Flu Fascination
Alex finally got his flu shot yesterday. He said it was more
than an hour wait at the Beaverton Kaiser, and he tried not to breathe in for
the entire visit because of all the sickies at the clinic. Not really, but kind
of. For the record, the Bean and I got our flu shots in September and didn’t
have to wait even one minute. Alex complained of a sore arm that night, and
then today he told me he didn’t feel that well. Pansy. He would never go as far
as to say that the flu shot made him sick, because he and I both know better
than that, but I’m suspicious a part of him believes this to be true. People
say it all the time.
I’ve had several conversations lately about the flu vaccine
and the flu in general, in part spurred by emails I’ve received at the VA
reporting increased flu diagnoses, amplified by recent news coverage of this
season’s early outbreak, and out of curiosity about whether or not our daycare
has any policies on the flu vaccine. In the interest of having not just An
Opinion but An Informed Opinion, I began researching influenza and the
vaccination via the CDC, Wikipedia, major players in the world of health and
medicine (e.g. NIH, Mayo Clinic, etc.), the actual research studies referred to
in the articles, and even anti-vaccine blog posts.
To start, let’s talk about risk in general. There is a huge
misperception about what is risky or “scary,” and what actually poses true danger
to our wellbeing. I’m a good example here. I am afraid of flying. In 2012, only
794 people died in plane crashes (in aircrafts carrying 6 or more people).
Contrastingly, more than 34,000 Americans died in motor vehicle accidents in the
same year. Statistically, as the story goes, I’m more likely to die on my way
to the airport than en route to my final destination. I, however, have the
self-awareness to know that my fear of flying is essentially unfounded and that,
statistically speaking, it ain’t that risky. (Besides, I’m actually more afraid
of having some sort of mid-air crisis than dying
per se). So I don’t stop flying just because I’m afraid.
Let’s take a look at some more stats, just because numbers
are fun. And it serves as a good reference point.
Cancer. In 2010, approximately 41,000 US women died from
breast cancer. In 2012, they estimate that 160,000 Americans died from lung
cancer, which is more than breast, prostate, and colon cancers combined.
Drugs. In 2010 more than 38,000 people died from drug
overdose in the US, with 60% of those related to pharmaceuticals.
Murder. The homicide rate last year was about 15,000.
Drunk driving. Last year just over 10,000 people were killed
in alcohol-impaired MVAs.
And then there’s influenza – the CDC reports that, on
average, 32,000 people die each year from the flu.
So you’re saying, statistically speaking, all other variables
aside (age, health, gender, etc.), any given person is MORE likely to
experience death related to influenza than to drunk-driving and murder
combined?!? They should do something to help us! To prevent that! Like a
medicine or an immunization or something!
Flu Facts
- The “flu” = influenza – a contagious respiratory
illness caused by viruses that infect the nose, throat, and lungs.
-
The flu does NOT equal a stomach virus, although
we often refer to puking out of our mouths and butts as the “stomach flu.”
-
Healthy adults can infect others beginning one
day prior to development of symptoms and up to five to seven days after
becoming sick.
-
Flu is unpredictable. The severity can vary
widely and depend on several factors including: which influenza viruses are
spreading; vaccine variables such as when it’s available, how much is
available, how many people get vaccinated, and how well matched it is to the
virus causing illness; the age, health and exposure of the person infected.
-
Complications of flu can include pneumonia, ear
infections, sinus infections, dehydration, and worsening of chronic medical conditions
e.g. CHF, asthma, DM.
-
To test for and confirm actual flu, doctors use
nasal/nasopharyngeal swabs; these rapid tests are more than 90% specific and
50-70% sensitive (meaning that false negatives are more common that false
positives; in other words, it’s more likely for a person with the flu to NOT
receive a flu diagnosis than a person withOUT the flu to test positive).
-
At the VA hospital where I work there are more
cases of flu so far this year than in all of last flu season:
-
50
of the 52 cases of confirmed flu this year are H1N1
-
34
of those patients required hospitalization
-
More
than 50% of those patients are between 20 and 30 years old
-
And
the majority had not received their influenza vaccine
Flu Vaccine
According to CDC reports and the research papers referenced,
the influenza vaccine is the most cost-effective counter-measure to seasonal
flu outbreaks, per controlled studies and rigorous scientific review of those
studies.
