OT: Flu shot effectiveness?

Most years I don't get a flu shot, and most years I don't get the flu even when multiple folks around me do get it. Like a few years ago when we had 2 contractors working in our house redoing our kitchen. Both had their flu shots, both came down with the flu. I didn't even though I was around them as they were getting sick, and I also had to drive our son to the clinic when he got it, and yes he had the shot. Now, I realize maybe I just somehow got lucky, and I am NOT advising anyone to ignore their docs advice about this. But last time I had the actual flu was probably 15 years ago when I took those shots religiously, they would hand them out free to every one(like me) that was working in the hospital.

So anyway, we were watching something about flu season and shots on the news. They are talking about how convenient it is to get the shots, even free sometimes or covered by insurance, and my wife- who always takes the shots- says sarcastically "and some people don't even get the shots". Meaning stupid me. But wouldn't you know it, the words had no sooner left her mouth when the TV doc advocating the shots says- in answer to a question about tri-valent vs quad-valent(sp?) "Yes, some might want to get the quad, because that gives you a better chance of falling into the 10% effective group". Then I hear the same thing repeated on a separate news program.

10% effective? The usual claim is between 20 and 60% most years. But 10%, are you kidding me? (of course, they also claim you get a milder case of it if you have had the shot. But leaving out the debates about possible SEs, is it worth even a possibility of serious SEs for just 10% effectiveness, what ever exactly that means?
fox8.com/2017/12/04/health-experts-this-years-flu-vaccine-only-10-effective/

Somebody said...
Their findings are based on what made people sick in the southern hemisphere’s most recent flu season. This approach usually provides effective coverage — 40% to 60% — from the flu.

This year, however, the virus appears to have mutated rendering the vaccine only about 10% effective.

But when I heard this 10% figure handed out by people who were strongly advocating for the flu shots, I could not help but be reminded of a recent thread I started asking if studies were sometimes designed to fail. It had to do with what seemed to me to be a very flawed study of vitamin D used to hopefully prevent common colds in young school children. But there was no placebo, the only thing compared was what would be a high dose of vitamin D(for children anyway) vs what I would call very high dose. So since high dose could well be all that was needed to lower incidence of colds(who will ever know since they had NO placebo! ), it is not all that surprising that even higher doses did not show a significant difference in colds.
/www.medscape.org/viewarticle/884182?nlid=117430_2713&src=wnl_cmemp_170911_mscpedu_nurs&uac=158102PN&impid=1430844&faf=1

But that (the claim that high dose does not decrease colds with no placebo for comparison, only in comparison to already fairly high levels) is not what made me think of this study when I saw the news on TV- from flu shot advocates- that effectiveness this year was only 10% . It was what was not trumpeted, what was not put in the headline or as the take away, which was this:

Somebody said...
At the end of the study period, serum vitamin D levels were 48.7 ng/mL (95% CI, 46.9-50.5 ng/mL) in the high-dose group and 36.8 ng/mL (95% CI, 35.4-38.2 ng/mL) in the standard-dose group.

Incidence of influenza was 50% lower in the high-dose group (IRR, 0.50; 95% CI, 0.28-0.89), but only 16 cases (4.4% of all infections) occurred in that group, and only 31 (8.5% of all infections) occurred in the standard-dose group. The groups did not differ for other types of viral infection.

The investigators conclude that high doses of vitamin D do not reduce the number of wintertime viral URTIs among healthy children aged 1 to 5 years and that supplementation is not indicated to prevent such infections.

( and BTW, this was a randomized clinical trial, though I don't know if it was blinded, and obviously there was no placebo, that is the biggy)

So, even though the comparison group already had a solid 36.8 ng/ml level after supplementation, the even higher dose group(48.7 ng/ml) had their flu results lowered a whopping 50 additional %. I don't know about others, but personally I would just love to see that same comparison against folks with no supplementation, and very common levels of < 20 ng/ml.

