Five things you need to know about the flu right now

Today, January 9, 2013, we are the peak of influenza activity in the United States. Places like Boston, Chicago, and North Dakota are seeing a surge in cases of influenza. The Centers for Disease Control and Prevention (CDC) is reporting that flu activity is widespread and intense in most of the nation.

WIDESPREAD!

INTENSE!

So here are five things you need to know about the flu right now:

1. The flu likes unvaccinated people. While there are some people who will get the flu eventhough they’re vaccinated, comparing apples to apples, people who are not vaccinated have a higher risk of getting the flu. There is an injectable vaccine and a nasal spray vaccine. The evidence seems to point to the spray being better for children and the injection being better for adults, while older adults need the high-dose vaccine. So get your flu vaccine, and get it each year. The flu likes to mutate, a lot. And, no, you can’t get the flu from a vaccine. If you do, you would be the first person in the world to do so, and scientists would like to talk to you.

2. The flu likes dirty people. The flu vaccine makes it harder for the virus to make you sick if it infects you. It doesn’t act as a magical barrier that keeps the virus off of you. To do that, you need to wash your hands, and wash them well. A simple rinse and go will not do. By washing your hands often, you minimize the chances of catching the flu from all the surfaces you touch during the day. When you touch a surface with the virus on it and then you touch your nose, mouth, or eyes, you have a good chance of getting infected. If you’re a food handler, you have a good chance of making a lot of other people sick if you don’t wash your hands well. That would be embarrassing.

3. The flu is deadly. Most of us will get through the flu just fine because most of us are otherwise healthy. We’ll feel bad for a few days and then recover with no lingering problems. This is not the case for people who have underlying medical conditions, and there are more of us with those underlying conditions out and about nowadays. What are those conditions? They include diabetes, pregnancy, asthma, cancer, heart conditions, lung conditions, even neurological conditions. This is why it is important for people who can be vaccinated to get vaccinated, and for everyone to wash their hands. Doing this protects people who are too weak or too sick to protect themselves. To date, according to CDC, there have been 18 deaths in children. That’s 18 too many, especially in an era where the flu is completely preventable with vaccination, hand hygiene, and social distancing.

4. The flu likes friendly people. Ever wonder why the flu is so active in the winter? One of the reasons is that people tend to pack into tight spaces in the winter. We do this almost automatically to get away from the cold weather. (The cold, dry air also helps the flu survive longer in the environment, so that’s a double whammy.) We pack ourselves into movie theaters, malls, schools, and at work, and we share the virus with everyone. So, if you are sick, stay away from crowds. If you want to increase your chances of not being sick, vaccinate, wash your hands, and stay away from crowds. (I don’t mean for you not to shop, but do it as off peak hours, online, or in places that are not too crowded.) If you must take the train in a crowded car, stay away from people who look ill and wash your hands as soon as you get to your destination.

5. The flu is inside you long before you know it. It takes between one to two days for you to feel the signs and symptoms of the flu once you’ve been infected. But here’s the kicker: You’re infectious one to two days before symptoms as well. That means that you can be completely healthy and be spreading the flu around. This is why quarantines generally fail when it comes to the flu if you base those quarantines on signs and symptoms. A perfectly healthy-looking person can make it through a checkpoint and be infectious. So, if you know you’ve been exposed, stay away from people who are susceptible to serious complications form the flu, complications like pneumonia and death.

Now that you’re armed with knowledge, you’ll be more likely to make it through the flu season, no colloidal silver or magic required. Good luck. I’ll see you on the other side.

Let’s play Russian Roulette

One of the things that amazes me the most about anti-vaccine (and anti-science) people is their lack of perception when it comes to risk. One in a million chance of Guillain-Barre Syndrome from the flu vaccine? UNACCEPTABLE! One in one-thousand chance of encephalitis from measles? YEAH, I CAN LIVE WITH THAT. It makes me think that they would be really bad at playing Russian Roulette, and here’s why.
Russian Roulette is a dangerous game, and I do not want anyone playing it. Got it?

However, if you were to play it, here’s how it would go:

  1. A six-chambered revolver is loaded with one bullet.
  2. The barrel is spun by the player.
  3. The barrel is locked.
  4. The gun is pointed to the player’s head.
  5. The trigger is pulled.
  6. Hilarity ensues.

All things being equal, your chance of plastering your brains all over the wall and other players is one in six. One bullet, six chambers, get it? So what would you do if presented with one gun with twelve chambers and one gun with six chambers, which one would you like to play with? I don’t know about you, but I’d play with the twelve-chambered one.

