Flu Shots

[Skeptic Ginger]

http://www.channel4.com/news/articles/society/health/warning+from+flu+jab+inventor/1090747

The scientist who invented the Flu vaccine says Tamiflu and Relenza would save lives.

Here's a little more about the good doctor.

Dr Graeme Laver

He's retired, worked on influenza for 35 years and has been voicing his dislike about the way AU has been planning for the flu pandemic. He complains that the AU authorities are not stockpiling enough antivirals. It appears from this article the reference to the vaccine not working is only in regards to response to a pandemic. And we know that. The problem isn't the vaccine's ineffectivness, it's the impracticality of producing and distributing it in time to affect the pandemic.

Here are the quotes from the news article that support my conclusion:

with warnings that a major outbreak of the illness is likely...

"You could have a really severe epidemic. Thousands will be ill and many will die. The safe and effective anti-flu drugs could, if used correctly, avoid much of this distress."...

He said drugs that fight flu once it has struck, such as Tamiflu and Relenza, should be readily available over the counter instead of by prescription as they are at present....

That's exactly what he is saying in the other article I linked to.

The news article is also misleading when after this discussion with the Dr they add,

Dr Laver said: "If the seasonal flu is as bad as it was in Australia, you are in for a pretty bad time...

The number of flu victims in Australia tripled this year compared to last year, with those normally not affected by the disease catching it.

In just five weeks in New South Wales, 800 people died from pneumonia, which often develops from flu.

Sure, but that's still the typical cycle and it was the same rate this year as in 2003. (scroll down to figure 3)


The news article implies the Dr is talking about vaccine use in seasonal flu but he is mostly talking about using the vaccine in a pandemic. His point is the anti-flu drugs could treat active cases and save lives. But Dr L seems to be oblivious to the fact if you dump Tamiflu on the market, drug resistance will emerge and the drug will not be effective curtailing a pandemic.

 

[Skeptic Ginger]

These news stories are typically DUMB. Tamiflu is not a vaccine, it's just an antiretroviral drug. The flu vaccine was never ever NEVER made to help ward of any type of pandemic that may be caused by things like H5N1. It's only made to fight of the yearly strain that comes through.

Where do you guys find the time to dig up such stupidity? Don't you have better things to read? For these news station to cherry pick bad studies like that after we've already explored them in this thread is just sad. They obviously are just regular journalists with no background in determing what is good data vs bad.

Well, Sinope was right to post it. I don't think she had to dig it up. But it's too bad that She, Ivor and robinson are so convinced vaccines are bad they read what they want to in a news report rather than actually look objectively at the research.

 

[Skeptic Ginger]

Here's more from the Dr.

Make antivirals available to everyone before the next flu season
Dr Graeme Laver - former professor of biochemistry & molecular biology at the Australian National University

Make Tamiflu S3 and stop flu deaths: biologist

Flu deaths 'could be prevented' - People are dying unnecessarily from flu as too many restrictions are placed on key drugs, a leading expert says.

Seasonal flu is estimated to kill several thousand people each year in the UK.

Dr Laver said: "People are dying from seasonal flu, but we seem to have a blind spot about it as there are drugs that would make them better in a couple of days.

"The current set of flu vaccines are not that effective, so having Tamiflu available over-the-counter would be of huge benefit.

"The problem is that at the moment there are lots of restrictions and you need to get a prescription and that can take a couple of days during which the flu will have taken hold."

'Overblown'

Dr Laver said if it was to work pharmacists would have to be in charge of testing patients for flu which can be done by a quick saliva test so that it was not given to people with a common cold.

And he added fears over resistance to the drug developing from increased use had been "overblown".

"What is the point of stockpiling Tamiflu and perhaps never using it when it could help people now."

One has to know the context of his statement the vaccine isn't "that effective". He could be into the antiviral approach and speaks to that bias. He could just be noting the deaths are still occurring and not looking at vaccine use.

But regardless, he doesn't support those remarks with any facts or research. And he clearly is on a promo campaign to make the antivirals easier to get.

 

[robinson]

Interesting stuff

Use of oseltamivir during an outbreak of influenza A in a long-term care facility in Taiwan.
Chang YM, Li WC, Huang CT, Huang CG, Tsao KC, Cheng YH, Chiang SL, Yang SY, Chen CH, Huang YC.

Center for Disease Control, Department of Health, Taiwan, ROC; Taipei Medical University, Taipei, Taiwan, ROC.

