Articles

Influenza Vaccine Mandates

I have been involved in infection control and in what is now called quality for my career. Since infection control issues can occur in any department, my job involves being on numerous quality related committees (Medical Executive, Pharmacy and Therapeutics, etc) where I have witnessed or participated in what seems to be innumerable quality initiatives.

It always gripes my cookies when someone says “Get your own house in order,” because that is a person who evidently is arguing from ignorance. Since To Err is Human was published at the turn of the century, the hospital systems in Portland and across the country have invested significant time and money into quality improvement. Do a Pubmed on ‘Hand Hygiene Compliance’ in the last decade; there are over 400 references. Or ‘deep venous thrombosis prophylaxis’ — over 5,000 references. Or ‘ventilator associated pneumonia prevention’ — over 750 references. Pick a topic related to safety and quality and search the literature, and you will find a remarkable amount of research into the best ways to decrease morbidity and mortality in the hospital.

Hospitals, at least those in my city, take safety and quality very seriously, and by applying the results of these studies, there has been a marked decrease in mortality and morbidity in my institutions. Compared to historical controls, we estimate we have, in the last 2 years, prevented about 600 hospital acquired infections and over 200 deaths. Those numbers are not fudged, but real progress. I make, or made, a large chunk of mortgage payment from hospital acquired infections. Not any more.

Not a single intervention we have implemented has required the use of a SCAM. We did not need to introduce reiki or homeopathy or acupuncture into the hospitals to get these benefits. Nope. Not a one. Just the application of science-based medicine. It did require an immense amount of time and energy, because human behavior and hospital systems are complex and making changes that are effective and can be incorporated into in the busy work environment of the hospital is not as easy as one would think.

Not only has the implementation of all our quality initiatives not required the input of any SCAMs, it is difficult to find a reference where the SCAM community is making any efforts to improve their quality. Take hand hygiene, probably the most important intervention you can do to decrease the spread of infectious diseases.

In the chiropractic literature there is one study. Acupuncture and naturopathy? None. These are the three fields that are often associated with Institutions of <sarcasm> Higher Learning </sarcasm> and they are not publishing in areas of quality. Of course, evaluating quality interventions requires a firm understanding of the scientific method, not, given their curricula, one of their strong points.

There is one quality indicator where we still lag: influenza vaccine compliance. Locally and nationally, it is rare to get influenza vaccine rates above 50%. It is a condition of employment in health care, or at least in hospitals, that all the workers are vaccinated, or immune from prior illness, to a number of infections including chicken pox, mumps, hepatitis B, and measles. Most of the infections are those that can be transmitted from the health care providers (HCP) to their vulnerable patients. All the employees are immune to these diseases and, if at the time of employment they refuse the vaccines, they get the opportunity to find employment elsewhere. No exceptions.

The influenza vaccine is different; at most institutions it is not mandated and compliance is low. In recent years I have gone on the wards with the flu cart and given influenza vaccinations to the staff. It is fun and you get the opportunity to talk with your colleagues about the importance of vaccination and answer their questions. There are always one or two who will not make eye contact and avoid me so they do not need to get the shot or to engage in conversation with me. But most people, even those who may refuse the vaccine, will talk to me and, even if I do not convince them on the spot, I will give them something to think about. Some websites trumpet the low compliance of health care workers (HCW) as evidence that the HCW’s know something that the rest of us do not, and that is why they are not vaccinated. I have yet to hear a compelling reason outside of Guillian Barre and anaphylaxis. Instead I hear a variety of myths or misunderstandings. I address those arguments with a slightly more snarky tone over on my Medscape blog, A Budget of Dumb Asses. It is worth the every penny of the free registration for the opportunity to read it.

There is a movement to make flu vaccine mandatory, a condition of employment, for health care providers as well. The Society for Healthcare Epidemiology of America (SHEA) released a position paper, supported by the Infectious Disease Society of America, that recommends the influenza vaccine be mandatory for HCP’s. To the surprise, I am sure, of no one, I would support such a move.

There are three reasons to make the vaccine mandatory: two evidence-based, one philosophical.

There are careers where you are expected to place the needs of others ahead of your own. The most extreme example is the military or the secret service, where it is expected that you might die as a result of your job. Less extreme examples include policemen, firemen, and, yes, health care providers.

Medicine is more than a job. It is a calling, which is a weird thing for me to say, because it is a calling to what? Or whom? Got me. But it is. In medicine the expectation is that I will care for anyone who comes my way and that I will place the patients needs before my own.

I remember the old days, standing at the bedside of AIDS patients, with no idea what caused the disease or how it was spread, hoping that the (it turned out excessive) gowns and gloves would prevent transmission of the disease to me. But I, and my colleagues, did the work. And should plagues, known and unknown, strike again, as they will, I expect that most of my colleagues will be at my side, tending to the ill, regardless of the personal risk. Society expects that we will be there.

HCP’s have an moral obligation to minimize the chance that will harm will occur to patients, many of whom are particularly vulnerable. This duty is summed up in the three laws of health care:

  1. A HCP may not injure a human being or, through inaction, allow a human being to come to harm.
  2. A HCP must obey any orders given to it by SBM, except where such orders would conflict with the First Law.
  3. A HCP must protect its own existence as long as such protection does not conflict with the First or Second Law.

SHEA summed it up:

Those in support of mandatory programs argue that influenza vaccination is an ethical responsibility of HCP, because HCP have a duty to act in the best interests of their patients (beneficence), to not place their patients at undue risk of harm (nonmaleficence), and to protect the vulnerable and those at high risk of infection. The duty to put patient interests first is outlined in nearly every professional code of ethics in medicine, nursing, and other healthcare fields.

The influenza vaccine is safe. Serious side effects are extremely rare and the risks from influenza are much greater. The vaccine is far safer than driving (30,000 deaths a year), taking a bath (450), or standing under a coconut tree (130). Of course people are not good at evaluating relative risks. I had a patient with a heart valve infection from heroin use who smoked 2 packs a day, drank a fifth a day, and rarely showered; but when he came in with new shortness of breath and I wanted to get a chest x-ray, he refused because he was worried about the radiation exposure. So it is with vaccine. Some people have a feeling, unsupported by the literature, that vaccines are unsafe, and if they were unsafe, I would not and could not recommend mandatory vaccination.

In adults

In placebo-controlled studies among adults, the most frequent side effect of vaccination was soreness at the vaccination site (affecting 10%–64% of patients) that lasted less than 2 days. These local reactions typically were mild and rarely interfered with the recipients’ ability to conduct usual daily activities. Placebo-controlled trials demonstrated that among older persons and healthy young adults, administration of TIV is not associated with higher rates for systemic symptoms (e.g., fever, malaise, myalgia, and headache) when compared with placebo injections. One prospective cohort study indicated that the rate of adverse events was similar among hospitalized persons who either were aged 65 years and older or were aged 18–64 years and had one or more chronic medical conditions compared with outpatients. Among adults vaccinated in consecutive years, reaction frequencies declined in the second year of vaccination. In clinical trials, serious adverse events were reported to occur after vaccination with TIV at a rate of less than 1%. Adverse events in adults aged 18 years and older reported to VAERS during 1990–2005 were analyzed. The most common adverse events reported to VAERS in adults included injection-site reactions, pain, fever, myalgia, and headache. The VAERS review identified no new safety concerns. Fourteen percent of the TIV VAERS reports in adults were classified as serious adverse events, similar to proportions seen overall in VAERS. The most common serious adverse event reported after receipt of TIV in VAERS in adults was GBS. The potential association between TIV and GBS has been an area of ongoing research (see Guillain-Barré Syndrome and TIV). No elevated risk for prespecified events after TIV was identified among 4,773,956 adults in a VSD analysis.

