Just how good is the flu vaccine?
January 24, 2015 2:17 PM Subscribe
Ontario's former Chief Medical Officer of Health Dr. Richard Schabas and infectious diseases specialist Dr. Neil Rau question the utility of mass, annual influenza vaccination: "Vaccines, in general, are perhaps the biggest success story of modern medicine. But in the league tables of vaccines, influenza vaccine hovers near the relegation zone."
No mention of meta reviews like the Cochrane? Fail.
posted by lalochezia at 2:30 PM on January 24, 2015 [2 favorites]
posted by lalochezia at 2:30 PM on January 24, 2015 [2 favorites]
it's possible to know if it's worked, really.
I meant "not possible" or "impossible." That's probably clear from context, though.
posted by If only I had a penguin... at 2:42 PM on January 24, 2015 [1 favorite]
I meant "not possible" or "impossible." That's probably clear from context, though.
posted by If only I had a penguin... at 2:42 PM on January 24, 2015 [1 favorite]
The vaccines we have might not be everything we need them to be, or would like them to be... but it's better than nothing at all. It's good to question whether mass vaccination is useful or not - good science means always questioning the world around you - but really, I'm okay with getting a shot that might only save 1/1000th of somebody's life. Herd immunity is like knitting - it takes a whole bunch of little stitches hanging together in order to make something useful... but it only takes a few dropped stitches to unravel everything into uselessness.
posted by Mary Ellen Carter at 2:52 PM on January 24, 2015 [13 favorites]
posted by Mary Ellen Carter at 2:52 PM on January 24, 2015 [13 favorites]
The lead time needed for producing enough vaccine can often work against its effectiveness. They have to take an educated guess at which strains are going to be most active. This year, it appears, they missed the mark somewhat. Still, it's not like this year's vaccine is a complete failure.
FWIW, this was the first year I bothered to get a flu vaccine. I got it largely because, due to my mom's situation, I will be spending a large amount of time in her nursing home, and I didn't want to run the risk of bringing the flu into the place. That, and, I discovered that my insurance covered the whole cost. As far as I know, they didn't do a vaccine for the residents at the nursing home. Weird.
My father-in-law's assisted-living facility was on quarantine lockdown a week or so ago because of a flu outbreak.
posted by Thorzdad at 2:53 PM on January 24, 2015 [3 favorites]
FWIW, this was the first year I bothered to get a flu vaccine. I got it largely because, due to my mom's situation, I will be spending a large amount of time in her nursing home, and I didn't want to run the risk of bringing the flu into the place. That, and, I discovered that my insurance covered the whole cost. As far as I know, they didn't do a vaccine for the residents at the nursing home. Weird.
My father-in-law's assisted-living facility was on quarantine lockdown a week or so ago because of a flu outbreak.
posted by Thorzdad at 2:53 PM on January 24, 2015 [3 favorites]
This small review/essay is appropriate: An Inoculation Against Mistrust: Eula Biss’s On Immunity
"On Immunity is a wide-ranging book, covering topics as diverse as pesticides, metaphor, and vampires, with influences ranging from Greek myth to Voltaire to Susan Sontag. Biss traces our understanding of the undead along with our understanding of germs, blood, vaccination, and capitalism, which has often been described as blood sucking. (Marx: “Capital is dead labor, that, vampire-like, only lives by sucking living labor, and lives the more, the more is sucks.”)posted by Fizz at 2:56 PM on January 24, 2015 [1 favorite]
It's interesting that some countries (such as the NHS in the UK) have decided against mass vaccination. The benefits for those outside of at-risk groups are not considered to outweigh the costs.
posted by Thing at 2:59 PM on January 24, 2015 [1 favorite]
posted by Thing at 2:59 PM on January 24, 2015 [1 favorite]
I don't remember mass flu vaccination being such a thing when I was young except for the swine flu. It's like I looked up one year and vaccination was everywhere for adults. For a long time, I didn't bother, but now I'm considered immune-compromised, I think my husband is too, and I visit my mother in an assisted living facility (which has had residents with flu this year despite vaccinations and was giving out Tamiflu as a preventative measure). Maybe I just notice it more because I'm in a population considered vulnerable.
posted by immlass at 3:09 PM on January 24, 2015
posted by immlass at 3:09 PM on January 24, 2015
Just in case people tl;dr - This article does not say that the flu vaccine is crappy so we don't need it. The tl;dr is that the flu vaccine isn't great as vaccines go but its still the best we've got against the flu so everyone should get it anyway.
Which is true. Compared to, say, the measles vaccine the influenza vaccine doesn't work super wonderfully. It still works better than no vaccine with almost no downside. So don't take the headline as an excuse not to get vaccinated.
posted by Justinian at 3:16 PM on January 24, 2015 [24 favorites]
Which is true. Compared to, say, the measles vaccine the influenza vaccine doesn't work super wonderfully. It still works better than no vaccine with almost no downside. So don't take the headline as an excuse not to get vaccinated.
posted by Justinian at 3:16 PM on January 24, 2015 [24 favorites]
free gov't-Tamiflu for everyone!
posted by Fupped Duck at 3:27 PM on January 24, 2015
posted by Fupped Duck at 3:27 PM on January 24, 2015
I'm with you there immlass - I'm still kind of confused by the people who not only think it is normal to get a flu shot every year, but who expect everyone else to get one too. Why do people believe this to be the default? When did this happen? What was the channel of communication by which this illusory consensus was formed? Whatever it was, I sure wasn't part of it, because the whole thing seems to have come up out of nowhere some time in the last decade or so.
