Flu Vaccine: Does It Work??

[facetguy]

Worthwhile article on the effectiveness (or possible lack thereof) of the flu vaccine:
http://www.theatlantic.com/doc/200911/brownlee-h1n1

The effectiveness of the seasonal flu vaccine has become dogma. Yet there are experts who point to quality studies to raise some doubt.

And apparently some recent Cochrane Reviews haven't exactly been ringing endorsements of flu vaccines, although I haven't read them myself yet.

Any thoughts?

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[Instatewaiter]

Instead of posting an article by a journalist without any evidence that the flu vaccine doesnt work, how about some real, well designed studies that show vaccination for the flu is not effective? Oh wait... you probably couldnt find any.

Here's a bit about the author: Shannon Brownlee is a senior research fellow at the New America Foundation and the author of Overtreated (2007).

As usual, nice post facetguy. Maybe the flu is just the mal-alignement of the spine.

 

[facetguy]

Instead of posting an article by a journalist without any evidence that the flu vaccine doesnt work, how about some real, well designed studies that show vaccination for the flu is not effective? Oh wait... you probably couldnt find any.

Here's a bit about the author: Shannon Brownlee is a senior research fellow at the New America Foundation and the author of Overtreated (2007).

As usual, nice post facetguy. Maybe the flu is just the mal-alignement of the spine.

Easy there big fella. You misinterpret my post. In case you haven't noticed, there is a lot of buzz this flu season, particularly with regard to H1N1. There is also a lot of confusion on the part of the public and, yes, healthcare professionals too as to all of this. At the same time, there are reports calling into question the effectiveness of the seasonal flu vaccine (as for the H1N1 vaccine effectiveness, time will tell).

Cochrane Reviews are generally well-regarded. Would it not concern you if such reviews of flu vaccination concluded that the flu vaccine isn't as effective as we think? That's all I'm asking: has anyone done any study in this area and what have you concluded? I myself have not done such study, although I've read a little about a flu vaccine researcher, Tom Jefferson, MD, of Cochrane's international flu vaccine team, and he isn't so sure the flu vaccine is all it's cracked up to be.

I understand, Instate, that I'm asking you to think a bit and momentarily put dogma aside, which may have made you uncomfortable. As to Shannon Brownlee, I'm not familiar with her organization or any of her work. I presume you've read the book you attributed to her, Overtreated. Can you tell us a bit about it and why you disagree with her (or are you judging the book by it's cover)? And the Atlantic magazine, to which I posted the link, isn't exactly a junk publication.

Any mature, objective opinions out there?

 

[Instatewaiter]

Some of the efficacy trials for the H1N1 vaccine were done at my hospital. It's effective.

You say dogma, I say thoroughly proven by medical research with almost nothing credible pointing to the counter argument.

I have not read the book in its entirety. I briefly read a bit of it in a barnes and noble. It was just like most of the other books out there with similar sensationalistic titles (the full title is Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer) - hype and dramatization written for an audience that eats that kind of stuff up.

 

[RGMSU]

It works. Anybody who advises people at risk for flu complications not to be vaccinated is being irresponsible in my view.

 

[hanakhan]

yes it does work

 

[facetguy]

"It works"? I'm impressed with the level of depth in your answers.

 

[Instatewaiter]

How about this for some proof of efficacy: I, and at least 20 other health professionals work in a pediatric ICU that is literally all H1N1 flu patients (we have a dirty PICU for only H1N1 and a clean PICU for non-H1N1 PICU cases) We all got vaccinated. No one has the flu. Were the vaccine ineffective every single person who works in that PICU would have H1N1 already.

Remember the flu is so contagious that there are reports of one sick contact contaminating literally an entire football team and 1/2 of the opposing team during a single game.

 

[Hernandez]

How about this for some proof of efficacy: .

It's so efficacious it even works in non-flu seasons! My review of the literature leads me to believe the benefits and the so called mortality reduction that were reported in the original observational studies was sorely overstated.

 

[RGMSU]

Does H1N1 vaccine work? Who knows? Who can get ahold of it to be vaccinated with it in time to see if its effective, since H1N1 is already rampant and the vaccine is virtually non-existent? Uh-oh, the government that's about to take over everybody's healthcare failed us again, didn't it?

 

[Pharmavixen]

Prevention and Control of Seasonal Influenza With Vaccines

Evaluating Influenza Vaccine Efficacy and Effectiveness Studies

The efficacy (i.e., prevention of illness among vaccinated persons in controlled trials) and effectiveness (i.e., prevention of illness in vaccinated populations) of influenza vaccines depend in part on the age and immunocompetence of the vaccine recipient, the degree of similarity between the viruses in the vaccine and those in circulation (see Effectiveness of Influenza Vaccination when Circulating Influenza Virus Strains Differ from Vaccine Strains), and the outcome being measured. Influenza vaccine efficacy and effectiveness studies have used multiple possible outcome measures, including the prevention of medically attended acute respiratory illness (MAARI), prevention of laboratory-confirmed influenza virus illness, prevention of influenza or pneumonia-associated hospitalizations or deaths, or prevention of seroconversion to circulating influenza virus strains. Efficacy or effectiveness for more specific outcomes such as laboratory-confirmed influenza typically will be higher than for less specific outcomes such as MAARI because the causes of MAARI include infections with other pathogens that influenza vaccination would not be expected to prevent (81). Observational studies that compare less-specific outcomes among vaccinated populations to those among unvaccinated populations are subject to biases that are difficult to control for during analyses. For example, an observational study that determines that influenza vaccination reduces overall mortality might be biased if healthier persons in the study are more likely to be vaccinated (82,83). Randomized controlled trials that measure laboratory-confirmed influenza virus infections as the outcome are the most persuasive evidence of vaccine efficacy, but such trials cannot be conducted ethically among groups recommended to receive vaccine annually.