Then there is efficacy. I have discussed the efficacy of the flu vaccine before. In the hospital, there is no single intervention that will prevent the spread of infection. One of the hallmarks of anti-science/anti-vaxers is a binary approach: either the medical intervention is 100% effective or it is 100% useless. It is rare to see a nuanced discussion of the science behind the efficacy of the flu vaccine on the anti-vax web sites. Success in decreasing transmission of disease is always multifactorial: hand hygiene, cough etiquette, not coming to work when ill (an all-too-common problem), proper isolation for those who may have influenza, and more are part of a multifaceted approach to prevent the spread of infection in hospitals. Vaccines are like Captain Crunch: only part of a healthy breakfast.

The rationale for vaccinating HCW’s is also multifaceted.

We do not want health care providers to be disease vectors for our patients, most of whom are at high risk for bad outcomes from influenza.
Many of our patients may not be vaccinated or be unable to respond to the vaccine (the old and immunoincompetent) and are not protected from influenza.

There are 4 studies that demonstrate when HCW’s are vaccinated, mortality declines in residents of long term care facilities (the current phrase for nursing home). While similar studies have yet to be done in hospitals, there are multiple lines of data that converge on the same conclusion: the more people that are vaccinated against the flu, the fewer people who die.

The Cochrane review, as always with influenza, gets it wrong. While noting that “pooled data from three C-RCTs showed reduced all-cause mortality in individuals >/= 60.”, they go on to say “The key interest is preventing laboratory-proven influenza in individuals >/= 60, pneumonia and deaths from pneumonia, and we cannot draw such conclusions.” No, it is not the key interest. Most deaths from influenza are secondary deaths from exacerbation of underlying medical problems. All-cause mortality is an important endpoint, especially if you are the one dying.

The recent Skeptics Guide to the Universe podcast (#274) had an interview with Ben Goldacre, author of Bad Science and discussed big pharma malfeasance, of which there are endless examples. They noted that the makers of olsetamivir (Tamiflu) did not want to give the unpublished data from clinical trials to the Cochrane group for fear they would make a botch of the data. For once I am sympathetic to big pharma, given the bias and spin (i.e. they do not agree with me) of the Cochrane reviews on influenza treatment and prevention. I would not give my influenza data to the current crop of Cochran flu reviewers if I were a drug company, and I am no fan of the shenanigans that so often define the interactions of pharmaceutical companies and science.

I can, at some level, understand the opposition to mandatory vaccination as a philosophical position, although I see it on par with opposition to mandatory sterile technique in the OR. Many philosophical positions are at odds with reality. But you will excuse me if I neither let you operate in my hospital nor take care of my patients. I cannot see where your philosophy gets to triumph the material safety of patients.

Several institutions and health care systems have instituted mandatory vaccination with good results, achieving 96% and greater vaccination rates.

I get the sense that those who rail against the morbidity and mortality of modern medicine are the same who would decry mandatory vaccination, even though it would improve the safety in the hospital that they so fret about.

I completely support the SHEA/IDSA position. The vaccine is safe, effective, and HCP’s have a ethical and professional imperative to prevent the spread of infection to their patients.

SHEA views influenza vaccination of HCP as a core patient and HCP safety practice with which noncompliance should not be tolerated. It is the professional and ethical responsibility of HCP and the institutions within which they work to prevent the spread of infectious pathogens to their patients through evidence-based infection prevention practices, including influenza vaccination. Therefore, for the safety of both patients and HCP, SHEA endorses a policy in which annual influenza vaccination is a condition of both initial and continued HCP employment and/or professional privileges.

Sounds good to me.

Posted in: Science and Medicine

Leave a Comment (106) ↓

106 thoughts on “Influenza Vaccine Mandates

  1. Reductionist Nurse says:

    I recently ran into this very problem with my nursing peers. During a lecture about infectious disease the question came up as to how many of us had gotten our annual flu shot. I was horrified to be one of the few minority in a gathering of more than fifty peers.

    I asked around to a couple folks and found lo and behold, superstition is alive and well; The old “I heard of someone who got the flu from the vaccine.” Sigh!

    Unfortunately as you’ve stated the problem is crucial with HCP, and from some recent literature I’ve been assigned, Nurses appear to be the leading the problem:


    Hospitals with low seasonal influenza vaccination rates among healthcare providers have higher rates of patient deaths from healthcare-transmitted influenza than facilities with higher influenza vaccination rates among healthcare providers.

    The CDC highly encourages and recommends that all healthcare workers be vaccinated for both seasonal influenza and the H1N1 strain of influenza, to protect themselves, their families, and their patients (especially immunocompromised patients) from infection.

    Interestingly, studies in Europe and the United States showed that flu immunization rates were lowest among nurses. Physicians and housekeeping staff had higher rates of immunization, refuting the argument that educational levels drive immunization rates.
    Some healthcare institutions have turned to the “declination” in an attempt to boost rates. In facilities using this strategy, healthcare workers refusing vaccination for other than medical reasons must sign a statement acknowledging that they’re putting their patients, self, and their family members at risk. In many settings, these declinations have improved vaccination rates dramatically.”

    Potter J, Stott DJ, Roberts MA, et al. Influenza vaccination of healthcare workers in long-term care hospitals reduces the mortality of elderly patients.
    J Infect Dis. 1997;175(1): 1-6.

    Carman WF, Elder AG, Wallace LA, et al.
    Effects of influenza vaccination of healthcare workers on mortality of elderly people in longterm care: a randomised controlled trial.
    Lancet. 2000;355(9198):93-97.

    I was sorely disappointed at the lack of critical thinking demonstrated by my fellow nurses. Thankfully, at the end of the day we are committed to evidenced-based practice and your article on flu vaccine efficacy provided me with an excellent resource which I distributed to the people who needed to see it the most.

    Please keep up the good work.

  2. hat_eater says:

    For the HCPs a good philosophical reason to get vaccinated is to support what you preach by what you practice. On the other hand, this means also getting off smokes which in your stressful work is as unlikely as it is desirable.
    Anyway – I think I’ll get my flu shot for the first time this year, despite my irrational fear of needles. Thanks, doc.

  3. Jojo says:

    Regarding nurses. The nurse who gave me my flu shot the other day noticed that I have the sniffles. After I explained that my son is in daycare and that I catch everything he brings home, she advised to me to take Airborne. I just stared at her and blinked, not knowing how to respond to that stupidity from a nurse.

  4. desta says:

    “Many philosophical positions are at odds with reality. But you will excuse me if I neither let you operate in my hospital nor take care of my patients. I cannot see where your philosophy gets to triumph the material safety of patients.”
    Here here.

    The world needs more Crislip.

    I find it a little ridiculous that the flu vaccine is not already required. I just assumed it was, considering that HCW already need to be updated on all their vaccines. Such a simple preventative measure.

  5. Robin says:

    Thank you, Dr. Crislip, for your efforts to prevent hospital acquired infection. That’s a laudable turnaround in the last couple of years!

    My grandmother died after getting c. diff. She had been hospitalized for pneumonia, recovered and spent a couple of weeks in a rehab facility getting her strength back. The c. diff symptoms started a day after she had returned home. We sent her back to the hospital. Flagyl, then vancomycin didn’t work and hospice was recommended.

    While C. diff isn’t necessarily an acquired infection it’s a lot more likely to happen in hospital settings. She had to be in isolation and handled with gowns and gloves. We also find out she had another hospital-related bug.

    The people that suffer from hospital acquired infections including influenza are usually the weak and elderly. I hope more hospitals put efforts into stemming their spread. Anyone who works with with the sick and elderly certainly has a moral obligation to get a flu shot. I started getting mine when I became a caregiver for my grandmother.

  6. DonSelgin says:

    Good stuff, as usual.

    As an aside, your 3 laws of HCP sound suspiciously similar to science fiction author Isaac Asimov’s 3 laws of robotics:

    1. A robot may not injure a human being or, through inaction, allow a human being to come to harm.

    2. A robot must obey any orders given to it by human beings, except where such orders would conflict with the First Law.

    3. A robot must protect its own existence as long as such protection does not conflict with the First or Second Law.

    As a scifi buff myself, I heartily approve!