We studied the effectiveness of oseltamivir during an outbreak of influenza A among previously vaccinated patients and staff in a long-term care facility. Seven of 14 staff members and 14 of 41 residents developed either influenza-like illness (ILI) or other respiratory symptoms during a 14-day period from late January to 8 February 2004. On 9 February, therapeutic oseltamivir (75mg twice daily for five days) was administered to one staff member and seven residents who had developed ILI within the previous 48h (treatment group). Prophylactic oseltamivir (75mg once daily for seven days) was administered to 12 staff members and 30 residents who were asymptomatic or whose respiratory symptoms did not meet the diagnosis of ILI (prophylaxis group). The remaining four residents and one staff member had had ILI for more than two days (with subsiding symptoms) and did not receive oseltamivir ('no-oseltamivir' group). None of the 42 subjects in the prophylaxis group developed ILI. Presence of influenza A virus was demonstrated in 24 subjects: seven out of eight in the treatment group, 12 of 42 in the prophylaxis group and all five in the no-oseltamivir group. For confirmation of diagnosis, real-time reverse transcription-polymerase chain reaction was more sensitive than antigen detection and virus isolation. In-time therapeutic and prophylactic oseltamivir successfully interrupted an outbreak of influenza A in a long-term care facility.

http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

What a conundrum. First people who were vaccinated got the Flu, then an antiviral drug prevented people from becoming very ill, maybe death as well. Some don't want the drug used because it might lead to the Flu becoming resistant to the drug. There seems to be a multitude of issues.

More and more reports are linking severe and sometimes fatal neuropsychiatric disorders to oseltamivir, especially in children and adolescents. These disorders include suicidal behaviour, hallucinations, seizures, delirium and extrapyramidal disorders.

(1) Oseltamivir is an antiviral drug used for influenza. It has only been tested in children to a limited extent. (2) A few deaths have been reported in children receiving oseltamivir, in some cases due to neurological causes. All of these deaths occurred in Japan. The European Medicines Agency has described 2 deaths, both attributed to suicide, in adolescents aged 14 and 17 who were taking oseltamivir. Both patients had developed behavioural disorders before their death. (3) According to the US Food and Drug Administration, neuropsychiatric disorders were reported in 32 children (mainly in Japan), and include delirium, behavioural disorders, hallucinations, convulsions and confusion. (4) Disturbing neurological toxicity has been observed in young rats exposed to oseltamivir, leading the American and European agencies to warn against the use of oseltamivir in infants less than one year old. (5) Severe cutaneous adverse effects, including cases of Lyell syndrome, were reported in children taking oseltamivir. (6) In practice, oseltamivir is only modestly effective in the prevention of influenza and treatment of suspected influenza. There is no evidence of an effect on complications of the flu in adults or children at higher risk. The possibility of serious adverse effects should be weighed against the limited benefit of oseltamivir.

Damn.

 

[robinson]

Why are Flu vaccines such a topic of conversation?

Flu Shot Not Necessary for Most People

DENVER — Public health officials say Americans should roll up their sleeves for a dose of reality: For most of us, getting a flu shot is not a life-or-death matter.

The flu vaccine (search) will not necessarily prevent you from experiencing the flu's miserable symptoms, like fever, hacking cough, runny nose and "hit-by-a-truck" body aches.

Studies show the shot generally works well, but its effectiveness can range from 52 to 90 percent depending on the strain of virus and a person's age.

If you are elderly or chronically ill, the vaccine can help jump-start your body's weakened defenses and perhaps prevent the worst from happening.

But the millions of people who are younger and healthier do not really need it — especially during a vaccine shortage, public health officials say.

"Right now the entire country runs on fear and we don't need to live like that," said Catharine A. Kopac, a Georgetown University gerontology researcher. "We somehow think we should be disease-free all the time. If you're leading a healthy life and you get sick with the flu, you're probably going to get through it."
...

In the United States, the flu's average annual death toll is 36,000. Rarely do the victims die from the virus itself. Rather, it weakens their immune systems so that a bacterial infection — often pneumonia — delivers the fatal blow.

...

Still, infectious-disease experts say flu should no longer be a catastrophic illness among otherwise healthy people, at least not in the way it was in 1918 when it killed 40 million people worldwide.
...

And unlike 1918, now there are at least four anti-viral medications that can relieve the flu's worst effects if taken within 48 hours of the onset of symptoms.

http://www.foxnews.com/story/0,2933,136611,00.html

I know, I know, I can't believe I am using a FOX News story as a source. It was just the first on the Google list. It does give some idea of the kind of things people read or hear from the News.

I know of one Flu vaccine riot that occurred two years ago when there was a shortage, or a perceived shortage. Old people went crazy, because they thought they wouldn't get a shot. It was horrible.

I consider vaccines the second most important advance in Medicine, (the first being clean water), and don't doubt vaccines have saved more lives and prevented more suffering than anything.

The concept of stimulating the immune system to prevent a life threatening illness is sound and scientific. I don't think any sane, educated person doubts this. Questioning the economics and science of vaccines, as well as wanting to know all the information about them, especially the cost, risk and the efficiency, is the sort of thing a skeptic would do.

One thing about medicine, modern science, is that every time it turns out there was some horrible unforeseen side effect, and it is covered up, or worse, denied by the authorities, it undermines trust. Evasion and dishonesty destroy our faith in medicine. The ever present economic issues also cause troubles. People remember bad events far more than they do all the good science has done.