In order to evaluate the influenza vaccine
(and in all good research), both efficacy and effectiveness are explored.
Efficacy is the extent to which the
vaccine reduces the risk of disease in controlled conditions.
Effectiveness is the observed reduction
in risk after the vaccine is put to use, or the actual prevention of the
illness in real-life vaccinated populations. The general consensus (save for
the anti-vax bloggers who usually fail to cite actual research articles or
whose logic has major holes) is that the vaccine provides moderate protection
for healthy adults, and children younger than 2 years. Adults over 65 years of
age are considered in the higher risk demographic, and while they are always
recommended the vaccination, the evidence to support the efficacy/effectiveness
here is mixed.
Let’s look at some actual numbers (sidenote: because I blog
and I’m not practicing good science in my personal life, I’m not providing any
citations of the research papers I actually perused, because, who are we
kidding, most people who read this wouldn’t care):
- Recent randomized controlled trials (RCTs) of
inactivated influenza vaccine among adults under 65 years of age have estimated
50-70% vaccine efficacy during seasons in which the vaccines' influenza A
components were well matched to circulating influenza A viruses.
-
Another analysis determined that flu shots were efficacious 67 percent of the
time; the populations that benefited the most were HIV-positive adults ages 18
to 55 (76 percent), healthy adults ages 18 to 46 (approximately 70 percent) and
healthy children ages 6 to 24 months (66 percent).
-
A
2012 meta-analysis showed that in adults, vaccines show a three-quarters
reduction in risk of contracting influenza (4% influenza rate among the
unvaccinated versus 1% among vaccinated persons) when the vaccine is perfectly
matched to the virus and a one-half reduction (2% get flu without vaccine
versus 1% with vaccine) when it is not, but no significant effect on the rate
of hospitalization.
And let’s talk “herd” immunity, or community immunity. This
is defined as when a critical portion of a community is immunized against a
contagious disease, so that most members of that community are protected
against the disease because there is little opportunity for outbreak. In other
words, when there’s some nasty contagion out there, the chain of infection can
be disrupted when a certain, large proportion of the population is immune or
less susceptible to said nasty contagion. As I heard one doctor say, the best
way to protect your 85-year-old grandmother from the flu is for your family and
her caregivers to get vaccinated. (To those who don’t “believe” in herd
immunity, one of the most accessible explanations and accompanying research I
encountered was regarding the rotavirus vaccination). And for the sake of
numbers, here are some examples I came across demonstrating herd immunity with
flu vaccines:
-
A
study looking at New Mexico's 75 long-term care facilities found that as
vaccination rates of health care personnel rose from 51 to 75 percent, the
chances of a flu outbreak among patients in that facility went down by 87
percent; the study demonstrated that vaccinating health care workers provided
more protection to residents than vaccinating the residents themselves.
-
Japan once required school children to receive
annual flu vaccinations, as they are a likely population to both catch and
spread the disease. Their data showed a positive effect of vaccinating children
in reducing mortality among older adults from flu – they report one life saved
for every 420 children vaccinated.
Obviously, I’m pro-vaccination – I work in healthcare, I’ve
read the reports, and I generally have faith in science. I’m happy to do the
simple things that research supports to better the environment for all of us. All
that said, there are, of course, no guarantees. The flu vaccination isn’t
perfect. No vaccine is. Science isn’t perfect. Nothing is. Theoretically, you
can get the numbers to tell you whatever you want them to. What’s that saying,
“If you torture the data long enough, it will always confess”???
Reasons People
Might Give to NOT Get a Flu Shot, and How I Might Respond
You: “I’m
allergic to eggs.”
Me: “That sounds like
it sucks. I love eggs. And baked goods. Especially chocolate chip cookies,
which you need eggs to make. Anyway, I think they make egg-free vaccines. Have
you asked your doctor about it?”
You: “I heard I
could get Guillain-Barre Syndrome from getting the flu vaccine.”
Me: “Yes,
technically that’s a risk. And it said so on that waiver I had to sign before
they stuck me and the Bean. But research shows that your risk of acquiring GBS
from a vaccine is lower than acquiring it in conjunction with the actual flu.
(The estimated frequency of influenza-related GBS was four to seven cases per
100,000 people, compared with one case per million persons following
vaccination).
You: “Flu
vaccines always give me the flu.”