In a nutshell, it's really hard to prove vaccine efficacy.

 

[aaliyahhaughton]

Worthwhile article on the effectiveness (or possible lack thereof) of the flu vaccine:
http://www.theatlantic.com/doc/200911/brownlee-h1n1

The effectiveness of the seasonal flu vaccine has become dogma. Yet there are experts who point to quality studies to raise some doubt.

And apparently some recent Cochrane Reviews haven't exactly been ringing endorsements of flu vaccines, although I haven't read them myself yet.

Any thoughts?

I can’t say anything.

 

[facetguy]

I can’t say anything.

I thank you for your candor.

 

[yasinthomas]

Flu vaccine works when it is taken at proper time and in the proper way...see that there is no duplicacy in vaccine....check its expiry date..it is very important to do that....

 

[facetguy]

Flu vaccine works when it is taken at proper time and in the proper way...see that there is no duplicacy in vaccine....check its expiry date..it is very important to do that....

You say it works. I admit I don't know how well it works. There are experts that say it doesn't work as well as advertised.

 

[AgActual]

I sure hope it works or else I got up early on Saturday and stood in a line for nothing.

Then again, I got the vaccine on Saturday and since then, I haven't come down with swine flu, so it must work.

 

[Bart Clarridge]

I remember thinking that vaccines obviously work. I mean it makes good sense. Then I heard more and more contrarians. One thing that makes me suspicious of drug effacacy calims (not simply vaccines) is the pharmaceutical industries history of hype (and I'm being charitable). There are some great example of the games they play in Marsah Angell's (former NEJM editor) book.

There is a bias toward publishing positive findings. And if you set the p-value to 0.05, you can run about 20 studies and publish the one that shows what you need it to.

Bottom line is that I don't really know. And even if you read all the studies you can find, you still may not get the truth. But I don't like things being forced on me. A bit like global warming...er, global climate change

 

[Stitch]

Specifically talking about the flu vaccine, there's little data on efficacy (unlike other standard vaccines where good epidemiological data exists), but I think asking for insurance of whether it works or not is the wrong way to look at it. As someone else pointed out, it's very difficult to design a study to track it, because when a vaccine like that works, nothing happens.

Look at it from a game theory perspective. You can get a shot or not. You may get the flu and you may not. Flu kills 36,000 people each year. Not getting a flu shot may decrease your risk or getting flu or getting sick with flu. Getting a flu shot really carries no risk (and please don't whine about 'oh I got the flu from the shot!). Of course if you want to believe Jenny McCarthy and say that it will give you autism, then I'm not interested in talking to you.

So by getting the shot you may decrease your risk of flu or related morbidity while taking on little to no other risk. Passing it up may not change your risk, but might also put you at higher risk of morbidity/mortality. So why not take the better odds and get the shot?

 

[facetguy]

Specifically talking about the flu vaccine, there's little data on efficacy (unlike other standard vaccines where good epidemiological data exists), but I think asking for insurance of whether it works or not is the wrong way to look at it. As someone else pointed out, it's very difficult to design a study to track it, because when a vaccine like that works, nothing happens.

Look at it from a game theory perspective. You can get a shot or not. You may get the flu and you may not. Flu kills 36,000 people each year. Not getting a flu shot may decrease your risk or getting flu or getting sick with flu. Getting a flu shot really carries no risk (and please don't whine about 'oh I got the flu from the shot!). Of course if you want to believe Jenny McCarthy and say that it will give you autism, then I'm not interested in talking to you.

So by getting the shot you may decrease your risk of flu or related morbidity while taking on little to no other risk. Passing it up may not change your risk, but might also put you at higher risk of morbidity/mortality. So why not take the better odds and get the shot?

Just curious. Do you take the same approach toward nutritional supplements?

 

[Stitch]

Just curious. Do you take the same approach toward nutritional supplements?

For the most part, but it depends on the supplement and the data behind it. In general a lot of patients take supplements of some kind, so it doesn't bother me. I like to know what they're on, but as long as it's not harmful it's fine by me.

 

[TDX]

The public health benefits have been overstated in the past, but it still has significant benefits.

