Here we go again with scary flu stories. Open up a newspaper or turn on the evening news, and you are likely see reports of worrisome influenza outbreaks all across the nation. Here are just a few examples of recent headlines:
- “Flu-Related Death Toll Doubles in Washington State”
- “Cases of Influenza in Minnesota Now Widespread”
- “Flu Cases Spread Across the United States”
- “CDC: 25 States Reporting Widespread Flu”
- “Flu Season Brings Renewed Pandemic Concerns.”
- “Outbreak Ups Demands for Flu Shots”
Does any of this sound familiar? Last year at this time we were told pretty much the same thing. The following comes from a People’s Pharmacy Alert from January 12, 2013:
“First we were told that influenza was hitting early and hitting hard. Network news shows aired scary video clips of sick people in overcrowded emergency rooms. On January 9th the mayor of Boston declared a public health emergency because hospitals in the city were overwhelmed with patients. The city of Boston began offering free flu shots on January 12th hoping to control the epidemic.
“On the same day, January 12, 2013 New York Governor Andrew Cuomo declared a public health emergency for his state and gave pharmacists the go-ahead to administer shots to children as young as 6 months old. Everyone is being urged to get a flu shot ASAP.”
Last year the people who had to make the vaccine guessed right. They anticipated with unusual accuracy what viruses would be circulating during flu season. It is rare that vaccine makers get a 92% match like they did in 2013. But how well did the shot actually work in preventing influenza? Not so well.
After the dust settled on flu season and the CDC did its post-flu analysis, the results were disappointing. According to the experts, the vaccine was roughly 27% effective for those over the age of 65. Remember, this is the high-risk group that seems to be most vulnerable to the complications of influenza.
Perhaps most disheartening of all was the 9% effectiveness of last year’s flu shot in protecting older people from H3N2, the most virulent form of influenza last year. Here is a link to the CDC’s own post-season vaccine assessment.
We certainly hope that this year’s flu shot will be much better at protecting people from catching influenza or developing complications. We have been told that the bad actor in 2014 is H1N1 and that the flu vaccine is a good match. We do fear, however, that public health officials often oversell the effectiveness of influenza vaccines in general.
An interesting special article in JAMA Internal Medicine (June 10, 2013) spilled the beans. It was titled: “Influenza Vaccines: Time for a Rethink.” Here is how Peter Doshi, PhD, introduced the article:
“Officials and professional societies treat influenza as a major public health threat for which the annual vaccine offers a safe and effective solution. In this article, I challenge these basic assumptions. I show that there is no good evidence that vaccines reduce serious complications of influenza, the outcomes the policy is meant to address. Moreover, promotional messages conflate ‘influenza’ (disease caused by influenza viruses) with ‘flu’ (a syndrome with many causes, of which influenza viruses appear to be a minor contributor). This lack of precision causes physicians and potential vaccine recipients to have unrealistic assumptions about the vaccine’s potential benefit, and impedes dissemination of the evidence on nonpharmaceutical interventions against respiratory diseases. In addition, there are potential vaccine-related harms, as unexpected and serious adverse effects of influenza vaccines have occurred. I argue that decisions surrounding influenza vaccines need to include a discussion of these risks and benefits.”
Dr. Doshi makes the following points in his perspective:
- Vaccines are less effective than most people believe.
- Anywhere between 33 to 100 people must be vaccinated to help one person avoid influenza.
- Adverse effects cannot be dismissed as inconsequential.
- The “flu” as described by most people is only caused by actual influenza virus about 7% of the time.
- Most “flu” is caused by other kinds of viruses that are unresponsive to the influenza vaccine.
- Many hospitals now require all health professionals to get an influenza vaccine to protect vulnerable older people. There is no high-quality evidence to support the belief that this strategy actually works.
- Adverse effects of vaccines have received little coverage in either the scientific or lay press.
The People’s Pharmacy Bottom Line:
We have not changed our tune from last year:
- We need better influenza vaccinations. Even in the best of times the current flu shots do not work as well as the hype implies. If public health officials are going to urge everyone to get vaccinated, the shots should protect at least 7 out of 10 people from getting influenza.
- Until we have such improved vaccines, public health officials should be more honest about effectiveness. If people realized that as many as 99 healthy people need to be vaccinated to protect one person from getting the flu, they might be more circumspect about getting a shot.
Antiviral drugs may be helpful when people come down with influenza. Although there is controversy about the benefits and risks of the oral drug Tamiflu (oseltamivir), a study in the journal Pediatrics (online, Nov. 25, 2013) revealed that very sick children who ended up in intensive care units did benefit from antiviral medicine. The researchers concluded:
“These results and our findings suggest that further efforts are needed to educate clinicians to increase antiviral treatment in hospitalized patients with seasonal influenza, including those who are critically ill.”
A physician who did not participate in the study, Peggy Weintraub, MD, chief of pediatric infectious diseases at UCSF (University of California, San Francisco) added this comment:
“Antivirals matter and they decrease mortality, and the sooner you give them the more effectively they do that.”
To read more about the latest study on antiviral medications such as Tamiflu and Relenza (zanamivir), here is a link to the research.
Tell us how you are making out this flu season? Did you get a vaccination? Has it worked so far? Have you experienced any side effects? Have you come down with influenza even after getting vaccinated? Share your story in the comment section below.