Insulting people, or worse, acting like they are dumb because they ask questions, because they are seeking the truth, really puts scientist or medical authorities in a bad light.

To be effective in educating people, about anything, you have to behave in a stable, rational, and most importantly, honest manner. Anything else and you put yourself in a position to be ignored, distrusted, or considered a pawn of the evil Multinational Military-Industrial complex.

Ignoring the facts, or acting like a jackass because you don't like the way people behave, or what they believe, doesn't change any of this. There are risks and pitfalls in everything, vaccines and medicine are no different. Covering up the unpleasant facts, or the errors that have been made, doesn't advance the goals of science. Putting profit first doesn't either. Pretending that these human failings don't exist is just dumb.

An honest discussion about something does far more to educate people than name calling, or venting your frustration in public. Try to behave like an educated self disciplined person, even when dealing with those you find ignorant.

Just some thoughts on Flu vaccines and the conversation. Don't take it too seriously.

I've been vaccinated many times, and depending on where I am going, I still get boosters for some things. I'm not sure if they all work, but I don't like to gamble with my health. I'm far more concerned about the safety of a vaccine than I am getting the disease the vaccine is designed to prevent. Because I am 100% sure I am getting the shot, while getting the disease is far less likely.

This is human nature.

 

[Skeptic Ginger]

Use of oseltamivir during an outbreak of influenza A in a long-term care facility in Taiwan.
.... http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

What a conundrum. First people who were vaccinated got the Flu, then an antiviral drug prevented people from becoming very ill, maybe death as well. Some don't want the drug used because it might lead to the Flu becoming resistant to the drug. There seems to be a multitude of issues.

Let me help you out here robinson, since you are drawing conclusions this data does not support.

Out of a total of 35 persons who were vaccinated, 19 eventually had influenza virus cultured. That is not unexpected in the elderly which is why we want to vaccinate the staff.

At first it looks like 50% of the staff got flu. Actually the abstract says 5 of those 7 were given "prophylaxis".

Prophylactic oseltamivir ... was administered to 12 staff members and 30 residents who were asymptomatic or whose respiratory symptoms did not meet the diagnosis of ILI

Only 2 of the 14 staff members actually had influenza. We don't know anything about whether or not they were expected to get a good or poor response to the vaccine.

Only one staff member was "treated" and one was already recovering. The staff member who was recovering and the 4 patients who were also recovering and not treated had vaccinations and cultured positive for flu and got better on their own without treatment. Nothing suggests they had severe illness or that the vaccine did not modify their illness.

The remaining four residents and one staff member had had ILI for more than two days (with subsiding symptoms)

19 of the 35 had treatment and positive flu cultures and no symptoms. Nothing here tells us how many of those people were expected to get a good or poor responses from the vaccine. A poor response is still expected to modify illness. Nothing here tells us what benefit occurred between vaccine and no vaccine. All we know is they had no symptoms. We also have 15 with no symptoms and no virus detected. We also don't know the attack rate without vaccine. Having virus cultured in a person with no symptoms does not indicate vaccine failure. It indicates success in preventing illness but perhaps failure in preventing spread. That is not a zero benefit outcome.

This study was looking at the benefit of adding Tamiflu, not the failure of the vaccine. You cannot draw the conclusions you would like to here that the vaccine was of no benefit. Well, you can but that would be ignorant because that isn't what this study found.

 

[Skeptic Ginger]

...http://www.foxnews.com/story/0,2933,136611,00.html

I know, I know, I can't believe I am using a FOX News story as a source. .....

Insulting people, or worse, acting like they are dumb because they ask questions, because they are seeking the truth, really puts scientist or medical authorities in a bad light.

To be effective in educating people, about anything, you have to behave in a stable, rational, and most importantly, honest manner. Anything else and you put yourself in a position to be ignored, distrusted, or considered a pawn of the evil Multinational Military-Industrial complex.

Ignoring the facts, or acting like a jackass because you don't like the way people behave, or what they believe, doesn't change any of this. There are risks and pitfalls in everything, vaccines and medicine are no different. Covering up the unpleasant facts, or the errors that have been made, doesn't advance the goals of science. Putting profit first doesn't either. Pretending that these human failings don't exist is just dumb.

An honest discussion about something does far more to educate people than name calling, or venting your frustration in public. Try to behave like an educated self disciplined person, even when dealing with those you find ignorant.

Just some thoughts on Flu vaccines and the conversation. Don't take it too seriously.

I've been vaccinated many times, and depending on where I am going, I still get boosters for some things. I'm not sure if they all work, but I don't like to gamble with my health. I'm far more concerned about the safety of a vaccine than I am getting the disease the vaccine is designed to prevent. Because I am 100% sure I am getting the shot, while getting the disease is far less likely.

This is human nature.