Some light reading for your enjoyment:

Rivetti D, Jefferson T, Thomas Roger E, Rudin M, Rivetti A, Di Pietrantonj C, et al. Vaccines for preventing influenza in the elderly. 2006(3).
Jefferson T, Di Pietrantonj C. Inactivated influenza vaccines in the elderly--are you sure? Lancet 2007 Oct 6;370(9594):1199-1200.
Jackson LA, Jackson ML, Nelson JC, Neuzil KM, Weiss NS. Evidence of bias in estimates of influenza vaccine effectiveness in seniors. Int.J.Epidemiol. 2006 Apr;35(2):337-344.
Jackson LA, Nelson JC, Benson P, Neuzil KM, Reid RJ, Psaty BM, et al. Functional status is a confounder of the association of influenza vaccine and risk of all cause mortality in seniors. Int.J.Epidemiol. 2006 Apr;35(2):345-352.
Simonsen L, Taylor RJ, Viboud C, Miller MA, Jackson LA. Mortality benefits of influenza vaccination in elderly people: an ongoing controversy. Lancet Infect.Dis. 2007 Oct;7(10):658-666.
Nichol KL. Challenges in evaluating influenza vaccine effectiveness and the mortality benefits controversy. Vaccine 2009 2009/10;27(45):6305.
Ortqvist A, Granath F, Askling J, Hedlund J. Influenza vaccination and mortality: prospective cohort study of the elderly in a large geographical area. Eur.Respir.J. 2007 Sep;30(3):414-422.
Kwong JC, Stukel TA, Lim J, McGeer AJ, Upshur RE, Johansen H, et al. The effect of universal influenza immunization on mortality and health care use. PLoS Med. 2008 Oct 28;5(10):e211.
Ferrer AL, Marcon SS, Santana RG. Hospital morbidity among elderly patients, before and after influenza vaccination in the state of Parana. Rev.Lat.Am.Enfermagem 2008 Sep-Oct;16(5):832-837.

It should, however, be noted that these articles mainly deal with vaccination for the elderly.

Edit: the first reference is to the 2006 Cochrane Review, but for some reason RefWorks refuses to mention that.

 

[facetguy]

The first 2 references include T. Jefferson as co-author. It was an article that included an interview with Dr. Jefferson that prompted me to ask the question in this thread. He is clearly an expert in this area, yet he has been critical of flu vaccine effectiveness, and that surprised me. Aside from elderly-centered studies, Dr. Jefferson mentioned that the data aren't that clear for children either and that the data are especially sparse for the very young. Sparse data doesn't inspire confidence in certain circles.

 

[TDX]

The first 2 references include T. Jefferson as co-author. It was an article that included an interview with Dr. Jefferson that prompted me to ask the question in this thread. He is clearly an expert in this area, yet he has been critical of flu vaccine effectiveness, and that surprised me. Aside from elderly-centered studies, Dr. Jefferson mentioned that the data aren't that clear for children either and that the data are especially sparse for the very young. Sparse data doesn't inspire confidence in certain circles.

The authors of the third, fourth and fifth articles are also mentioned.

But it's important not to draw the wrong conclusions from their research - something the article, unfortunately, does attempt to do. The proper conclusion isn't that "flu vaccines don't work at all", but that they probably aren't quite as effective as was previously believed and that more research should be done.

In the mean time, however, more recent studies which compensate for the newly identified confounders have still found significant benefits. A bit smaller than the benefits flu vaccination was believed to have, but significant nevertheless.

That is not to say that new studies won't turn these findings around one day (one way or the other), but for now vaccination is still the responsible choice.

 

[facetguy]

Flu vaccine not very effective in elderly.
http://minnesota.publicradio.org/display/web/2010/04/27/flu-vaccine-not-effective-in-elderly/

From the article:
"The revelation has been so unsettling that public health officials have not shared the information widely with the public - even though some of the early findings have been a part of the scientific literature for several years now."

"Osterholm said he knows the idea that the flu vaccine doesn't prevent deaths in the elderly sounds almost blasphemous and he admits he didn't really want to believe it at first either. But he says the new research is incontrovertible, and that data must drive health policy."

I doubt we'll see any changes in public health policy, regardless of new evidence.

 

[FutureDoc4]

Ask and ye shall receive.

You keep quoting random biased news articles (not science).

JAMA did a great review of influenza a few weeks ago (I guess you need to be reading more scientific journals rather than trash news).

There is a section on prevention and the evidence :

JAMA: A 29 Year Old woman with Flu-like Symptoms a review of Influenza Diagnosis and Treatment. (Clinicians Corner), August 11, 2010, Vol 304, No. 6. pg. 671-676

Highlights include review of SCIENTIFIC articles. One example;

" When vaccine strains closely match circulating strains, 1 dose of TIV has been shown to prevent laboratory-confirmed influenza in about 70%-90% of recipients compared with those not vaccinated; rates decrease to 50% to 70% with a poor match" (Hak, et al., Herrera, et al)

The efficacy of the vaccine depends on the health status of the patient, how the circulating strains compare to the vaccine (remember its a guessing game), and the age of the patient.

For the elderly, who don't have a great immune response to the vaccine (cause they are OLD), a lot of protection comes from vaccinating the younger (especially small children) and healthier so they are not passing it on quite as much in the population.

facet guy... are a resident/attending/healthcare provider?

