Influenza/Flu Shots

[Dreadnaught]

This past week me and my family got our flu shots. But I'm noticing a strange number of people I work with who are simply refusing to get them. It's leading to some awkward confrontations. EG I work in the same seating area as two pregnant women. Besides me and the pregnant women (plus one other person), no one else who sits near us is getting a flu shot. They are being offered FREE flu shots and these folks are refusing.

All of them say they've never gotten vaccinated. I've been coaxing them about putting pregnant people at risk, but they won't budge and it's gotten awkward so I feel compelled to stop pushing it.

Is this a recent thing? Or do lots of people just not like flu shots and don't get 'em?

[Aimless]

I think opposition has been growing with the growth of the alternative medicine movement and boosted by the swine-flu-vaccine-narcolepsy connection.

[Khendraja'aro]

They're idiots. I myself don't get flu shots as I'm not in the "at risk" part of our population but I'll probably change my mind when I get older. Every other vaccine which was reasonable to get, I got, however (and by this I mean: I don't need vaccinations against tropical diseases).

If I were their boss, by the way, and I had some pregnant women in the workforce and those idiots who obviously never heard of Rubella, I'd fire them on the spot. I have exactly zero tolerance for that kind of stupidity.

[Flixy]

I don't get flu shots because I'm not at risk like Khen, but I'm not opposed to them. And I have had all the usual vacations, and frankly I don't know anyone who hasn't.

[Dreadnaught]

They're idiots. I myself don't get flu shots as I'm not in the "at risk" part of our population but I'll probably change my mind when I get older. Every other vaccine which was reasonable to get, I got, however (and by this I mean: I don't need vaccinations against tropical diseases).

If I were their boss, by the way, and I had some pregnant women in the workforce and those idiots who obviously never heard of Rubella, I'd fire them on the spot. I have exactly zero tolerance for that kind of stupidity.

Doesn't your job involve interacting with a lot of, uhh, concentrations of influenza vectors?

[Khendraja'aro]

Doesn't your job involve interacting with a lot of, uhh, concentrations of influenza vectors?

Yes. But I'm not (yet) in the part of the populace for whom the current strains of influenza mean an appreciable lethal risk. Which means that I have to weigh the side effects against the beneficial effects - and currently, that pendulum swings towards no vaccination against influenza for me.

That will change, of course, when I become older and/or when (not if, by the way) we get a particularly nasty strain making the rounds.

[GGT]

This past week me and my family got our flu shots. But I'm noticing a strange number of people I work with who are simply refusing to get them. It's leading to some awkward confrontations. EG I work in the same seating area as two pregnant women. Besides me and the pregnant women (plus one other person), no one else who sits near us is getting a flu shot. They are being offered FREE flu shots and these folks are refusing.

All of them say they've never gotten vaccinated. I've been coaxing them about putting pregnant people at risk, but they won't budge and it's gotten awkward so I feel compelled to stop pushing it.

I hope you meant they've never had a flu shot....not that they skipped childhood vaccinations?

Anyway, pregnant women are supposed to get the flu vaccine as part of their prenatal care. That reduces their risk even if they're around un-vaccinated people or active carriers. If you feel awkward and confrontational, it's probably because that kind of thing is best handled by Management and/or Human Resources, not cubicle mates or "seating area" co-workers.

Is this a recent thing? Or do lots of people just not like flu shots and don't get 'em?

I think what's different is CDC basically saying everyone over 6 months should get vaccinated, with some special exceptions. The guidelines used to be more like what the Euro posters are saying -- where only high risk groups like pregnant women, the elderly, those with certain diseases or chronic conditions, or anyone working in Day Care/Schools/Hospitals or high volume public contact, etc. would need the vaccine. Not sure why there are different guidelines between countries, unless it's a vaccine availability problem, or a matter of public funding?

I think there's a lot of public confusion between Influenza and 'the flu'. Every virus we get during 'flu season' isn't necessarily Influenza strains that epidemiologists have tracked and studied, and created specialized vaccines for. It doesn't help that we tend to call everything 'the flu', including stomach bugs.

I've heard people complain they got a flu shot, but still got the flu, and concluded the vaccination was a waste of time. What they don't realize is that either they had a severe case of the Common Cold or some other respiratory virus....or their Influenza symptoms were greatly reduced (and not life-threatening) thanks to the vaccine.