Robinson, if you were the least bit interested in learning new things, you wouldn't find yourself being insulted. But if you are going to proclaim interpretations of research and news reports that are simply false, I am going to say so. Get an education, learn what it is you are reading, or stop whining about being criticized.

No where in that news article is the public health saying not to get flu shots. They are saying in times of vaccine shortage the vaccine needs to be prioritized. This article is from 2004 when there was a critical vaccine shortage.

Nevertheless, the sudden vaccine shortage this fall is igniting a "scarcity mentality" similar to runs on banks during stock market crashes and convenience stores when hurricanes brew offshore.

This is a misinterpretation by the reporter:

The flu vaccine (search) will not necessarily prevent you from experiencing the flu's miserable symptoms, like fever, hacking cough, runny nose and "hit-by-a-truck" body aches.

The flu vaccine won't prevent all colds. The reporter doesn't get it and adds to the public's ignorance because of it.

One thing about medicine, modern science, is that every time it turns out there was some horrible unforeseen side effect, and it is covered up, or worse, denied by the authorities, it undermines trust. Evasion and dishonesty destroy our faith in medicine. The ever present economic issues also cause troubles. People remember bad events far more than they do all the good science has done.

So you don't like personal attacks then you turn around and attack every health care professional on this board. Maybe it didn't occur to you that this false accusation is a personal affront to me and many other people here.

 

[Ivor the Engineer]

Well, Sinope was right to post it. I don't think she had to dig it up. But it's too bad that She, Ivor and robinson are so convinced vaccines are bad they read what they want to in a news report rather than actually look objectively at the research.

I DO NOT THINK VACCINES [IN GENERAL] ARE BAD!

STOP TELLING LIES!

 

[Sinope]

I DO NOT THINK VACCINES [IN GENERAL] ARE BAD!

STOP TELLING LIES!

Yeah, neither do I! In fact, I just got myself a Hep B vaccination on Friday. I don't agree with the "immunisation schedule" in this country but that does not equate to thinking vaccines are "bad".

 

[Dymanic]

These comments again refer to a particular "we". In this case it is the lay public.

No, they don't. Here, try another sample:

"We've talked here fairly often that the way and how far influenza virus spreads isn't understood or known precisely. That seems to be a big surprise, not only to the public but to many in the public health community who should know better."
http://scienceblogs.com/effectmeasure/2007/09/knowing_what_we_dont_know.php#more

What the reveres are saying here is that it isn't just the lay public that doesn't get it that nobody knows exactly how influenza spreads; lots of people in the public health community don't get it either. I think you're doing a fine job of illustrating the point.

So in the context of this article, the author is correct in saying the people making the decisions about respiratory protection are not basing those decisions on adequate science.

That author is saying that the science doesn't yet exist.

I beg to differ that it is the researchers with the knowledge deficit. Rather, it is the policy makers and the health care providers. And respiratory protection measures need to be tested. We most definitely have not done that research.

Sounds like what you're saying here is that researchers have no deficit of knowledge, even when it comes to things they haven't yet researched.

Which doesn't mean we don't really know how influenza is transmitted. Rather, it means the people making policy decisions are not paying careful enough attention to the role aerosols might play when the pandemic strain emerges.

I'm not at all optimistic about the prospects for containing or even slowing the spread of a pandemic strain of flu. In a discussion we had not long ago, we explored at some length (to a point approaching meltdown, actually) the contrast between this lack of optimism on my part and confidence on your part in the adequacy of public health measures to contain early outbreaks. I remembered some of the details of that discussion, but sort of forgot why I decided not to continue it.

My personal pandemic response plan may be summarized by the single word: "hunkering", and I wouldn't relish the prospect of being on the front lines in that battle. I don't want to add to the list of incorrect assumptions I may have made in that thread, but I'll risk guessing that you are among those likely to be on those front lines should a pandemic occur anytime soon. That alone deserves some respect, as does your willingness to prepare yourself by delving deeply into the science. There are ample opportunities for various interpretations of the available evidence. Some of them are mutually exclusive. I expect to continue to find aspects of your interpretations that I regard as mistaken, but I'll try harder to find more tactful ways to express these concerns. Taking a good hard look at some of these issues can be upsetting for just about anyone (an observation which may go a long way toward explaining why so many people seem to prefer to ignore them), and I'm also willing to guess that you're capable of finding enough about this to get upset about without any help from me. (Yes, this is my awkward way of apologizing for getting snarky).