I never made any decision *not* to get a flu shot, I just haven't ever gotten one, because it's not like something you opt out of - I've simply never made a decision to go get one, because it's never seemed worthwhile.
posted by Mars Saxman at 3:31 PM on January 24, 2015 [5 favorites]
I never made any decision *not* to get a flu shot, I just haven't ever gotten one, because it's not like something you opt out of - I've simply never made a decision to go get one, because it's never seemed worthwhile.
posted by Mars Saxman at 3:31 PM on January 24, 2015 [5 favorites]
I think the main reason for pushing for mass flu immunization isn't that it's necessary or useful in any given year, but that we need the machinery of mass flu immunization in place so that when we have a year where there is another spanish flu, we don't have to spin everything up again before millions of people die.
posted by empath at 3:34 PM on January 24, 2015 [23 favorites]
posted by empath at 3:34 PM on January 24, 2015 [23 favorites]
One of the unfortunate constraints to having an intelligent public debate on something like this, one informed by epidemiology and data, is the sheer quantity and pervasiveness of anti-vaccination woo.
empath's point is a good one in this regard.
I once had an older coworker who had lived through the polio epidemic and had contracted it herself. She was very lucky in that she was left only with a lifelong limp. This threat has reemerged. I remember her grumbling about "Anti-vaccination idiots. Do you know what vaccination has stopped?"
I've had severe enough flu in the past that I'm happy, here, in Ontario, to walk into my local pharmacy and get a flu shot free of charge (yes, I know there's a public cost for it, but this reduces the barriers to people getting it).
Point being, if getting the flu vaccine does nothing but un-scare some people about the notion of vaccination generally (which has saved untold countless lives over many years in many places), maybe it's all for the good, particularly if a new viral threat emerges.
posted by mandolin conspiracy at 3:57 PM on January 24, 2015 [4 favorites]
empath's point is a good one in this regard.
I once had an older coworker who had lived through the polio epidemic and had contracted it herself. She was very lucky in that she was left only with a lifelong limp. This threat has reemerged. I remember her grumbling about "Anti-vaccination idiots. Do you know what vaccination has stopped?"
I've had severe enough flu in the past that I'm happy, here, in Ontario, to walk into my local pharmacy and get a flu shot free of charge (yes, I know there's a public cost for it, but this reduces the barriers to people getting it).
Point being, if getting the flu vaccine does nothing but un-scare some people about the notion of vaccination generally (which has saved untold countless lives over many years in many places), maybe it's all for the good, particularly if a new viral threat emerges.
posted by mandolin conspiracy at 3:57 PM on January 24, 2015 [4 favorites]
It seems intellectually irresponsible to write an article of this nature if the only conclusion you're going to arrive at is, effectively, a shrug of the shoulders. If they have sufficient evidence to suggest some other course of action is more sound they should give that evidence and recommend that specific course of action. If they don't they should wait until they do. This article contributes precisely nothing to any potential debate.
posted by yoink at 3:59 PM on January 24, 2015 [6 favorites]
posted by yoink at 3:59 PM on January 24, 2015 [6 favorites]
@Mars Saxman - I suspect you feel that way because no infant or elderly family member of yours has died from flu they caught from you. Had that happened, I think you'd feel differently about how important herd immunity is to the health of our society, and you'd likely get a flu shot every year thereafter. There are a lot of people who work with children and elderly, and I imagine the push for flu vaccines for everyone was popularized by them.
posted by greermahoney at 4:09 PM on January 24, 2015 [16 favorites]
posted by greermahoney at 4:09 PM on January 24, 2015 [16 favorites]
Mars Saxman: "I'm still kind of confused by the people who not only think it is normal to get a flu shot every year, but who expect everyone else to get one too. Why do people believe this to be the default? When did this happen? What was the channel of communication by which this illusory consensus was formed?"
They -- that is, public health authorities -- started pushing it round about 2000 in the US, as manufacturing costs for the flu vaccine went down and availability increased. I have a family member who's immunocompromised (so I have been getting it yearly for a long time), and I remember it became a lot more available around 2004; before that you often had to be in a "preferred category" in my area. (Indeed, the CDC notes it was added to the US childhood immunization schedule in 2004.) A little googling shows that Canada started recommending it nationwide for everyone ages 2-64 in 2008.
The really bad flu season in 2009 had lines of families outdoor in the freezing cold for literally two or three hours at a time to get their kids the doses that were being rationed out by US county health departments that winter (to high-priority patients, including children). There was a lot of news coverage of the shortages and the deaths (18,000 worldwide) and where and how to get the vaccine. That seems to have really amplified the public health messages about getting a yearly flu shot, and that's when a lot of people got it firmly into their heads that they ought to get one yearly.
It's also now an active part of pediatric practice, where pediatricians push flu shots for parents and children, so if you have kids you will probably get the speech. A lot of people I know started getting yearly shots when they had kids.
Also studies suggest that flu vaccines, even if they're ineffective this year, may help protect you against future strains -- apparently the 1976 swine flu vaccine that gave so many people Guillane-Barre syndrome actually protected those people against the 2009 outbreak. I always think to myself, "Well, even if it doesn't help this year, it'll be one more layer of protection against the coming Mongolian Death Flu epidemic of 2025."
posted by Eyebrows McGee at 4:12 PM on January 24, 2015 [23 favorites]
They -- that is, public health authorities -- started pushing it round about 2000 in the US, as manufacturing costs for the flu vaccine went down and availability increased. I have a family member who's immunocompromised (so I have been getting it yearly for a long time), and I remember it became a lot more available around 2004; before that you often had to be in a "preferred category" in my area. (Indeed, the CDC notes it was added to the US childhood immunization schedule in 2004.) A little googling shows that Canada started recommending it nationwide for everyone ages 2-64 in 2008.
The really bad flu season in 2009 had lines of families outdoor in the freezing cold for literally two or three hours at a time to get their kids the doses that were being rationed out by US county health departments that winter (to high-priority patients, including children). There was a lot of news coverage of the shortages and the deaths (18,000 worldwide) and where and how to get the vaccine. That seems to have really amplified the public health messages about getting a yearly flu shot, and that's when a lot of people got it firmly into their heads that they ought to get one yearly.
It's also now an active part of pediatric practice, where pediatricians push flu shots for parents and children, so if you have kids you will probably get the speech. A lot of people I know started getting yearly shots when they had kids.