If the flu vaccine is as horrible as some would put it, it is at worst a one million-chambered gun with one bullet in one of those chambers. You spin the barrel, pull the trigger, and then pass it on. If you don’t blow your brains off, you then have a 60-70% chance of being protected against the flu. No, you don’t get 100% protection. The man-made flu vaccine is not 100% effective. Nothing is.

We’re not gods.

But anti-vaccine activists will tell you that your chance of dying — yes, dying — from the flu vaccine are high. They won’t quote you the number so as to not reveal their ruse, but they will tell you that it’s horrible. I just don’t get it. Do they really think we’re all idiots?

Don’t get an anti-vaxer to be your partner in a gunfight.

Eight nurses with one neuron between them

If you haven’t heard it by now, here’s the scoop. Eight nurses at a hospital at the IU Health Goshen Hospital in Goshen, Indiana, refused to comply with hospital policy on influenza immunization and were fired. You know where this is going, right? Yeah, you do. The words “Nazi”, “Marxist”, “Forced”, and “Vaccination” are forthcoming.

First, some case law. The US Supreme Court, in Jacobson v. Massachusetts, ruled that the states have the authority to impose compulsory vaccination laws. This decision was upheld in Zucht v. King and even expanded to local town ordinances. Yes, in this Great Republic, filled with Democracy and Equality Under The Law, you must comply with immunization orders from your elected officials and their designated health officers or suffer the consequences. No, no one will hold you down and forcibly immunize you, but you may be put under quarantine, kept away from the vulnerable public, or fined/incarcerated. But, again, no one will hold you down and jab a needle in your arm.

We’re not Nazis.

Second, a word on “discrimination”. Discrimination has to do with selective reprisals or impositions on individuals based on a trait that they can’t help, like their race, ethnicity, place of birth, sexual orientation, color of their skin, etc. If someone says that you, you there in front of your computer or other digital device, cannot enter a building because of any of those traits and those traits alone, you’re being discriminated against. If you are fired because you are Hispanic, then you have a good case for discrimination.

Now, onto the nurses. These eight nurses were told that influenza vaccines were going to be required as a condition of their employment at the hospital. They were not going to be held down and vaccinated. None of their families were going to be dragged away to an internment camp. They were just going to be let go, free to find another job as nurses. (I hear there is quite the demand.) So what did the nurses do? They refused to get the flu vaccine.

They didn’t refuse because of an allergy or a medical condition that prevented them from being immunized. No. They refused because of their religion. This is what one of the nurses had to say about her dismissal:

““We all have different faith walks,” said Gingerich, who describes herself as a nondenominational Christian. “I feel like in my personal faith walk, I have felt instructed not to get a flu vaccination, but it’s also the whole matter of the right to choose what I put in my body and what I feel God wants me to put in versus someone mandating what I put in. It is a very big issue for me.” Gingerich was horrified that she was forced to choose between her beliefs and her job, but ultimately she said she knew what the right path was for her. “I feel like our religious freedoms are being challenged and not honored in a country that supposedly has these freedoms,” she said.”

Was she being told not to practice her religion? No. Was she not able to go to the church of her choice whenever she wanted to? No. Was she being forced to worship a different deity than the one she worships now? No. She was just asked to get a flu vaccine. A [expletive deleted] flu vaccine!

If you’re not familiar with the work of nurses, they play a critical role in the care of patients. They take orders from a healthcare provider and administer care, often in the form of medication. That is, they inject sick patients with medicine to make them feel better. So what did another vaccine-refusing nurse have to say about her situation? This:

“Your body has its natural responses to fight off certain viruses and infections, and if you continually inoculate your body with something that’s not even guaranteed from preventing you from getting it, why would you do it?”

The same can be said of any medicine; none of them are guaranteed to work. Why would you do it? Because the flu vaccine reduces the chances of you getting the flu, something that can be deadly for many people, especially hospitalized patients. What does this nurse have to add? This:

“As a nurse, my passion was to be the best advocate I could be for my patients. They knew I could be there for them even if sometimes it caused a rippling of the waters, but as a nurse there was no advocate for me except for several physicians who attempted to go to bat for our cause, but they were denied. So, what message is this sending to the public if this institution shoots down their own patient advocates?”

The message that this hospital is sending is that it cannot pussyfoot around when it comes to protecting its patients from influenza. If that takes firing nurses that will not comply — for whatever reason — then so be it.

And there is the hospice nurse, someone who works with incredibly frail people:

“Schrock believes that there are other steps people can take to stay healthy rather than getting a flu shot, like taking natural vitamins, eating well and exercising. The last time she had a flu shot was about 30 years ago.
“I just learned more and more about natural healing,” she said. “We’ve been using natural products for a good 20 years, and that’s the way we believe healing takes place.”
Schrock said her decision to decline the vaccination was, in part, “God-led.”
“I’m a pretty quiet, spiritual person, and for me, it was a big decision, but it was something that was very meaningful for me not to have in my body,” she said.”