BTW, I like how you emphasized the FREE part. Would that be hypocritical or ironical?

[Lewkowski]

I see it as a few things -

Because the flu shot doesn't guarantee prevention of the flu, people who have got the flu shot can still get sick. And then they whine and complain about how this year was the only year they ever got the flu.

Secondly some folks just hate needles.

And finally there are the fools who think vaccinations cause everything from autism to cancer.

[littlelolligagged]

And finally there are the fools who think vaccinations cause everything from autism to cancer.

I get exposed to rather a lot of the vaccines-cause-autism crowd, unfortunately. In some cases they really are just looking for an explanation, and latch onto whatever they can. It's misguided, and if they spread their misinformation it puts others at risk.

Even so, I don't think I've ever heard anyone use that as a reasoning against getting a flu shot. For that it's always either that "they don't work," "they give you the flu," or the old stand-by "I'm not at risk."

[GGT]

Has anyone else actually experienced a potent Influenza strain illness? I used to think I knew what 'the flu' meant....until my baby and I both experienced a global strain in '92. It was quite horrible.

[Flixy]

Wait, almost everybody gets a flu shot over there? Among my friends here only a few have had those - asthmatic friends for example. It's definitely not so common here. To be honest, I've also never been accused of placing other people at risk because of it.

[Ominous Gamer]

no, not by a long shot. Its so uncommon that its given away for free in order to convince people to do it.
Can't recall the last time I got one, I was thinking about it this year but I had a fever the day they came to my work so I wasn't offered the shot.

[BalticSailor]

I don't get the shot because for me, the benefit/cost ratio isn't that great (the shots aren't free over here, they are, in fact, quite expensive). Last year was the first time in 5 or so years I got the flu, and it was fairly mild.

[wiggin]

Wow, lots of misinformation here.

First off:

Approximately half of Americans get the flu shot each year (though only about a third get it on time); this is concentrated more in the child and senior populations, but a large proportion of non-senior adults also get vaccinated. Numbers are boosted by widespread availability of cheap of free shots, especially through most workplaces. This is hardly some marginal phenomenon.

Furthermore, it's the height of idiocy to imagine that because catching the flu isn't likely to kill a relatively young person one shouldn't get vaccinated. Herd immunity is how vaccines really work, and the more people who get vaccinated, the better. The risks are absolutely minimal, especially compared to the gain to the population both from an economic perspective (less sick time, etc.) as well as a public health one (tens of thousands of Americans may die each year from the flu). Lastly, those who suggest that the flu only kills the very young and very old have clearly never heard of a cytokine storm. Not likely, perhaps, at least with most flu strains, but certainly far from impossible - the 1918 epidemic probably caused such cascades, which is likely part of why it was so lethal to the young and healthy.

I can't speak to the other countries represented here, but in the US we have both the means and the desire to get most adults vaccinated, and people should take every opportunity to do so. It costs at MOST a small chunk of time and something like $5 for most people (free for many). The CDC spends a great deal of time and effort figuring out which strains are risks in the coming season, and we have developed a massive vaccination scale-up capability to rapidly produce hundreds of millions of doses in a few short months. Why waste this capability over laziness when the cost/benefit analysis is so clear?

[Flixy]

Over here it's generally only free for risk groups, I think. If the government set out to create herd immunity I'd go along with it - but as it stands it means paying myself for a flu shot while it won't add to the herd immunity because almost nobody else does it.

I wonder if the costs of flu shots would be offset by the decrease of sick people - I imagine it only takes a few people visiting a hospital to offset a lot of vaccinations. Then again, if that was the case, our for profit health insurers surely would push vaccinations.

On advice of the Dutch Health Council people at high risk for complications of influenza are personally invited to see their family doctor for a free of charge vaccination.People at high risk are defined as:

• all patients in the age of 60 year or older;
• people with lung diseases, cardiovascular diseases, diabetes mellitus or serious kidney conditions;
• people with poor resistance due to other illnesses or medical treatment such as chemotherapy.

http://www.rivm.nl/en/Topics/I/Influenza_vaccination

Plus healthcare workers get it for free from their employer. From what I can quickly find, it's otherwise €20-€40, which may be covered on your insurance but that varies - it appears only if you have the right 'extra' insurance on top of the legally required minimum.