My point? All of the medical authorities are begging me to get a flu shot once again(which I might cave and do so, I did year before last- or was it 3 years ago?), no one in any traditional medicine is saying otherwise, and enormous $ are spent on a national TV campaign to get me to do so. They really want me to get this 10% effective solution. (and if indeed there are no significant downsides, maybe even 10% is better than nothing)

But where is there a single national medical authority to tout this randomized study from Canada which showed that increasing blood levels of vitamin D from the already higher than average level of 37 to 49 dropped flu incidence a solid 50%, from and in addition to whatever the lower dose did- or didn't, do. Who knows, no placebo? I have not heard this touted anywhere, and even if you know about the article, you have to read the entire thing because the headline is "Daily high-dose vitamin D during the winter months did not reduce the incidence of viral URTIs among children aged 1 to 5 years, according to results of a study published in the July 18 issue of JAMA. ". (since I am retired anesthesia, I still get these sorts of things sent to me so I can study them, take a test, and get some CME credits)

What about your local doctors, who are no doubt telling you to get this 10% effective flu shot? Are they at least also telling you to make sure your vitamin D level are adequate? Do they know about this study and the effectiveness vitamin D showed against flu? If not, why not? It just makes me think that I can not trust our medical system to point to anything that might be good for my health other than what comes from the pharmaceutical companies. I hate to sound so cynical, but how can they pound the table year after year for flu shots- even 10% effective flu shots- and not at least also tell you about alternatives that might be even way more helpful? And why are there no good, high quality placebo controlled trials to really tell us? (or are there?)

Post Edited (BillyBob@388) : 12/5/2017 1:19:11 PM (GMT-7)

alephnull said...
I have had a flu shot twice, a week to ten days later I became sick with flu like symptoms.
Every other year for the past 30, I have't gotten sick with flu like symptoms.......

So, I will not take the shots ever again.

In addition, flu shots used to only be recommended for the frail. IE elderly and others. I'm not frail.

Can you clarify that a bit for me? Are you saying that for 28 years of the last 30, 28 years when you did NOT get the flu shot, you also did NOT get the flu? But you did get flu like symptoms for the 2 years that you did get a shot, and those 2 years only?

Is that correct? Or something else? If correct, I can see why you might stay away from flu shots. Even though, as always, nothing is proven. After all, I admit it is at least possible that you just happened to catch the flu- 2 different times mind you- just before you got the shot, and the bugs just had the minimum time needed to incubate and produce symptoms just after those 2 different shots. I guess almost anything is possible, however unlikely.

Has a doctor ever advised you to stay on top of your vitamin D levels to help lower your odds of catching the flu, or maybe fighting it off once you have it? I'm pretty sure they have advised you to get flu shots, even this year.

Post Edited (BillyBob@388) : 12/5/2017 1:16:49 PM (GMT-7)

I'm a vaccination true-believer and get 'em all. I take a Vitamin D supplement because I live on the 47th parallel north and am sun-starved all winter. I take a preventive baby aspirin. But I have my limits, and refuse to take a preventive statin.

The flu kills more people every year than Prostate Cancer does. Why be a statistic?

The 10% number is one of those things that happens due to mutation of the virus. It's been known to be in the high 60% effective range... So don't let the "Boy that cried wolf" syndrome kick in.

Since we are quoting CDC. All their numbers are estimates.

"CDC does not know exactly how many people die from seasonal flu each year."

That quote is from their own mouth. And this article also states that ALL their numbers are ESTIMATES.

/www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm

Alephnull--You're right. CDC statistics are an estimate. The best course is to weigh the benefits against risks. In your case, nearly 30 years of not getting vaccinated and not getting the flu is strong personal evidence against getting the flu vaccine. I've gotten the vaccine (High Dose since age 65) for the past 30 years and have dodged the flu each year. Lucky me!

I wish you 30 more flu-free years.

My wife and I had ours last week as we do every year - the high dose version. There is no downside other than a slightly sore arm for a day or so.

Found an article today in the Washington Post talking about the awful H3N2 virus dominating this year.

https://www.washingtonpost.com/news/to-your-health/wp/2017/12/07/a-mother-got-the-flu-from-her-children-and-was-dead-two-days-later/

Australia gets a special mention:
He and his colleagues say flu season started early this year, and the dominant strain of the virus that has emerged is the H3N2. That’s the same strain that pinballed around the world last flu season and wreaked havoc in Australia during the southern hemisphere’s winter months.

My thoughts are get the flu shot this year. A lot of people, many young healthy people got really sick this year. I wouldn’t say that every year but I would say that this year.

Tim G said...

Steve n Dallas said...
The flu kills more people every year than Prostate Cancer does. Why be a statistic?

The 10% number is one of those things that happens due to mutation of the virus. It's been known to be in the high 60% effective range... So don't let the "Boy that cried wolf" syndrome kick in.