I am sorry to say that many, many of your views frighten me if you are.

By the way there are 120 citations in that article---real science... happy reading.

I would also ask that you not come back with any more trashy news articles in response to this... please, come back with science (and good science, mind you).

Flu vaccine not very effective in elderly.
http://minnesota.publicradio.org/display/web/2010/04/27/flu-vaccine-not-effective-in-elderly/

From the article:
"The revelation has been so unsettling that public health officials have not shared the information widely with the public - even though some of the early findings have been a part of the scientific literature for several years now."

"Osterholm said he knows the idea that the flu vaccine doesn't prevent deaths in the elderly sounds almost blasphemous and he admits he didn't really want to believe it at first either. But he says the new research is incontrovertible, and that data must drive health policy."

I doubt we'll see any changes in public health policy, regardless of new evidence.

 

[facetguy]

Ask and ye shall receive.

You keep quoting random biased news articles (not science).

JAMA did a great review of influenza a few weeks ago (I guess you need to be reading more scientific journals rather than trash news).

There is a section on prevention and the evidence :

JAMA: A 29 Year Old woman with Flu-like Symptoms a review of Influenza Diagnosis and Treatment. (Clinicians Corner), August 11, 2010, Vol 304, No. 6. pg. 671-676

Highlights include review of SCIENTIFIC articles. One example;

" When vaccine strains closely match circulating strains, 1 dose of TIV has been shown to prevent laboratory-confirmed influenza in about 70%-90% of recipients compared with those not vaccinated; rates decrease to 50% to 70% with a poor match" (Hak, et al., Herrera, et al)

The efficacy of the vaccine depends on the health status of the patient, how the circulating strains compare to the vaccine (remember its a guessing game), and the age of the patient.

For the elderly, who don't have a great immune response to the vaccine (cause they are OLD), a lot of protection comes from vaccinating the younger (especially small children) and healthier so they are not passing it on quite as much in the population.

facet guy... are a resident/attending/healthcare provider?

I am sorry to say that many, many of your views frighten me if you are.

By the way there are 120 citations in that article---real science... happy reading.

I would also ask that you not come back with any more trashy news articles in response to this... please, come back with science (and good science, mind you).

A quick check in The National Enquirer didn't turn up any relevant articles, so I guess you're right.

You seem to have missed the point of this whole thread. The flu vaccine is sold to the public as this magical intervention, yet the literature isn't always so supportive. We speak of evidence-based practices, yet some aspects of healthcare get a bit of a pass.

I ask you, does it not interest you at all that there are some flu vaccine experts/researchers that question the strength of the current evidence? Perhaps you need to poke your head out of that box of yours once in awhile.

I'm not suggesting we close all the hospitals and shut down the whole medical system here. I am suggesting that, when it comes to a recommendation (mandate?) pushed as hard as flu vaccination, we should have some really convincing evidence to back that up. Being a scientist and presumably a proponent of evidence-based practice, you should agree with that, no?

In my last post, I quoted Michael Osterholm, PhD, MPH, clearly someone knowledgable in the area of influenza. At the risk of repeating myself, according to the article, "Osterholm said he knows the idea that the flu vaccine doesn't prevent deaths in the elderly sounds almost blasphemous and he admits he didn't really want to believe it at first either. [FutureDoc4, this is where you are right now.] But he says the new research is incontrovertible, and that data must drive health policy." [In contrast, this is where an expert with some balls and some academic honesty is right now.]


Cochrane Review published last month:
http://www.ncbi.nlm.nih.gov/pubmed/20614424
"The review showed that reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies." Imagine that, industry manipulating published data to make their product look better. Who would think?

http://www.bmj.com/cgi/content/full/340/jun09_3/c2994
"Influenza vaccine is said to have "an established record of safety in all age groups."However, published data on the effects of vaccinating young children against influenza are comparatively few.Some manufacturers have even withheld data from public scrutiny amid general indifference."

Cochrane Review from Feb 2010:
http://www.ncbi.nlm.nih.gov/pubmed/20166073
"We conclude there is no evidence that vaccinating healthcare workers prevents influenza in elderly residents in longterm care facilities."

Cochrane Review from Feb 2010:
http://www.ncbi.nlm.nih.gov/pubmed/20166072
"The available evidence is of poor quality and provides no guidance regarding the safety, efficacy or effectiveness of influenza vaccines for people aged 65 years or older."

Cochrane Review regarding flu vaccines in kids:
http://www.ncbi.nlm.nih.gov/pubmed/18425905
"Influenza vaccines are efficacious in children older than two but little evidence is available for children under two. There was a marked difference between vaccine efficacy and effectiveness. No safety comparisons could be carried out, emphasizing 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 current recommendations to vaccinate healthy children from six months old in the USA and Canada. If immunisation in children is to be recommended as a public health policy, large-scale studies assessing important outcomes and directly comparing vaccine types are urgently required."

A ringing endorsement of the current evidence. Let's at least be honest.

And which of my "many, many views frighten" you?

 

[FutureDoc4]

Though, I am running out the door, so I do not have the time to read through the articles you posted. One thing I wanted to comment on.

