12.05.2011

A Critical Flu Season Q&A

December 4 - 10 is National Influenza Vaccination Week. I was asked to participate in a conference call hosted by Every Child by Two (www.ecbt.org) and Families Fighting Flu (www.familiesfightingflu.org), to help spread the word about correct and helpful flu vaccine information. The call featured:
  • Dr. William Schaffner, a renowned flu expert and Chairman of the Department of Preventive Medicine from Vanderbilt University School of Medicine and current president of the National Foundation for Infectious Diseases; and 
  • Jennifer Lastinger, a mother of four who lost her young daughter to the flu and who as a results is now a founding member of Families Fighting Flu and a passionate advocate for flu vaccination.
Both Ms. Lastinger and Dr. Schaffner spoke at length -- Dr. Scaffner about the most current information and recommendations for flu vaccines, and Ms. Lastinger courageously shared the story of losing her perfectly healthy daughter to influenza. I will be reporting on that section of the call at BlogHer. But the call also featured a lengthy Q&A, in which I and several other participants were able to query Ms. Lastinger and Dr. Schaffner directly, and that is what follows -- absolutely critical reading for anyone concerned about keeping their children and themselves healthy.

A thread that ran through the Q&A was how to counter the harm caused by vaccine opponents and misinformation. Jennifer Lastinger's response was impassioned:
I get very frustrated with a lot of the arguments [against vaccination]. The bottom argument is, do you want your your children alive? YES!

I fully believe vaccination would have kept my daughter here with me, so that's as simple as I can get.
Here is the remainder of the Q&A:

Shannon Rosa: Who cannot receive the flu vaccine?

Dr. Shaffner: There are some people who cannot be vaccinated or who respond poorly to vaccines, but really the only group in which flu vaccines are medically contraindicated is those with a genuine allergy to eggs. But even that group has been narrowed down to only those who really cannot eat eggs at all. Beyond that, as we get older -- here's the paradox -- senior citizens are the ones who tend to get the most complications, but because their immune systems aren't as robust as they used to be, and they also tend to not respond to immunizations as well as younger people. So they clearly should be vaccinated -- but all of us who have contact with them should also be vaccinated.

And then of course there younger persons who for reasons of immunodeficiency or because they're taking immune-suppressing medication do not respond to the vaccines as strongly either -- and therefore everyone who has contact with them needs to get immunized for influenza, that important "cocoon" of protection.

Trish Parnell from www.PKids.org: There were some recent official concerns regarding the intradermal flu vaccine injection, can you tell us what happened?


Dr. Schaffner: The FDA discovered that some pharmacies were using the intradermal "jet" injector with the regular flu vaccine -- and that combination is not licensed, it hasn't been tested. So in the interests of being overly cautious, they recommended that people get re-immunized. But after more thought they realized that re-immunization wasn't necessary.

Vincent Iannelli, Pediatrics.About.Com: In my area of Texas, half the pulmonologists say it's OK to use the FluMist [nasal spray] vaccine in kids with stable asthma, and the other half say it's not OK.

Dr. Schaffner: The FDA and the CDC recommend that it not be used in children with asthma because in rare occasions it can provoke a broncho-spastic response. I do know that very astute pediatric pulmonologists will use the FluMist vaccine in children whose conditions are very stable.

So then the question is, why would these doctors be more interested in using the FluMist version of the influenza vaccine in children? The answer is that for the A strains of influenza, the nasal spray provides more immunity than the injectable vaccines, and it's also a little bit broader, more likely to provide protection against those mutant variations of the flu. Though that's not a big issue so far this year.

Dr. Iannelli: We're also seeing some parents who are skeptical of the FluMist vaccine because they say it's a live virus vaccine -- though my kids all got FluMist because they don't like shots.


Dr. Schaffner: The pediatricians in our area are definitely moving to FluMist because it's quicker and easier to administer in a busy office practice, and also because the kids seem to like it better than the inoculation.

The live virus in FluMist is a live attenuated strain. So it's been tamed in the lab to be what's called "cold sensitive." What that means is that if we take the temperature of any of us at the back of our nasopharynx, it's a degree and a half cooler than it is in our lungs -- unsurprising as our nose and throat are exposed to air. The virus can only multiply at that cooler temperature; it cannot multiply in our lungs or cause any mischief there. It may cause, just for a day or two, a little bit of a scratchy throat, and in some people a little bit of nasal discharge. But that's it. It cannot cause influenza.

