Flu roundup

This was a really crappy season. The system for developing flu viruses is the best we’ve got, but it’s imperfect. This year, we had significant mismatch between the vaccine and the circulating strains.

According to the CDC, this season peaked in mid-February, and was “moderately severe”—and the worst season in four years.

Improving our system of flu prevention will take lots of work, including epidemiology, basic science, and front-line medicine.

A lousy flu season not only causes suffering and death, but also fuels denialits, who sit at their keyboards drooling at the prospect of pointing out vaccine failures. Most arguments center around the tu quoque fallacy: “maybe my vaccine lunacy is useless, but look, you made a big boo-boo this year.” The problem with this reasoning is that in the final analysis, vaccines always do far more good than harm.

Some critics (OK, one obsessive-compulsive commenter) bring up outbreaks of vaccine-related polio in Nigeria and India. This is an example of imcomplete knowledge. The response to a vaccine-related polio outbreak is the same as a natural outbreak—mass vaccination.

As I’ve told you before
, there are two types of polio vaccine: IPV and OPV. Both have certain advantages and disadvantages. The OPV (oral polio vaccine) is a live virus, but usually does not cause disease. The disadvantage is that rarely it can cause human disease. The advantage is that if you give it to several children in a rural village, it will be passed to the rest of the village via contaminated drinking water—the same way that wild-type poliovirus is spread. Kids take the vaccine and poop out the virus. Poor sewerage takes the vaccine to the water supply, and the villagers drink it. Mass vaccination then occurs passively. In the U.S., this has been phased out. One of the reasons for this is the large number of immunosuppressed people in this country—those undergoing chemotherapy, etc. They are the ones most at risk for having problems with the live oral vaccine.

The other polio vaccine is the IPV, which is an inactivated virus that is injected. This confers immunity, and avoids the problems of the live vaccine. What it doesn’t do is passively immunize others like the OPV.

The usual effective response to an outbreak of vaccine-preventable disease is to create a wide area of vaccination around the center of the outbreak. This has been very effective. The correct response is not to throw your hands in the air and say, “I guess vaccines don’t work, let’s give up.”

One of the basic problems with the anti-vaccine crowd is that they offer no real solutions. Vaccines have been found in study after study to prevent death and debility from many different illnesses. Since denialists don’t have the data on their side, they like to simply point at the problems with current vaccines, without offering solutions.

If they really wanted to help, denialists could get an education and join the fight. Help us find ways of improving our methods of developing and delivering flu vaccines.

But quit yer whining.


Comments

25 responses to “Flu roundup”

  1. Did the CDC report 36,000 deaths this year? If it reported more that would probably help market the vaccine, but that would probably cause people to ask why the deaths increased when there was no production problems this year.

    I am willing to bet the number the CDC uses will not change for the 2007 season.

  2. Alexandra

    Did the CDC report 36,000 deaths this year?

    36000 is not a count, it’s an estimate of the average yearly mortality. Read whole sentences, OK?

    Each year, the flu results in 200,000 hospitalizations and 36,000 deaths, according to official estimates.

    Each year… according to official estimates… got it? Not a count for 2007. Counts are, as the CDC freely admits, not possible.

  3. I’m a young, mostly healthy guy, so flu for me is an inconvenience rather than a hazard. When I got vaccinated last year in October, I was hoping that I wouldn’t get sick this year, or at least have a quicker immune response. It seems I got a full flu this year as well, around the time you specify. I’m still not sure if it was just a really bad cold though, it’s so hard to tell.

    @Chuck, and if they don’t use the same numbers, will you admit your mistake? Probably not I’m afraid.

  4. Another denialist with trouble reading for comprehension. Is this one of the problems? Did they all fail middle school?

  5. If there is no accountability in the government agency responsible, then why should there be any trust?

    I have made no mistakes in my statements. I made a wager that I believe the estimate will not change. Given medical advances shouldn’t it?

    If they do change the 36,000 on their web site:
    http://www.cdc.gov/flu/keyfacts.htm
    I would gladly stand corrected

    As long as we are talking about government accountability, should NVICP compensate EVERYONE for expenses for a failed flu vaccine and subsequent complications? It probably has never happened, but I will admit I have never looked. It would be the responsible thing for the government to do to instill confidence in the vaccine.
    http://www.hrsa.gov/vaccinecompensation/

  6. Actually, Chuck, the flu vaccine did not fail. It succeeded in protecting those who were vaccinated against the strains of flu that were included in the vaccine. The problem arose when a DIFFERENT strain of the flu arrived. Also, I do not believe the flu vaccine is manufactured by the government. The formulation may be set by the CDC, but the vaccines are manufactured by the pharmaceutical companies. Why would NVICP compensate anyone?

    As for the correction, you do understand the difference between a yearly average used to give an overview of the flu, and actual numbers, right?