Me: “No they
don’t. Your flu vaccine probably wasn’t even a live virus, so that wouldn’t
make sense anyway. There is zero evidence that the flu vaccine causes flu. You
probably already had the flu. Or it’s not the flu anyway and you just have a
cold. Don’t be such a pansy. It is winter after all.”
You: “I could
have an allergic reaction.”
Me: “Yup, you
could. But you could have an allergic reaction if you eat peanut butter, or
shellfish, or get stung by a bee or a jellyfish. Do you carry an epi-pen just
in case any of those things happen? Probably note. The good thing about
experiencing anaphalaxys post-vaccine is that at least you’re already at the
doctor, so they could probably get your treated really quickly.”
You: “I don’t
want my kid to get the flu vaccine because of the heavy metals, like mercury.”
Me: “I don’t know
enough about the quantities or risks associated with mercury, but I doubt it’s
the only environmental exposure. You eat fish don’t you? Are you telling me you
want your kid to get the flu? Because old people, young people, and
immuno-compromised people have the highest incidence of flu-related
complications.”
You: “Shots
hurt.”
Me: “Don’t be
such a pussy. It hurts for, like, a second. Taking the bandaid off hurts worse.
And maybe your arm will be sore like from a good charley horse or an intense
workout. Besides, the flu hurts worse.”
You: “I’m a
healthy person. I eat well, I exercise, I never get sick. ”
Me: “Well lucky you.
You have a lot to be thankful for. So pay it forward – help your family,
friends and neighbors by getting vaccinated so that you don’t potentially
transmit the virus to anyone else. And keep practicing your healthy habits. I
could use some of your self control.”
You: “The flu shot
doesn’t even do anything. I know people who get vaccinated still get the flu.”
Me: “It’s true,
you can get the flu shot and still get the flu. But the research is pretty
convincing. If you are otherwise healthy and you get the flu shot, you’re not
very likely to get the flu. But if you do, you will more likely have milder
symptoms. Maybe instead of wanting to die for a week you only feel like ass for
3 days. I wear a seatbelt – it doesn’t guarantee I won’t get hurt in a car
accident, but it reduced my chances. I’ll take the extra protection.”
You: “The flu
isn’t that bad anyway. I mean, it would suck, but I’d survive.”
Me: “Maybe you’d
survive okay, but what about your baby? Or your grandpa? They might not fare
so well if you pass your nasty virus along to them. Then wouldn’t you feel like
an asshole? What if they had to be hospitalized? Or died from complications?
You’d wish you’d gotten a wimpy little shot.”
You: “How do we
even know the flu vaccine is for the correct strain?”
Me: “We don’t.
But I have more confidence in the virologists to wisely predict the correct
strain of influenza than I do in my own ability to avoid said strains at work,
in the Target bathroom, or when buying my Starbucks chai skinny latte. Plus,
there’s evidence of cross-protection, meaning that the annual flu vaccine
provides some protection against flu viruses it wasn’t designed for. And
there’s evidence that people who get immunized but still get the flu experience
more mild symptoms. My vote, if I have to be sick, I’d rather not be too sick.”
You: “You can’t
trust the government. They’re probably lying about the research. It’s all to
benefit big pharma. They make a profit off all this shit.”
Me: “Sure, you
might be right, to some degree. I’m as much a conspiracy theorist as the next
GenXer. But I have a good deal of confidence in the medical professionals I have
worked with, even if I’m not so trustworthy of “the man.” I’ll save my
conspiracy theories for the food manufacturing industry and the environment.
From what I can tell with the information available, the science in favor of
influenza vaccines seems pretty sound.”
Final Thoughts
The bottom line: there is far more/better/faster/stronger (Daft
Punk anyone?) evidence in support of the influenza vaccination. So even if it
doesn’t work perfectly, and it saves only a few lives and a little bit of money and time, isn’t
that better than the alternative? And because it’s clear a flu shot is no
guarantee, you should still practice good health habits such as washing your hands
regularly (I see you fakin’ it in the public restroom – sing the full ABC’s, people), eating
healthfully (alcohol overconsumption lowers your immune system), sleeping well
(>7 hours/night), and exercising regularly (get your heart rate up, like, every
day). That much we really do have control over, so protect yoself before you
wreck yoself. Or your herd.