FLU SHOTS: Yes or No?
by
Carole Tashel
Influenza
is a hot topic these days. Avian flu is in the news, and flu shots
are about to arrive at a health clinic near you. Should you get
vaccinated against the flu?
First, understand that the common flu vaccine will not protect
you against Avian flu. Pandemics such as those that occurred in
1918, 1957 and 1968, as well as the Avian Flu, are caused by deadly
viruses to which many people have no immunity.
The statistics you can read in the media and at your doctor's
office make flu shots sound like a great idea: They are said to
be 70 to 90% effective against an illness that claims 36,000 lives
per year. But if you crunch some of those numbers differently,
another story emerges.
WHICH
"FLU" DO YOU ACTUALLY HAVE?
Every year, people get what appears to be the "flu." But only
around 25 to 30% of all flu-like illnesses are actually caused
by viruses that could be addressed by the vaccine. About 1/3 of
the cases are caused by an unknown agent, 1/3 are caused by the
same virus that causes the common cold (a rhinovirus), and the
remaining cases (true influenza) are caused by influenza A and
B viruses and other viral agents. Any flu not caused by A or B
viruses is called "influenza-like illness."
Before each flu season begins, US and World Health Organization
officials study flu outbreaks in Asia and make an educated guess
about which three A or B viral strains to include in the current
year's vaccine. The flu shot exposes your body to just enough
of the killed influenza virus or its surface antigens so that
your immune system sets up a defense against those strains. This
immunity is temporary, and the shot must be repeated yearly.
The CDC and the media downplay the fact that flu vaccines protect
only against A or B viruses, and more importantly, only against
the three strains chosen each year out of all the possible A&B
viruses. There is a slim likelihood of getting a perfect match
of the vaccine to the circulating viruses. Another type of vaccine,
"FluMist," is a nasal spray made of live (but weakened) A and
B viruses, offered only to healthy people between the ages of
5 and 50.
Aside from the vaccine, conventional antiviral drugs such as Tamiflu
and Amantadine reduce the duration of the flu by about one day,
but only if taken within the first 48 hours of illness. Not tremendously
impressive! Tamiflu is prescribed both for prevention and treatment
of the flu, but again, it attacks only the A or B type influenza
virus. Its efficacy is not established in high-risk patients,
nor has it been proven to reduce flu-related complications such
as pneumonia. Unfortunately (but not surprisingly), flu viruses
are steadily building resistance to Tamiflu.
JUST
HOW DANGEROUS IS INFLUENZA?
Of the 5-20% of the population that contracts the flu each season,
most do not face serious complications. Though the flu can be
extremely uncomfortable, it rarely causes death; it is respiratory
complications such as pneumonia that can be lethal. Here again,
we need more clarity on the language and numbers. Of the 5 to
20% of the population who gets the "flu," at most a third is caused
by influenza A and B strains. So the vaccine could protect only
about 2 to 7% of the population -- if it's the right match.
The statistics boldly state that 36,000 Americans die of flu-related
illnesses during a typical flu season. This number combines flu
deaths with pneumonia deaths; the actual number of people who
die of influenza alone is much smaller.
36,000 deaths sounds huge until the number is placed in context:
About one in 10,000 people die of flu-related illness. (To compare,
heart disease kills 24 people out of 10,000, or 704,000 people
per year [2003-04 season].) For people younger than 65 (including
children), the chance of a flu-related death is extremely small
-- about only one in 100,000. That's a very small risk.
Some people have a much higher likelihood of complications, and
hence, a well-crafted flu shot may protect them:
-
People over 65 in poor health, or elderly people living in a
nursing home. Their immune systems are often less able to mount
an effective defense. This is the group with the highest risk,
comprising 90% of all flu-related deaths.
-
Children under the age of two, especially if in ill health.
The immune systems of very young children are inexperienced,
making this population more vulnerable.
-
Adults who are chronically ill, alcoholic, immune compromised,
with very poor nutritional status, or on long-term immune-suppressing
drugs such as steroids.
-
Though the CDC includes pregnant women in the "at risk" group
that should get a flu shot, this recommendation is troublesome,
mainly because of the mercury contained in the vaccine. (See
ARE FLU VACCINES SAFE?)
HOW
EFFECTIVE ARE THE VACCINES?
Do the vaccines prevent someone from contracting influenza, and,
more importantly, do they prevent complications and death from
flu-related illness?
The flu shot works best in healthy adults under age 65. For all
others, effectiveness drops. Effectiveness is also compromised
if the flu virus has mutated or if the vaccine doesn't perfectly
match the season's virus strains.
Commonly-quoted statistics boast the vaccine is 70-90% effective.
