted by Estellea

Jefferson is undoubtedly arrogant and speaks outside the scope of his work at times. However, that is a separate issue than what he and his co-authors have reported in the Cochrane reviews of influenza vaccine effectiveness.Another strawman noted and moving on.

Este

It wasn't a straw man it was an analogy. Bottom line, Jefferson makes a false charge that any knowledgeable professional is confusing ILIs with raw flu counts.

Originally Posted by Estellea

Just yesterday a neighbour informed me that one of her children is ill and her physician informed her that it "was probably flu" but no need to bring him in to be tested since that or any other respiratory illness was treated the same. [snipped another irrelevant remark]

If onset is past the initial 24 hours, antivirals like Tamiflu are not useful. If a child is hospitalized for RSV, they are likely to get ribavirin. If/when a secondary bacterial pneumonia develops an antibiotic is indicated.

So "treated the same" is something you might tell a patient on the phone avoiding a lengthy explanation. Not all people with influenza need to be seen by a doctor. So?

[kellyb]

Quote:

Your whole premise is that we count all ILIs as flu cases AND WE DON'T DO THAT! For whatever reason, you and kellyb can't seem to let go of that misinformation.

Nope. Neither of us said that.

Quote:

Predicting the Epidemic Sizes of Influenza A/H1N1, A/H3N2, and B: A Statistical Method

Quote:

Quote:
Early circulation of one influenza strain is associated with a reduced total incidence of the other strains, consistent with the presence of interference between subtypes. Routine ILI and virologic surveillance data can be combined using this new method to predict the relative size of each influenza strain's epidemic by following the change in incidence of a given strain in the context of the incidence of cocirculating strains.

I.e. ILI data is useful. Imagine that

That's actually a really interesting study, but probably not for the reasons you think, SG.

Quote:

And this is relevant to the thread, how?

I suppose I was mostly talking to Este there. We've been discussing flu epidemiology and RSV off and on for almost a decade now.

Also, SG:

Quote:

Estimation of the mortality burden of winter-seasonal pathogens is notoriously difficult. In this issue of the journal, van Asten et al estimate the mortality burden of 9 viral and bacterial pathogens in Dutch persons aged >65 years using statistical time series models [1]. They report that influenza A and respiratory syncytial virus (RSV) each cause approximately 1.5% of total deaths in this age group, whereas parainfluenza, influenza B, and norovirus account for respectively 0.9%, 0.6%, and 0.2% of deaths.

[Dymanic]

Originally Posted by Skeptic Ginger

If onset is past the initial 24 hours, antivirals like Tamiflu are not useful.

Not past 48 hours, I'm sure you meant to say. You being such an expert and all.

[Skeptic Ginger]

Originally Posted by kellyb

Nope. Neither of us said that.

Then what's your problem with ILIs?

Both of you claim without evidence that ILIs are not a good flu correlate.
Both of you claim without evidence the morbidity and mortality flu burden is overestimated because it is based on ILIs and P&I mortality. ILIs and P&I mortality is only one of many data sets that goes into determining the morbidity and mortality flu burden.

Originally Posted by kellyb

I suppose I was mostly talking to Este there. We've been discussing flu epidemiology and RSV off and on for almost a decade now.

Also, SG:

Then you can learn something about how you've been incorrectly comparing different data subsets.

Both of you claim incorrectly that RSV cases are being counted as flu cases, and that seasonal RSV epidemics are a significant cause of ILIs exceeding the epidemic threshold in winter.

[Professor Yaffle]

And that's if Tamiflu works at all, given that Roche are still hiding data.

http://www.dailymail.co.uk/news/arti...#axzz2K9qUaqbG

Don't worry, I know its from the Daily Fail, but its by Ben Goldacre, so that makes it ok.

[Skeptic Ginger]

Here's an example of the lab data being confused here:

Quote:

In SC, laboratories are required to report positive influenza cultures, RT-PCRs, DFA, and IFAs. Reports are received from the DHEC Bureau of Labs (BOL), clinical, and commercial laboratories. In addition, a voluntary network of providers submit specimens for viral culture testing by the BOL.

The ILINet and labs reporting their findings to public health are two separate patient subsets. They represent widely different populations. They have different denominators.