That because one "expert" with a PhD believes flu shots are bad that is sufficient enough for us to ignore (or really doubt) all the rigorous evidence to the contrary.

You know, there are people out (a well-known person, with a PhD--though his name escapes me right now), that believes AIDS is NOT caused by a virus.....

Well, I am sure he has done tons of his own research... should that be enough to question all our evidence ? Wrong. One idiot does not science make.

End Rant

P.S. You're right.... the flu vaccine isnt some magical intervention that will work for medicine. Though, I would put it to you... is anything in medicine? (I would argue, no)

 

[Instatewaiter]

I had a long post about facetguy's articles but SDN had a glitch so I will give you the long and short of it.

Some of those links are not articles at all and are irrelevant. The others are on populations that shouldn't be vaccinated. The others are poorly done. I can find you about 20 RCTs that show efficacy in the populations that should actually be vaccinated and I linked a bunch of them in the post SDN wouldn't let me post.

 

[facetguy]

Though, I am running out the door, so I do not have the time to read through the articles you posted. One thing I wanted to comment on.

That because one "expert" with a PhD believes flu shots are bad that is sufficient enough for us to ignore (or really doubt) all the rigorous evidence to the contrary.

You know, there are people out (a well-known person, with a PhD--though his name escapes me right now), that believes AIDS is NOT caused by a virus.....

Well, I am sure he has done tons of his own research... should that be enough to question all our evidence ? Wrong. One idiot does not science make.

End Rant

P.S. You're right.... the flu vaccine isnt some magical intervention that will work for medicine. Though, I would put it to you... is anything in medicine? (I would argue, no)

You can run but you can't hide.

 

[facetguy]

I had a long post about facetguy's articles but SDN had a glitch so I will give you the long and short of it.

Some of those links are not articles at all and are irrelevant. The others are on populations that shouldn't be vaccinated. The others are poorly done. I can find you about 20 RCTs that show efficacy in the populations that should actually be vaccinated and I linked a bunch of them in the post SDN wouldn't let me post.

I've lost a few long posts too and it's very frustrating. Effort appreciated nonetheless.

Most of the links (from this morning's post, to which I assume you are referring) are Cochrane Reviews, which are exactly that: reviews. The BMJ link was a letter or something similar that was intended to support the Cochrane conclusion that the evidence is not as good as it needs to be and that the quality of some of the published studies, particularly those done by vaccine manufacturers, is of questionable value. Perhaps your 20 RCTs are counted among the sub-par studies?

And let's not lose sight of the broader issue here. Flu vaccines may indeed benefit certain populations. The point of all of this, however, is that billions of dollars are poured into flu vaccine campaigns aimed at very large segments of the population year after year. A program promoted with such vigor and economic cost should be backed by stellar research. The current literature is, apparently, less than stellar. I'm sure we can find a number of studies showing benefit. But for certain populations the evidence is thinner than it should be, and furthermore those experts who have gone over all the available literature have found concerning inconsistencies between industry-funded and non-industry-funded studies, going so far as to put a warning on the interpretation of at least one of the Cochrane Review conclusions because of this fact.

 

[facetguy]

I would also ask that you not come back with any more trashy news articles in response to this... please, come back with science (and good science, mind you).

You asked and received. Then you ran out the door. Awaiting your thoughts.

 

[MOHS_01]

Well of course it does... the mere production of the swine flu vaccine prevented this imminent global population destroyer from becoming even a mild flu season.... and people did not even have to take it!!!!

 

[facetguy]

Medscape: Do Healthy Adults Really Need a Flu Shot?
(posted 12/17/10)

"Overall, the current review finds that the evidence for universal vaccination of all healthy adults is underwhelming. Even when the vaccine was well-matched to the circulating virus, vaccination against influenza was far from fully protective against infection. Moreover, the flu vaccine had a minimal impact on the number of days of work missed, and it did not prevent complications of influenza.
Unfortunately, a recent review of influenza vaccination among adults at age 65 or older also suggested that the vaccine was of questionable efficacy."

This article is referencing Cochrane Reviews of all the studies out there on the topic. Or, as FutureDoc put it, trashy news articles and not real science. (FutureDoc, I'm still waiting for your comments on my earlier links.)

 

[Pharmavixen]

I had this article thrown in my face by loony anti-vaxers here in Canada. Trouble is, it only addresses efficacy in the patients being vaccinated. When we vaccinate, we don't only do it for the benefit (such as it is) of that person, but also the contacts of that person. So I get the flu shot because I work with people who could become seriously sick from the flu. People with significant immune suppression, such as end-stage AIDS, sometimes can't launch a sufficient immune response from vaccinations.

So the benefits may be relatively marginal in young and healthy people, but if you could quantify the lives saved from the avoidance of exposure in debilitated individuals, the risk reduction could be much more substantial.

Also, they need to consider the secondary infections, the bacterial pneumonias, that were avoided by flu shots to get a complete picture of the benefits.