Ashley Shelby with the Moms Who Vax blog momswhovax.blogspot.com: I've been hearing from parents who have had nurses or physician's assistants wait until the pediatrician leaves the room, and then discourage them from getting the flu vaccine. Have you heard about this, are there safeguards in place, and what can parents do about it?

Dr. Schaffner: I'm not shocked, because within medical centers all around the country -- as we try to persuade everyone who works in such places to be vaccinated -- it paradoxically turns out that our nurses are the group most wary of immunization. Also the myth that you can get flu from the flu vaccine is most common among nurses. And their opinion is often extremely persuasive. So we're working hard not just to persuade them to get immunized but to become immunization advocates.

If you encounter nurses who have misinformation about vaccines, I would say to parents: be adamant! Insist on vaccination. If you have trouble, ask for the doctor.

Lara Zibner, pediatric emergency specialist, Author of If Your Kid Eats This Book, Everything Will Still Be Okay, writer for Parenting Magazine: Are there currently any reimbursement issues with the flu vaccine?


Dr. Schaffner: There aren't any problems with insurance and flu vaccines in the U.S. When it comes to influenza vaccines, it's difficult to find a child who isn't covered either by their private insurance, or by Vaccines for Children, which provides no-cost immunizations for children whose families are not able to pay for them. Also pharmacies like Walgreens often have programs that offer free vaccines to people in underserved communities.

Melody from Nurses Who Vaccinate (www.facebook.com/NursesWhoVaccinate): What is the best point in pregnancy for expectant mothers to receive the influenza vaccine, to allow for optimal results for both the mother and the unborn child, and create the most prolonged protection?


Dr. Schaffner: At any time during pregnancy. Initially when the AICP -- the Advisory Committee on Immunization Practices -- recommended second and third trimester only, but then a few years later along with their colleagues in ACOG, the American College of Obstetricians and Gynecologists, they reevaluated it and said that when you're pregnant and in the doctor's office is the time to do it.

Natasha Burgert: Private Pediatrician in Kansas City, blogger at kckidsdoc.com: I have a very Internet-savvy patient population who keep bringing to my attention a recent Lancet article from late October with the claim that the influenza vaccine may not be as protective as we thought it was. That was not my interpretation after reading the paper myself, but I'm wondering if you're familiar with the paper and what your comments would be.

Dr. Schaffner: What they did in a very rigorous way is summarize what we already knew. The influenza vaccine has limitations. I like to say that it's a good vaccine, it's not a great vaccine -- in the sense that if the influenza virus changes, we haven't matched it up exactly. Also, there are individuals in our society who don't respond optimally to influenza vaccines. We need a new one, a better one. The lights are definitely on in the research labs at night as people are trying to provide a better vaccine. Some of the innovations -- the intradermal vaccine, the high-dose vaccine that's now available for people age 65 and older -- are products of that research, as is the nasal spray variant.

There are adjuvanted vaccines that are licensed in Europe but not the U.S., and there are many people working on the Holy Grail of vaccines -- the universal flu vaccine that would allow us to get our flu shots like we do our tetanus shots -- once every ten years. The director of the NIH hopes there will be one ready for testing in 2014.

Until that happens, we need to use our "good" vaccine to its best advantage. It will protect many people against illness, it will protect against complications of pneumonia and hospitalization, and it will protect against  deaths. It can't protect against all of them, but protecting against some of those things is the current good, while we hope and wait for perfection down the road.

Shannon (again): I keep up on anti-vaccine literature, and one myth I keep seeing is that of "virus shedding," of people who get vaccinated for the flu then infecting other people.


Dr. Schaffner: If you get any of the injectable vaccines, not only is it a killed vaccine but it is broken up into tiny little pieces and can't reassemble, so it can't become a new virus in your body and you can't shed it. The nasal spray vaccine is a live attenuated vaccine, but it just goes in your nose and the studies show that it is not spread to any people roundabout, so you don't have to worry about that either.

Christine Vara, Shot of Prevention: The universal influenza vaccination recommendations have been in effect for two years, what has the uptake been like?

Dr. Schaffner: We now have a universal recommendation that everyone who comes to a clinic, hospital, pharmacy; everyone should be vaccinated -- not just to keep themselves healthy, but so they don't transmit the virus to others. The more people we get vaccinated, the more likely it is that we will reduce transmission in and protect our communities.

Amy Pisani from Every Child by Two: We hear a lot about the safety of influenza and people questioning that because it's new every year. I wonder if you could talk a little bit about how the basic strain of the vaccine has already been tested and has such a long profile, and how they achieve such a quick turnaround time each year.