The science of influenza is advancing so rapidly that even full-time virologists (let alone policy makers) are hard pressed to keep up (so if you're more concerned now about the possibility of airborne transmission than you were six months ago, I'll take that as an indication that you've been reading since the last time we discussed this). On the opposite end of the spectrum are the other ninety-nine plus percent of the people whose decisions will impact the spread of a pandemic flu just as they impact the spread of seasonal flu, and (as we're seeing in this very thread) most of them are going to base those decisions on whatever they are able to glean from the popular news media. Where some of the details are concerned the jury is still out. We're not going to get the public interested in those deliberations. They don't give a damn about alpha 2,6 galactose linkages, or how many microns in size an influenza virion is, and they aren't ever going to. While we're waiting for a final verdict, what the public needs to know is that even seasonal flu can touch their lives in ways that they may tend to underestimate (and which surely justify at least the simplest level of precaution such as flu shots and handwashing) and that a pandemic flu has the potential to rock their world, and if they're counting on somebody else to save their butts when it happens, they're likely to end up as disappointed as some former residents of New Orleans who once took the same gamble.

 

[Ivor the Engineer]

Reality check, anyone?

http://www.swissre.co.nz/resources/...a45d76a0-Publ07_FR_Influenza_Pandemics_en.pdf

ETA: http://www.swissre.com/resources/bbab850046606bf6b89cfd276a9800c6-SHAN-753GRL_Pandemic influenza.pdf

 

[Deetee]

Using your definition, the guy who puts £26 on the 100-to-1 shot at the races is being extremely rational.

How is taking a gamble which is so heavily stacked in your favour irrational? Am I also being irrational when I choose to drive to work, rather than walk? We all know walking has health benefits and I'm much less likely to die if I walk instead of using a car.

What you don't seem to get is that there are some risks which are below the level of significance for most people to be bothered to do anything about reducing them. There are all sorts of things you could spend your time and money on reducing the risk of them happening to you. Getting a flu vaccination is nowhere near the top of that list.

The risk/rationality analogy is not that someone is rational if he will bet £26 hoping the 100 to one shot comes in, but that he is rational betting £26 as insurance against the possibility that the 100 to one shot does come in (an outcome he does not wish to happen), -just in case.

The question then becomes one of choice regarding the percieved risks - Is it really 100 to one? Can I afford to risk having no insurance/protection? What if it is 1000 to one, or 10 to one - will my choice be the same?
What if the risks are slight even if the horse comes in - do I risk death if it does, or just a minor inconvenience?

If the risk of death is high, then I may choose to insure myself against what may be extremely long odds - that is rational. E.g., The risk of catching HIV from a single sexual exposure with someone whose HIV status is unknown is probably something like one hundred thousand to one in the UK. But catching HIV could kill you, so rational(?) people use protective methods.
If on the other hand the illness one risks catching is trivial, then one may choose to entertain quite short odds, say 10 to one, and choose to not have protection.

We continually face a large variety of risks in life. We can choose to run the risk of some things, like driving as opposed to walking. Some risks are necessary to run, just for us to enjoy a decent life on this earth. Vaccinations are mostly actions that protect against risks - for some diseases it's a no-brainer, for others like flu or chickenpox the benefits may be less clear. There is sufficient evidence to point to the benefits of flu vaccine in the elderly, so that is something I would have/recommend. That's my opinion. Having the vaccine costs very little in terms of risks and in the UK it is free.

Sure, other things might work out as more cost-effective interventions in a health care setting. Perhaps the answer is to charge for vaccines, so their costs are covered in some way?

Regarding risks, people also chose to run risks if they feel they can control whether they will experience the adverse event. So people drive, thinking "I'm a skillful driver, if something happens I am in control and can react/avoid the accident". In an aeroplane, there is no control factor, so some are irrationally afraid to fly, but happily drive like maniacs on the road.

This philosophy is often pure kidology, but its a factor in what we chose to do each day. Catching diseases can be viewed in this way too - we might say "But I can chose my sexual partners with care - the chance she has an STD will be very small". But with droplet or airborne infections such as flu, measles or chicken pox it is harder to predict exposure.

 

[Skeptic Ginger]

No, they don't. Here, try another sample:

"We've talked here fairly often that the way and how far influenza virus spreads isn't understood or known precisely. That seems to be a big surprise, not only to the public but to many in the public health community who should know better."
http://scienceblogs.com/effectmeasure/2007/09/knowing_what_we_dont_know.php#more

What the reveres are saying here is that it isn't just the lay public that doesn't get it that nobody knows exactly how influenza spreads; lots of people in the public health community don't get it either. I think you're doing a fine job of illustrating the point.

We are looking at a half full/empty glass here. There is no sense trying to argue which it is. My comment about the lay public was in reference to the blog which is discussing a different "we" than me. In addition, I think I made it clear that many health care professionals do not understand disease transmission. Did you simply ignore what I posted?

But from my perspective as an infectious disease specialist, and from the influenza researcher's perspective, half full half empty depends on the context of the discussion. Just what is it you don't know about influenza transmission?

That author is saying that the science doesn't yet exist.

Again, just what specific unknown are you referring to? What kind of detail are you referring to? There's no data on N95s. I practically screamed about that in my post in case you missed it. If you are referring to whether it is 60/40 aerosol/droplet or 5/95, again DEPENDS on the specific strain. So unless you want the answer regarding a single strain, no amount of research is going to answer the question about all strains. But whether it is droplet and aerosols specifically, there is evidence of both.