  7. WilliamLawrenceUtridge says:

    I don’t know if I’m stereotyping or not, but I’ve noticed a depressingly low level of appreciation for science and research in nurses. I’d love to know if this is actually a real phenomenon or simply my own self-confirming prejudices. Anyone know of any studies on the subject of critical thinking, scientific literacy, evidenced-based decision making, etc. regards nurses? Particuarly as compared to, say, doctors? Is it just a matter of a little bit of knowledge being more dangerous than none at all?

  8. Th1Th2 says:

    “The influenza vaccine is safe. Serious side effects are extremely rare and the risks from influenza are much greater.  The vaccine is far safer than driving, (30,000 deaths a year), taking a bath (450 deaths a year), or standing under a coconut tree (130 deaths )”

    How about more than 700,000 patients die every year just for being a good patient who had listened to this kind of medical advise perceived to be safe.
    Car driving is safe unless the driver’s intention is to commit suicide or manslaughter and that would turn every highway a killing zone. But do you always see dead bodies along the highway? No you don’t. Cars are neither bumper cars nor stunt cars and if it is, your figures are way too low. Irresponsible drivers, at least, should be blame for accidents. And as opposed to vaccines, intentional inoculation of KNOWN pathogen-associated crap into the body is never an accident. It is deliberate infection and you cannot change or hide its inherent nature.

    Why don’t you take a bath in a shark-infested Pacific Ocean, that is, if you really want to kill yourself, because 450 is kinda small. Why wait under the coconut tree when you can let someone do it for you and bashed in the head with a coconut. Similarly, why these ignorant people have to wait for diseases to infect them when they can have it in advance via artificial inoculation.

    Therefore, your analogies are very inaccurate, fallacious and absolutely farcical. I always laugh when vaccine apologists resort to these silly comparisons.

  9. Th1Th2 says:

    Reduced Nurse,

    “I asked around to a couple folks and found lo and behold, superstition is alive and well; The old “I heard of someone who got the flu from the vaccine.” Sigh!”

    I would be surprise if people got polio from the flu shot. Do you get what I mean? Do you ever read the vaccine contents, at least the MAIN ingredient, before you administered them? It seems not though.

  10. Dr Benway says:

    Th1Th2, does it ever occur to you that you might be insane?

  11. Chris says:

    More examples of Th1Th2 insanity here. Please ignore the troll.

  12. Epinephrine says:

    Th1Th2 seems to think that inactivated viri are dangerous. This is false. Since the argument is based off a false premise, we can ignore the argument.

  13. Th1Th2 says:

    Dr. Benway,

    Just answer for your own. It’s either you or Dr Offit is a quack.

    You asked this “Do you think Nature can be divided into “pathogen” and “not a pathogen”?” http://www.sciencebasedmedicine.org/?p=7223#comments

  14. ejwillingham says:

    I have to confess, I’ve wondered the same about nurses given (a) various conversations I’ve had with them, (b) things that I read like the comments posted here, and (c) the fact that nurses in our community declined last year to get the H1N1 vax, even those working in a pediatric hospital, and one of them even wrote an idiotic editorial for the local newspaper trying to rationalize this choice. I know RN programs require that nurses learn a great deal of actual science, but do they receive much training in grasping science-based medicine and practice? I don’t know. I believe that many nurses consider their professional also to be a calling, but I don’t think it calls them to refuse protections that prevent their serving as death vectors for their patients.

  15. Sid Offit says:

    You really need to do something about the Flinstones era technology powering your website. Anyway,

    The vaccine gives me the flu. Dumb Ass

    Perhaps they/ the dumbasses confuse “makes me feel like shit” with getting the flu

  16. Deetee says:

    Keep right on posting Th Troll.

    Every time you do so, more people become aware that the antivaccine zealots like yourself are totally, utterly, barking mad, and they become ever more convinced by the rational scientific arguments in favor of vaccination.

  17. daedalus2u says:

    I think that law #3 is superfluous, for HCP who are human, and I think it is not appropriate.

    I consider it to be not ethical for an HCP to prioritize their patient’s health over their own (or vice versa). They have to have equal priority.

    I think the mythology that has built up around sacrificing HCP health for patient health leads to exploitation of HCPs and also to bad care.

    One of the first things to go due to fatigue and overwork is judgment. Some amount of “practice” in a state of extreme fatigue is appropriate so that the HCP can learn how to operate under such conditions if it becomes necessary due to a public health emergency. Compelling HCPs to work under such conditions to save money and increase health insurance company profits is inappropriate and is exploitation.

  18. Zetetic says:

    Here here! I applaud this posting!

    Providence Health & Services, at least here in the State of Washington, has strengthened their HCP flu vaccination policies this year. Staff who decline the flu vax will be required to wear masks in patient care areas.

  19. DTR says:

    I was all set to offer a more charitable explanation to Dr. Benway’s comment (maybe his computer is infected with spell/grammar check disabling demons?) until I read Chris’ link. As a father of four kids age 5 and under, all I can say is – wow.

    So, why hasn’t Th1Th2 been banned?

  20. Th1Th2 says:

    Epinephrine,

    “Th1Th2 seems to think that inactivated viri are dangerous. This is false. Since the argument is based off a false premise, we can ignore the argument.”

    Well, inactivated viruses outside of the body is one thing, they cannot penetrate the innate system because they’re dead but forcing them into the muscles tissues is a serious thing and as always requires an intrusive maneuver like vaccination.

    Likewise, sewage and garbages can kill aquatic life. So stop making the newborns a dumping site of pathogen-associated crap. It’s hideous.

    So how do you plan to infect a newborn with inactivated viruses without injecting it into the body?

  21. lillym says:

    When I saw the posts jump I knew Th1Th2 had posted.

    I keep wondering what would happen if everyone would just stop responding to him/her? Would s/he just keep posting?

  22. Th1Th2 says:

    Deetee,

    “Every time you do so, more people become aware that the antivaccine zealots like yourself are totally, utterly, barking mad, and they become ever more convinced by the rational scientific arguments in favor of vaccination.”

    You assumed. In fact, vaccination is a scientific process on how to make these inactivated viruses bypass the innate barriers and establish infection. Need I say more?

  23. DTR says:

    @Th1Th2,
    No, you don’t need to say more. Please, don’t say more.

  24. Th1Th2 says:

    Where’s Dr Benway’s *scientific* explanation to his own question:

    “Do you think Nature can be divided into “pathogen” and “not a pathogen”?” http://www.sciencebasedmedicine.org/?p=7223#comments

    I thought this a blasphemy to the world of Microbiology to say the least.

  25. Zetetic says:

    @Th1Th2:

    Your understanding of epidemiology and immunology would scarcely fill a thimble. Where did you get your Public Health degree?

    Maybe this is really another persona for DULLman?

  26. windriven says:

    @Dr Benway & Chris

    I’ve come to believe that, like turk, Th1Th2 doesn’t actually believe this crap. It is just the only way that s/he can get people to pay attention to him or her. Thing spouts nonsense too egregious to be ignored in the usually requited expectation that people will respond.

    Chris has the right idea: ignore it and it will go away.

  27. dwpeabody says:

    Thank you Th1Th2!
    …….I needed a good laugh this morning.

    As a side note my work is providing the flu vax on november the 2nd, I can’t wait!

  28. Chris says:

    DTR:

    So, why hasn’t Th1Th2 been banned?

    Entertainment value.

    (though as a parent of four kids age five and under, you must get plenty of entertainment!)

  29. Th1Th2 says:

    Mark Crislip,

    “I have been involved in infection control and in what is now called quality for my career. ”

    That’s bull. How can you justify such when you can’t even protect or prevent patients from inactivated influenza viral strains getting into their muscle tissues? You’re promoting infection, that’s what it is.

