Apr 06 2012
Drinking from the Fire Hose: Odds and Ends on the Gasping Oppression
You are currently browsing comments. If you would like to return to the full story, you can read the full entry here: “Drinking from the Fire Hose: Odds and Ends on the Gasping Oppression”.
42 Responses to “Drinking from the Fire Hose: Odds and Ends on the Gasping Oppression”
any data to show that the same formula of last years flu vaccine the cdc now recommends we all get again this year is medically not economically conceived advice?
art malernee dvm
fla lic 1820
Most of the advice is from the Swine and Fowl Farmers of America and their veterinarian shills to protect the pork and chicken industry from collapse should the flu jump from humans to the food supply.
“First smallpox, then rinderpest (good thing Wakefield was not a veterinarian), then influenza?”
Thanks for brightening what started as a very dull day. I’m still laughing!
——–
Nursing school needs to implement some vaccination of its own against magical thinking. I’ll be coming home this summer and will be wearing one of those MedAlert bracelets that says I’m allergic to unvaccinated nurses.
Thank you Dr. Crislip for this article. You seem very good at getting some gems in that relatively small percentage of readings. Also much thanks for the advice to keep HCWs out of a relative’s room if they’ve not been vaccinated. I’m also going to ask at my doctors office what is the staff vaccination rate. All good things to know.
“Most of the advice is from the Swine and Fowl Farmers of America and their veterinarian shills to protect the pork and chicken industry from collapse should the flu jump from humans to the food supply.”
LOL. It’s dangerous to expose the herds of conspiracy. Expect a visit later today from Big Oink and Big Cluck, riding inside a trojan horse built by Big Moo. And if you’re a gourmand and like foie gras, expect a discrete and dapper visit from Big Quack. With any luck it’ll all look like a barnyard scene from Orwell’s “Animal Farm.”
we will may be able to eradicate influenza. . . .
Typo aside, I don’t see how, given its extensive non-human reservoirs.
Cervantes
You are right. Duh. It is what I get for writing late at night and mostly thinking about the wakefield line
Thank you for your excellent review.
At the beginning of the 2009 H1N1 pandemic I overheard a nursing colleague of mine spouting “swine flu” conspiracies – this, while a pregnant woman lay dying of 2009 H1N1 at the end of the hall.
My response: “Show me your sources.” His response: “I will!”
I didn’t hear another word from him on the subject.
I am proud of my profession and appalled when I hear my colleagues speaking out of ignorance, especially in areas that can negatively affect our patients.
“Complications of the vaccine are always a concern and the big one with H1N1 was Guillain-Barre syndrome (GBS), since after the 1979 flu vaccine there was an uptick in cases of the disease…’
Don’t you mean 1976?
I guess it is awkward for a patient or his/her relatives to go around asking whether HCWs got their flu shots. And it is also difficult for managers to demand that HCW get their shots or else …
But what about requiring all HCWs without flu shots to wear an orange niqaab (if you think that is outrageous, then just an orange mouth mask) as long as one is on the premises. It won’t do much for infectiousness, but I guess that many HCW rather take their shots than having to wear such garb. And patients asking why some of the HCW are dressed like that will add to the embarassment of having to explain that one on philosophical grounds insists on the inalienable right to infect others.
“Since the flu vaccine is not close to 100% effective…”
An understatement.
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70295-X/abstract
“Pooled evidence from randomized controlled trials (RCTs) showed that standard trivalent inactivated vaccines (TIVs) had an efficacy of 59% in young adults (18 to 65), but the authors found no RCTs demonstrating TIV efficacy in adults 65 and older or children aged 2 to 17.”
LAIVs showed higher efficacy in children up to age 7. Pursuant to your comments above about protecting others, presumably you would recommend that recent LAIV recipients stay away from the elderly and immune compromised crowd, due to risk of viral shedding.
On communicating efficacy rates, there are two schools of thought on how much flu vaccine efficacy data should be divulged in public health recommendations…the “don’t-focus-on-the-numbers” camp and the “embrace the data” approach as described in this piece. It appears to depend upon how one weighs the balance between “full disclosure” with the “desire to induce vaccination”.
http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/nov0411messages.html
Kristen Ehresmann’s frankness is refreshing, contrasted with CDC spokesperson Glen Nowak’s more paternal method. “Nowak said the CDC has found that stressing specific numbers is not very helpful in inducing people to get vaccinated, especially given the impossibility of predicting vaccine effectiveness in any flu season. “When doing communication and messaging, you have to consider, ‘What is my communication goal?’ Obviously Nowak believes the communication goal (vaccination persuasion) is more important (and loftier?) than an forthright presentation of the efficacy rates. Yes there’s always the chance that the “public” will just get confused by all those numbers….