Dr. Schaffner: The influenza vaccine is the most used vaccine, it's given in the millions upon millions around the world every year; the CDC monitors its safety like a hawk. It's an extraordinarily safe vaccine. The FDA, although it licenses a new variant of the vaccine every year, has all the safety history of the basic construct of the vaccine in mind. This year in the U.S. we will give more than 120 million doses of the vaccine, the safey profile does not change -- it continues to be extraordinarily safe.

Amy Pisani: To clarify for a prior question: You said that some people don't respond optimally to the flu vacine. You're not talking about a reaction, but rather than they don't realize their body is not building up the antibodies, correct?

Dr. Schaffner: Correct. Some people's bodies are not capable of responding and creating those antibodies that will protect them against influenza. They're too frail, or they are immunodeficient, or they are taking immune suppressant medications that prevents their body from responding optimally, from creating the prevention that the vaccine is designed to produce.

And as lay people we use the word "flu" rather casually, a lot of people mistakenly think a bad cold is the flu. But when you get influenza, and you've had the vaccine, your illness will be milder, and you're less likely to have complications like pneumonia, hospitalization, or death.

Christine Vara: Jen, could you elaborate on Emily's Law?

Jennifer Lastinger: My husband Joe was really passionate about getting the word out [about the real-world consequences of not getting vaccinated for vaccine-preventable disease], especially through schools -- we felt the schools were the key to getting kids vaccinated. We worked with a local senator who helped us pass the law a couple of years ago, and now school websites in Texas have to post information during flu season about the flu, how to prevent it, where to get shots, and how to keep your kids healthy.

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In case you are unfamiliar with how dramatically misinformed vaccine opponents are and why ongoing efforts to communicate helpful, correct vaccine information are so necessary, consider the excerpts from the Up Your Nose post by AoA's Cathy Jameson:

  • "...we were recently exposed to some kids who had received the Flumist [sic] vaccine.  Hours and hours and hours of contact, play time, meal time and chit chat occurred before I found out those children opted to have the live flu virus jammed up their nostrils earlier in the day."
  • "…when people get live virus vaccinations but then don’t quarantine themselves while the live virus sheds, other people are at risk."
  • "...Three days later my five-year old came down with her flu-like symptoms.  She was the third to get pummeled getting hit hard with the aches, chills and a very high fever.  Coming home from school very distraught that day, she told me that a classmate of hers missed the morning portion of school to get his flu shot.  In the throes of her high fever she burst into tears, “Mommy, why’d they go and do that?”  My typical son listened to this sad story and announced through his horrible wheezing and coughing, “I wish the flu shot had never been invented.”"
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Additional Flu information resources:

2 comments:

  1. Wow, that last one--"I wish they'd never invented flu shot"--defies belief. Well, all of those comments from AoA defy belief, but the last one is particularly, and unwittingly, ironic! I'd laugh if it weren't so depressing.

    ReplyDelete
  2. This seems to be some sort of Autism debate that I (and the majority of individuals with autism - which are busy adults) was totally unaware of. All I know is secondhand comments that some people believed measle vaccine causes autism. Is that now a belief for a flu vaccine?

    Here are the reasons I thank anyone who gets the flu vaccine.

    1) Yes, a very few people can get the flu from the vaccine, but they have disfunctioning autonomic systems which lower the entire body tempature and eliminate immune systems. This makes the number 1 reason they die from contact with someone with a cold or flu, number 2 is heart failure by autonomic failure
    2) I have had four friends die this year. All were immune compromised, one a 13 year old girl who died in 18 hours, as any sore throat goes into full pneumonia in a few hours, the lungs fill with fluid and you drown to death. It is not the elderly you are protecting, it is the person you pass money to, who happens to work for me, preparing food who forgot to wash her hands.
    3) Wish the mist would come to Canada!
    4) Working with the public or with children, colds and flus are inevitable. Working at a cinema, I got ill 16 times in one winter. At uni, everyone waits for the 7 days after students arrive for that year's "Fresher Flu" to hit, as the germs from all countries mix and create a local cocktail which knocks everyone down. Getting ill from interacting is the cost of interacting, a 21st century luxury. Having half of your nieces die because of lack of immune system is more than just annoying.
    5) I don't shake hands, I don't touch money, and I don't trust you - if you get a flu shot, I might live this winter, if you don't, maybe you kill me or a child, someone in the 20's or 30's. That is the real cost, and if it is unpleasant to hear from me, well, I have baffles around me all the time, people I can't see, can't touch, I haven't shaken a hand in almost five years. That is what the flu means in my life.

    ReplyDelete

Respectful disagreement encouraged.

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