  30. DTR says:

    @windriven,
    Espousing a point of view with which one does not agree while also trying to sound like an idiot would require an exceptional degree of intelligence. Most people who try to sound like an idiot come across as transparently trying to sound like an idiot. Consider this gem:

    “Do you ever read the vaccine contents, at least the MAIN ingredient, before you administered them? It seems not though.”

    How does one write that without actually believing it?

  31. Reductionist Nurse says:

    @ejwillingham

    “I know RN programs require that nurses learn a great deal of actual science, but do they receive much training in grasping science-based medicine and practice? I don’t know. I believe that many nurses consider their professional also to be a calling, but I don’t think it calls them to refuse protections that prevent their serving as death vectors for their patients.”

    You have the right idea. In regard to current RN education, my school required higher level microbiology along with the A&P. The primary focus is pathophysiology and evidenced-based practice, which is why it was so shocking to hear them uttering what can only be described as paranoid superstition.

    I did some volunteer work about a month ago and five out of fifteen homeless patients I triaged were also afraid to get the flu vaccine because of fear that it causes the flu.

    I wish the people who spread conspiracies really knew about this trickle-down effect their lies are having on the most vulnerable populations.

    The running theme here matches up exactly with Dr. Crislip’s description of a feeling that vaccines are unsafe. Nurses are often taught to use feeling and intuition (“Nursing logic”) when implementing therapeutic communication among other “soft” science interventions. I believe this is the gateway that allows a lapse in rational plausibility to occur. Although this isn’t exclusive to nurses (one of my classmates even spoke with an ER physician that was a doubter), they report lowest annual vaccinations between physicians and housekeeping.

    Without trying to degrade my peers, it is an embarrassing problem, we all have to chip in some patience to get the facts out and promote education.

    As for hospitals, as previously stated, the solution is mandatory HCP compliance or a signed statement acknowledging that they’re putting their patients, self, and their family members at risk.

  32. windriven says:

    @DTR

    Touche’. To paraphrase Forrest Gump, stupid is as stupid writes.

    His comment to Crislip just before yours underscores your point beautifully. I stand corrected.

    But I maintain that ignoring Th1Th2 is the best approach. Engaging Th1Th2 isn’t going to throw light into any shadowy corners much less change its mind. It just wastes time and space and feeds its ego.

  33. Th1Th2 says:

    Just put up or shut up. When people gets stumped and embarrassed by their own medicine, they always prefer the latter.

  34. dlpfc says:

    Dr. Crislip,
    You raise some excellent points, and your article prompted me to email my med school’s administration to encourage them to make flu vaccine mandatory. Turns out it’s already in the works – they’re developing the computer systems to track compliance. So maybe there’s some hope on the horizon…
    -2nd year med student in Colorado

  35. Epinephrine says:

    Well, inactivated viruses outside of the body is one thing, they cannot penetrate the innate system

    What’s an innate system?

    because they’re dead but forcing them into the muscles tissues is a serious thing

    [citation needed]

    and as always requires an intrusive maneuver like vaccination.

    I’ll grant you that to get inactivated viri into muscle tissue does require intrusion. Bravo!

    Likewise, sewage and garbages can kill aquatic life.

    What do you mean, “likewise”? Like what? This is a non-sequitur, right?

    So stop making the newborns a dumping site of pathogen-associated crap.

    A dumping site? It’s not virus disposal, it’s purposeful innoculation. I can’t contest the words, as it really is pathogen-associated, that’s the whole point. It’s not a pathogen, but it is pathogen associated. that’s why it allows the body to develop a reaction that will fight the pathogen.

    It’s hideous.

    I prefer “fantastic!”

    So how do you plan to infect a newborn with inactivated viruses without injecting it into the body?

    Well, one could deliver some vaccines orally, or through the mucosa. But I never suggested not injecting them, IM and SC can be very effective ways of establishing seroprotection.

    Sorry for engaging him/her, but it’s somewhat amusing, and we’re already a long thread. I’ll ignore him next thread.

  36. tmac57 says:

    @hat_eater “I think I’ll get my flu shot for the first time this year, despite my irrational fear of needles.”
    I too have been a lifelong needle-phobe,but I have been getting flu shots for years now with no phobic reaction because it is so benign.There have been several times when I literally could not feel a thing,and didn’t realize that the nurse had given me the injection,so fear not.

  37. windriven says:

    @Th1Th2

    In an ample demonstration of not following one’s own best instincts I cannot let this pass:

    “In fact, vaccination is a scientific process on how to make these inactivated viruses bypass the innate barriers and establish infection.”

    You seem to know the words and how to spell them but when you assemble them into a sentence all meaning melts away. Inactivated viruses* BY DEFINITION cannot establish infection.

    In any event the live influenza virus is quite able to “bypass the innate barriers” and establish infection. That is why we vaccinate. Have you been vaccinated against smallpox? Polio? Measles? Mumps? Tetanus? Well influenza vaccination differs only in detail. What possible fantasy deludes you into believing this is a bad thing? Is this some sort of precious bodily fluids thing? Religious? If god wants me to be ill who am I to argue? Or do you, like modern day alchemists, dwell in a fantasy world where you have been blessed with THE TRUTH while the whole of science labors on in misguided self-deception?

    * Some of the nasal vaccines use an attenuated rather than an inactivated virus but let’s not clutter Th1Th2′s mind with facts. His assertion cites inactivated viruses and it is to that I respond.

  38. Th1Th2 says:

    Epinephrine,

    “What’s an innate system?”

    Protective and defense barriers from infection that you were born with like the skin, surface mucosa and epithelium. The muscle tissues, like the brain, blood and the CSF are normally sterile and free of any microorganisms and other contaminants.

    “It’s not a pathogen, but it is pathogen associated. that’s why it allows the body to develop a reaction that will fight the pathogen.”

    First, it has to fight the pathogen-associated crap you infected the body with. It’s nothing different in getting a first natural exposure to a disease in which secondary response to infection is developed (humoral).

    If you discussed vaccination to a vegetarian, you cannot say “Hey, it’s alright for you to eat pork chop, you know it’s not really a pig. “lol.

    “Well, one could deliver some vaccines orally, or through the mucosa. But I never suggested not injecting them, IM and SC can be very effective ways of establishing seroprotection. ”

    Seroprotection or infection? Inactivated vaccines cannot cause infection into the muscle tissues if administered other than parenterally.

  39. I feel like I’m reading Groundhog’s Day. I say the next person who responses to Th1Th2 should buy everyone a beer.

  40. Th1Th2 says:

    windriven,

    “Inactivated viruses* BY DEFINITION cannot establish infection. ”

    Of course, inactivated vaccines cannot cause infection above the mucosal barrier because they are dead. There’s not a chance for these killed microorganisms to even reach the muscle tissues. Have you ever known of an inactivated vaccine given mucosally? There is not one. This is because the establishment of infection is necessary to trigger an immune response.

    “In any event the live influenza virus is quite able to “bypass the innate barriers” and establish infection. That is why we vaccinate. ”

    LAIV vaccines promote infection and is a MUST.

  41. Harriet Hall says:

    In a recent exchange reported on a discussion list, a vaccine refuser’s objections were systematically debunked, one by one. He accepted the debunking but ended up saying he still wouldn’t get a flu shot because he just didn’t like needles. I suspect there’s a lot of that. Someone decides on purely subjective, irrational grounds that he doesn’t want a flu shot, then looks for any misinformation that will help him rationalize his decision. What can you do in a case like that? Logic and information can’t counteract a stubborn “I don’t wanna.”

    Just as no amount of logic and information can counteract Th1Th2′s delusions.

  42. LovleAnjel says:

    As to nurses – the nurses in our program get A&P, micro, and pathophys, but they’re interested in cramming as much info into their skulls as possible, and that doesn’t leave much room to apply critical thinking. Add to that teachers that emphasize intuition and you’ve got a bad mix going.