I am a teacher and I get my flu shot every year. I work with teens, so I’m not really doing this to protect them from getting flu from me – I’ve just figured that being around 600 kids every day is a real threat for me. And perhaps I’m one of those few lucky bastards but the vaccine really works for me – I started getting the shot 12 years ago and I haven’t had flu since then. Some of my colleagues look at me like I’m an idiot to pay for my flu shot every year (over here it’s free only for risk groups like the elderly) – but it works. I’ve worked at this particular school for 9 years now and I haven’t had a single day of sick leave (much to the dismay of some students).
On the other hand – my mother had very severe adverse reaction the only time she had her flu shot, so she decided to skip it. However, she does not go around claiming that flu vaccine is evil incarnate and she’s really happy that the rest of our family gets their shots.
wales,
I gotta tell you, I’m looking around and am not seeing a lot of polio or smallpox. As a non expert in this field, that tells me all I really need to know about the effectiveness of vaccines generally. I’m happy to leave it to the experts to recommend which specific vaccines I should receive – and they recommend that I receive the flu shot.
I bet if in addition to giving free flu vaccines to hospital employees If the hospital also vaccinated their entire family for Flu free more Hospital employees would get vaccinated. It would also be good pr for the hospital to show what the hospital was willing to do to protect patients.Art malernee dvm
@art malernee dvm
The three nurses that I know personally who have attempted to refuse vaccination would not get them voluntarily if you paid them, let alone want their family members to get them. They are all about “health freedom”. I think they all listen to Gary Null or Mike Adams, or some other guru. They are too far gone to even attempt to reason with them. One of them quit nursing and became a teacher, and another would quit nursing if she could find another job. The other is near retirement. They are late middle aged but none has ever had a mammogram or colonoscopy. They only go to “integrative” doctors–and they all do multiple woo regimens of fad food, supplements, treatments, and so on. They take great pride in the things they “research on the internet”.
Luckily, Wisconsin requires the flu vaccine for HCW (apparently or they would not have got them), and the two that remain nurses got them–under protest (that I have had to listen to with my teeth tightly clenched). I do forward these blogs to them from time to time but they either ignore them or tell me that they are not “science’y types” and that I need to “respect” their “beliefs”.
It scares me to death to thing that any of these women would be taking care of me in a hospital.
Don’t worry. Your mother or anyone from your family will be just fine. Isn’t it the hospital is where the “immune” herd always get fleeced? How do I know? Because these sheep are all over the effin’ hospital! Stop whining or don’t go to the hospital and stay home instead. Geez.
Grammatical corrections to previous post…
Don’t worry, your mother or anyone from your family will be just fine. Isn’t it the hospital where the “immune” flock always get fleeced? How do I know? Because these sheep are all over the effin’ hospital! Stop whining, or don’t go to the hospital. Stay home instead. Geez.
Unfortunately, it is still not correct.
Yikes! That is scary. Nurses who aren’t “sciency types”. And here, I always thought you needed a science background in your education before you could begin nursing school.
The GBS anomaly was associated with the 1976 H1N1 vaccine, not 1979. A recent report in JAMA suggested that this may have been caused by contamination with Campylobacter. The rationale is that this bacterium has a known association with GBS, is found in poultry, and influenza vaccine is cultivated in chicken eggs:
http://jama.ama-assn.org/content/292/20/2478.full
Ivan Ilyich beat me to it, about the connection of GBS with recently diagnosed Campylobacter infection.
Then, there is this article from the Emerging Infectious Diseases Journal.
http://wwwnc.cdc.gov/eid/article/18/2/pdfs/11-1126.pdf
The epidemiological study was conducted in New Zealand. Hospital records of patients diagnosed and hospitalized with GBS were linked to recently confirmed cases of Campylobacteriosis. The study authors also concluded, that implementing stricter food safety regulations and inspecting-for-compliance at chicken/fowl processing plants, has a direct impact on the incidence of this food-borne illness and incidence of Campylobacter-associated GBS.
Thanks for the infectious deluge, Mark Crislip.
Regarding flu and pregnancy. My mother was extremely sick with the Asian flu in ’57 when she was pregnant with my brother. He has schizophrenia, diagnosed in his twenties.