Do we know if the aerosols can drift 50 yards or 100 yards? Probably not.

Sounds like what you're saying here is that researchers have no deficit of knowledge, even when it comes to things they haven't yet researched.

It sounds to me like you aren't reading what I posted, have a preconceived idea what I've said and fit what I said into that preconceived idea. I suggest you re-read my posts.

I'm not at all optimistic about the prospects for containing or even slowing the spread of a pandemic strain of flu. In a discussion we had not long ago, we explored at some length (to a point approaching meltdown, actually) the contrast between this lack of optimism on my part and confidence on your part in the adequacy of public health measures to contain early outbreaks. I remembered some of the details of that discussion, but sort of forgot why I decided not to continue it.

Here we are getting closer to the actual underlying difference in our opinions.

So tell me, what is it you think the public health is going to mess up on? I'll give you my scenario.

The initial outbreak will be in a third world country. It will go unnoticed at first because the country lacks public health infrastructure. Once recognized, it will be too late to completely contain it. (Any outbreaks in countries with infrastructure occurring earlier will be contained.)

It will begin to spread but in the first wave of the pandemic, the virus will have not yet mutated to the fully adapted human strain. It will be less contagious than in the second wave. In this phase, persons entering this country from areas experiencing acute cases will be isolated and contacts including health care workers will all be given Tamiflu.

This is the time when the public health interventions will be the most effective. Heck, Indonesia is successfully implementing these measures now.

Again, in the countries without public health infrastructure, WHO will step in to assist. Tamiflu will slow the spread but not by enough to stop it. The virus strain will continue to drift and the most infectious version will replace the less infectious versions. Vaccine production will begin about this time. Some time after these events a second wave will begin.

The public health agencies in developed countries will continue to slow the spread by using Tamiflu and Relenza as Tamiflu resistance increases. The vaccine supply will begin and the prioritized persons will get their first doses. Whether from here it turns out the virus overwhelms the system or the system keeps the worst of it under control is unknown. It will depend on the speed of the pandemic spread and the production and effectiveness of vaccine and the anti-virals.

I base this scenario on what is currently being done when human cases occur today, on the public health infrastructure one can observe today, on the outcome of current interventions, on current surveillance, on the genetic discoveries about how H5N1 influenza is spreading and the comparisons between H5N1 and the 1918 strain, and on the history of the 1918 pandemic which began with a smaller, shorter wave of cases, subsided and re-emerged as a much more widespread pandemic.

My personal pandemic response plan may be summarized by the single word: "hunkering", and I wouldn't relish the prospect of being on the front lines in that battle. I don't want to add to the list of incorrect assumptions I may have made in that thread, but I'll risk guessing that you are among those likely to be on those front lines should a pandemic occur anytime soon.

No, I'll be in the back giving advice, vaccines and prophylactic prescriptions. I am a health care worker advocate. I don't believe we should be martyrs. Had I been a hospital nurse told to take care of a SARS patient without being given PPE that was tested and known to be effective in protecting the worker, I would have walked off the job. And I wouldn't have been the least bit hesitant nor would I have felt guilty about doing so. I hold a deep grudge against the health care establishment for their failure to protect health care workers against airborne and bloodborne infections. The same hazards would have never been tolerated in the industrial fields.

... I expect to continue to find aspects of your interpretations that I regard as mistaken,

Just be sure you are interpreting my 'aspects' correctly. I don't think you are.

The science of influenza is advancing so rapidly that even full-time virologists (let alone policy makers) are hard pressed to keep up (so if you're more concerned now about the possibility of airborne transmission than you were six months ago, I'll take that as an indication that you've been reading since the last time we discussed this).

I've always assumed airborne transmission. Where do you see I posted otherwise?

 

[Skeptic Ginger]

I DO NOT THINK VACCINES [IN GENERAL] ARE BAD!

STOP TELLING LIES!

Oh, excuse me, "some vaccines".

 

[Skeptic Ginger]

Yeah, neither do I! In fact, I just got myself a Hep B vaccination on Friday. I don't agree with the "immunisation schedule" in this country but that does not equate to thinking vaccines are "bad".

Right, just the ones you are misinformed about.

To be honest, Ivor, I don't think the NHS/HPA are much better than the CDC (well maybe a little bit, but not much)

When I first started researching vaccines, I was struck by how "wrong" the NHS information was. (I mean they didn't quite claim measles caused death in 1 in 333 but some of the information was nearly that far off!) Now, I sorta agree with Beth(CDC), I can't trust what they say.

(I feel I should point out here I am not anti-vaccination at all, I just think parents should have clear and accurate information on which to make decisions for their children, which is not happening at the moment)

There is no way I would give my child ALL the vaccines on the UK schedule right now. If I was in the US, I think only really uneducated (about vaccines) people would give their children ALL the recommended vaccines. It is really crazy there. There are so many vaccines.