    My MIL is a nurse and she makes the whole family drink Airborne before every flight. She also thinks aspartame turns into huge amounts of formaldehyde in your blood.

  43. LovleAnjel says:

    Oh yeah – got the flu shot today. Arm hurts like a biscuit, but I didn’t faint. Go team.

  44. windriven says:

    @Th1Th2

    Jesus. What is your academic background?

    “This is because the establishment of infection is necessary to trigger an immune response.”

    No, that isn’t precisely true. IM influenza vaccines do not establish an infection thereby generating an immune response. The inactivated virus – while incapable of causing influenze infection – IS a foreign body and the immune system responds to it. The immune system generates antibodies that cue to receptors on the protein shell of the virus. That is how immunity is achieved without suffering the consequences of an actual influenza infection.

    In your earlier post YOU chose to address standard IM influenza vaccines. I made clear in my response that there were attenuated virus vaccines that are usually administered as a nasal spray.

    So what is your freaking point already? Both patent and attenuated viruses are able to pass the mucosal barrier without use of a needle.

    Inactivated virus vaccines are given IM, presumably to get enough of the protein shells into the body to trigger a meaningful antibody response. Live and attenuated viruses do not need this helping hand. They breed in your freaking cells and make plenty of copies of themselves! Yes, that’s right Th1Th2, evil bits of genetic material insinuate themselves into the very core of the cells that make you … you. You can welcome this evil spawn with open arms or go to your physician and get an inoculation. Your choice.

  45. windriven says:

    @ Dr. Hall

    Given that some people are hypodermophobic (do I get credit for a neologism?) aren’t there pneumatic injectors available that don’t use needles? Are they common?

    1. Harriet Hall says:

      “aren’t there pneumatic injectors available that don’t use needles?”

      Yes, but they’re not in common use. For that matter, there is a nasal flu vaccine. But if someone is irrationally rejecting the shots, chances are he’d come up with a rationalization to avoid those options too.

  46. tommyhj says:

    Got my flu shot today too… My arm hurts like hell and i’m feverish and nauseated. On top of that I have to put together an important presentation, but I can’t because i’m really tired and exhausted from the “low grade” fever…

    Now. I’m all for the flu vaccine. But don’t ask people to go through this if they don’t want, because it really hurts and I really do feel bad (well, I am a man, so I feel entitled to whine about it :)).

    So even though it’s a good idea, practicalities and “I’d rather take the chance, than willingly subject myself to pain and discomfort” wins the argument. Same reason people don’t work out more btw.!

    On a side-note, being a doctor shouldn’t be a calling per se. If it’s a calling it will be expected of us to sacrifice everything for the job. And i’m against expectations of sacrifice. I told an older college today that if we were all to sacrifice ourselves for each other – there would be no one left to mob up the mess :)

  47. weing says:

    “The muscle tissues, like the brain, blood and the CSF are normally sterile and free of any microorganisms and other contaminants. ”

    Now I see what the problem is. Brains etc have been replaced by muscle.

  48. Even if flu vaccination were one or two orders of magnitude more dangerous than it is — as dangerous as standing under coconut trees, say, or even as perilous as bathtubs deficient in adhesive ducks — I would still line up for it. Risk-benefit analysis with big numbers does indeed seem to be difficult for homo sapiens, but I can do the math.

  49. Reductionist Nurse says:

    I had a quick question thats been on my brain lately. I found Dr. Mark’s previous article “The Infection Schedule versus the Vaccination Schedule” quite compelling against one the debunked “Too many! Too soon!” argument.

    However it also left me curious about another topic, and forgive me if its been previously addressed. Basically, one of the few remaining excuses I encounter is the risk of vaccine-allergic reactions.

    Its pretty easy to rule out most vaccine ingredients (gelatin- mmm jello, mercury- they love tuna, eggs- over easy) which only leaves the antigens themselves.

    (For a moment we must ignore the overwhelmingly plausible explanation of it being just plain coincidental.)

    My question is, if a person indeed experiences a significant to severe allergic reaction from such a small amount of antigens, and when you examine it from the hard raw numbers of total antigenic exposure (like Dr. Mark’s article that I cited, “the drop in the ocean”), would that not suggest that natural infection/colonization by that specific strain of the pathogen would be more enough to induce a case of deadly anaphylaxis?

    I guess I’m working from the angle that the immunization is even -more- important, -even- if you had a moderate to severe allergic reaction(that could only be explained as pathogen-antigenic in origin).

    Example, if only a couple of antigens caused a moderate allergic reaction, then “natural” colonization/infection would kill you. All the more reason to warrant a dire need for developing specific immunity to stave off that allergic reaction long enough to get to help.

    Is this a reasonable conclusion?

  50. windriven says:

    @Reductionist

    Actually I understand it to be egg proteins that cause the allergic reaction. Allergy to egg protein is rare … as are severe allergic reactions to the influenza vaccine.

  51. windriven says:

    @weing

    “Now I see what the problem is. Brains etc have been replaced by muscle.”

    Hmmm. Certain commenters to this page must be weaklings!

  52. Reductionist Nurse says:

    @windriven

    I understand that egg allergies are most commonly attributed, however, as always, I’ve found the person claiming they are the one exception.

    I have a classmate who swears up and down that she had an allergic reaction to the flu vaccine. She suffered “flu-like” symptoms for a day or so (nausea, fever, chills, malaise ect.)

    She’s not allergic to eggs, gelatin, or mercury(as far as I know, evidenced by her history of safe tuna consumption), and no one else had a similar reaction from the batch she received so I would rule out contamination/storage issues.

    So in dismissal of it being just a coincidence or psychosomatic, she claims the reaction was vaccination-antigen-induced(due to the ingredients of the vaccine itself).

    So to that end, I hypothesis that if she is allergic to the influenza virus antigens, then if she were infected by the real virus, she would die from anaphylaxis, thus the vaccine, despite causing “flu-like” symptoms, highlights an essentially life-saving hidden benefit that would have been idiopathic otherwise.

    Anybody follow me?

  53. Chris says:

    Dr. Hall:

    He accepted the debunking but ended up saying he still wouldn’t get a flu shot because he just didn’t like needles.

    Did he know about FluMist? Plus, the needles are so tiny I could not feel the vaccine I got last year!

    windriven, I suspect the troll is a homeschooled middle-school age kid who is being fed the anti-vax nonsense, and access to online documents. I kind of get that feel from the level of rhetoric and the fantasy world of child development in from the previous thread. The brain as a muscle is another entertaining gem!

  54. Solandra says:

    I just got my flu vaccine yesterday and, I’m alive! No anaphylactic shock or anything too bad. I admit, my arm was a little sore, and I did have a robust immune response: A slight fever and tiredness, that’s all. I think people confuse your immune system kicking in with something terrible.

  55. Maz says:

    OH. MY. GOD.

    I’m not sure why it took this long, but I finally realized that Th1Th2 has been right this whole time! I’m never gonna let anything penetrate me again.

    Sorry, SBM — I know we’ve had some good times, but a world of fantastic delusion awaits me!

    On a less mocking note:

    Why does the flu vaccine only contain three or four strains each year? From what I understand, there are many circulating viruses that cause flu-like symptoms (influenza and otherwise) — why not just throw a hundred antigens into a flu shot? I’d take it!

  56. As someone with an unreasonable (not phobic) fear of spiders, I would guess someone with a similar fear of needles would not be accepting of even a small needle, I guess it would depend upon the severity of their fear, though.

    I can’t see how the nasal vaccine would be a problem, unless they have other a condition that prevents them from using that. I seem to remember the h1n1 nasal mist was not recommended for people with asthma, don’t think that’s applicable this year, but don’t know.