It seems there is conflicting research on whether there is an association between schizophrenia and prenatal expoture to flu. I don’t really have the skills to sort out which studies are better. I just thought I’d throw it out there.
“…the population has never been vaccinated at levels, more than 90%, where herd immunity would likely kick in.”
Question: How does herd immunity kick in at all when the vaccine is 59% effective in the 18-65 age range (63% of the population), and much less effective in the under 18 and over 65 portions of the population (total 37% of the population)? What is the threshold for herd immunity in this case?
Even if 100% of the population were vaccinated, the total rate of protected individuals would be well below 59%.
Make that “TIVs are much less effective than 59% in the under 18 and over 65 crowd”. LAIVs show efficacy greater than 59% in the under age 7 crowd, but I do not know what the uptake rates are for LAIVs in that age group.
Infection promoters flock together. Yup, thanks for banning me.
I’ve been reading a lot lately about growing lack of herd immunity, usually in the context of measles, sometimes mumps or flu or another disease, but never polio. Although I am wary about making assumptions, I think it is safe to assume that people who are witholding measles vaccines from their kids likely aren’t giving them the polio vaccine either. How come we don’t hear about a resurgence of polio? Is there something about polio that is different from the other diseases? Was it closer to being eradicated than the other diseases?
@ gretemike:
Yes, polio was very very close to being eradicated. Its scope is still pretty limited, despite the best efforts of antivaccinationists – only Nigeria, Afghanistan, and Pakistan still have endemic polio per Wikipedia. Not exactly tourism hot spots, you’ll note. The antivax efforts were largely religiously-based in this case; one of the most prominent claims was that the vaccine was a Zionist plot to kill/sterilize Muslims.
It’s also not airborne, which helps too.
So it’s less likely to crop up than something like measles. But the risk still exists, and eventually it’ll happen if nothing changes.
Scott is very confident that eradication will occur “eventually”, however experts are not so optimistic about OPV eradicating the disease, and IPV seems to be too expensive for the “developing” world. A dilemma.
Actually a respiratory route of infection may be possible with Polio, according to the second citation below. Eradication is not as simple as was originally anticipated. The WHO officially declares a region polio-free when no cases of polio caused by wild virus strains have been recorded for three years. However, cVDPV (circulating vaccine derived polio virus) is still present in countries declared polio-free, which presents an intractable problem for eradication. Of course it depends on how you define eradication, just wild type virus or the various VDPVs (vaccine derived polio virus): cVDPV, iVDPV and aVDPV. Characterizing the failure of eradication as a result of anti-vaccination efforts is inaccurate and overly simplistic.
“The difficulties of using OPV for global eradication have been described. They are vaccine-associated paralytic polio, circulating vaccine-derived polio, and virulent vaccine virus excreted by immune-compromised individuals. A further complication is that vaccine virus may recombine with other enteroviruses; some of these recombinants have caused AFP indistinguishable from polio. “
“The most important difference between smallpox and polio that affects eradication is that in smallpox there were no subclinical cases; every infectious patient had obvious clinical disease. By contrast, there are 100 to 200 subclinical and therefore “invisible” poliovirus infections for every case of paralysis.”
http://www.sciencemag.org/content/312/5775/852.full
The below citation references the most complete article I have seen about polio virus. See the “Barriers to Eradication” section. Surpisingly, one of the reference citations for this article documents a case of a healthy child excreting vaccine-derived virus for 6 months.
“The agent must be eradicated to eradicate the disease and, where silent circulation is possible, as for poliovirus, this is not easy to track. The remaining issues of principle concern the vaccine, where the oral vaccine that has eradicated disease can itself cause outbreaks, and also the wild-type strains for the production of IPV.”
http://vir.sgmjournals.org/content/93/3/457.full
Actually I was saying that a polio outbreak in the US would happen eventually if the antivax loons keep it up.
Thanks for clarifying. We may have a resurgence anyway without the “loons” given the mutations of VDPV.
Even if we are all vaccinated with IPV?
Dunno, do you see the entire world getting vaccinated with IPV anytime soon?
http://www.telegraphindia.com/1101024/jsp/nation/story_13094132.jsp
“As long as oral polio vaccine continues to be used anywhere in the world, there will be a continued threat of VDPV and hence of outbreaks of (polio),” Philip Minor, a virologist at the National Institute for Biological Standards and Control in the UK, wrote last year in the journal Vaccine.
It would be decades after vaccinating the entire world with IPV before polio risk would disappear.