[Ominous Gamer]

(though only about a third get it on time)

1 in 3 sounds like the standard Wizards of the Coast uncommon ratio
Not surprising considering this years vaccine was only 62% effective.

[Hazir]

Given the risk to a healthy person and the relative usefulness of a flu shot, I don't really see why I should get one. I also fail to see how you increase or reduce the risk to a person who's got the shot.

[Loki]

As someone who's gotten the flu once in the last 15 years, I fail to see the benefit of getting a flu shot.

Let's see, if I get the flu, I'm out for 10 days.
This shot reduces the odds of getting a flu by ~50% on average
I get the flu once every 15 years.
Expected gain from flu shot = 0.33 days

Getting a flu shot has a high chance of giving you some flu-like symptoms that last a day or two.
Expected loss from flu shot = 1.5 days

In fact, in order for this to make any sense, I'd need to get the flu every 4 years...Plus, a vast majority of health adults that I know don't get the flu anywhere near this often...

[GGT]

CDC WONDER is not available due to federal government shutdown.

I was going to look up the H3N2 strain from '92, but fuck it. It was a horrible, virulent strain of Influenza that made every other "flu" I'd had seem like the a bad chest cold. It didn't just put folks in bed for a week....it put healthy people in the hospital for a week, with pneumonia, 105 degree fevers unresponsive to meds, dehydration, sepsis, kidney failure. School districts and businesses closed, it was really creepy to see how fast a county/region could become a ghost-town.

Flu-like symptoms is not the same thing as Influenza. Vaccinations are intended to prevent an outbreak from becoming an epidemic, and then a pandemic. I'd say anyone who's routinely exposed to lots of people, whether it's at work, living in urban areas, or flying on an airplane, should consider getting the vaccination.

[EyeKhan]

This past week me and my family got our flu shots. But I'm noticing a strange number of people I work with who are simply refusing to get them. It's leading to some awkward confrontations. EG I work in the same seating area as two pregnant women. Besides me and the pregnant women (plus one other person), no one else who sits near us is getting a flu shot. They are being offered FREE flu shots and these folks are refusing.

All of them say they've never gotten vaccinated. I've been coaxing them about putting pregnant people at risk, but they won't budge and it's gotten awkward so I feel compelled to stop pushing it.

Is this a recent thing? Or do lots of people just not like flu shots and don't get 'em?

If the pregnant women are vaccinated, are they still at risk?


Edit: I listened to the interview below of a guy pushing his book on Fresh Air the other day -- VERY good interview, btw -- and toward the end he talks a bit about a fairly new hypothesis to explain the increase in allergies and other immune related disorders/ diseases. In short -- some researchers are beginning to suspect we are too clean, too insulated from parasites and disease, and that this new auto-immune stuff is occurring because our immune systems need something more to do -- they freak out when languishing too much and can attack the body or over-react to non-hostile invaders.

In that context, should healthy people get vaccinated against diseases not likely to cause them lasting harm? Economically, vaccination is the way to go IMHO. But what if over-protecting ourselves from disease of every type is causing these other problems -- and generating tremendous cost in the process? Law of Unintended Consequences. . . .



http://www.npr.org/2013/09/30/227777...n-modern-times

How Our Stone Age Bodies Struggle To Stay Healthy In Modern Times


September 30, 2013 2:54 PM


The Story of the Human Body

Evolution, Health, and Disease
by Daniel E. Lieberman


If you got sick, you probably wouldn't go to an evolutionary biologist to get treated. But Daniel Lieberman, professor of evolutionary biology at Harvard University, says that his field can help you understand why you got sick, and make you more aware of healthy and harmful behaviors.

He joins Fresh Air's Terry Gross to talk about some of the noninfectious diseases that may result from our Paleolithic bodies not being well-adapted to modern conditions. It's a list of ailments big and small, including acid reflux, acne, anxiety, asthma, certain cancers, depression, Type 2 diabetes, flat feet, high blood pressure, irritable bowel syndrome, lower back pain and osteoporosis. In his new book, The Story of the Human Body: Evolution, Health and Disease, Lieberman traces these troubles back to their origins

<snip>

On the evolutionary explanation for the rise in allergies and autoimmune diseases