[Skeptic Ginger]

Here's a study with some important findings:
Sentinel Surveillance of Influenza-Like Illness in Two Hospitals in Maracay, Venezuela: 2

Quote:

We performed a prospective surveillance study of persons with ILI who presented for care at two hospitals in Maracay, Venezuela, from October 2006 to December 2010. A respiratory specimen and clinical information were obtained from each participant. Viral isolation and identification with immunofluorescent antibodies and molecular methods were employed to detect respiratory viruses such as adenovirus, influenza A and B, parainfluenza, and respiratory sincytial virus, among others. There were 916 participants in the study (median age: 17 years; range: 1 month – 86 years). Viruses were identified in 143 (15.6%) subjects, and one participant was found to have a co-infection with more than one virus.

What this indicates is detecting viruses isn't easy. Many of the 85% of specimens that no virus was found are false negatives. (We know this because antibody increases are found more often than antigen.)

Quote:

Influenza viruses, including pandemic H1N1 2009, were the most frequently detected pathogens, accounting for 67.4% (97/144) of the viruses detected. Adenovirus (15/144), parainfluenza virus (13/144), and respiratory syncytial virus (11/144) were also important causes of ILI in this study.

Jefferson's claim that influenza is a minor pathogen is not evidence based. I'll get back to his paper tomorrow.

[Skeptic Ginger]

Originally Posted by Professor Yaffle

And that's if Tamiflu works at all, given that Roche are still hiding data.

http://www.dailymail.co.uk/news/arti...#axzz2K9qUaqbG

Don't worry, I know its from the Daily Fail, but its by Ben Goldacre, so that makes it ok.

When studies fail to sort out Tamiflu given within the first 24 hours compared to Tamiflu given later (3 days in the antiviral drug does very little if anything) the results are invalid.

I've not looked at the most recent Tamiflu data but when it was given to patients with the 2009H1N1v and the HPAI H5N1 they were more likely to survive if it was given early in the course of disease, while no Tamiflu or Tamiflu given later than 3 days in, was not likely to affect mortality. I'll try to drum up the studies. They were done looking at the characteristics of flu fatalities, and they weren't studies done by drug companies.

I'm not defending the drug company shenanigans.

[Capsid]

Quote:

Many of the 85% of specimens that no virus was found are false negatives. (We know this because antibody increases are found more often than antigen.)

Couldn't this be a matter of timing? The virus titre may have declined in the serum but the antibody persists.

[kellyb]

Originally Posted by Capsid

Couldn't this be a matter of timing? The virus titre may have declined in the serum but the antibody persists.

You're basically right, although flu viremia is very rare, so they test the upper respiratory tract for actual virus/antigen and not the blood, and antibody tests aren't very reliable (I'm guessing because people are so frequently infected, most people have antibodies most the time?)

[Skeptic Ginger]

Originally Posted by Capsid

Couldn't this be a matter of timing? The virus titre may have declined in the serum but the antibody persists.

I wasn't talking about viral titers, I was talking about antigen detection from a nasal or pharyngeal smear.

There are many reasons viral tests give false negatives, timing is definitely one of the reasons.

It's also not always easy to get a good nasal or pharyngeal smear. You are supposed to leave the swab in for a designated period of time. Not easy when the person is gagging.

And the direct tests on the smear require a fair viral load:
Routine viral culture for pediatric respiratory specimens submitted for direct immunofluorescence testing.

Quote:

From 1986 to 1987, 69 (25%) of 274 specimens from children with lower respiratory tract syndromes were positive for respiratory syncytial virus antigen by direct immunofluorescence assay (DFA). Comprehensive viral culture was performed on all 205 DFA-negative specimens, and 72 specimens yielded viruses; 5 specimens yielded multiple agents. Thus, 52% of specimens yielded a specific virus, supporting the routine use of viral culture. Isolates from the DFA-negative specimens included respiratory syncytial virus (n = 7), rhinovirus (n = 34), hemadsorbing viruses (n = 13), cytomegalovirus (n = 11), adenovirus (n = 8), enteroviruses (n = 3), and herpes simplex virus (n = 2). Although serologic confirmation is needed, cytomegalovirus may be an underappreciated cause of acute lower respiratory tract infection in normal children. Further studies must be conducted to document this possibility.

And, not all viruses are equally easily cultured.

There are drawbacks and benefits of course to different tests. Antibodies might yield fewer false negatives, but they are subject to a delay before they show up and with some pathogens you need acute and convalescing titers, a single measurement isn't easily interpreted.

[Skeptic Ginger]

Originally Posted by kellyb

You're basically right, although flu viremia is very rare, so they test the upper respiratory tract for actual virus/antigen and not the blood, and antibody tests aren't very reliable (I'm guessing because people are so frequently infected, most people have antibodies most the time?)

