Flu Season 2014-15 is here!

[astaft]

Disclaimer: This is my field of expertise, but I am not a MD.

Influenza vaccine effectiveness is typically 50-65% and the benefits outweigh the risks. Two types of vaccines, the attenuated live vaccine and the "shot". This year, the experts picked 3 strains for the trivalent (H1N1, H3N2 and B) and 4 strains for the quadrivalent (H1N1, H3N2, and two B). Research shows that typically the intranasal (live) vaccine works better in kids.

Some of the problems encountered are when the specific strains are chosen (~6 months before influenza season) and also after the strains are chosen, they are grown in eggs or cell-culture. Sometimes the virus does not grow well or changes its antigenicity during growth.

Any specific questions?

Can someone who knows more about this than I do speak to the science of the flu shots? I've never had one and have always been sort of leery as I've always thought it was just another pharmaceutical company pushing something and profiting from it. I don't remember people getting flu shots when I lived overseas.

This said, I'm not a fanatic or a fringe lunatic believing in conspiracies or anything like that so don't put me in with the anti-vaccination crowd. But I've always been a bit suspicious of the concept of the benefits of the flu shot.

Any scientists here who know about this stuff?

[Lionel]

I have 3 MD friends, none of them do it and 2 of them actually recommended against it in private. Not sure why but they all said that "at best" it does nothing.

[astaft]

Here is the 2009 pandemic H1N1 data, the curve is very different than typical seasonal mortality.

qa_graphC.gif

A healthy body with an immune system in tip top shape can beat a virus and a superior diet and outdoor exercise builds a strong immune system. But get the shot if you want. It "probably" won't do any harm.

[Jonathan]

A healthy body with an immune system in tip top shape can beat a virus and a superior diet and outdoor exercise builds a strong immune system. But get the shot if you want. It "probably" won't do any harm.

Yes, healthy folks don't die of flu. A superior diet and exercise doesn't build an immune system though. I've been sorting through my IG panels, Lymphocte tests, t-lymph mitogen stimulation tests this morning and no where have I come across diet as being effective to change those numbers. But I would suggest a strong body would help deal with what happens if you get the flu and getting the flu and being down for some days may be enough motivation for some folks.

In the immunodeficint patient and doctor community we have been discussing this topic quite a bit. Our docs recommend we get the shot, even if it doesn't help us build immunity because it doesn't hurt. With that said, maybe 1/1000 of the immunodeficient do have a reaction like aseptic meningitis, a lupus or MS flare etc. We are talking really small numbers of people.

[Jonathan]

I have 3 MD friends, none of them do it and 2 of them actually recommended against it in private. Not sure why but they all said that "at best" it does nothing.

I've also seen this. Many people don't trust the data. I know in the last year or two transparency has increased or at least the pledge of transparency. Maybe astaft can enlighten us if this is still on his area of expertise.

[astaft]

I agree that healthy folks usually don't die of the flu, but the 1918 pandemic killed a lot of healthy people and so did the 2009 H1N1. What does happen is that healthy people get the flu and spread it to less healthy people eg. old people and kids.

Recent study data: The effectiveness of TIV against influenza A virus infection was 63% (95% confidence interval [CI], 37%-78%). The effectiveness of TIV against A(H1N1)pdm09 infection was 77% (95% CI, 44%-90%).

Yes, healthy folks don't die of flu. A superior diet and exercise doesn't build an immune system though. I've been sorting through my IG panels, Lymphocte tests, t-lymph mitogen stimulation tests this morning and no where have I come across diet as being effective to change those numbers. But I would suggest a strong body would help deal with what happens if you get the flu and getting the flu and being down for some days may be enough motivation for some folks.

In the immunodeficint patient and doctor community we have been discussing this topic quite a bit. Our docs recommend we get the shot, even if it doesn't help us build immunity because it doesn't hurt. With that said, maybe 1/1000 of the immunodeficient do have a reaction like aseptic meningitis, a lupus or MS flare etc. We are talking really small numbers of people.

[classtimesailer]

Can someone who knows more about this than I do speak to the science of the flu shots? I've never had one and have always been sort of leery as I've always thought it was just another pharmaceutical company pushing something and profiting from it. I don't remember people getting flu shots when I lived overseas.

This said, I'm not a fanatic or a fringe lunatic believing in conspiracies or anything like that so don't put me in with the anti-vaccination crowd. But I've always been a bit suspicious of the concept of the benefits of the flu shot.