Also studies suggest that flu vaccines, even if they're ineffective this year, may help protect you against future strains -- apparently the 1976 swine flu vaccine that gave so many people Guillane-Barre syndrome actually protected those people against the 2009 outbreak. I always think to myself, "Well, even if it doesn't help this year, it'll be one more layer of protection against the coming Mongolian Death Flu epidemic of 2025."
posted by Eyebrows McGee at 4:12 PM on January 24, 2015 [23 favorites]
Fizz, thanks for that link.
“Vaccination is a precursor to modern medicine, not the product of it,” writes Eula Biss, in On Immunity: An Inoculation. “Its roots are in folk medicine, and its first practitioners were farmers.” During an epidemic in 1774...
I'm going to read this book. Moreover, the next time I have a conversation with someone who starts asserting that "well, I prefer traditional medicine [?] over vaccination and modern medicine..." I at least will have words instead of red-faced hand waving as a tool for getting my point across.
posted by mandolin conspiracy at 4:17 PM on January 24, 2015 [2 favorites]
“Vaccination is a precursor to modern medicine, not the product of it,” writes Eula Biss, in On Immunity: An Inoculation. “Its roots are in folk medicine, and its first practitioners were farmers.” During an epidemic in 1774...
I'm going to read this book. Moreover, the next time I have a conversation with someone who starts asserting that "well, I prefer traditional medicine [?] over vaccination and modern medicine..." I at least will have words instead of red-faced hand waving as a tool for getting my point across.
posted by mandolin conspiracy at 4:17 PM on January 24, 2015 [2 favorites]
Don't y'all remember when vaccinating adults for flu became the norm? It was only five years ago, after the H1N1 pandemic. This is when the CDC was authorizing emergency usage of Tamiflu, which recent studies have found not so good at preventing negative outcomes.
We don't even really have good data on how long immunity lasts in various populations, and some years we're inoculating with the same vaccine components as the previous year. Should we reallocate that once-a-year shot for a healthy adult to a twice-a-year shot for a senior?
We really kind of suck at handing the flu on a global scale. I don't mind people pointing out how much we suck so that we may eventually get better at it. There's a lot of money to be made in maintaining the status quo. I only wish our national dialogue could handle a little ... er, nuance.
posted by RobotVoodooPower at 4:17 PM on January 24, 2015 [2 favorites]
We don't even really have good data on how long immunity lasts in various populations, and some years we're inoculating with the same vaccine components as the previous year. Should we reallocate that once-a-year shot for a healthy adult to a twice-a-year shot for a senior?
We really kind of suck at handing the flu on a global scale. I don't mind people pointing out how much we suck so that we may eventually get better at it. There's a lot of money to be made in maintaining the status quo. I only wish our national dialogue could handle a little ... er, nuance.
posted by RobotVoodooPower at 4:17 PM on January 24, 2015 [2 favorites]
PS, if you live in the US and have health insurance, your health insurance is now required to cover your flu vaccine under Obamacare with no cost to you (thanks Obama!), and you can almost certainly get it at your local pharmacy instead of having to go to your doctor's office or county health department. If they already fill your prescriptions, they already have your insurance information in the computer and it takes two minutes for them to print out the consent form, give you the little speech, and jab you in the arm with the world's tiniest needle* that barely hurts and I am a wuss about needles. If they don't already have your insurance information, it takes FIVE minutes for them to type the stuff in and print the stuff out and jab you. Still free!
*Unless you are pregnant or breastfeeding in which case you get the world's LARGEST needle which TOTALLY hurts because it has a slightly different formulation that's been tested more widely on pregnant women.
posted by Eyebrows McGee at 4:19 PM on January 24, 2015 [9 favorites]
*Unless you are pregnant or breastfeeding in which case you get the world's LARGEST needle which TOTALLY hurts because it has a slightly different formulation that's been tested more widely on pregnant women.
posted by Eyebrows McGee at 4:19 PM on January 24, 2015 [9 favorites]
Thanks, Eyebrows McGee, that was really informative. Makes sense that the vector of meme propagation would have been through pediatrics, since that's not part of my world at all.
posted by Mars Saxman at 4:32 PM on January 24, 2015 [2 favorites]
posted by Mars Saxman at 4:32 PM on January 24, 2015 [2 favorites]
No mention of meta reviews like the Cochrane? Fail.
It's worth reading the Cochrane library's publications on this, or at least their abstracts; their "plain language" summaries are excellent for non-scientists. On the whole they're very uninspiring, ranging from no effect on missed workdays or hospitalisations in healthy adults to
Reviewers do seem to agree that the safety data are generally very good (unsurprising, given how safe vaccines are generally), so there's no reason not to take it. But the case for population-wide vaccination is nowhere near as strong as you might think. I strongly suspect that a lot of its popular support in some circles is at least partly a reaction against anti-vaxers, which is understandable but not a good basis for forming public health policy.
posted by metaBugs at 4:35 PM on January 24, 2015 [7 favorites]
It's worth reading the Cochrane library's publications on this, or at least their abstracts; their "plain language" summaries are excellent for non-scientists. On the whole they're very uninspiring, ranging from no effect on missed workdays or hospitalisations in healthy adults to
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.and
no evidence that only vaccinating healthcare workers prevents laboratory-proven influenza or its complications (lower respiratory tract infection, hospitalisation or death due to lower respiratory tract infection) in individuals aged 60 or over in [long term care institutions]...Other systemic reviews in decent journals (BMJ and the Lancet, among others) say pretty much the same thing: the available data on the effectiveness of flu vaccination is patchy, mostly poor-quality, and weakly positive at best.
Reviewers do seem to agree that the safety data are generally very good (unsurprising, given how safe vaccines are generally), so there's no reason not to take it. But the case for population-wide vaccination is nowhere near as strong as you might think. I strongly suspect that a lot of its popular support in some circles is at least partly a reaction against anti-vaxers, which is understandable but not a good basis for forming public health policy.
posted by metaBugs at 4:35 PM on January 24, 2015 [7 favorites]
....your health insurance is now required to cover your flu vaccine under Obamacare with no cost to you.