Immunocompromised individuals can become chronically infected with polio virus, like this 44 year old US woman who succumbed to the disease 12 years after her child was vaccinated with OPV.
http://www.ncbi.nlm.nih.gov/pubmed/21675890?dopt=Abstract
Then there’s the risk of wild-type strains escaping containment…(from the P. Minor article cited yesterday) “At the moment, there are four licensed producers of IPV, all in western Europe; two provide the majority of the vaccine, which is manufactured under high containment to prevent reintroduction of polio after eradication. As the world economy changes, new manufacturers are likely to enter the market, and the containment of the paralytic wild-type strains in the massive quantities required is a major concern.”
” We may have a resurgence anyway without the “loons” given the mutations of VDPV.”
In the US, what scenario for a resurgence of polio is more likely? Loons who won’t vaccinate their kids and bringing in VDPV or wild type from abroad or mutations of VDPV causing a resurgence?
Since over 95% of polio infections are inapparent, subclinical, invisible, lacking symptoms, silent….how will we know if/when a resurgence has begun? And how will we know if it is the “loons” or the chronically infected immunocompromised or the back-mutating VDPV or silent wild-type virus that was inapparent for many years that caused it?
“And how will we know if it is the “loons” or the chronically infected immunocompromised or the back-mutating VDPV or silent wild-type virus that was inapparent for many years that caused it?”
Because the loons didn’t get their kids vaccinated and allowed it to happen, that’s how.
As usual, an over simplistic response and you completely ignored the multiple vectors of infection I noted above.
You may find this interesting…
From the article cited below: Critically important to the herd immunity effect is the degree of mucosal immunity offered by vaccination against infection and shedding of poliovirus. Immunization with live-attenuated vaccine (OPV) mimics natural infection and results in the induction of a local secretory antibody (IgA) response that is associated with a reduction in shedding of poliovirus from the intestine. In contrast, intramuscular injection of IPV induces serum antibodies but does not induce secretory IgA at the mucosal surfaces and has a much more limited impact on the resistance of the intestine to infection.
IPV vaccinated children may therefore play a role in the circulation of imported wild poliovirus, and for this reason these outbreaks have usually been controlled through the reintroduction of OPV to induce adequate mucosal immunity to stop transmission.
http://www.plospathogens.org/article/info%3Adoi%2F10.1371%2Fjournal.ppat.1002599
Curious as to why you find it necessary to defend loons? I asked what was more likely. You seem to be trying to tell us that a less likely scenario is more probable than a more likely scenario. That doesn’t make sense.
I re-read my comments and see no statements defending anyone. I am pointing out that with the multiple documented risk factors for polio resurgence, your tunnel vision allows you to see only one.
This guy was excreting polio virus for 22 years.
http://www.sciencedirect.com/science/article/pii/S0140673604161503
About 40% of people with primary immundeficiency disease are between the ages of 30-65. Between roughly 1960 and 2000 US vaccinees received OPV, not IPV. Between the walking excretors, and the virus replicating in the gut of IPV vaccine recipients, there is likely a silent reservoir of polio virus in the US even now.
It’s no fun sparring with you anymore Weing. You’ve become dull and repetitive.
“Between the walking excretors, and the virus replicating in the gut of IPV vaccine recipients, there is likely a silent reservoir of polio virus in the US even now.”
We know that. Your point is…? If enough loons don’t have their kids vaccinated, you are likely to get a resurgence among them. You don’t agree?
One final comment, to respond to your question of probability. The 2010 US immunization survey results show national IPV coverage at 93%, up from 92% in 2009. LA County, land of the “loons” is at 95%.
You calculate the probability between the loons and the walking excretors. Have a good weekend.
I really have trouble understanding you. You consider LA County to be the land of the “loons”? I was not aware that was the definition of the term. It certainly is not mine. Is it because more of them are vaccinated? I just don’t get it. The reported cases of polio infection in the US since 2000 have been either in the unvaccinated, eight cases, and one reported case of polio in an immunoncompromised individual that had received OPV about 12 years earlier. Looks to me, that the loons win the booby prize.
[...] influenza (I’m a little behind on some items). A while ago, I came across this post which demonstrates just how critical influenza vaccination (the ‘flu shot’) is for medical personnel (boldface mine): As a reminder, we have [...]
Weing,
This is my last comment on this post. “Land of the Loons” is loosely borrowed from many of the past SBM posts on “anti-vaccination” where California was highlighted as having high exemption rates.