And I'd like to see a paper, if it's possible, on the benefits of flu shots in pregnant women. One of my professors was involved in the care of a pregnant woman who developed the flu, then pneumonia, then a worsening hypoxia requiring intubation and ventilation, then ARDS. Her baby had to be delivered substantially early and suffers from numerous developmental challenges requiring lots of expensive care. The patient herself did survive, but she has some hypoxic brain damage requiring rehab. The virus that started it all was typed, and it was an influenza strain that was available in the seasonal flu shot for that year, which she did not get. True; this is just one case, but this lady and her child has cost the health care system millions of dollars in that province.

The CDC website has some interesting discussions on the challenges of quantifying the risks and benefits of flu shots. In a nutshell, it's difficult because it's not ethical to conduct randomized controlled trials.

 

[Hernandez]

I had this article thrown in my face by loony anti-vaxers here in Canada. Trouble is, it only addresses efficacy in the patients being vaccinated. When we vaccinate, we don't only do it for the benefit (such as it is) of that person, but also the contacts of that person.

you know of any good data that shows immuniaztions for flu decrease transmission?

 

[facetguy]

I had this article thrown in my face by loony anti-vaxers here in Canada. Trouble is, it only addresses efficacy in the patients being vaccinated. When we vaccinate, we don't only do it for the benefit (such as it is) of that person, but also the contacts of that person. So I get the flu shot because I work with people who could become seriously sick from the flu. People with significant immune suppression, such as end-stage AIDS, sometimes can't launch a sufficient immune response from vaccinations.

So the benefits may be relatively marginal in young and healthy people, but if you could quantify the lives saved from the avoidance of exposure in debilitated individuals, the risk reduction could be much more substantial.

Also, they need to consider the secondary infections, the bacterial pneumonias, that were avoided by flu shots to get a complete picture of the benefits.

And I'd like to see a paper, if it's possible, on the benefits of flu shots in pregnant women. One of my professors was involved in the care of a pregnant woman who developed the flu, then pneumonia, then a worsening hypoxia requiring intubation and ventilation, then ARDS. Her baby had to be delivered substantially early and suffers from numerous developmental challenges requiring lots of expensive care. The patient herself did survive, but she has some hypoxic brain damage requiring rehab. The virus that started it all was typed, and it was an influenza strain that was available in the seasonal flu shot for that year, which she did not get. True; this is just one case, but this lady and her child has cost the health care system millions of dollars in that province.

The CDC website has some interesting discussions on the challenges of quantifying the risks and benefits of flu shots. In a nutshell, it's difficult because it's not ethical to conduct randomized controlled trials.

Anyone pointing to data that runs counter to popular notions regarding any vaccine is automatically an anti-vaxxer.

We talk about evidence-based practice, and here's some evidence. It's worth knowing this evidence exists. (What's the sense of evidence-based practice if the only evidence one is willing to consider is the evidence that agrees with his/her position?)

To the issue of preventing infection in those with low immunity, this Cochrane Review from 2010 (that I had posted earlier) http://www.ncbi.nlm.nih.gov/pubmed/20166073 looked at vaccinating healthcare workers in a long-term care facility to see if that practice reduced flu in elderly residents. It didn't. Should that be the end of all further discussion? Of course not. But it reminds us that what we've routinely come to believe about the flu vaccine doesn't always stand up to the available evidence.

 

[J-Rad]

I had this article thrown in my face by loony anti-vaxers here in Canada. Trouble is, it only addresses efficacy in the patients being vaccinated. When we vaccinate, we don't only do it for the benefit (such as it is) of that person, but also the contacts of that person. So I get the flu shot because I work with people who could become seriously sick from the flu. People with significant immune suppression, such as end-stage AIDS, sometimes can't launch a sufficient immune response from vaccinations.

So the benefits may be relatively marginal in young and healthy people, but if you could quantify the lives saved from the avoidance of exposure in debilitated individuals, the risk reduction could be much more substantial.

Also, they need to consider the secondary infections, the bacterial pneumonias, that were avoided by flu shots to get a complete picture of the benefits.

And I'd like to see a paper, if it's possible, on the benefits of flu shots in pregnant women. One of my professors was involved in the care of a pregnant woman who developed the flu, then pneumonia, then a worsening hypoxia requiring intubation and ventilation, then ARDS. Her baby had to be delivered substantially early and suffers from numerous developmental challenges requiring lots of expensive care. The patient herself did survive, but she has some hypoxic brain damage requiring rehab. The virus that started it all was typed, and it was an influenza strain that was available in the seasonal flu shot for that year, which she did not get. True; this is just one case, but this lady and her child has cost the health care system millions of dollars in that province.

The CDC website has some interesting discussions on the challenges of quantifying the risks and benefits of flu shots. In a nutshell, it's difficult because it's not ethical to conduct randomized controlled trials.

I will go peruse the mentioned Medscape, the CDC website to see these arguments mentioned, as well as my latest issue of Pediatric Infectious Disease-one of the most informative magazines I get-as one of its foci this month is flu vaccination. So I am pending some self education.