You guys are just becoming a regular Red Menace down there, aren't you?
posted by mandolin conspiracy at 4:35 PM on January 24, 2015 [14 favorites]
You guys are just becoming a regular Red Menace down there, aren't you?
posted by mandolin conspiracy at 4:35 PM on January 24, 2015 [14 favorites]
What was the channel of communication by which this illusory *actual* consensus was formed?
The Center for Disease Control Influenza Advisories that have been published every year for many years.
You're a bit out of the loop.
posted by j_curiouser at 5:11 PM on January 24, 2015 [4 favorites]
The Center for Disease Control Influenza Advisories that have been published every year for many years.
You're a bit out of the loop.
posted by j_curiouser at 5:11 PM on January 24, 2015 [4 favorites]
The health burden of all infectious diseases has been declining for more than a century. They now cause less than one in every 25 deaths in Canada.
It really drives me crazy when health professionals downplay death. Only 1 in 25 deaths? How about "OMG, 1 in 25 deaths!!" In 2009 350 people died of influenza in Canada.
There's a phenomena recently discovered that they are calling the 'back-boost' effect of the flu shot. Apparently the flu shot triggers your body to boost its immunity to every previous flu and flu shot you've been exposed to.
What this means is that if three types of flu don't look like they have changed from the year before, but there may be one or two candidates for a new type of flu, they can take the chance and put them in the shot, because the if you had the shot the year before, the new shot will boost your immunity to those types of flu.
If this works, it means that the flu shot will be more likely to be effective (and less likely to miss) in the future.
posted by eye of newt at 5:11 PM on January 24, 2015 [4 favorites]
It really drives me crazy when health professionals downplay death. Only 1 in 25 deaths? How about "OMG, 1 in 25 deaths!!" In 2009 350 people died of influenza in Canada.
There's a phenomena recently discovered that they are calling the 'back-boost' effect of the flu shot. Apparently the flu shot triggers your body to boost its immunity to every previous flu and flu shot you've been exposed to.
What this means is that if three types of flu don't look like they have changed from the year before, but there may be one or two candidates for a new type of flu, they can take the chance and put them in the shot, because the if you had the shot the year before, the new shot will boost your immunity to those types of flu.
If this works, it means that the flu shot will be more likely to be effective (and less likely to miss) in the future.
posted by eye of newt at 5:11 PM on January 24, 2015 [4 favorites]
Seven years ago I got the flu, which led to pneumonia, which resulted in a 104 degree fever and a trip to the hospital. (The flu is the biggest cause of adult viral pneumonia.) A year later a friend of a friend ended up with pneumonia the same way and died. Both of us were healthy, 30-40 year olds. Anecdotal yes, but I get the shot every year now. 23% effectiveness on a bad year isn't nothing. We're spoiled by some of the effectiveness of modern medicine.
posted by chris24 at 5:16 PM on January 24, 2015 [11 favorites]
posted by chris24 at 5:16 PM on January 24, 2015 [11 favorites]
23% effectiveness on a bad year isn't nothing.
Also, the effectiveness rates are typically per individual, not change in population flu levels. Imagine this. An invaccinated population with each person who gets the flu passing it to .67 others. Say 100 people get the flu:
Round 1: 100 people with flu.
Round 2: 67 people get flu now 167 total infections)
Round 3: 44 new (211 total)
Round 4: 30 new (241 total)
ROund 5: 20 new (261 total)
Now same thing, except assume the whole population is vaccinated with 23% individual effectiveness for the vaccine:
Round 1: 67 people with flu.
ROund 2: 33 new people (that's the 44 who would have gotten it with no vaccine - 23%) = 100 total)
ROund 3: 17 new = 117 total
Round 4: 9 new (126 total)
Round 5: 5 new (131 total).
That's obviously back of the envelope and hugely over-simpliefied, but the point is that cutting individual susceptibility by X percent actually reduced disease prevelance by much more. In this case after 5 rounds of infection it was cut by about 50%. Again, this is hugely oversimplified and I'm not arguing these numbers specifically, and even in the simple model, the reduction will depend on the virus' base transmission rate, but the point is the individual cut in susceptibility isn't the whole story.
posted by If only I had a penguin... at 5:26 PM on January 24, 2015 [7 favorites]
Also, the effectiveness rates are typically per individual, not change in population flu levels. Imagine this. An invaccinated population with each person who gets the flu passing it to .67 others. Say 100 people get the flu:
Round 1: 100 people with flu.
Round 2: 67 people get flu now 167 total infections)
Round 3: 44 new (211 total)
Round 4: 30 new (241 total)
ROund 5: 20 new (261 total)
Now same thing, except assume the whole population is vaccinated with 23% individual effectiveness for the vaccine:
Round 1: 67 people with flu.
ROund 2: 33 new people (that's the 44 who would have gotten it with no vaccine - 23%) = 100 total)
ROund 3: 17 new = 117 total
Round 4: 9 new (126 total)
Round 5: 5 new (131 total).
That's obviously back of the envelope and hugely over-simpliefied, but the point is that cutting individual susceptibility by X percent actually reduced disease prevelance by much more. In this case after 5 rounds of infection it was cut by about 50%. Again, this is hugely oversimplified and I'm not arguing these numbers specifically, and even in the simple model, the reduction will depend on the virus' base transmission rate, but the point is the individual cut in susceptibility isn't the whole story.
posted by If only I had a penguin... at 5:26 PM on January 24, 2015 [7 favorites]
The people I know who don't get the shot often say things like, "I've gotten the flu, it's like a bad cold. Why bother?" and then I wonder if they've ever really had the flu. I never used to get a flu shot. I was rarely sick, and figured it was just something for old folks or the chronically ill.