    See here for a summary of last year’s flu season. See here for an updated summary of this year’s season through Feb 9.

    We await your admission patiently.

  7. you do understand the difference between a yearly average used to give an overview of the flu, and actual numbers, right?

    I’m going to guess … no.

  8. Alexandra

    If there is no accountability in the government agency responsible, then why should there be any trust?

    This has nothing to do with accountability and everything to do with your comprehension. 36000 deaths is an estimate of how many people die from the flu each year. A single “severe” season, or a single “light” season doesn’t, and shouldn’t, really affect that estimate. How you manage to spin that fact into a lack of government accountability escapes me.

    I made a wager that I believe the estimate will not change. Given medical advances shouldn’t it?

    No, actually, it shouldn’t. (At least, not just because this flu season was not perfectly average.) As far as medical advances changing the average… exactly which ones did you have in mind?

  9. Anonymous

    “As for the correction, you do understand the difference between a yearly average used to give an overview of the flu, and actual numbers, right?”

    Yes.

    You do understand that averages change and this one has not changed, right?

  10. The 36,000 has become perfectly inelastic compared to population size. If this is due to medical advances, then you should pat yourselves on the back for a job well done.

  11. Another Reading for Comprehension Epic Fail brought to you by Denialist(tm) brand Blinders!

    Yes, folks, Denialist(tm) brand Blinders can help you to ignore inconvenient facts, twist irrelevant studies, and blather on for hours on topics you really don’t understand! Denialist(tm) brand Blinders even help you not see your own denial!

    Trust Denialist(tm) brand Blinders for all your evidence ignoring needs! Sold wherever people have lost their minds!

    (void where prohibited by reason. will not actually cure cancer. your mileage may vary.)

  12. Anonymous

    LanceR,

    Maybe if you suggested to the CDC that they take their Denialist(tm) Blinders off.

  13. Right… the CDC has blinders on.

    You don’t get out much, do you?

  14. Anonymous

    I play on The Hill a few times a year, and you?

  15. An anonymouse commenter who claims to go to Congress! Anyone believe that? Anyone? Bueller? Bueller?

  16. I play on The Hill a few times a year, and you?

    Explains a lot.

  17. Anonymous

    I was a beltway bandit for DOD, DOE, and DOL. Relatives live in Stabenow’s district, so I am friendly will her. My congressman gave a non-profit I help an inside track on a grant for a great deal of money so I always say hello and to voice my concerns with him. I go downtown on the MARC train and help other organizations as the “local rep”. I do what I can to help spin the political wheels.

  18. IIRC Stabenow’s “district” is the entire state of Michigan (both peninsulas!!)

  19. So, you *claim* to be a lobbyist. So this qualifies you… how? Other than to repeat the usual gibberish while hiding behind anonymity…

  20. Anonymous

    My uncle and his children live in Grosse Pointe Farms. He meets with her when she is in MI and asks me to stop by and say hello if she and I are in DC at the same time, which I do when I can. Detroit and Ann Arbor are all I know of MI. I have not seen his new home.

  21. Anonymous

    If repeating the usual gibberish while hiding behind anonymity was a crime, then PalMD would be in jail. He has his reason to hide, as do I. It is called free speech and it is not a crime.

  22. Actually, Sr. Anon hasn’t actually made any substantive statements so there is really nothing to agree or disagree with. No need to argue about anonymity, or even if anon is sleeping with senators. It’s immaterial.

  23. Chris Noble

    The advantage is that if you give it to several children in a rural village, it will be passed to the rest of the village via contaminated drinking water—the same way that wild-type poliovirus is spread. Kids take the vaccine and poop out the virus. Poor sewerage takes the vaccine to the water supply, and the villagers drink it. Mass vaccination then occurs passively.

    This is not a good idea!

    Poliovirus has an extremely high evolution rate. During the few weeks in takes an individual to clear the virus multiple mutations occur and these variant are excreted. If a second person is then infected more mutations occur.

    The Sabin 3 strain can revert to neurovirulence with only 1 or 2 mutations.

    Reversion of the attenuated and temperature-sensitive phenotypes of the Sabin type 3 strain of poliovirus in vaccinees.

    It is important to vaccinate all people in the region at the same time.

    Not that evolution is really of any importance to medicine!!!

  24. “In the U.S., this [OPV] has been phased out. One of the reasons for this is the large number of immunosuppressed people in this country”

    So American cancer patients are a concern due to immunosuppression, but African villages, which can have HIV infection rates of more that 30% are fine?

  25. Interesting, isn’t it? I’m not sure the reasoning behind it, but part of it that we’ve been successful enough with vaccination in the U.S. that we don’t need the OPV anymore. I wouldn’t be surprised if there is a cost factor, too, but i’ll have to do a little research.

    The OPV does offer additional protection at the gut mucosa via IgA production, and as stated does provide immunity to the unvaccinated, but it certainly has disadvantages.