That said, I wonder if you are engaging in some dangerously magical thinking here (one engaged in by the most cultic alternative medicine practitioners). I can think of no reason why an RCT of the flu vaccine would be unethical. How would it be so? Before I go to an important historical example, might I also ask: if the story of the pregnant woman who developed the flu had included her having gotten the flu shot the appropriate strain, would that have been a powerful anecdote against the flu shot (I'd bet those stories exist)? Here's a more important story to know: http://www.nejm.org/doi/full/10.1056/NEJM198908103210629. CAST trial looking at antiarrhythmics after MI. Try to dig up the full references. Couple things to note: the reason this was looked at was that previous studies had shown that mortality was decreased with these antiarrhythmics after MI. This was a larger follow up. The more important point (personal communication from one of our pediatric electrophysiologists who was around at this time and would have this knowledge): it was difficult to get IRB approval for this because the established thinking was that it would be unethical to deny these meds that were "known" to be life-saving-based on previous studies, clinical experience, and proposes mechanisms of action. A more contemporary example of a med that may not be as useful as thought: enalapril for children with single ventricles. Makes sense, right? Single, volume overloaded ventricle (that's why a bidirectional cavopulmonary anastamosis is done at 6 months-offloads an overloaded V). ACE-I-shown to have positive effects on ventricular remodeling post MI in animal models. Why not afterload reduce all these kids with an ACE-I? This is common practice. For the flaws of the following article, the evidence is underwhelming: http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.109.927988v1. Sometimes even the most sensical and intuitive leaps we make about medications turn out to be wrong. I don't think the flu vaccine deserves any special exemption from critical evaluation.

 

[Pharmavixen]

you know of any good data that shows immuniaztions for flu decrease transmission?

Some of the studies cited by TDX in post #21 have data on reduced incidence.

Regarding the ethics of RCTs of flu shots: here's what the CDC says.

Randomized controlled trials that measure laboratory-confirmed influenza virus infections as the outcome are the most persuasive evidence of vaccine efficacy, but such trials cannot be conducted ethically among groups recommended to receive vaccine annually.

So it's the whole research conundrum of deliberately withholding a potentially life-saving intervention for the sake of having better data. The comparison with the CAST trial doesn't hold water because there are no data finding improved mortality from anti-arrhythmics. The CAST trial was conducted to test the hypothesis that suppressing premature ventricular depolarizations in post-MI pts would reduce mortality. So it was a hypothesis they were testing, not an actual finding from previous research.

 

[facetguy]

Looks like a mixed bag, with very modest benefits:
http://www.scientificamerican.com/a...-protect-the-elderly-or-the-very-young&page=2

And is the current flu vaccine dogma standing in the way of developing a "game changing" flu vaccine? (From Univ. of Minnesota)
http://www.cidrap.umn.edu/cidrap/files/80/ccivi report.pdf (Executive Summary, pg. 5)

 

[hereticmnk]

I don't know how one could include all flu vaccines in a blanket statement like that. They are are different and a product of intelligent guesswork. One year's batch might be excellent while the next years might suck. How would one do efficacy trials given the temporal relationship of manufacturing processes to the season. And how would one do effectiveness research when the data on who gets the vaccine is extremely fragmented.

 

[facetguy]

I don't know how one could include all flu vaccines in a blanket statement like that. They are are different and a product of intelligent guesswork. One year's batch might be excellent while the next years might suck. How would one do efficacy trials given the temporal relationship of manufacturing processes to the season. And how would one do effectiveness research when the data on who gets the vaccine is extremely fragmented.

To which statement are you referring?

 

[hereticmnk]

To which statement are you referring?

I was referring to the topic name of this thread.

 

[facetguy]

I don't know how one could include all flu vaccines in a blanket statement like that. They are are different and a product of intelligent guesswork. One year's batch might be excellent while the next years might suck. How would one do efficacy trials given the temporal relationship of manufacturing processes to the season. And how would one do effectiveness research when the data on who gets the vaccine is extremely fragmented.

As the U. of Minnesota report states in Key Point #2 (sorry for weird cut/paste spacing):

"2. A major barrier to the development of gamechanging

influenza vaccines is the perception that

current vaccines are already highly effective in

preventing influenza infection.

The perception that current vaccines are already highly

effective in preventing influenza is a major barrier to

pursuing game-changing alternatives. Indeed, hundreds

of influenza vaccine efficacy and effectiveness studies

have been conducted since the 1940s, and vaccine

efficacy in healthy adults of 70% to 90% is frequently

cited. However, the preponderance of the available

influenza vaccine efficacy and effectiveness data is

derived from studies with suboptimal methodology,

poorly defined end points, or end points not proven to

be associated with influenza infection. Studies using

optimal methodology have not found the level of

protection often attributed to the current vaccines."

Apparently these studies have been done, just not always very well. That last line is telling. When done right, the flu vaccines underperform.

So, do these authors have a point? If everyone believes, apparently incorrectly, that our current flu vaccines work well, is that holding us back from producing a better (or "game-changing", as they say) flu vaccine? With all the money and fanfare and hype spent on our flu vaccine campaigns, one would think we'd have a better product by now.