Then about 15 years ago my wife and I got the flu. This wasn't a bad cold, this was the FLU. At one point I remember staring up at the ceiling with chills, a fever and body aches so intense and painful I questioned whether or not I'd be able to get out of the apartment if the smoke alarm went off. My wife was unable to keep down even water and we ended up at the ER with her hooked to an IV and me slumped in a chair staring at the wall next to her. I ended up missing almost 3 full weeks of work, and didn't get my normal energy level back for almost 2 months.
So in the "upside vs. downside" argument in my head, you can guess who wins. I've gotten the shot every year since then.
posted by jalexei at 6:23 PM on January 24, 2015 [15 favorites]
Then about 15 years ago my wife and I got the flu. This wasn't a bad cold, this was the FLU. At one point I remember staring up at the ceiling with chills, a fever and body aches so intense and painful I questioned whether or not I'd be able to get out of the apartment if the smoke alarm went off. My wife was unable to keep down even water and we ended up at the ER with her hooked to an IV and me slumped in a chair staring at the wall next to her. I ended up missing almost 3 full weeks of work, and didn't get my normal energy level back for almost 2 months.
So in the "upside vs. downside" argument in my head, you can guess who wins. I've gotten the shot every year since then.
posted by jalexei at 6:23 PM on January 24, 2015 [15 favorites]
Mars Saxman, for anyone who lived around the GTA when SARS erupted, there was a huge shift in the social awareness of infectious diseases. Suddenly, sneezing and coughing made you a social pariah, even if it was caused by allergies or drinking something too fast. There is also a huge public education push by public health, with constant ads and vaccinations mentioned at every doctor visit. This may be due to a larger interest in keeping health care costs down as well, as that is frequently mentioned as a positive effect from mass vaccinations.
posted by saucysault at 6:30 PM on January 24, 2015
posted by saucysault at 6:30 PM on January 24, 2015
Jalexei, exactly. I'd had what I 'thought' was the flu before, but the flu that led to the pneumonia was 4 days absolutely unable to get out of bed, feeling like I was going to die. My previous 'flus' were either very mild cases or just bad colds.
posted by chris24 at 6:40 PM on January 24, 2015 [3 favorites]
posted by chris24 at 6:40 PM on January 24, 2015 [3 favorites]
What chris24 said. I had that, but it was close to a week, and I was damn lucky it didn't become pneumonia.
So, if flu vaccinations prevent even a handful of deaths, is it worth the cost in dollars? What if that's you or someone you care about?
In the Ontario context, which is what the Globe and Mail article focuses on, it puts into place an infrastructure where it's possible to deliver vaccines to people who are trained to adminster them, have storage facilities that can keep them, and which are located all over the place (i.e., pharmacies in Ontario). That might be worth hanging onto. You know, just in case.
The research says the flu vaccine is essentially safe. Very safe, in fact.
We do know that it does prevent some deaths. So.
posted by mandolin conspiracy at 6:59 PM on January 24, 2015
So, if flu vaccinations prevent even a handful of deaths, is it worth the cost in dollars? What if that's you or someone you care about?
In the Ontario context, which is what the Globe and Mail article focuses on, it puts into place an infrastructure where it's possible to deliver vaccines to people who are trained to adminster them, have storage facilities that can keep them, and which are located all over the place (i.e., pharmacies in Ontario). That might be worth hanging onto. You know, just in case.
The research says the flu vaccine is essentially safe. Very safe, in fact.
We do know that it does prevent some deaths. So.
posted by mandolin conspiracy at 6:59 PM on January 24, 2015
I've had the flu before and it was two days of being knocked on my ass, aches, sweating, chills, delirium. The cough was the least bad part of it.
posted by empath at 7:08 PM on January 24, 2015
posted by empath at 7:08 PM on January 24, 2015
People who think the flu is like a bad cold have either never had the flu or never had a cold.
posted by Justinian at 7:09 PM on January 24, 2015 [12 favorites]
posted by Justinian at 7:09 PM on January 24, 2015 [12 favorites]
People who think the flu is like a bad cold have either never had the flu or never had a cold.
But the former Chief Medical Officer and the infectious diseases specialist write in the linked article: For healthy children and adults – the great majority of Canadians – influenza is a relatively mild, self-limited illness. For them, it is more akin to a bad cold than a life-threatening disease. Shouldn't these experts have a better than anecdotal sense of the effects of the flu?
Everyone has been sick in one way or the other, but we don't really know the causes. When I was a kid, in my household we called it the flu if it involved vomiting or diarrhea and a cold if it was coughing, sniffling and sneezing. But now what I hear called the flu is usually something else, chills and fever.
posted by TimTypeZed at 7:34 PM on January 24, 2015 [4 favorites]
But the former Chief Medical Officer and the infectious diseases specialist write in the linked article: For healthy children and adults – the great majority of Canadians – influenza is a relatively mild, self-limited illness. For them, it is more akin to a bad cold than a life-threatening disease. Shouldn't these experts have a better than anecdotal sense of the effects of the flu?
Everyone has been sick in one way or the other, but we don't really know the causes. When I was a kid, in my household we called it the flu if it involved vomiting or diarrhea and a cold if it was coughing, sniffling and sneezing. But now what I hear called the flu is usually something else, chills and fever.
posted by TimTypeZed at 7:34 PM on January 24, 2015 [4 favorites]
We get free flu shots at work, so I get one every year because it just takes about 15 minutes of my time. My mom started bugging me about getting a flu shot about, say, 10 years or so ago because I have asthma and at first I was "ugh, why bother?" but then I started getting them so she would stop calling me. Now it's an easy habit and having suffered though some bad bronchitis in the past, I am happy to think I am doing something to avoid flu-related bronchitis or pneumonia.
My father-in-law is 75 and proudly never got the flu shot because it made him "feels bad for a day or two." Three weeks ago, he came down with the flu and it has knocked him on his ass. He is way sick. He lives alone, an hour from us, and my husband has been driving down there to grocery shop and do laundry because my f-i-l can barely get out of bed. Getting him, and bringing him to the city for doctor's appointments requires four hours of driving a day on my husband's part. The vaccine might not have prevented this, but I do wish my f-i-l had paid more attention to recommendations for the elderly.