Our immune systems evolved to be active. Just like our muscles and skeletons evolved to be used and stressed, our immune systems evolved to cope with all of those germs in the outside world. We've now created environments that are very sterile, that are extremely clean; we have very few pathogens that we have to deal with. And if we do get them, we nuke them with antibiotics. In so doing, we are now affecting how our immune system functions; it's still there, and it's primed and ready and waiting to attack all those germs and worms that used to make us sick, but now those pathogens are absent, so it sometimes by chance finds the wrong targets. So that's the hypothesis for why so many allergies and autoimmune diseases are on the rise — is that our immune systems are essentially not being used properly, and as a result they go into overdrive; they attack ourselves

EDIT: Was just thinking this topic might be a debate/ discussion candidate...

[GGT]

If the pregnant women are vaccinated, are they still at risk?

Their risks are reduced.

It's worth noting that flu vaccinations have improved dramatically over the years, and become more targeted and specific. When I was pregnant, they weren't recommended for pregnant women. When my kids were infants and toddlers, they weren't recommended for infants or toddlers.

But then again....I'm from the generation that didn't have vaccinations for all sorts of things, like Hib, or Meningococcal infections. My first child (22 yrs old now) got Varicella Zoster immunity the same way I did, by direct infection. My second child didn't get the "Chicken Pox", because four years later there was a vaccine (and required before he could attend pre-school). That's how fast the medical science changed, within one generation.


Edit: surely anyone who watches TV has noticed the ads surrounding "Shingles" treatment, aimed at Baby Boomers who had Chicken Pox, right? Well, I've also had Shingles, during my college-aged years. I was lucky enough to be 'young and healthy', and the virus attack in torso neural pathways, away from my eyes.

[GGT]

Dang, I didn't hear that NPR segment.

The Human Body, and its "natural" immunity is a great wonder. Most folks my age ( ) have no tonsils, adenoids, or appendix.

[Khendraja'aro]

In that context, should healthy people get vaccinated against diseases not likely to cause them lasting harm? Economically, vaccination is the way to go IMHO. But what if over-protecting ourselves from disease of every type is causing these other problems -- and generating tremendous cost in the process? Law of Unintended Consequences. . . .

Yes, that's usually the false conclusion the anti-vaccine crowd also draws. Here's the thing, though: Vaccines only work through training your immune system to be able to identify the threat and annihilate it immediately.

It's the exact same method your body undergoes when it catches the non-weakened version of the illness itself. You don't get any kind of advantage by undergoing the actual illness itself - you only get the disadvantages.

[EyeKhan]

Yes, that's usually the false conclusion the anti-vaccine crowd also draws. Here's the thing, though: Vaccines only work through training your immune system to be able to identify the threat and annihilate it immediately.

It's the exact same method your body undergoes when it catches the non-weakened version of the illness itself. You don't get any kind of advantage by undergoing the actual illness itself - you only get the disadvantages.

Ah, noted. The argument - if valid, and as noted it's just a hypothesis - would only be relevant to antibiotics, excessively sterile living environments, etc.... NOT vaccines.

If you consider the tap water in Mexico as an example of living environment, I'm told the locals can drink it with no ill effect but if a visitor from north of the border - the land of very clean drinking water - is exposed, he's going to get a bad case of gastrointestinal distress. This mismatch in vulnerability has to be related to immune system conditioning through exposure to dirtier living conditions....

[EyeKhan]

Dang, I didn't hear that NPR segment.

The Human Body, and its "natural" immunity is a great wonder. Most folks my age ( ) have no tonsils, adenoids, or appendix.

You can still listen to it via the link....

[GGT]

Choobs, Antibiotics treat bacteria, not viruses. Vaccines are given to create immunity to viruses. Yeah, our guts can build tolerance to certain bacteria over time (like in drinking water), and need a certain type and amount of 'natural' bacteria to assist our immune system.

Our over-use of Antibiotics, especially broad-spectrum big guns, often caused diarrhea and losing the 'good' gut bacteria, sometimes causing secondary yeast infections. It also led to Antibiotic-resistant bacteria that's a pretty serious situation now. There was a time when Americans could get a 10 day Rx for antibiotics before traveling, in anticipation of Montezuma's Revenge (diarrhea from drinking water). Antibiotics were given for bad complexions/acne, and people would use them for tanning purposes (sensitivity to UV rays). Folks would demand their doctor give them Ab for the common cold, ear aches, sore throats....and too many wrote that prescription. I'll listen to that podcast tomorrow.