 

[facetguy]

Reports so far are that this year's flu season will be a tough one. This quote from a news article caught my eye:

"The Centers for Disease Control (CDC) is warning the flu season appears to be bad this year - spreading faster and earlier than usual.

Officials with the CDC have said the South and Southeast sections of the country are getting hit hard.

Even people who received the flu shot can still get sick, they said."

It's one thing to promote the flu vaccine based on risk/benefit; if it's low risk and might...might...help, then just do it. But why can't we be honest and say that the flu vaccine just doesn't work all that great? Here's the CDC making it sound as though 'OMG, this year even if you get the flu shot you may still get the flu', as if that isn't always the case every year.

 

[SpecterGT260]

Reports so far are that this year's flu season will be a tough one. This quote from a news article caught my eye:

"The Centers for Disease Control (CDC) is warning the flu season appears to be bad this year - spreading faster and earlier than usual.

Officials with the CDC have said the South and Southeast sections of the country are getting hit hard.

Even people who received the flu shot can still get sick, they said."

It's one thing to promote the flu vaccine based on risk/benefit; if it's low risk and might...might...help, then just do it. But why can't we be honest and say that the flu vaccine just doesn't work all that great? Here's the CDC making it sound as though 'OMG, this year even if you get the flu shot you may still get the flu', as if that isn't always the case every year.

Do you know how the flu vaccine is made, what parts of the virus is targeted, and why the flu virus is so variable and thus requires a vaccine cocktail each year?

Sent from my DROID RAZR using SDN Mobile

 

[All4MyDaughter]

I currently have the flu, although I got my flu shot this season, as I always do. I'm on Day 3, and I feel pretty good. My unvaccinated friends have been knocked out for a week to 10 days with this particular strain of influenza B that's hit our area.

Any health care professional should understand that no vaccine confers absolute 100% immunity, but lowers the risk of infection, and that individuals who have been vaccinated often have a shorter and easier course of illness.

It's interesting that the "our vaccines don't work that great but we pretend otherwise and therefore don't develop GOOD vaccines" argument is often made by the anti-vaccination crowd. Why is that?

 

[SpecterGT260]

I currently have the flu, although I got my flu shot this season, as I always do. I'm on Day 3, and I feel pretty good. My unvaccinated friends have been knocked out for a week to 10 days with this particular strain of influenza B that's hit our area.

Any health care professional should understand that no vaccine confers absolute 100% immunity, but lowers the risk of infection, and that individuals who have been vaccinated often have a shorter and easier course of illness.

It's interesting that the "our vaccines don't work that great but we pretend otherwise and therefore don't develop GOOD vaccines" argument is often made by the anti-vaccination crowd. Why is that?

Ignorance and the faulty idea that those in healthcare share such ignorance.

Sent from my DROID RAZR using SDN Mobile

 

[facetguy]

I currently have the flu, although I got my flu shot this season, as I always do. I'm on Day 3, and I feel pretty good. My unvaccinated friends have been knocked out for a week to 10 days with this particular strain of influenza B that's hit our area.

Any health care professional should understand that no vaccine confers absolute 100% immunity, but lowers the risk of infection, and that individuals who have been vaccinated often have a shorter and easier course of illness.

Your personal experience of course matters and is important. However, it's anecdotal. Specter will be along momentarily to explain to you why it doesn't count as real evidence.

It's interesting that the "our vaccines don't work that great but we pretend otherwise and therefore don't develop GOOD vaccines" argument is often made by the anti-vaccination crowd. Why is that?

Let's stay focused here. We're talking about the flu vaccine, not all vaccines. And there are some mainstream voices expressing these sentiments about the flu vaccines. They wouldn't qualify as members of the anti-vaccination crowd.

But your comment does reflect the general attitude toward vaccines: don't point out any possible shortcomings or we will label you anti-vax.

 

[Instatewaiter]

Reports so far are that this year's flu season will be a tough one. This quote from a news article caught my eye:

"The Centers for Disease Control (CDC) is warning the flu season appears to be bad this year - spreading faster and earlier than usual.

Officials with the CDC have said the South and Southeast sections of the country are getting hit hard.

Even people who received the flu shot can still get sick, they said."

It's one thing to promote the flu vaccine based on risk/benefit; if it's low risk and might...might...help, then just do it. But why can't we be honest and say that the flu vaccine just doesn't work all that great? Here's the CDC making it sound as though 'OMG, this year even if you get the flu shot you may still get the flu', as if that isn't always the case every year.

That you bolded what you did, leads me to believe that you clearly do not understand how the flu vaccine is made each year... which is not surprising.

 

[facetguy]

That you bolded what you did, leads me to believe that you clearly do not understand how the flu vaccine is made each year... which is not surprising.

My understanding of how the flu vaccine is made each year is irrelevant (although I do understand). I bolded what I bolded for the exact reason I said I bolded it. The implication from that quoted comment is that the flu shot usually works, but this year's flu season will be particularly rough and so, this year, you can get the flu even if you get the shot. This is of course misleading and suggests that in typical years the flu shot actually works as well as advertised, which the data tells us isn't true. Admitting that truth (or lack thereof) is the whole point.