Excuse me? There are other steps… Like vitamins and eating well? I’m not even going to touch the religiosity of her statements. I’ll touch the stupidity. There is no evidence that eating well and exercising prevents you from getting the flu. Washing your hands thoroughly, wearing a mask when working with people who are sick, those are evidence-based ways to prevent the flu. But a nurse recommending vitamins and exercise instead of the flu vaccine? Really?

The nurses continued to display their lack of science knowledge in the comments section of the article:

Name that vaxlie!

Can’t even spell “Guillain-Barre“, a 1 in 1,000,000 reaction. Shameful.

Also telling were the comments to the news article.

I don’t like to mention names, but, in this instance, I’m all for naming names. Thank God Almighty, Maker of Heaven and Earth, that Sue Schrock, Joyce Gingerich, and Ethel Hoover are no longer nurses at that hospital. Their inability to think critically and in an evidence-based way put a lot of people in danger, in my opinion. I mean, the all-or-nothing fallacy about the vaccine, really?

And the commenters? They said these things in public.

Others covering this:
Skewed Distribution
Harpocrates Speaks

One error that every anti-vaccine activist jumps all over (UPDATED)

There is this book called “Your Baby’s Best Shot“. It’s a book about childhood vaccines and their benefits versus their perceived dangers. It’s pretty good, but it’s not perfect. In one of their pages, the word “free” is missing from a statement. The statement reads like the authors are recommending “aspirin” instead of “aspirin free” fever reducers. We’ve known for a while that aspirin and kids with fevers don’t get along because there is an increased risk of a condition called “Reye’s Syndrome“. It’s a serious condition that can be seen with viral infections and the administration of aspirin. The aspirin doesn’t cause it, necessarily. It does increase the risk of it.

UPDATE: The authors have issued a correction on their Facebook page. I made the mistake of saying that “free” was left out. It wasn’t. As you can see in the correction, it was something else entirely:

“It has been brought to our attention that a typo exists on page 71 of the book. The sentence that reads: ‘A mild vaccine reaction is easily treatable with a few aspirin’ should have read ‘A mild vaccine reaction is easily treatable with a few Tylenol.’ Children should not be given aspirin due to the possibility of developing Reye’s Syndrome, a rare but serious illness. We apologize for the typo, and are grateful for your continued support of the book!”

Yes. I make mistakes too. We all do. Unlike anti-vaccine people, and other unsavory characters, I try to spread out my mistakes throughout my lifetime, not concentrate them in one single anti-vaccine blog post.

I knew a girl in high school who had it when she was ten years old. She had a lot of trouble walking after it. Very bad.

The book has that one flaw, that one little thing. The authors are aware, and they are working on issuing an erratum to amend that mistake. But that has not stopped the anti-vaccine people from relentlessly attacking it, calling for a banning of the book:

Vaccine Skeptic Society” is the online, Facebook-only pseudonym of a woman who has gone by “Stacy” in the past. Stacy has openly claimed that she is a healthcare worker, but she’s also clarified that her work in healthcare goes as far as working as a medical transcriptionist/coder out of her home. Her science degree diploma must be enormous. Yet she’s not the only one getting all bent out of shape over that one error in the book:

Her followers may very well be frothing at the mouth. To please them even further, Stacy went and created a whole new Facebook page aimed at the book and its authors. Medical coders have so much time on their hands.

The worst thing is that a person who is reasonably pro-vaccine decided to attack the book on her Facebook page. I hate Facebook. I’m hardly on it anymore. Here is what she wrote:

The way you look at the timeline of events, the only reason Stacy learned of the error was from “Informed” writing about it, all the while “Informed” is just writing about it out of concern.

What a mess.

The same rule does not apply to all the lies and misinformation in anti-vaccine books and publications, of course.

Flu Vaccine Not As Effective As We Thought: Ring The Alarm?

Science is a funny thing. Just when you think you have it all figured out, something comes along that challenges the status quo, and we scientists end up going back to the drawing board. It happened to Einstein, believe it or not. When Edwin Hubble came along with observations that stated that the universe was expanding, Einstein didn’t quite want to believe it. When those observations were shown to be true, Einstein didn’t hold fast to his own views. He analyzed the evidence and judged it for what it was. Then he changed his mind.

Likewise, when we are talking about vaccines with an anti-vax person — and most discussions are not really about “talking” — the accusation comes up that we, the people who support and encourage the use of vaccines to prevent some horrible epidemics, somehow belong to a “cult” or a “religion” that worships vaccines. Nothing could be further from the truth. What we do is take in the evidence that has shown that vaccines — the licensed ones — are safe and effective against some nasty diseases. We weigh that evidence against what we know, and then we render judgment on that evidence.