(Remember, that's only for A and B strains.) But some years, it's
almost worthless. In the 2003-2004 season, the CDC admitted the
vaccine helped only 16 to 63% of the population. Again, this percentage
would be much lower in the people who really need protection.
It is difficult to wrap your mind around all these numbers; luckily,
we can look to the highly respected Cochrane Collaboration, an
international organization that conducts systematic reviews of
all relevant studies to determine whether or not medical treatments
work. They conclude that only 6% fewer vaccinated people got the
flu, compared to the unvaccinated people. Not only that, their
review reveals no evidence that the flu shot prevents hospitalizations,
serious influenza-related complications, or death.
WHAT
ABOUT CHILDREN?
New CDC policy recommends flu shots for all children over the
age of six months. Of course, any child's death is a tragedy,
but to put it into perspective, it is estimated that there are
fewer than 100 flu-related deaths per year among children under
the age of five. For healthy children, the risk of dying from
influenza is exceeded by the risk of dying in a fire or drowning.
Regardless, can the vaccines help?
The Cochrane Collaboration finds no evidence that vaccines can
prevent the serious complications that are the primary justification
for vaccinating children. Though benefits may not outweigh risks
of vaccinating healthy infants and young children, some parents
uncomfortable with any risk may still choose to vaccinate their
children; this, of course, is a purely personal decision.
ARE FLU VACCINES SAFE?
Some people think you can get the flu from the flu shot. Technically,
this is not possible, though the shot may be an insult to the
immune system, making the recipient more susceptible to other
circulating viruses causing influenza-like illnesses. This seems
minor compared to some of the other risks:
-
Most clinical trials of flu vaccines are not designed to track
serious adverse reactions. What's more, there are cases where
clinical research evidence was suppressed. MedImmune, the manufacturer
of the FluMist vaccine, refused to release data on adverse events
to any outside parties, even the authors of the trials.
-
Mercury:
Flu shots (but not FluMist) still contain mercury, hidden as
the preservative thimerosal. The 25 micrograms mercury per shot
is 6 to 24 times the limits of exposure set by the EPA and the
FDA, respectively. Mercury is proven to attack brain neurons,
stripping them of their protective myelin coating and is particularly
toxic to the developing fetus.
-
Though the EPA, the FDA and the Institute of Medicine have recommended
since 1999 that mercury be removed from flu vaccines, compliance
is incomplete. It's unclear just which shots still contain it.
In fact, there are thimerosal-laden vaccines destined for New
Mexico citizens age three and older, this season. And according
to Dr. Kenneth Stoller, Santa Fe pediatrician and Professor
of Pediatrics at the University of New Mexico School of Medicine,
these vaccines do not list thimerosal as an ingredient, which
is in violation of the New Mexico Drug Act. Stoller suggests
that all pregnant women and children under 50 pounds avoid flu
shots containing thimerosal.
-
FluMist
Risks: The vaccine manufacturer’s website states that 80%
of FluMist recipients shed live flu virus particles for up to
21 days. Because common side effects include cough, runny nose
and nasal congestion (great ways to spread viruses), vaccinated
individuals are advised to avoid close contact with immune compromised
individuals for this period of time. Even if it were possible
to protect those most vulnerable, the ongoing release of live
viruses throughout the community is a significant risk to take,
with unproven benefits.
CONFLICTS OF INTEREST
The Centers for Disease Control (CDC) has not leveled with US citizens by revealing all the facts. It should have a neutral public health role but instead advocates nearly universal vaccination.
Dr. Tom Jefferson, vaccine researcher, interviewed by Maryann Napoli in the October, 2005 issue of HealthFacts, reflects on a major problem: "Vaccines are a business, like any other. The only difference is that governments are co-sponsors with industry. Overestimation of the threat by the target diseases, suppression of data on possible adverse events, and exaggeration of effectiveness are frequent. …Beware."
MY
PERSONAL BIAS
The
vast majority of healthy people can mount an effective immune
defense, making the flu shot unnecessary. Immune systems must
be exercised in order to function optimally, and by getting and
recovering from any flu, you acquire a natural and long-term immunity
to that strain. Your immune system also learns something specifically
and generally about how to protect you in the future -- viral
recognition, learned ways of responding, etc. In the end, you
are strengthened. As an added benefit, fevers may nip precancerous
cells in the bud.
RESOURCES
* National Vaccine Information Center, a national, nonprofit advocacy
organization, (703) 938-0342 www.nvic.org
* Centers for Disease Control, (800) 232-2522 www.cdc.gov/flu.
This government agency sets vaccine policy, but is not considered
an objective source of information.
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