Exactly! And the 60% effective is directly from the CDC (Centers for Disease Control). The anti-flu vaccine crowd uses a lot of data doctoring to create misunderstandings. A little knowledge is a dangerous thing. Get the facts from gold-standard information sources on disease prevention like the CDC and World Health Organization.

For those interested, a high-dose flu vaccine is available and recommended for those of us over 65

Well, personally, I am not advising anyone to not get the vaccine, even though I have not yet done so and often do not. But I don't think what I have linked to so far is a case of "The anti-flu vaccine crowd uses a lot of data doctoring to create misunderstandings.". It is simply the science and facts of what we know so far about the flu season that is just ending in the southern hemisphere, the one that is now up here, and based on the same flu vaccine that was used down there. Or, as these docs reported in New England Journal of Medicine on 11/29/17:
www.nejm.org/doi/full/10.1056/NEJMp1714916

Somebody said...
As clinicians in the United States prepare for the start of another influenza season, experts have been watching the Southern Hemisphere winter for hints of what might be in store for us in the North. Reports from Australia have caused mounting concern, with record-high numbers of laboratory-confirmed influenza notifications and outbreaks and higher-than-average numbers of hospitalizations and deaths.1 The number of notifications reached 215,280 by mid-October, far exceeding the 59,022 cases reported during the 2009 H1N1 influenza pandemic, according to the Australian Government Department of Health. Influenza A (H3N2) viruses predominated, and the preliminary estimate of vaccine effectiveness against influenza A (H3N2) was only 10%. The implications for the Northern Hemisphere are not clear, but it is of note that the vaccine for this upcoming season has the same composition as that used in the Southern Hemisphere. As we prepare for a potentially severe influenza season, we must consider whether our current vaccines can be improved and whether longer-term, transformative vaccine approaches are needed to minimize influenza-related morbidity and mortality.

Seasonal influenza epidemics cause 3 million to 5 million severe cases and 300,000 to 500,000 deaths globally each year, according to the World Health Organization (WHO). The United States alone sees 140,000 to 710,000 influenza-related hospitalizations and 12,000 to 56,000 deaths each year, with the highest burden of disease affecting the very young, the very old, and people with coexisting medical conditions.2

The cornerstone of influenza prevention and epidemic control is strain-specific vaccination. Since influenza viruses are subject to continual antigenic changes (“antigenic drift”), vaccine updates are recommended by the WHO each February for the Northern Hemisphere and each September for the Southern Hemisphere. This guidance relies on global viral surveillance data from the previous 5 to 8 months and occurs 6 to 9 months before vaccine deployment. In addition, there are always several closely related strains circulating; therefore, experts must combine antigenic and genetic characterization and modeling to predict which strains are likely to predominate in the coming season.

Vaccine mismatches have occurred in years in which circulating influenza strains change after the decision is made about vaccine composition, resulting in reduced vaccine effectiveness. For example, during the 2014–2015 influenza season in the United States, more than 80% of the circulating influenza A (H3N2) viruses that were characterized differed from the vaccine virus, and vaccine effectiveness was only 13% against influenza A (H3N2).2 This mismatch most likely contributed to the severity of the 2014–2015 influenza season and the substantial related morbidity and mortality among people over 65 years of age.

Even in years when influenza vaccines are well matched to circulating viruses, estimates of vaccine effectiveness range from 40 to 60%, which is lower than that for most licensed noninfluenza vaccines.2 For instance, although the 2016–2017 Northern Hemisphere influenza vaccine was updated to include a new influenza A (H3N2) component and the majority of viral isolates characterized by the Centers for Disease Control and Prevention (CDC) were antigenically similar to the vaccine reference virus,2 the preliminary estimate of vaccine effectiveness was 42% overall and only 34% against influenza A (H3N2) viruses.

It seems reasonable to expect the flu vaccine this year to be very low in effectiveness in North America. Time will tell. But in the meantime, my real purpose for this thread is to show how the Canadian study( RCT ) published in the July 18, 2017 JAMA showed that even going from a relatively high dose of vitamin D to an even higher dose of Vit D reduced flu another 50%. Another 50% over whatever the control (but still fairly high for a child) dose may have reduced the flu, if any. ( sure would be nice to know, wouldn't it? Wonder why no one checked this by using a placebo? How strange. )

So, even with an expected effectiveness of only 10%, our medical community pounds the table insisting we get the shot anyway, yet according to our poll so far are totally silent when it comes to recommending vitamin D for avoidance of flu. Despite the RCT. This just seems strange to me.