I posted on Robinsons thread about aluminium. I think that is a real worry, especially in the US if a baby gets all the "mandated" vaccines. The MRL in the US is also a lot higher than the WHO's MRL. (WHO revised in 2006 to 0.14mg/kg Oral therefore injected safety 0.00014mg/kg)

If lives would be saved...

All the "meningitis" vaccines seem to be very effective at preventing whatever particular serotype they are for. I am not seeing a big decrease in overall cases of meningitis though.

We started vaccinating for Men C in 2001 in the UK. Now we have practically no cases of Men C but the total number of cases of meningococcal meningitis are more in 2005 than in 1990 for example.

w ww.hpa.org.uk/infections/topics_az/meningo/data_meni_t03.htm (you will have to C+P )

I think they would be better off putting the money into investigating why these bacteria cause problems for a small number of people instead of vaccinating all children.

Well if only that were true. Unfortunately it's not. I am not sure how Prevenar (prevnar) got onto the UK schedule for example, after the JCVI looked at the US results. (they initally rejected it 4 months before it was passed) "Willy Nilly" would be a good description I think

What "facts" do you mean?

 

[Dymanic]

Just what is it you don't know about influenza transmission?

I don't know whether most cases of influenza are spread by large or small droplets. For one thing.

I've always assumed airborne transmission. Where do you see I posted otherwise?

You might be surprised to find out most cases of influenza are spread by droplets, rather than truly airborne.

To which I responded:

I'd be surprised to find that all the back-and-forth over the issue of large versus small droplet transmission has been resolved.

 

[Skeptic Ginger]

I don't know whether most cases of influenza are spread by large or small droplets. For one thing.



To which I responded:

In context:

Originally Posted by Dymanic
That's good, because when you start talking about contacts of contacts, you could be looking at a pretty large number of people. Due to the way influenza is transmitted, just the number of contacts could be nothing to sneeze at (so to speak).

You might be surprised to find out most cases of influenza are spread by droplets, rather than truly airborne. That means short airborne distances and surface contact. Hand washing alone could probably prevent more than half of influenza cases.

Most of the research does show large droplet spread and very little aerosol.

Some of the research found aerosol.

Conclusion, some strains can be more infectious, not all strains are. It isn't a "back and forth" issue. That's what I tried to tell you in the beginning of this exchange.

 

[Ove]

There is a history behind not vaccinating healthy people. Vaccine supply has put restraints on how many doses one has to use each year. Then came some additional research showing that vaccinating people around those who are most vulnerable also prevents influenza deaths. Vaccine production is therefore being encouraged by the public health system in the US at least and the vaccine promotion is being expanded.

And, as a healthy person with a healthy child who is well aware of the fact influenza risk is not zero in all healthy people all the time, I have made sure both my son and I have a flu shot every year. Infectious disease prevention is my specialty, I have an MSN as a nurse practitioner, 30 years of experience and 17 years in private practice in this field. I am not duped and I am not poorly informed. I'm certainly not exaggerating the risks to others or promoting vaccine for profit when I make the decision to vaccinate my son and myself every year.

I read a voracious amount of the research in vaccines and infectious disease. I know full well why I vaccinate my son and myself. The risk of influenza, however small, is still higher than the risk of influenza vaccine and the outcome of the gamble Ivor thinks nothing of taking can, in the worst case, be death. It's a simple risk reduction measure. It is relatively inexpensive. The idea of not preventing a preventable death with such a simple measure is a superstitious decision. The evidence based decision is to get an annual influenza vaccination.

I an definitely not a member of the "All vaccinations are bad" army but i am opposed to forcing people into taking a vaccination against a disease that pose no lethal threat to them and that is unfortunately what some employers are doing. Flu is a annoying disease, yes but is is not lethal to the average person. You, as a professional, must know that the risk you are talking about reducing for you and your son doesn't exist. The "risk" is a week in bed more or less nothing else, unless off course you are suffering from some disease that has weakned you.

The other thing is that we over here HAS been in the situation where those really needing the shot couldn't get it because "healthy" people had used up all the vaccine.

I am by no means against vaccinations, my kids have had them all, MFR - Meningitis ... you name it and i have too but as a normal healthy person i will not take a flu shot just because my boss is afraid that i might stay home for a week.

 

[Skeptic Ginger]

I an definitely not a member of the "All vaccinations are bad" army but i am opposed to forcing people into taking a vaccination against a disease that pose no lethal threat to them and that is unfortunately what some employers are doing. Flu is a annoying disease, yes but is is not lethal to the average person. You, as a professional, must know that the risk you are talking about reducing for you and your son doesn't exist. The "risk" is a week in bed more or less nothing else, unless off course you are suffering from some disease that has weakned you.
....

I addressed the shortage issue, see my previous posts. Regarding the week in bed thing, believe what you want. The actual data is the influenza virus causes serious disease including pneumonia and death. If you think that isn't the case then post some actual science not your misinformed opinion.