Oh and while we're on vaccines for the elderly - get the shingles vaccine if you're getting towards 60. My dad didn't have the vaccine and got shingles at 67, and it was fucking horrible for him. Really painful.
posted by Squeak Attack at 7:35 PM on January 24, 2015 [4 favorites]
My father-in-law is 75 and proudly never got the flu shot because it made him "feels bad for a day or two." Three weeks ago, he came down with the flu and it has knocked him on his ass. He is way sick. He lives alone, an hour from us, and my husband has been driving down there to grocery shop and do laundry because my f-i-l can barely get out of bed. Getting him, and bringing him to the city for doctor's appointments requires four hours of driving a day on my husband's part. The vaccine might not have prevented this, but I do wish my f-i-l had paid more attention to recommendations for the elderly.
Oh and while we're on vaccines for the elderly - get the shingles vaccine if you're getting towards 60. My dad didn't have the vaccine and got shingles at 67, and it was fucking horrible for him. Really painful.
posted by Squeak Attack at 7:35 PM on January 24, 2015 [4 favorites]
Shouldn't these experts have a better than anecdotal sense of the effects of the flu?
I don't think they are talking about the subjective experience of having the flu which is very much not like a cold, I think they are talking about the costs of treatment and hospitalization/mortality rates. Because for healthy children and adults the flu really is usually a self-limiting disease that requires nothing but palliative care. But that doesn't mean it doesn't feel a lot more serious than a cold.
"Relatively mild" means different things when you are head of infectious diseases for a large state/province. Because you're concerned with things like ebola and deadly pandemics and so forth. The flu is relatively mild compared to those things.
posted by Justinian at 7:41 PM on January 24, 2015 [1 favorite]
I don't think they are talking about the subjective experience of having the flu which is very much not like a cold, I think they are talking about the costs of treatment and hospitalization/mortality rates. Because for healthy children and adults the flu really is usually a self-limiting disease that requires nothing but palliative care. But that doesn't mean it doesn't feel a lot more serious than a cold.
"Relatively mild" means different things when you are head of infectious diseases for a large state/province. Because you're concerned with things like ebola and deadly pandemics and so forth. The flu is relatively mild compared to those things.
posted by Justinian at 7:41 PM on January 24, 2015 [1 favorite]
I'd be more than happy to get a flu shot every year and even pay for it out-of-pocket if need be if I could do it without the SHOT part of it. But it's been years since I last found a place offering the nasal spray version. Meanwhile, my needle phobia is pretty severe and I'm just not willing to have a panic attack and break down into hysterical sobbing in the middle of CVS.
If there were some way to "subscribe" to the vaccine so that a nasal spray dose was set aside for me at either my doctor's office or pharmacy every year and a reminder notice sent to come get it then I would be all over that, even if it were a paid service.
posted by Jacqueline at 8:34 PM on January 24, 2015 [4 favorites]
If there were some way to "subscribe" to the vaccine so that a nasal spray dose was set aside for me at either my doctor's office or pharmacy every year and a reminder notice sent to come get it then I would be all over that, even if it were a paid service.
posted by Jacqueline at 8:34 PM on January 24, 2015 [4 favorites]
Jacqueline: Have you asked your doctor? They could probably make a point of ordering a dose every year. When you get your shot make an appointment for roughly a year later and the appointment reminder call will serve as the reminder.
posted by If only I had a penguin... at 8:55 PM on January 24, 2015
posted by If only I had a penguin... at 8:55 PM on January 24, 2015
> So, if flu vaccinations prevent even a handful of deaths, is it worth the cost in dollars? What if that's you or someone you care about?
That's not a good argument - based on that we should spend every penny we have on every possible thing that might possibly save a life.
The fact is that we have limited resources and lots of things to spend money on that will save lives. We need to pick the most effective use of our money, and it isn't clear that flu shots are it.
If only I had a penguin...: This argument is also not correct.
You're assuming that people who get the flu are only getting the virus from one person - and that people who don't get the flu aren't infectious. But neither of these are true. Indeed, one of the benefits of the flu vaccination is that it will often mean a wretched, days-in-bed flu is replaced by a sub-clinical flu. And if you live in a major city during flu season, you're pretty well guaranteed to get some exposure to the current bug no matter what - though of course more exposure definitely increases the chance of getting the flu.
Epidemiology is tricky - I did one course covering mathematical epidemiology in school and the takeaway is that the qualitative behavior of epidemics and pandemics over time is extremely sensitive to both the initial conditions and tiny changes in the model.
I'm very, very strong on the standard vaccinations, which is why I feel it's important to distinguish between vaccinations that you must, must, must get or you're a bad person (measles, TB, etc) and the more marginal flu vaccine, where you are free to choose.
In the previous flu thread I said much the same, and I pointed out that there were definite benefits to the flu shot but that I don't personally do it - and I got a lot of people accusing me of being irresponsible in not-particularly-polite terms, even though the numbers from that article were marginal at best. So it's good to see some more information on this, even though it's still somewhat ambiguous.
> get the shingles vaccine if you're getting towards 60.
Thanks for the reminder, I should do this! Shingles is just chicken pox, back years later for its revenge. So it's particularly important to get a shingles vaccination if you've ever had chicken pox.
Doctors will sometimes not give you this, because it isn't really life-threatening nor as infectious as the original chicken pox. But the pain is wretched (my father got this), and it goes on for weeks or months - well worth avoiding. Unfortunately, the vaccine is only about 50% effective in preventing the disease, but it also has a two-thirds chance of preventing the moderate or longer-term neuralgia (i.e. nasty brutal pain) that is so common to this disease.
posted by lupus_yonderboy at 9:40 PM on January 24, 2015 [4 favorites]
That's not a good argument - based on that we should spend every penny we have on every possible thing that might possibly save a life.