BB--Google "anti-vaccine movement" and you'll get any eyeful of the kinds of data-doctoring the anti-vaccine crowd promulgates in the name of science.

81GyGuy said...
The topic of this thread reminds me of a term I remember reading about years ago: herd immunity.

What it essentially means is that if enough members of a given population have been immunized against a certain disease, then the remaining members of the population who have not been immunized are automatically less likely to get the disease.

A more formal definition from the Wikipedia article on "Herd Immunity":

"Herd immunity (also called herd effect, community immunity, or social immunity) is a form of indirect protection from infectious disease that occurs when a large percentage of a population has become immune to an infection, thereby providing a measure of protection for individuals who are not immune. In a population in which a large number of individuals are immune, chains of infection are likely to be disrupted, which stops or slows the spread of disease. The greater the proportion of individuals in a community who are immune, the smaller the probability that those who are not immune will come into contact with an infectious individual."

and

"Once a certain threshold has been reached, herd immunity gradually eliminates a disease from a population."

Source:
/en.wikipedia.org/wiki/Herd_immunity

Also, the graphic in this Wikipedia article present a good, quick description of the process.

It sounds like "herd immunity" may be a factor at work here in the issue of vaccination versus non-vaccination, and whether one gets a disease, whether vaccinated or not.

Good points about herd immunity, and no doubt very important. Buy I'm not sure how much herd immunity will be boosted if the effectiveness of the vaccine is 10%, as it apparently was in Australia? It would seem that even with whatever herd immunity has already been developed against the flu in Australia after decades of flu vaccine, and with or without this years flu vaccine, there was still a boatload of folks getting the flu in the southern hemisphere, pretty close to the same amount as would have got it without the vaccine. And sounds like about the same is expected for us.

BTW, I never quite understand what the definition of 10% ( or 60%) effective means. Can some one more knowledgeable clue me in? Does it mean that in a group getting the flu shots, there will be 10% fewer cases of flu than in the group not getting the shot? IOW, they will have 90% as much flu as he group which is vaccinated? Or does it mean something else entirely?

TimG said...
BB--Google "anti-vaccine movement" and you'll get any eyeful of the kinds of data-doctoring the anti-vaccine crowd promulgates in the name of science.

Yes, I am well aware of all of that, and the arguments against those views. It's just that I don't think any of that applies to this thread which presents the science that- in Australia- the vaccine we have been getting has proven 10% effective against the virus we are expected to be dealing with. Therefore, about the same result is expected for us. That is just the facts. And the other fact that goes with that one: the RCT out of Canada that shows that boosting vitamin D higher than an already fairly stout level was associated with 50% lower flu rates than the lower dose of vitamin D. And it does not seem out of the question to ask if even the lower dose had already decreased flu rates compared to folks that get zero. If that is so, that additional 50% boost might actually be a 60-90% reduced flu rate compared to zero vitamin D. But we will never know since they chose not to find out.

While even just that extra 50% over the lower dose seems worthwhile to me, but it appears no one in the med profession wants to tell anyone about this. Though they surely want us to get the 10% protection without fail. No matter how crazy the anti-vaccine folks might be, this also seems quite crazy to me. No? Couldn't they at least tell folks about both, even if there is no added profit in sharing that news? Isn't it crazy, or at least uncaring or at least less than optimum care, not to? I think it is.

Post Edited (BillyBob@388) : 12/8/2017 6:05:12 PM (GMT-7)

Tim G said...
I had the high-dose flu vaccine and take 2,000 units of Vitamin D daily, so I am fully armed and ready.

Well sounds like if it can be avoided, you have at least put the odds maximally in your favor! Covering all bases!

The last time I had the flu - about 15 years ago, it was the worst I ever had. Sweating, shivering, an absolutely pounding headache especially when I raised my head from the pillow and attempted to move. I saw the 80-something year-old lady next door shoveling out her walk in a heavy snow. So I dragged myself out of bed, put on snow gear, fired up the snow blower and dug her out. She thanked me and then went across to street to shovel out the church since I was now doing her property. She was clearly in better shape at the time than I was and had I known I'd have stayed in bed. Since then I've had the shot every year and haven't had the flu. Maybe just coincidence, but I'm not going to mess with a winning streak.
Jim