Any scientists here who know about this stuff?

I don't know if she is a member/cyclist, but check this out:
A Shot Never Worth Taking: The Flu Vaccine ~ by Kelly Brogan, MD | International Medical Council on Vaccination

[theflashunc]

CDC seems fairly confident in them: Vaccine Effectiveness - How Well Does the Flu Vaccine Work? | Seasonal Influenza (Flu) | CDC


I picked up a pretty nasty case of the flu back around Labor Day weekend 2009. Went downhill fast. From fine to fever, chills, aches in about 3 hours. Cleared in about 48 hours, but probably some of the worst 48 hours I've had, save for the pneumonia I got as an idiot teenager.

[astaft]

Our bodies/immune systems are complex. New data has come out that repeated flu vaccinations (with the same strain) lowers vaccine effectiveness. For example, the H1N1 strain in the vaccine has not changed in 4 years. I guess it comes down to what you think is right for you.

The 2011-2012 season was mild and peaked late, with circulation of both type A viruses and both lineages of type B. Overall adjusted vaccine effectiveness was 47% (95% confidence interval [CI], 36-56) in preventing medically attended influenza; vaccine effectiveness was 65% (95% CI, 44-79) against type A (H1N1) pdm09 but only 39% (95% CI, 23-52) against type A (H3N2). Estimates of vaccine effectiveness against both type B lineages were similar (overall, 58%; 95% CI, 35-73). An apparent negative effect of prior year vaccination on current year effectiveness estimates was noted, particularly for A (H3N2) outcomes.

[davids]

A healthy body with an immune system in tip top shape can beat a virus and a superior diet and outdoor exercise builds a strong immune system. But get the shot if you want. It "probably" won't do any harm.

I'm a generally healthy middle-aged guy who eats passably well and gets regular strenuous exercise. I've got allergic asthma, so it puts me at greater risk for pulmonary symptoms.

I "probably" haven't had the flu since I've started getting the annual shot.

It's not 100% effective - read astaft's post - but it's not something I will ever forego.

[znfdl]

I'm a generally healthy middle-aged guy who eats passably well and gets regular strenuous exercise. I've got allergic asthma, so it puts me at greater risk for pulmonary symptoms.

I "probably" haven't had the flu since I've started getting the annual shot.

It's not 100% effective - read astaft's post - but it's not something I will ever forego.

David, I agree with you. My RA medication suppresses my immune system. I too also have not had the flu since getting the vaccine. I will be getting the shot tomorrow.

[Saab2000]

Another question.....

How many strains of influenza do we typically see? Dozens? Hundreds? Countless? And if we get one and recover, are we immune to that particular strain in the future?

The reason I ask is that when I was younger I got lots of colds - 3 or 4 per year. I've heard that there are only a few hundred known viruses that we recognize as causing "The Common Cold" and that eventually I would have to run out of them!

I don't really know if I get sick now less than I used to but I know I eat a lot more naturally occurring vitamin C than I used to, in the form of fruits and berries and I'd like to think that this helps.

All these questions are asked out of ignorance. I just don't know much. Thanks for the answers to those who are knowledgeable.

[Matthew Strongin]

Obviously not a scientist here. Part of the problem Jim is that big pharma has been tight fisted with the clinical trial data. Even a scientist will be short of data to give a full answer. Here is my short answer. There's been very little drop in the death rate of healthy people who get the flu. Healthy people don't die of flu. It may save you a bad day or three. There is some evidence that children have benefitted. It's not conclusive if old folks really have seen a benefit wrt to death. Old people die anyway in predictable numbers. It should be mentioned that death is only one possible side effect and the least likely for you. Flu can kill you, but the shot won't. As far as big pharma goes, vaccines make up 1% of worldwide revenue. A flu pandemic probably puts more money in their pocket than the 135 million flu shots delivered in the US every year. Some people have a very strong inate and adaptive immune system. That may be you if you've never gotten a shot and don't get the flu. The flu shot makes 100% sense if we are talking about broad public policy. Vaccines have changed the course of humanity, that's not an over exaggeration.

I think this was mentioned above, but a good reason is to minimize exposure for those around you, who may have weaker immune systems. I don't typically get the shot, but this year I will. Someone close to me is dealing with tough health issues and the doctor requested we all get the shot. I'd much rather get the shot and take what minimal (or so it seems) risk that comes with it than potentially pass the flu along to someone who can't fight it.