Regarding the "being forced to get a flu shot", do you work in a hospital or other health care setting? That is the only adult vaccine requirement I can think of which fits your description. In the case of hospitals and other health care inpatient settings, the evidence is the staff bring the flu virus into the hospital and patients become infected. Some of them then die from the infections they acquired from the health care provider. Just as hospitals strive to decrease the spread of nosocomial infections to the patients by having health care workers practice good infection control technique, employers have every right to require employees get flu shots to protect the patients. Employees have to by law get TB skin tests to work in the hospitals here. The employees superstitious beliefs about flu vaccinations is not a sufficient reason to put patients at risk. Go work somewhere else if you think it infringes on your rights. What about the rights of the patients not to be put at risk because of someone's superstitious fears?

And like it or not, the recommendations come from a panel of experts who do a thorough evaluation of the research. The fact some not-even-medically-educated maybe not-even-college-graduates believe they personally are more qualified and have done a more thorough job of reviewing the literature does not place the opinions of the experts in question.

 

[Ivor the Engineer]

Here's what another expert thinks about the evidence for flu vaccination:

http://www.bmj.com/cgi/content/full/333/7574/912

Summary points
Public policy worldwide recommends the use of inactivated influenza vaccines to prevent seasonal outbreaks

Because viral circulation and antigenic match vary each year and non-randomised studies predominate, systematic reviews of large datasets from several decades provide the best information on vaccine performance

Evidence from systematic reviews shows that inactivated vaccines have little or no effect on the effects measured

Most studies are of poor methodological quality and the impact of confounders is high

Little comparative evidence exists on the safety of these vaccines

Reasons for the current gap between policy and evidence are unclear, but given the huge resources involved, a re-evaluation should be urgently undertaken

The optimistic and confident tone of some predictions of viral circulation and of the impact of inactivated vaccines, which are at odds with the evidence, is striking. The reasons are probably complex and may involve "a messy blend of truth conflicts and conflicts of interest making it difficult to separate factual disputes from value disputes"22 or a manifestation of optimism bias (an unwarranted belief in the efficacy of interventions).23

ETA: http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Vaccines for preventing influenza in healthy adults.

BACKGROUND: Different types of influenza vaccines are currently produced world-wide. Healthy adults are at present targeted only in North America. Despite the publication of a large number of clinical trials, there is still substantial uncertainty about the clinical effectiveness of influenza vaccines and this has a negative impact on their acceptance and uptake. OBJECTIVES: To identify, retrieve and assess all studies evaluating the effects (efficacy, effectiveness and harms) of vaccines against influenza in healthy adults. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2005) which contains the Cochrane Acute Respiratory Infections Group trials register; MEDLINE (January 1966 to January 2006); and EMBASE (1990 to January 2006). We wrote to vaccine manufacturers and first or corresponding authors of studies in the review. SELECTION CRITERIA: Any randomised or quasi-randomised studies comparing influenza vaccines in humans with placebo, no intervention. Live, attenuated, or killed vaccines or fractions of them administered by any route, irrespective of antigenic configuration were assessed. Only studies assessing protection from exposure to naturally occurring influenza in healthy individuals aged 16 to 65 years were considered. Comparative non-randomised studies were included if they assessed evidence of the possible association between influenza vaccines and serious harms. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. MAIN RESULTS: Forty-eight reports were included: 38 (57 sub-studies) were clinical trials providing data about effectiveness, efficacy and harms of influenza vaccines and involved 66,248 people; 8 were comparative non-randomised studies and tested the association of the vaccines with serious harms; 2 were reports of harms which could not be introduced in the data analysis.Inactivated parenteral vaccines were 30% effective (95% CI 17% to 41%) against influenza-like illness, and 80% (95% CI 56% to 91%) efficacious against influenza when the vaccine matched the circulating strain and circulation was high, but decreased to 50% (95% CI 27% to 65%) when it did not. Excluding the studies of the 1968 to 1969 pandemic, effectiveness was 15% (95% CI 9% to 22%) and efficacy was 73% (95% CI 53% to 84%). Vaccination had a modest effect on time off work, but there was insufficient evidence to draw conclusions on hospital admissions or complication rates. Inactivated vaccines caused local tenderness and soreness and erythema. Spray vaccines had more modest performance. Monovalent whole-virion vaccines matching circulating viruses had high efficacy (VE 93%, 95% CI 69% to 98%) and effectiveness (VE 66%, 95% CI 51% to 77%) against the 1968 to 1969 pandemic. AUTHORS' CONCLUSIONS: Influenza vaccines are effective in reducing cases of influenza, especially when the content predicts accurately circulating types and circulation is high. However, they are less effective in reducing cases of influenza-like illness and have a modest impact on working days lost. There is insufficient evidence to assess their impact on complications. Whole-virion monovalent vaccines may perform best in a pandemic.