Once in a while, like it happened with Einstein, something will come along to change our view about vaccines, or a vaccine, and we do change our view. Again, we weigh the evidence. (Can you see a recurring theme here?)

The National Association of County and City Health Officials (NACCHO) did an extensive study of the influenza vaccine in the United States. Guess what? It’s not as good as we thought it was.

Let that sink in for a minute or two.

Did you catch your breath? Well, you shouldn’t be out of breath to begin with because this is not earth-shattering news. It’s not to us epidemiologists, anyway. We’ve been noticing that, despite some pretty good vaccine coverages in different populations, we were still seeing some gnarly flu outbreaks each year. We were lacking the evidence on why this was occurring, but now we have it.

Here is the full report.

The long and short of it is that the flu vaccine is not as effective as public relations campaigns will have you believe. Were they lying? No. They were making those statements based on sub-par scientific evidence. (That’s why we weigh evidence before we render judgment, though it doesn’t always happen that way.) Also, the Advisory Committee on Immunization Practices (ACIP) has been making some of the flu vaccine recommendations based on expert opinion and not hard data. So the NACCHO report suggests that better vaccines be developed, that current vaccine recommendations be based on hard data, and that we don’t stop vaccinating in light of this evidence.

Why not? Because the flu vaccine is still the best thing we have against a disease that kills thousands of Americans each year and millions worldwide. So, while we work on the next best thing — and we must — we must also continue to use what we have.

It’s kind of hard to think about this from a scientific point of view, so it will not surprise me at all if the anti-vax crowd twists and bends what is in the report to fit their views. I’ll bet you $5 that they will.

Nevertheless, this report tells us that there are dedicated public health officials looking at these things and not being afraid to criticize them. If Edwin had been afraid to tell Albert that his general theory of relativity was a bit off, our GPS systems would be off. (They really would.) So, while the anti-vax crowd will raise this report as a failure of vaccine policy in this country, I raise it here as a success.

Now that we know what is going on with the flu vaccine, we can make a better, more efficacious one. And that is not a bad thing at all.

Let’s play with numbers, and your head, just a little bit

From this site:

“New research brought to us by The Lancet shows some startling news regarding the true effectiveness of the flu vaccination. The study involved a control group of 13,095 adults who were not vaccinated. The group were watched to see if they caught the influenza virus, but 97 percent of them did not. Only 2.7 percent, or 357 people, of the non-vaccinated group ended up catching the virus. Another group of adults whom were vaccinated with a trivalent inactivated influenza vaccine ended up with 1.2 percent of them not catching the flu. The difference between the two outcomes is 1.5 people out of 100 which shows that the flu vaccine only prevents the flu in 1.5 out of every 100 adults injected with the flu vaccine.”
 
Emphasis so totally not mine.

But the person then explains their own misunderstanding:

“While the media runs around “spreading the rumor” that flu shots are 60 percent effective, one would assume that 60 out of 100 people receive the flu based on those claims. The problem with this claim is that it’s wrong. Anyone who takes a crash course in college statistics knows how to skew data. Methods for exaggerating data range from manipulating the graph to using complex statistical algorithms to eventually reach the desired conclusion. In this case, the 60 percent effectiveness claim births from an ongoing equation which transforms the numbers properly. First, 2.73% is taken for the people who got the flu in the control group. That number is then divided into 1.18% which stands for the percentage of people who got the flu in the treatment group. The answer comes out  to be 0.43. You are now able to say that 0.43 is 43% of 2.73 (control group people who got the flu) and make the claim 57% are protected by the flu vaccine.”

Well, yes, that’s how it works. This is what we epidemiologists call a “case-control” study, and it is very robust in terms of determining whether or not things happen by chance. In short, that reduction in influenza was not by chance, and it was significant, and it was by more than a half. But let me explain it differently.

The problem with looking at things in terms of percentages is that you lose sight of the magnitude of what you are looking at. If I tell you that 1% of the population of the United States has an ailment, you might think that’s not worth it to try and find a cure or prevention for it. But that 1% translates into roughly 3 million people. That’s a large city!

In the study cited by this particular anti-vaxer, you had a reduction in cases from 2.73% to 1.18%. Using our example of the US population, this would translate into helping 4.65 million people avoid the flu. In this person’s mind, going from 8.19 million to 4.65 million is meaningless. This person seems to be playing mind games to try and convince you that this is not a significant finding. It is, very much. It just seems small because, again, you’re looking at percentages.

So don’t just look at the percentages. Look a the whole picture. Even a reduction in disease burden of 1% or 2% is huge when it comes to saving lives and maintaining productivity.