    As to the rationalizations that go along with a fear. I find I don’t have those with spiders. I perfectly aware of how advantageous spiders are. Keep down the mosquito and fly population, etc. They are actually quite lovely, etc. Of course, I also feel that if one touches me something worse than death would happen. Honestly, I’m not sure if I could physical allow a large spider to crawl on me to save my life. Maybe with a strong sedative.
    I’m assuming that some people’s fear of needles is similar. So even without the rationalizations, it is a true impediment. Probably not that common though. Pretty much a waste of time to try to talk them out of the fear. (I’d say), unless, it is problematic enough that they are willing to undergo exposure therapy with a professional.

  57. Dr Benway says:

    I was all set to offer a more charitable explanation to Dr. Benway’s comment (maybe his computer is infected with spell/grammar check disabling demons?) until I read Chris’ link.

    This Th1Th2 incarnation uses a syntax structure with an eastern European flavor. The one during the post-pec era was a little more articulate.

    Can we get the more upstat Th1Th2 back plz?

  58. Th1Th2 says:

    windriven,

    “No, that isn’t precisely true. IM influenza vaccines do not establish an infection thereby generating an immune response.”

    Don’t give the inactivated vaccines and it wouldn’t establish an infection let alone an immune response. Similarly, a sick child with influenzae can neither cause nor transmit infection to others if properly secluded thus breaking the chain of infection.

    “The inactivated virus – while incapable of causing influenze infection – IS a foreign body and the immune system responds to it. The immune system generates antibodies that cue to receptors on the protein shell of the virus. That is how immunity is achieved without suffering the consequences of an actual influenza infection.”

    Nah. This is the part where people are being misled most of the time. First off, the immune system responds to infection (natural and inoculation). It can be symptomatic or not. And through repeated exposure to the same infection like the one you see in the vaccination schedule can someone develop antigen-specific antibodies. Antibody production does not even correlate to protective immunity. I have never seen a hospital or worked in a children’s ward or NICU where they only cater unvaccinated patients. Almost all of them are vaccinated.

  59. Reductionist Nurse says:

    Maz I agree with you that I’d just as soon sign up for the ∞-tuple valent all-in-one vaccine. But I’m assuming they like to keep the risk of error low and ID high considering the controversy heh.

    What do you think of my argument?

  60. Th1Th2 says:

    windriven,

    “In your earlier post YOU chose to address standard IM influenza vaccines. I made clear in my response that there were attenuated virus vaccines that are usually administered as a nasal spray. ”

    I am not surprised at all. Wild-type influenzae virus are transmitted this way. And so are poliovirus being transmitted thru fecal-oral route, hence there’s no difference between an OPV on a sugar cube or a wild-type poliovirus sitting on top a fecal matter. But children love sweets, you know.

    “You can welcome this evil spawn with open arms or go to your physician and get an inoculation. Your choice.”

    Geez. It’s not even a choice. Nobody wants to be infected.

  61. Th1Th2 says:

    weing,

    “Now I see what the problem is. Brains etc have been replaced by muscle.”

    You’re not dyslexic, are you?

  62. Th1Th2 says:

    Dr Benway,

    …and yet you’re a doubter. Care to enlighten us why do have to ask this: “Do you think Nature can be divided into “pathogen” and “not a pathogen”?” http://www.sciencebasedmedicine.org/?p=7223#comments

    Go on.

  63. Chris says:

    Reductionist Nurse, do you know about the This Week in Virology podcast? There was some discussion a week or so ago about the universal influenza vaccine (and there has been discussion of using something other than eggs). You might be interested in the associated blog:
    http://www.virology.ws/2010/10/13/universal-influenza-vaccines/

  64. Dr Benway says:

    On a side-note, being a doctor shouldn’t be a calling per se. If it’s a calling it will be expected of us to sacrifice everything for the job.

    It is a calling for most but not all.

    You don’t have to sacrifice everything, but you must be real and present when people are seriously ill or dying. You must do right by them, even when that’s not convenient or easy.

  65. Bogeymama says:

    I find the comments about the nurses interesting – my Mother is a nurse, from the “old-school” where they started in the hospitals on Day 1 and lived there together for 3 years. When I was in university, I lived with a nursing student – she was in 3rd year at the time. Not only had she NOT had a single hospital rotation up until that year, she had never given an injection. She had a breakdown the morning that she was supposed to give her 1st one, and called in sick. She wrote essay after essay after essay, while the rest of us med and pharm students spent our days and nights in labs and the hospitals. She said that her essays were all about “theories”, they were not research articles. She hoped that after getting her degree she could go straight to her Masters and then start out as a nurse manager.

    So from my personal observations (this was 20 years ago), the newer curriculums of nursing tend to focus less on the science and more about patient care. And theories … about what, I’m not sure.

  66. Dr Benway says:

    The map is not the territory OneTwo.

    Nature itself is not divided at all. Humans create divisions and categories on their maps of Nature for the sake of communication and convenience. Humans say “red” or “orange,” when the reality is a gradation of hue with no clear boundaries. Humans say “species,” when life is actually a continuum of gradual adaptations.

    When we ask, “what is good?” I wonder who is allowed to answer? Do the dolphins have a vote? The mice? The spiders? The E. coli?

    One day I will be nothing more than a long-dead “ancestor.” If I could peer into the future, would I recognize my descendants? Would I even like any of them?

  67. Th1Th2 says:

    Unbelievable.

  68. Th1Th2 says:

    Maz,

    “Why does the flu vaccine only contain three or four strains each year? From what I understand, there are many circulating viruses that cause flu-like symptoms (influenza and otherwise) — why not just throw a hundred antigens into a flu shot? I’d take it!”

    It depends on the level of ignorance by the vaccinator and the vaccinee.

  69. squirrelelite says:

    It seems Th1Th2′s 10:44 comment describes virtually every comment I can remember they have posted (at least the ones I have read).

    @Harriet Hall and Chris,

    I remember getting shots from pneumatic injectors about 20 years ago when I was in the Air Force, but I haven’t seen one for years (not that I’ve had all that many opportunities). My flu shot at a special clinic at work a couple days ago was a single use vial, probably no thimerasol. A little soreness in the arm for one day but no other discernible side effects.

    Incidentally, I was watching some show on a cafeteria monitor with the sound turned off. I think it was some cable channel called Green Planet? It looked like some travelogue show set in Tibet. It was about pain. But what struck me was one Tibetan with a smashed thumb. The Anglo smeared the whole thumb with something that sure looked a lot like mercurochrome. Any idea what that might have been? It was a dilute liquid with a reddish tint.

  70. nitpicking says:

    @MichelleInMichigan, actually that does sound like a phobia. If you can’t let a spider touch you even to save your life … that’s phobic. (I used to be a professional tarantula handler. Really.)

    Got vaccinated today. FWIW, the nurse my company brought in was knowledgeable and clearly ready to debunk many of the bizarre antivax contentions, e.g. “Thimerosal will give you mercury poisoning.”

    The reason they don’t make hundred-strain influenza vaccines with current technology is simple: it would be fantastically expensive and wouldn’t improve the effectiveness of the vaccine enough to justify it. Consider how many millions of eggs would have to be used to raise all those virus strains ….

  71. Chris says:

    squirrlite:

    The Anglo smeared the whole thumb with something that sure looked a lot like mercurochrome. Any idea what that might have been? It was a dilute liquid with a reddish tint

    That would be Mercurochrome… a common item smeared on every kid who grew up in the 1960s. It was used on me when we encountered chiggers in Missouri. If you have experience with it, talk the Autism Diva..

  72. Harriet Hall says:

    Since others have posted comments about their symptoms following the flu shot, I’ll counteract that by reporting that my husband and I got the high-dose shot with four times as much antigen, and neither of us had any reaction, not even the slightest soreness at the injection site. According to the studies, most recipients have no symptoms.

  73. Samantha says:

    Got my flu shot at the end of September, and the TDaP (finally) middle of last week. [Huzzah for contributing to herd immunity!] The TDaP hurt a helluva lot more than the flu shot did – didn’t feel anything with that one, but the TDaP – ugh, my arm was sore for 3 days and is still bruised a bit – the arm I usually sleep on. Might have had something to do with the people who stuck me, but still. I’ll take 50 flu shots over doing the TDaP again.