Khen, vaccinations aren't meant to "annihilate the threat immediately", but to recognize a particular virus as an "interloper", and activate the immune-response. It is like 'training the immune system', as you say, but vaccinations don't appear to have the 'exact same' results as natural immunity. That's why booster shots are required.

Since I had mumps, measles, rubella, and varicella as a child, I've only needed DPT boosters. I got the Polio vaccine in a sugar cube, and an updated version some years later. Not sure if my small pox vaccination means much at this point in time.

[wiggin]

I wonder if the costs of flu shots would be offset by the decrease of sick people - I imagine it only takes a few people visiting a hospital to offset a lot of vaccinations. Then again, if that was the case, our for profit health insurers surely would push vaccinations.

I obviously can't speak for every country and situation, but in general herd immunity pays off given the fairly high mortality overall from influenza, and the cost in missed work days. I have a friend in epidemiology; I can ask her for some numbers, but I would imagine that the CDC et al have run these numbers to death to justify the fairly large expense of the flu vaccination program. (BTW insurers only push something if it benefits them directly, but most people don't spend much healthcare dollars on the flu; it's a bigger economic cost for the working age chaps.)

Given the risk to a healthy person and the relative usefulness of a flu shot, I don't really see why I should get one. I also fail to see how you increase or reduce the risk to a person who's got the shot.

The way herd immunity works is roughly thus: Let's say that only 90% of people who get vaccinated actually develop a robust enough immune response to fight off the virus (with these trivalent and quadrivalent vaccines it gets a bit more complex, but let's stick with simple numbers for now). If most of the population has been vaccinated, those unlucky 10% are probably fine, since there's not a large enough reservoir of susceptible people to readily spread the disease throughout the population. If only those at-risk got vaccinated, the unlucky 10% are up a creek without a paddle. You have to attach realistic numbers and do some fairly sophisticated modeling to figure out whether it's worth it for a given vaccine, but in general it is.

As someone who's gotten the flu once in the last 15 years, I fail to see the benefit of getting a flu shot.

Let's see, if I get the flu, I'm out for 10 days.
This shot reduces the odds of getting a flu by ~50% on average
I get the flu once every 15 years.
Expected gain from flu shot = 0.33 days

Getting a flu shot has a high chance of giving you some flu-like symptoms that last a day or two.
Expected loss from flu shot = 1.5 days

In fact, in order for this to make any sense, I'd need to get the flu every 4 years...Plus, a vast majority of health adults that I know don't get the flu anywhere near this often...

No offense, but anecdotes are useless here (especially your rather pessimistic assumption of missing 1.5 days for every flu shot - I've never missed a single day from one... let alone your apparent knowledge of when a certain illness constituted influenza or not). You have to have hard data, and that's quite challenging to get - influenza rates among the healthy are tough to find out since most people aren't tested unless they land in a hospital (and sometimes not then, either).

[GGT]

wiggin, while you're at it, please ask your friend in epidemiology about the HPV vaccine.

[Khendraja'aro]

Khen, vaccinations aren't meant to "annihilate the threat immediately", but to recognize a particular virus as an "interloper", and activate the immune-response. It is like 'training the immune system', as you say, but vaccinations don't appear to have the 'exact same' results as natural immunity. That's why booster shots are required.

They have the same result. Booster shots are required because for some people (not all!), immunization is not achieved on the first try. That also happens with diseases! Which means that, just like after a "failed" vaccination, you can also contract a disease like Measles a 2nd time.

And regarding the "annihilation" you lectured me about: Please read what I wrote. Because you got it wrong.

[RandBlade]

Over here its only recommended for at risk people I believe and as a healthy young adult I've never had it. Given that my wife is pregnant this year I'm assuming she'll get it and I'll follow whatever advice we get from the midwife as to whether I should get it or not.

What I hate with a passion on a related but separate note are the idiots who insist every cold they get is the flu. Or every headache is a migraine. The flu and the common cold/a migraine and a headache are completely different things! I've got a cold at the moment, which seems to have been doing the rounds, Amanda had one before me and a work colleague of ours had it first. I'll joke that its "Man Flu" but its just a cold, whereas some people sneeze and the must rush to a doctors surgery.