I'm guessing you are guessing.

Yes, it's extremely rare one would test blood for a circulating influenza antigen. On a really sick patient not responding to treatment, or if one was specifically looking for something like CMV or a viral encephalitis, but not for a respiratory infection. And studies have been done looking at influenza viremia:

Sensitive detection assays for influenza RNA do not reveal viremia in US blood donors.
Influenza viral RNA detection in blood as a marker to predict disease severity in hematopoietic cell transplant recipients.


As for the antibodies, it depends on the pathogen one is concerned about and/or why you are doing the test, but influenza antibody tests are available to determine very specific strains and can distinguish between recent and older exposures.

Most of the time we do them for epidemiological surveys, not for testing a person with an ILI. Other viral infections, yes, we often (well less often now because tests to recover viruses have improved) look at acute and convalescing titers to distinguish an acute infection from a past one.

I've posted a couple links in this thread that surveyed population antibody to various influenza strains. The testing is very accurate. It's just not useful to diagnose an acute infection.

[kellyb]

Originally Posted by Skeptic Ginger

I'm guessing you are guessing.

Yes, it's extremely rare one would test blood for a circulating influenza antigen. On a really sick patient not responding to treatment, or if one was specifically looking for something like CMV or a viral encephalitis, but not for a respiratory infection. And studies have been done looking at influenza viremia:

Sensitive detection assays for influenza RNA do not reveal viremia in US blood donors.
Influenza viral RNA detection in blood as a marker to predict disease severity in hematopoietic cell transplant recipients.


As for the antibodies, it depends on the pathogen one is concerned about and/or why you are doing the test, but influenza antibody tests are available to determine very specific strains and can distinguish between recent and older exposures.

Most of the time we do them for epidemiological surveys, not for testing a person with an ILI. Other viral infections, yes, we often (well less often now because tests to recover viruses have improved) look at acute and convalescing titers to distinguish an acute infection from a past one.

I've posted a couple links in this thread that surveyed population antibody to various influenza strains. The testing is very accurate. It's just not useful to diagnose an acute infection.

The testing is very accurate when you have both a pre and post infection sample for an individual within a given season. That's why the seroepidemiological surveys collect samples before flu season hits and after. They're looking for a relative rise in antibodies.

[MarkCorrigan]

Interesting thread, although I have to say I'm disappointed in myself because I'm not entirely following. As far as I can tell though, SG is setting herself up as an authority and Kellyb and Estella are questioning what she's saying?

Am I at least following the internal politics of the thread?

[kellyb]

Originally Posted by MarkCorrigan

Interesting thread, although I have to say I'm disappointed in myself because I'm not entirely following. As far as I can tell though, SG is setting herself up as an authority and Kellyb and Estella are questioning what she's saying?

Am I at least following the internal politics of the thread?

SG is trying to play "U R ignorant, I R authority" while reading/encountering for the first time stuff (fairly complicated stuff, to be fair) that kellyB and Este have been arguing about in detail with each other (off and on) for almost a decade now.

[MarkCorrigan]

Thank you, that helps.

You know the weird thing is even though I can't claim to follow all the science being as I am a lowly PoliSci rather than actual scientist, I can't say I'm even remotely surprised at that.

[Skeptic Ginger]

Originally Posted by kellyb

The testing is very accurate when you have both a pre and post infection sample for an individual within a given season. That's why the seroepidemiological surveys collect samples before flu season hits and after. They're looking for a relative rise in antibodies.

You don't know what you're talking about. Antibodies and the reagents to test for them come in a gazillion flavors.

Here's one example of a very general test I can order on a patient. Quest is the main lab I use in my practice:

Quote:

Reference Range(s)
Influenza A Ab <1:8
Influenza B Ab <1:8
Interpretive Criteria
<1:8 Antibody not detected
≥1:8 Antibody detected Single titers of ≥1:64 are indicative of recent infection. Titers of 1:8 to 1:32 may be indicative of either past or recent infection, since CF antibody levels persist for only a few months. A fourfold or greater increase in titer between acute and convalescent specimens confirms the diagnosis

Only if the titer is between 1:8 and 1:32 is a second specimen needed.