    I still don’t understand the seemingly deliberate obtuseness of people who should know better. Makes me want names and workplaces of those HCPs who refuse to get the vaccination, just so I know where NOT to go.

  74. squirrelelite says:

    Thanks Chris.

    I’ll try to post a good comment on Autism Diva.

    My mother was an RN who went to college during WW II. When we were growing up, she used to apply it as a topical antibiotic every time we got a cut or scrape and we got quite a few of them. (There were five kids.) I don’t recall any trouble with secondary infections, but those are old memories and strictly anecdotal.

    A little research shows the episode was World of Pain from the Medicine Go Wild series on Planet Green.

    Unfortunately the clips don’t seem to be viewable here in the U.S.

    http://www.channel4.com/programmes/medicine-men-go-wild/video/series-1/

  75. takoyaki says:

    Excellent article, as always, Dr Crislip. I also enjoyed “A Budget of Dumb A$ses”. Any plans to post more often, or write a book?

    Got my Fluvirin shot at the pharmacy a few weeks ago. I’m happy to pay the $28 for it – insurance doesn’t cover it although my pulmonologist has me get one every year (I’m asthmatic)

    I also vaccinate for the immunocompromised (like friends on chemo, my late parents who often suffered from pneumonia), children too young to be vaccinated (recently had an infected puncture wound on my foot, had a Tdap since I wasn’t certain when my last tetanus shot was and don’t think I’d ever had a pertussis booster), etc. It’s the cheapest, most effective way to prevent the spread of deadly disease.

    @Reductionist Nurse: The CDC “what you need to know” handout lists flu symptoms and states “Other illlnesses can have the same symptoms and are often mistaken for influenza.” IMHO, not a valid reason for declining a flu shot, especially when one may be caring for patients who may die due to one’s ignorance.

    @DonSelgin, Zetetic: I agree!

    @tmac57: went to my company’s benefits fair and was offered a short acupuncture session. The person who asked me implied I was afraid of needles. I explained that I had had about 10 years of allergy shots, and donate blood regularly, so that wasn’t the case, I just don’t believe in acupuncture.

    @windriven: I haven’t seen those air-driven “injection” guns since I was in grade school many years ago, and don’t remember what the mass vaccination campaign was for. That was a one-timw event. I do not believe it was for the original swine flu. I have not seen or heard of them being used since. It did hurt about the same as a regular shot. (Back then, my sisters and I would regularly get strep throat, so there were many trips to the doc for a shot in the gluteus maximus, our own packet of antibiotics, and bottle of Novahistine Expectorant.)

    The CDC sheet states “People with a severe egg allergy should not get influenza vaccine. A severe allergy to any vaccine component is also a reason not to get the vaccine….However, if there is a risk for GBS from current flu vaccines, it would be no more than 1 or 2 cases per million people vaccinated. This is much lower than the risk of severe influenza, which can be prevented by vaccination.

    @micheleinmichigan: IIRC, FluMist is contraindicated for asthmatics because it contains attenuated live virus. As I understand it (IANAD), it could possibly cause the flu in a patient with a sufficiently weakened immune system.

    @Chris: There is an item on the Shearlings Got Plowed blog – a couple of people left “new Merck” and formed a company exploring new ways to create vaccines without growing them in eggs.

  76. Ken Hamer says:

    [quote]Inactivated viruses* BY DEFINITION cannot establish infection.[/quote]

    But I got shot by a dead guy.

    Or something like that.

    BTW many people say don’t feed the trolls. I say feed them poison.

    A nice warm cup of Hemlock Tea, Th?

  77. Ken Hamer says:

    “…I’ll counteract that by reporting that my husband and I got the high-dose shot with four times as much antigen, and neither of us had any reaction, not even the slightest soreness at the injection site.”

    I got a band-aid.

    But it fell off.

  78. Reductionist Nurse says:

    I understand the importance of being uncensored but what Th1Th2 is doing is without question spamming. There’s no substance in his/her posts and replying to them is a waste of this communities valuable intellect.

    @Chris
    Thanks for the link, I listened to a couple last night, very eye opening stuff.

    @TsuDhoNymh
    Good info, however we’re pretty solid on the basic chemistry of the inflammatory response and chemotaxis and all that good stuff.

    My point is, following Dr. Crislip’s analysis in his previous article

    “If the alleged ill effects of the vaccine are due to too many antigens, or too much antigens, or too frequent antigens, the diseases should be far worse than the vaccine in causing autism and autoimmune diseases. “

    Doesn’t this principle also theoretically apply to allergic reaction? It was roughly outlined that if the problem lies within the antigens themselves, and the vaccines contain at the very most a thousandth or a millionth ect of the antigens you’d get exposed to in the event of colonization. So if your specific immune response to viral proteins was such that one thousandth of a natural exposure was alleged to be enough to invoke a pyrectic response, wouldn’t that indicate that the real virus would prompt at least a 100-fold greater IgE or IgG response with concurrent anaphylaxis or psudo-anaphylaxis?

    I guess it begs the question, if your specifically hyper-sensitive to a vaccine virus antigen, wouldn’t that mean that its bona-fide constituent viral infection would most likely kill you?

    Thus my argument stems: Take the vaccine and its minor “flu-like” side effects or risk the actual infection and its major “systemic-inflammatory-response-syndrome-like” side effects.

    Plausible?

  79. Th1Th2 says:

    Redundant Nurse,

    Just stick to the 5 Rs of vaccine administration and stay within the scope and limitation of being a nurse. Alright?

    “systemic-inflammatory-response-syndrome-like” = S.W.A.G.

  80. DrRobC says:

    Regarding the needle phobia as I pediatrician I have seen parents and kids / teens be more acceting of flu vaccine when thye do not need to get a shot.
    I think there is a definate fear of shots that prevents some from getting vaccines.
    On the other hand I have some patients who dislike nose sprays and ask for the shot.

    BTW Dr Crislip, its “Cap’n Crunch”

  81. Regarding symptoms following the flu shot. The vaccine information sheet states that the mild symptoms may be, soreness, red itchy eyes, cough, fever, aches. They begin soon after the shot is given last 1-2 days.

    Find the sheet here. http://www.cdc.gov/flu/protect/vaccine/

    It’s not a big surprise that some people occasionally have these symptoms, it seems like it’s been on every flu sheet I’ve been given.

    I have gotten those symptoms maybe once of five or more times of getting the flu shot. I have also gotten the flu and it did not kill me (due to some extreme reaction to the anti-gen.) or even make me sicker than the typical flu misery that you would expect.

    I get the flu shot because I feel even the risk of mild discomfort for a day is better than more days of intense misery, having to find a babysitter and the chance of triggering my asthma, which is more misery, prescriptions, etc. My son also has weekly appointments at a Children’s Hospital, so I think it’s maybe safer for the other patients if I’ve been shot.

    I feel that there’s some over thinking going on. When my daughter was younger she would sometimes get a low fever and crankiness for the rest of the day/evening after vaccinations. I would give her some tylenol to keep her comfortable and we were in like Flint.

    Really, it’s surprising how well Tylenol works for a low fever and mild aches and pains.

  82. windriven says:

    @micheleinmichigan

    “…and we were in like Flint.”

    I used to believe that to be the expression too but have subsequently learned differently. The expression is actually ‘in like Flynn, ‘ the reference being to Errol Flynn. A quick Google will bring a landslide of information and anecdote about this.

    Isn’t it about time that we changed ‘ad nauseum’ to ‘ad googleum’?

  83. windriven – Ah, I thought it was a take off the spy movie “In like Flint” with one of my favorite tough guys James Coburn*. http://www.imdb.com/title/tt0061810/

    I will say that while ad googleum is slightly easier to spell, ad nauseum is a little easier on the tongue.

