Sep 30 2009
This is a quick entry to allow me to have a little spleen venting. And I am cross posting this over at Medscape.
Background for you youngsters. In 1989 two electrochemists Martin Fleischmann and Stanley Pons, announced they had successfully developed cold fusion: nuclear fusion at room temperature. Pons was chairman of the chemistry department at the University of Utah at the time and lent a fair amount of respectability to the announcement.
A great deal of brouhaha followed, but in the end “is heard no more: it is a tale Told by an idiot, full of sound and fury, Signifying nothing.” Cold fusion was and is a bust, although millions were spent in pursuit of that pot of gold.
Fast forward to this week. Here is the data upon which important public health decisions are being made, in its entirety:
“new Canadian study — which has not yet been peer reviewed or published —that found those who receive the seasonal flu vaccine become two times more likely to get H1N1.”
That is all I can find as of 8:15 on 9/29/9. Interesting but we do not have the data, the methodology, confirmatory data from similar or other populations. Nothing.
There is some biologic plausibility for this effect. The flu vaccine or infection can increase the uptake of unrelated influenza strains into cells that have an Fc receptor.
So maybe its true. I don’t know. No one knows. Yet. It is almost, but not quite, an unsubstantiated rumor, and it is not known if it is clinically relevant. Hardly the information upon which you would want to use to make sweeping public health decisions that could affect the health of millions. Unless, of course, you are Canadian. Evidently Canadians have decided to stop vaccination with seasonal flu as a result of that information. That’s it. And that makes little sense.
You already have a population of people who already have had either the vaccine or influenza year after year after year after year. So everyone should already be at risk from this phenomena, if clinically relevant, from either having had influenza or the vaccine. They should already have the evil antibody, either from disease or vaccine. Please note. No one had received THIS years seasonal flu vaccine before the H1N1 hit. Its PRIOR years vaccines that may have lead to this phenomena. Stopping this years vaccination should be too little too late.
All that should happen by discontinuing the vaccination this year is denying protection from the seasonal flu but not preventing slight increased risk for H1N1. Instead people should go on to get seasonal flu, have an increased risk of dying as a result, and in the end have ‘natural’ antibody from disease that should increase the risk for H1N1 anyway.
Unless I am missing something (and I often am), it would appear stopping seasonal flu vaccination is a decision that should have no upside in preventing H1N1 but should increase morbidity and mortality from seasonal flu.
It just does not seem rational to stop the vaccination program on so little information and with the knowledge that if the effect is real, it is from prior years vaccinations. The horse is out of the barn. All that should happen is increase the risk of seasonal flu and death without decreasing the risk of H1N1.
And in the end what I bet will happen is rather than getting two vaccines late, Canadians will get no vaccines at all and flu will cut loose in Canada.
And that is assuming that this study is the real deal and will be reproduced and is clinically relevant. Or it all may be cold flusion.
I have been perseverating on this since I posted it last night. It occurs to me that the phenomena, if real and due to antibody, should not be one way. If prior exposure to the seasonal flu or the vaccine increases risk for H1N1, then H1N1 vaccine or disease should increase risk for seasonal flu. That leads to the following possibilities:
1) You have had flu or the vaccine in the past. You have the increased risk already. There is no data that the current vaccine will increase the preexisting risk and all you will do is be at risk for seasonal flu when it hits. Might as well get the vaccine for seasonal then get H1N1 vaccine when available.
2) You have never had the vaccine or the disease.
You avoid all vaccines. But you do not avoid the flu.
a)You get seasonal flu, then increase your risk for H1N1, and then you develop H1N1. So you get flu twice in a year.
b) You get H1N1, then increase your risk for seasonal flu, and then you develop seasonal flu. So you get flu twice in a year.
By avoiding the vaccine, you increase the risk of getting disease twice.
So if you get the seasonal vaccine, you decrease the risk of seasonal influenza, but either way you slightly increase you risk for H1N1.
3) You avoid the vaccines and get lucky and avoid seasonal flu and H1N1. For this season. One day you will get flu unless you are a full time lighthouse keeper. Then you are there with the rest of us.
Some clever person can run the numbers and calculate the relative risk of seasonal and H1N1 flu with each behavior. As best I can tell, the best bet is to get vaccinated, it is the best way to decrease you risk for getting ill.
J Infect Dis. 1994 Jan;169(1):200-3. Primary influenza A virus infection induces cross-reactive antibodies that enhance uptake of virus into Fc receptor-bearing cells. Gotoff R, Tamura M, Janus J, Thompson J, Wright P, Ennis FA.
Department of Medicine, University of Massachusetts Medical Center, Worcester.
Sera of young children who had had a primary infection with influenza A virus or were immunized with a live attenuated influenza A virus vaccine were examined for antibody responses that neutralized virus or enhanced uptake of virus into Fc receptor-bearing cells, because antibodies that enhance uptake of influenza virus into Fc receptor-bearing cells have been reported using mouse immune serum and monoclonal antibodies. The neutralizing antibody titers to the homologous infecting virus and to another H1N1 virus isolated several years later were higher after natural infection than after infection with the live attenuated virus. Natural infection and the attenuated vaccine induced antibodies that enhanced uptake of homologous virus and H1N1 virus isolated several years later. These results demonstrate that primary influenza A virus infection results in the induction of infection-enhancing antibodies.
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