The fact is that we have limited resources and lots of things to spend money on that will save lives. We need to pick the most effective use of our money, and it isn't clear that flu shots are it.
If only I had a penguin...: This argument is also not correct.
You're assuming that people who get the flu are only getting the virus from one person - and that people who don't get the flu aren't infectious. But neither of these are true. Indeed, one of the benefits of the flu vaccination is that it will often mean a wretched, days-in-bed flu is replaced by a sub-clinical flu. And if you live in a major city during flu season, you're pretty well guaranteed to get some exposure to the current bug no matter what - though of course more exposure definitely increases the chance of getting the flu.
Epidemiology is tricky - I did one course covering mathematical epidemiology in school and the takeaway is that the qualitative behavior of epidemics and pandemics over time is extremely sensitive to both the initial conditions and tiny changes in the model.
I'm very, very strong on the standard vaccinations, which is why I feel it's important to distinguish between vaccinations that you must, must, must get or you're a bad person (measles, TB, etc) and the more marginal flu vaccine, where you are free to choose.
In the previous flu thread I said much the same, and I pointed out that there were definite benefits to the flu shot but that I don't personally do it - and I got a lot of people accusing me of being irresponsible in not-particularly-polite terms, even though the numbers from that article were marginal at best. So it's good to see some more information on this, even though it's still somewhat ambiguous.
> get the shingles vaccine if you're getting towards 60.
Thanks for the reminder, I should do this! Shingles is just chicken pox, back years later for its revenge. So it's particularly important to get a shingles vaccination if you've ever had chicken pox.
Doctors will sometimes not give you this, because it isn't really life-threatening nor as infectious as the original chicken pox. But the pain is wretched (my father got this), and it goes on for weeks or months - well worth avoiding. Unfortunately, the vaccine is only about 50% effective in preventing the disease, but it also has a two-thirds chance of preventing the moderate or longer-term neuralgia (i.e. nasty brutal pain) that is so common to this disease.
posted by lupus_yonderboy at 9:40 PM on January 24, 2015 [4 favorites]
Thanks, lupos, that was interesting.
On the shingles vaccine, my doc won't give it to me because she says I'm too young and that I should wait, especially since we don't know yet how long it lasts or how/when to booster it. So I don't have the shingles vaccine. However, my doc did tell me (so if, like me, you're too young to get the vaccine listen up): That the first symptom of shingles is a blistery rash in a line usually on your torso. If you get such a rash, go to the ER immediately. Do not pass go, do not collect $200. If you get the drug you need to get immediately that point, then your shingles will be essentially nothing, but it's hugely time sensitive and you need to go to the ER right away.
posted by If only I had a penguin... at 9:50 PM on January 24, 2015
On the shingles vaccine, my doc won't give it to me because she says I'm too young and that I should wait, especially since we don't know yet how long it lasts or how/when to booster it. So I don't have the shingles vaccine. However, my doc did tell me (so if, like me, you're too young to get the vaccine listen up): That the first symptom of shingles is a blistery rash in a line usually on your torso. If you get such a rash, go to the ER immediately. Do not pass go, do not collect $200. If you get the drug you need to get immediately that point, then your shingles will be essentially nothing, but it's hugely time sensitive and you need to go to the ER right away.
posted by If only I had a penguin... at 9:50 PM on January 24, 2015
That's not a good argument - based on that we should spend every penny we have on every possible thing that might possibly save a life.
The fact is that we have limited resources and lots of things to spend money on that will save lives. We need to pick the most effective use of our money, and it isn't clear that flu shots are it.
That's a valid point. Picking up on the Globe and Mail article in the FPP, though, it's talking about the program that's in place here in Ontario, where it's not a case of spending the last penny on it.
Part of what's driving this in Ontario is the desire to keep a lot of potential acute care cases related to flu out of hospital ERs. If you're a citizen in Ontario, you can show up at an ER with anything from massive trauma to a case of the sniffles and you won't be getting a bill for doing so.
If containing flu outbreaks via vaccinations reduces emergency room visits, even without saving lives, it's a way of directing health dollars and treatment hours where they're needed for more important things. Or at least not spending them on too many flu cases.
Hey, it's not a perfect system here, but its a system that can treat people's injuries and illnesses without an epic invoice showing up in the mail that, depending on your economic circumstances, might ruin your life. So there's a calculus around "where can we divert or prevent pressure on the system via vaccinating for the flu?" And, obviously, there's some degree of debate among public health officials around the efficacy of that approach.
Again, it's important to be able to have an open conversation founded on facts and data versus knee-jerk reactions. But if it is demonstrably saving a few lives, then I think it's public dollars (in our system) well spent.
posted by mandolin conspiracy at 10:34 PM on January 24, 2015
The fact is that we have limited resources and lots of things to spend money on that will save lives. We need to pick the most effective use of our money, and it isn't clear that flu shots are it.
That's a valid point. Picking up on the Globe and Mail article in the FPP, though, it's talking about the program that's in place here in Ontario, where it's not a case of spending the last penny on it.
Part of what's driving this in Ontario is the desire to keep a lot of potential acute care cases related to flu out of hospital ERs. If you're a citizen in Ontario, you can show up at an ER with anything from massive trauma to a case of the sniffles and you won't be getting a bill for doing so.
If containing flu outbreaks via vaccinations reduces emergency room visits, even without saving lives, it's a way of directing health dollars and treatment hours where they're needed for more important things. Or at least not spending them on too many flu cases.
Hey, it's not a perfect system here, but its a system that can treat people's injuries and illnesses without an epic invoice showing up in the mail that, depending on your economic circumstances, might ruin your life. So there's a calculus around "where can we divert or prevent pressure on the system via vaccinating for the flu?" And, obviously, there's some degree of debate among public health officials around the efficacy of that approach.
