Another shot at the flu vaccine

Here’s a great article on why you should get the flu vaccine by Mark Crislip at Science Based Medicine. I’ll just hit the highlights, for details, you’ll need to click the link.

He starts out by talking about what is known about classical influenza, and then moves on.

1) The disease influenza, the gasping oppression, is a disease that has been plaguing humans for about 500 years. It is a predominantly respiratory infection, causing a protracted cough with fevers and myalgias.

2) The flu is due to a virus, the influenza virus. There is influenza A and B and C.

3) Not every flu like illness is due to the influenza virus. In a given season the influenza virus may account for around 10-15% of flu like illness in the community, although during epidemics influenza can account for 60% of flu like illnesses.

4) Influenza kills. It kills directly, it kills by acute secondary infections, it kills by worsening underlying diseases like heart failure, it kills long term by increasing vascular events such as heart attacks and stroke. Influenza kills the young, the old, the obese and the pregnant.

5) When exposed to influenza, either as an infection or as a vaccine, the body responds in part by making antibody. Roughly, the better the antibody response to the influenza antigens, the better the protection to that strain of influenza.

6) The influenza vaccine offers moderate protection against influenza. Unfortunately the antigens of the virus change year to year (antigenic drift) and decade to decade (antigenic shift), while the vaccine strain are fixed prior to a given season and may not optimally match the circulating strains.

7) Unfortunately those who need to be protected from the influenza virus are those most likely not to respond to the vaccine: the obese, the pregnant, the elderly and those with chronic medical diseases.

8) The benefit of the vaccine extends beyond prevention of flu. Of course, if you don’t get influenza, you cannot spread it to others. If you do not get influenza, then, of course you can’t die of its complications, like pneumonia and heart attack. Influenza vaccination could potentially reduce the occurrence of sudden death, AMI, and stroke by 50%.

9) Influenza spread can be decreased by mechanical/environmental interventions: hand washing and masks, although these interventions have variable efficacy depending on the population studied

10) Health care workers are particularly problematic. For a variety of reasons they are likely to come to work ill, influenza can be potentially infectious before people are symptomatic, and spread in the hospital occurs.

11) Because those in the hospital are particularly vulnerable to the ravages of infections, mortality from hospital acquired influenza is remarkably high: 25%.

12) Influenza vaccine is safe as well as effective.  There have been some rare complications to the vaccine: Guillian-Barre in the 1970′s and the recent reports that prior vaccination may have made disease from H1N1 worse. Biologic systems are complex.

13) Influenza vaccination for health care workers runs at best 70% in the US, which if it were my kids math grade would be cause for some ‘splanin. Doctors and nurses run a bit higher, with an 80% influenza vaccination rate in some institutions.

14) It would be nice to prevent the spread of influenza from health care workers to patients. There is no data for hospitals, although there are nursing home studies to suggest that when staff is vaccinated against flu there is a decrease in flu in the residents.

15) And this leads to my final thought. There is a tremendous amount of medical literature pointing to the safety and wide ranging benefits of the influenza vaccine as well as the morbidity and mortality that influenza inflicts on humans every year.

His article includes a few case descriptions and also debunks some erroneous claims about the vaccine. One of the most common ones that i hear is that people got the flu right after getting the shot, so it either caused the flu or didn’t protect them. There are a couple of reasons why this might happen, and the first on the list is that you were exposed to the virus shortly before you were vaccinated but the symptoms didn’t manifest until after the shot. Another is that you were ill, but not with influenza, or not with the particular virus that was in the vaccine. And, as with all vaccines, you might not obtain full immunity from the shot, and were exposed by other people who did not get vaccinated.

There are, of course, a small subset of the population who are allergic to certain ingredients in the vaccine. If you are concerned, talk to your physician.

In summary – get the shot.

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