[Jonathan]

Another question.....

How many strains of influenza do we typically see? Dozens? Hundreds? Countless? And if we get one and recover, are we immune to that particular strain in the future?

The reason I ask is that when I was younger I got lots of colds - 3 or 4 per year. I've heard that there are only a few hundred known viruses that we recognize as causing "The Common Cold" and that eventually I would have to run out of them!

I don't really know if I get sick now less than I used to but I know I eat a lot more naturally occurring vitamin C than I used to, in the form of fruits and berries and I'd like to think that this helps.

All these questions are asked out of ignorance. I just don't know much. Thanks for the answers to those who are knowledgeable.

For some reason my iPad will no longer cut and paste, but lots of info can be found at primaryimmune.org under the education tab. The first link is an overview of the immune system. It's easy to read.

[Lionel]

I think this was mentioned above, but a good reason is to minimize exposure for those around you, who may have weaker immune systems. I don't typically get the shot, but this year I will. Someone close to me is dealing with tough health issues and the doctor requested we all get the shot. I'd much rather get the shot and take what minimal (or so it seems) risk that comes with it than potentially pass the flu along to someone who can't fight it.

This logic only works if you assume the vaccine actually protects you. I had the flu 3 times, the real thing that knocks you out completely in bed for 7 days. 2 out of 3 times where during years I took the shot. YMMV.

[znfdl]

This logic only works if you assume the vaccine actually protects you. I had the flu 3 times, the real thing that knocks you out completely in bed for 7 days. 2 out of 3 times where during years I took the shot. YMMV.

As Astaft said"Influenza vaccine effectiveness is typically 50-65% and the benefits outweigh the risks."

If you are at the 50% effectiveness rate, then you should get the vaccine this year. The statistics would be on your side :)

[astaft]

Subtype = HxNx (like H1N1), Strain is this virus from a source eg A/California/04/09 (someone that got H1N1)

How many strains of influenza do we typically see?

Short answer, countless (theoretically there is close to an infinite number of strains that can be generated)! More detailed answer is that most strains of influenza "evolve". That is, the HA protein, that we make antibodies to changes over time. For example, the H3N2 virus has changed multiple times since emergence in 1968 requiring the vaccine to change >12 times.

And if we get one and recover, are we immune to that particular strain in the future?
Yes, we even get protection from re-emerging subtypes. If you got 1918 H1N1 Spanish flu, you are most likely protected against 2009 H1N1





Dozens? Hundreds? Countless? And if we get one and recover, are we immune to that particular strain in the future?

The reason I ask is that when I was younger I got lots of colds - 3 or 4 per year. I've heard that there are only a few hundred known viruses that we recognize as causing "The Common Cold" and that eventually I would have to run out of them!

I don't really know if I get sick now less than I used to but I know I eat a lot more naturally occurring vitamin C than I used to, in the form of fruits and berries and I'd like to think that this helps.

All these questions are asked out of ignorance. I just don't know much. Thanks for the answers to those who are knowledgeable.[/QUOTE]

[Matthew Strongin]

This logic only works if you assume the vaccine actually protects you. I had the flu 3 times, the real thing that knocks you out completely in bed for 7 days. 2 out of 3 times where during years I took the shot. YMMV.

I definitely don't expect 100% protection. I haven't gotten the vaccine in years. I'm not willing to take any chances this year given the situation mentioned above. I may get the shot and still get the flu, but if I don't get the shot and get the flu...and pass it on, that could end up being a worst case scenario situation for people I love.

[bcm119]

One point to keep in mind is that the 1918 flu pandemic killed more healthy people than infants, elderly or immune compromised people. From what I've read about it, that particular strain was most deadly to healthy people aged 20-40, as it caused healthy immune systems to overreact. 1918 was a worst case scenario, but a reminder that flu is something to take seriously. If there's any chance the flu shot reduces my chances of getting it, and it's free or almost free, and has an extremely low rate of serious side effects, I don't know why you'd not get it.

[Jonathan]

S

As Astaft said"Influenza vaccine effectiveness is typically 50-65% and the benefits outweigh the risks."

If you are at the 50% effectiveness rate, then you should get the vaccine this year. The statistics would be on your side :)

Stu, I think there may be some nuance about effectiveness too. My understanding is that the flu shot may lower the severity of flu too if one does get it.