Here's a variety of tests one can use for research purposes:
World's largest influenza research reagent manufacturer 300+ influenza research tools: protein, antibody, ELISA kit, gene cDNA clone

Quote:

Browse Influenza Antibodies by Subtype
H1N1 Antibody
H1N2 Antibody
H1N3 Antibody
H2N2 Antibody
H3N2 Antibody
H4N4 Antibody
H4N6 Antibody
H4N8 Antibody
H5N1 Antibody
H5N2 Antibody
H5N3 Antibody H5N8 Antibody
H6N1 Antibody
H6N4 Antibody
H7N7 Antibody
H8N4 Antibody
H9N2 Antibody
H10N3 Antibody
H10N9 Antibody
H11N2 Antibody
H11N9 Antibody
H12N1 Antibody
H12N5 Antibody
H13N8 Antibody
H15N8 Antibody
H16N3 Antibody
Influenza B Antibody

Additional Influenza Research Reagents
Influenza ELISA Kit
Influenza Hemagglutinin Protein & Antibody
Influenza Neuraminidase Protein & Antibody
Influenza Neuraminidase (NA) Antibody
Influenza Nucleoprotein & Antibody
Influenza M1 Protein
Influenza NS1 Protein
Influenza NS2 Protein (NEP)

Influenza antibody and influenza antibodies are very important research tools for influenza diagnosis, influenza vaccine development, and anti-influenza virus therapy development. Monoclonal or polyclonal antibody can be raised with protein based antigen or peptide based antigen. Antibody raised with protein based antigen could have better specificity and/or binding affinity than antibody raised with peptide based antigen, but cost associated with the recombinant protein antigen is usually higher. Anti influenza virus hemagglutinin (HA) monoclonal antibody or polyclonal antibody can be used for ELISA assay, western blotting detection, Immunohistochemistry (IHC), flow cytometry, neutralization assay, hemagglutinin inhibition assay, and early diagnosis of influenza viral infection.
Sino Biological has developed state-of-the-art monoclonal antibody development technology platforms: mouse monoclonal antibody and rabbit monoclonal antibody. Our rabbit monoclonal antibody platform is one of a kind and offers some unique advantages over mouse monoclonal antibodies, such as high affinity, low cross-reactivity with rabbit polyclonal antibodies.
Sino Biological offers a broad range of anti-influenza virus hemagglutinin antibodies, including rabbit polyclonal antibodies, mouse monoclonal antibodies, and rabbit monoclonal antibodies. Specific monoclonal antibodies to swine influenza H1N1 Hemagglutinin proteins and avian influenza H5N1 hemagglutinin proteins were obtained. These antibodies have very high specificity and high affinity which leads to very low detection limit. These antibodies can be used in research applications such as diagnosis, ELISA assay, western blotting (WB), IHC, Flow cytometry assay etc.

[Skeptic Ginger]

Originally Posted by MarkCorrigan

Interesting thread, although I have to say I'm disappointed in myself because I'm not entirely following. As far as I can tell though, SG is setting herself up as an authority and Kellyb and Estella are questioning what she's saying?

Am I at least following the internal politics of the thread?

I don't know what you mean by, "an authority". I'm a nurse practitioner who specializes in infection prevention and occupational infectious disease hazards. I give a ~1,000 flu vaccinations/yr and am a paid consultant to a number of health care facilities where promoting health care worker flu vaccinations has been a key component in infection control since 2005.

I started the thread because one team of Cochrane Reviewers (an important evidence based medicine source) headed by Dr Tom Jefferson has published a number of meta-analyses that suggest flu vaccinations are not useful in healthy people. However, a very large body of experts in the field do not agree with the findings and Dr Jefferson has very strong opinions that could be resulting in confirmation bias in his work.

This is a useful place to start: The Cochrane Collaborative’s Tom Jefferson makes the huge mistake of appearing on Gary Null’s show

Este, kellyb and I believe Professor Yaffle as well, find the Cochrane Review to be authoritative while I find the rest of the medical community with expertise in influenza to be a more reliable source given Dr Jefferson's less than objective opinion about influenza and influenza vaccine.

If I reply to a post that has incorrect information in it, like the posts misinterpreting surveillance data or the most recent one with incomplete information about influenza antibody testing, I have tried to support my position with evidence. If someone wants to whine that is acting as a know-it-all, I refer to my posts with the very specific reasons and sources for why I am calling something misinformed.

[Skeptic Ginger]

Originally Posted by MarkCorrigan

Thank you, that helps.

You know the weird thing is even though I can't claim to follow all the science being as I am a lowly PoliSci rather than actual scientist, I can't say I'm even remotely surprised at that.

The science isn't that complicated. But it becomes more complex when, as I said in the thread title, the science contradicts the science.