    *who am I kidding? I actually like almost all the tough guys.

  84. also windriven – I might add that if I’m not going to let Merriam-Webster prevent me from using words like pollockcentric, then I’m hardly going to let Google influence the content of my idioms. :)

  85. ccbowers says:

    “I have yet to hear a compelling reason outside of Guillian Barre and anaphylaxis”

    Do you really find these reasons compelling? Even when these examples, rarely does the person have any reason to think they are at risk for either of the above. Rarely does a person have a history of Guillian Barre in the past or have a severe allergy to eggs. I’m not even sure that the evidence indicates any additional risk of Guillian Barre for those who are vaccinated for influenza (versus baseline rate in the general population).

  86. windriven says:

    @michele
    Pollockcentric? I love it! I grew up in suburban Cleveland, OH – a pollockcentric community if one ever existed.

    And I always love a good neologism.

    Coburn was great. And I will always have a special place for Jack Palance and Richard Boone, two actors who could bring a real sense of menace to the old western shoot-em-ups.

  87. Jackson Pollock is from Cleveland? I did not know that. :)

  88. Calli Arcale says:

    DrRobC:

    On the other hand I have some patients who dislike nose sprays and ask for the shot.

    *raises hand*

    I cannot stand nasal sprays. They drive me nuts. I’ll take the needle any day; you can hardly even feel the thing. I got mine last Thursday; arm was a little sore the next day, but that was it.

    Re: Th1Th2….

    Discourse with Th1Th2 is marginally more intelligent than Eliza, but the results from conversation are pretty much equivalent. There is really no point in engaging him, apart from personal amusement.

  89. windriven says:

    @Calli Arcale

    I must respectfully disagree on the superiority of discourse with Th1Th2 versus ELIZA. ELIZA has a discernible logic to its responses. Thing … well … logic doesn’t seem to figure in.

    My personal speculation is that Thing has a relatively low level job in a hospital, an orderly or technician perhaps, that brings him(?) in contact with physicians who by and large ignore him. SBM gives him the opportunity to engage with physicians and scientists and mirable dictu: they actually interact with him.

    Chris has it right: ignore him. Hopefully, like an importunate and petulant child he will go away.

  90. Enkidu says:

    I once had someone tell me that they experienced “flu-like” symptoms within MINUTES of getting the flu shot. Besides some pain in their arm, I told them that was impossible: either they were already sick before the shot, or that they were full of it. :)

  91. Enkidu “I once had someone tell me that they experienced “flu-like” symptoms within MINUTES of getting the flu shot.”

    I wonder if they might have been mistaking a vasovagal response to the shot for flu-like symptoms.

  92. Enkidu says:

    @micheleinmichigan: I dunno, the exact quote was, “I got sick within minutes with flu-like symptoms…it was the shot (killed.) And so did my brother-in-law (he stayed sick for a week.) And so did many, many others that I have come in contact with through the vaccine organization I work with.”

    Someone else had also said, “everyone I have ever known to get it [the flu shot] gets sick within minutes to days of getting it.” My husband, daughter, and myself must be super-people never to have gotten sick from the flu shot!!!

  93. rork says:

    While I think mandates might save lives, I dream of a situation where the public hears that 98% of health care type people get the jab by choice. You’d think we could accomplish that by education alone. Why do we fail?

    I agree with Paul Ingraham that risk/benefit analysis is a problem for humans, and call for the wide-spread teaching of decision theory. I also think it’s a problem of ethics, where people cannot compute their responsibility to other people, or do not admit any such responsibility cause they’ve never thought about it much.

  94. Th1Th2 says:

    Enkidu,

    “My husband, daughter, and myself must be super-people never to have gotten sick from the flu shot!!!”

    You were infected with influenzae viral strains from the vaccine. It’s called asymptomatic infection, if you didn’t manifest flu symptoms. You may think otherwise but your immune system is smarter than you. It knows what it’s getting from the flu shot, do you?

  95. Th1Th2 says:

    Ken hamer,

    “But I got shot by a dead guy.
    Or something like that.
    BTW many people say don’t feed the trolls. I say feed them poison.
    A nice warm cup of Hemlock Tea, Th?”

    No, you were not shot by the dead guy. It’s nonsense, he’s dead. But instead, they dumped the dead body inside you and that’s why it stinks.

    Smart people know how to reject poisons like vaccines.

  96. Jurjen S. says:

    Speaking as a parent of a 4 year-old, and as someone who has to (somewhat sheepishly) cop to not having gotten an H1N1 shot last year, or a flu shot this year (yet), I think the low uptake rate may very simply be largely a result of laziness/procrastrination.

    Part of it is that, unlike most vaccines, a flu shot is only good for one season, and then you have to get another. It can readily be perceived that the effort of getting one outweighs the benefits, especially if you’re a generally healthy person to begin with and are unlikely to suffer any major effects from an infection. Of course, to counteract this, it’s made as convenient as possible to get one: there isn’t pharmacy around here that can’t provide you with a flu shot on the spot, but paradoxically, that actually aids procrastrination. For example, I’ll have just checked out at the supermarket and I’m headed for the car with my groceries, and as I pass the pharmacy I see the sign advertising flu shots. And I tell myself I really should get one, but it’s not convenient right now because I have frozen foods in the bag that I really need to get home and put in the freezer, or I have to pick my kid of from day care (you’d better believe he’s vaccinated!), and besides, I can get a flu shot just about anywhere and anytime, so I can skip it for the moment. Do that often enough, and before you know it, flu season is over and you never got the shot.

    It’s kind of like how people rarely visit the landmarks they live close to. I lived near the Keukenhof in the Netherlands for over twenty years, and never visited. I’ve now lived within sight of Mount Rainier eight years almost to the day, and never been up there. There’s little pressure to do something when, in principle, you can do it any old time.

  97. Jurjen S. – I agree on the procrastination factor. I think that things like workplace vaccination days are great for this. When you are procrastinating doing your time sheet, you can go get a flu shot and look virtuous (workplace blood drives are good for this too). Another thing that is helpful is our pediatrician’s community flu shot day. When I take the kids in for a flu shot, I can also get mine too. It used to be that I had to attend two different flu shot clinics (pediatricians and my GP) on separate week-ends. That was a drag.

  98. squirrelelite says:

    @michelleinmichigan,

    I agree that workplace vaccination days are a great way to overcome the procrastination factor.

    Last year I got the regular flu shot at a doctor visit but the H1N1 wasn’t available yet. However, the school I was working at had a clinic to give shots to students and staff, so I slipped in during a slow time and got it then.

    This year I had been waiting for an appointment, but when I started a new job last week they were having a flu shot clinic. So, I stopped by on one of my breaks and took care of it.

  99. Dawn says:

    I got my flu shot last week. No reaction, which I attribute to the fact that I went home and took 3 Advil right afterwards. I hate needles but I’ll do a flu shot over the flu any day.

    Nursing school: 30 years ago (oh god does that sound horrible to type…I can’t believe it’s been that long!) we had classes in microbiology, anatomy, chemistry, etc, but nothing really regarding immunology except some information during our senior year in public health, when one of our required books was The Medical Detective by Berton Roueché.

    At Big University, we started clinical work our sophomore year, doing procedures on each other in clinical lab before we were allowed to do them to patients. I still clearly recall learning to inject oranges then my classmate! (My classmate who injected me hit a ticklish spot, I jumped, and in a panic she let go of the syringe and left it sticking out of my hip…the teacher had to pull it out because she started to cry!)

    @micheleinmichigan: Loved “in like Flint”. Never heard it that way, but my grandmother was a huge Errol Flynn fan and I knew what the phrase referred to at a very young age. As for Pollackcentric, never heard of that one before, and it spurred thoughts of Ypsitucky (yes, I realize one is an adjective and one a noun; just the way my mind works!)

Comments are closed.