Again, it's important to be able to have an open conversation founded on facts and data versus knee-jerk reactions. But if it is demonstrably saving a few lives, then I think it's public dollars (in our system) well spent.
posted by mandolin conspiracy at 10:34 PM on January 24, 2015
"Relatively mild" means different things when you are head of infectious diseases for a large state/province. Because you're concerned with things like ebola and deadly pandemics and so forth. The flu is relatively mild compared to those things.
I don't see anything stated or implied in the article that makes me believe the writers are saying that the flu will feel like a bad cold relative to coming down with Ebola. By my reading they're saying that should I as a healthy middle-aged adult contact influenza this season my experience will most likely feel like a bad cold. Which corresponds with how many people remember their life history of mid-winter bugs, actual diagnosis of cause unknown.
posted by TimTypeZed at 11:46 PM on January 24, 2015
I don't see anything stated or implied in the article that makes me believe the writers are saying that the flu will feel like a bad cold relative to coming down with Ebola. By my reading they're saying that should I as a healthy middle-aged adult contact influenza this season my experience will most likely feel like a bad cold. Which corresponds with how many people remember their life history of mid-winter bugs, actual diagnosis of cause unknown.
posted by TimTypeZed at 11:46 PM on January 24, 2015
in my household we called it the flu if it involved vomiting or diarrhea
That's what used to be called "stomach flu". Generally today it's called norovirus, viral gastroenteritis, Norwalk, etc. -- the endemic cruise ship illness. Also, a lot of vomiting with few other symptoms turns out to be really food poisoning related -- which itself is often a kind of norovirus (if it isn't salmonella or giardia or worse). So your parents weren't wrong, they were just using the vernacular of the day. I think this plays a role in the "flu vs. cold" debate in that many people still don't have a proper understanding of what the flu actually is.
posted by dhartung at 8:24 AM on January 25, 2015
That's what used to be called "stomach flu". Generally today it's called norovirus, viral gastroenteritis, Norwalk, etc. -- the endemic cruise ship illness. Also, a lot of vomiting with few other symptoms turns out to be really food poisoning related -- which itself is often a kind of norovirus (if it isn't salmonella or giardia or worse). So your parents weren't wrong, they were just using the vernacular of the day. I think this plays a role in the "flu vs. cold" debate in that many people still don't have a proper understanding of what the flu actually is.
posted by dhartung at 8:24 AM on January 25, 2015
Then about 15 years ago my wife and I got the flu. This wasn't a bad cold, this was the FLU. At one point I remember staring up at the ceiling with chills, a fever and body aches so intense and painful I questioned whether or not I'd be able to get out of the apartment if the smoke alarm went off. My wife was unable to keep down even water and we ended up at the ER with her hooked to an IV and me slumped in a chair staring at the wall next to her. I ended up missing almost 3 full weeks of work, and didn't get my normal energy level back for almost 2 months.
I like to ask people how much they would pay to get rid of the flu both when they haven't recently had it and when they have. It is pretty interesting how different the numbers are. In the first the number is usually between 20 and 50 bucks. In the second case the number is often "anythng'.
posted by srboisvert at 9:14 AM on January 25, 2015 [3 favorites]
I like to ask people how much they would pay to get rid of the flu both when they haven't recently had it and when they have. It is pretty interesting how different the numbers are. In the first the number is usually between 20 and 50 bucks. In the second case the number is often "anythng'.
posted by srboisvert at 9:14 AM on January 25, 2015 [3 favorites]
The flu is relatively mild compared to those things.
33% of people infected with influenza have no symptoms. I am sure there is a continuum between being "completely asymptomatic" and "on death's door". I mean, sure, if you're bedridden for a week and are vomiting, hallucinating, shaking, etc, etc, you know for sure that you had the flu, but that doesn't mean that someone else's mild cold might not have also been the flu.
posted by empath at 10:53 AM on January 25, 2015 [1 favorite]
33% of people infected with influenza have no symptoms. I am sure there is a continuum between being "completely asymptomatic" and "on death's door". I mean, sure, if you're bedridden for a week and are vomiting, hallucinating, shaking, etc, etc, you know for sure that you had the flu, but that doesn't mean that someone else's mild cold might not have also been the flu.
posted by empath at 10:53 AM on January 25, 2015 [1 favorite]
Flu shots were mandatory in the Marine Corps as long ago as 1962. At least for me.
posted by notreally at 11:17 AM on January 25, 2015
posted by notreally at 11:17 AM on January 25, 2015
I'm very, very strong on the standard vaccinations, which is why I feel it's important to distinguish between vaccinations that you must, must, must get or you're a bad person (measles, TB, etc) and the more marginal flu vaccine, where you are free to choose.
The NHS changed their guidance on the TB vaccine in 2005 and no longer routinely vaccinates everyone, instead focusing on targeted vaccinations in at-risk groups. So in the UK at least, TB is no longer one of the vaccines you must must get.
posted by penguinliz at 3:53 PM on January 25, 2015
The NHS changed their guidance on the TB vaccine in 2005 and no longer routinely vaccinates everyone, instead focusing on targeted vaccinations in at-risk groups. So in the UK at least, TB is no longer one of the vaccines you must must get.
posted by penguinliz at 3:53 PM on January 25, 2015
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I mean every year when they say "Oops, we picked the wrong strain" I'm thinking "Maybe you didn't. Maybe those strains aren't an issue because lots of people are vaccinated against them. Or maybe they're not an issue because one person was vaccinated against them, and that was the one person in whom it would have mutated into something much more contagious and dangerous, or that was the one person who would have gone to the airport and spread it far and wide. To say "not to many people have that strain, it turns out" doesn't tell us the vaccine was mis-designed because we have no control world and disease spread can be so path dependent (so the fact that it's also not an issue in some other place where people weren't vaccinated doesn't really tell us anything either).
Also, I don't quite get how those "single case" numbers are calculated. It's nearly impossible to prevent a "single case." Once you prevent one case, you're preventing any downstream cases, too, right?
posted by If only I had a penguin... at 2:28 PM on January 24, 2015 [16 favorites]