Undue influenza

By Phil Plait | September 15, 2009 12:30 pm

The flu season is rapidly approaching, and as you may already know, swine flu is already here. There was a case of it at PAX, and a friend of mine at Gnomedex had it as well. Some doctors I know are seeing far more flu cases than usual for this time of year, and so when the real season hits we may be in for quite a ride.

I strongly urge you to read this influenza primer by my friend Dr. Joe Albietz. I’ve linked to his stuff before; he’s a pediatrician and skeptic who cares very deeply about the health of children. He is a clear and thoughtful writer, and his primer will give you a huge amount of basic info on the "regular" flu as well as the swine flu, and why he’s worried about it.

The antivax folks have been spreading their usual manure about the swine flu, and (as also usual) giving bad and frankly dangerous advice about it. Go read what Dr. Albietz has to say, and then talk to your own doctor. This is a serious matter, and we need to rely on serious professionals.

CATEGORIZED UNDER: Alt-Med, Antiscience

Comments (45)

  1. That article by Dr. Albietz is a wonderful read. I also recommend it. Science-Based Medicine blog also has a bunch of other articles about the swine flu, about influenza in general and vaccines.

    And, for general vaccine-related stuff, also gotta plug some of the stuff at my humble site: antiantivax.flurf.net

  2. My biggest uphill battle seems to be with my wife. I think that she’s been listening to some anti-vax folks. She’s not “Jenny McCarthy level”, i.e. she’s not saying vaccines cause autism or that we should recall all vaccines until they are 100% safe. However, she has repeatedly said that multiple virus vaccines could overwhelm a child’s immune system. (I counter that exposing a kid to 3 disease vaccines is nothing compared to the hundreds of germs that they are exposed each day.)

    Lately, she’s been saying that the H1N1 vaccines was rushed out, wasn’t tested enough and it could cause bad reactions so she’s not sure whether she would vaccinate our kids.

    Now, our children are at risk for febrile seizures. My oldest had one. My youngest had three. Both of them wound up in the ER and my youngest actually was hospitalized because he stopped breathing and didn’t start breathing again on his own. (Thank goodness for my mother-in-law giving rescue breaths!!!) So you can understand why my kids catching the flu scares the you-know-what out of me. Toss in that my son is in first grade – aka Germ Central – and our chances for flu rise dramatically.

    Now I know that the H1N1 vaccine’s been tested as much as a fast-tracked vaccine can be and there hasn’t been any major adverse reactions, however, those general statements don’t dent my wife’s certainty that H1N1 vaccine = high risk. Can anyone give me some concrete evidence that I could present her with to help sway her?

  3. Phillip M

    Am I antivax because I do not believe in flu shots for healthy adults? I am all for children and seniors getting them. I am healthy with a normal immune system, and I just think if I get a flu shot there is one less for a person who really needs it.

    Now before you label me as antivax I have had all of my vax (except for a flu shot) and my children will have all of theirs (including flu shots).

  4. @Phillip M,

    What’s wrong with flu shots for healthy adults? Healthy adults (with certain exemptions like those with egg allergies) should definitely get their flu shots. It will turn a serious, life-threatening, full on flu (yes, normal flu kills 36,000 people per year) into a shorter, less life-threatening illness. And, of course, a better immune system response from you means less time for the flu to spread itself to others and thus less chance that those other folks will get ill.

    This is, of course, assuming a decent flu vaccine supply. If supplies are low, priorities definitely come into play and healthy adults might not be at the front of the line.

  5. Dan I.

    @ 3. Phillip M

    I understand your argument. I would point out that the Swine Flu seems to be disproportionately affecting “healthy adults.” So you might want to reconsider in this particular case.

    Also consider the issue of exposure. I am a very healthy adult with a very strong immune system. My brother, however, has a compromised immune system. I always got a flu shot because, even though I very rarely get the flu and even when I do I always have a very mild case, the risk that I would expose him was very high.

    Just because you don’t get sick doesn’t mean you can’t infect others. You might not feel like you have the flu but if you go visit your grandmother suddenly you’ve exposed her immune system to it.

    Vaccines aren’t just about protecting the recipient, they’re about protection those the recipient may come into contact with.

  6. @Todd W.,

    While your resource is great, part of me wonders if we should really be billing this as “anti-anti-vax”. Some people might be misinformed about vaccines and not consider themselves “anti-vax.” Thus, they would think that “anti-anti-vax” isn’t for them. Perhaps “Vax Facts” or something along those lines? (VaxFacts.com is taken, unfortunately, but “Vax-Facts.com” isn’t.)

  7. Unfortunately, it is my understanding that the flu vaccine is grown in eggs, which means that for some people (like me) the vaccine is contraindicated. I still have to confirm the egg thing, but since most flu vaccine is grown in chicken eggs, I have little reason to expect that swine flu is not.

    Which is all the more reason for everyone else to get vaccinated.

  8. Bob Portnell

    Seconding Dan I at 5: the best reason to get the shots isn’t for personal convenience (though that’s nice, too) — it’s to contribute to the so-called herd immunity effect. My work provides flu shots every year, and I take them, because my wife and two daughters cannot. Work and I both get an extra smidge of peace-of-mind for doing what we can to protect our respective interests.

  9. @TechyDad

    Well, it was originally set up as a resource to counter the truly anti-vax folks of the vaccines-cause-autism variety and is primarily focused on the myths promoted by anti-vaxers. I can see your point, though.

    For those who think it would not be for them, Science-Based Medicine would probably be a better place to go. They’ve had several articles recently by multiple doctors all about influenza, H1N1 and the vaccine.

  10. @Phillip M

    I used to be of the same mind as you, but as I’ve gotten more involved in the vaccine issues and questions raised about them, my mindset has broadened to include how my actions affect those around me, in terms of me being a vector for the disease. Like others, I know people who have compromised immune systems. I want to make sure I’m not responsible for getting them sick, and vaccines help me with that. Further, they look just like anyone else. So, when I’m riding the bus or subway, go to the grocery store, the library, etc., I could be coming into contact with someone who, for whatever reason, cannot get the vaccine and is therefore at greater risk of being infected.

    So, don’t do it for yourself. Do it for those around you.

    P.S. I’ll be getting my seasonal shot next week. And I’ll get the H1N1 shot when it becomes available.

  11. Phil, this might be a good time to let people know that the seasonal flu vaccine is already available at some doctors’ offices (my pediatrician has it — the kid’s vaccinated already — but my internist didn’t have it yet, last time I called). Go get the vaccine as soon as your doctor has it!

  12. Dave H

    Phillip M: For your reading pleasure and edification may I recommend: “FLU The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It” by Gina Kolata.

    This current strain is very close to the “Spanish Flu” of 1918 which wiped out millions of people. The main deaths were infants under 5 years; healthy adults aged 20 to 40; and elderly 70 to 74. It began as a mild, garden variety flu, but then mutated into a variety 25 times more deadly. And these victims had healthy immune systems which, in fact, made their illness even more deadly. I’ll bet that every graveyard in America over 100 years old contains some bodies of the victims of the 1918 pandemic.

    Dan I is correct: just because you don’t get sick, or your case is mild, doesn’t mean you are not infecting those around you.

  13. Can we stop calling it “swine flu” and just call it H1N1? A bunch of innocent piggies were murderized by the ignoramous governments (I’m looking at YOU, egypt) basically because it was called swine flu and they found it to be an opportune time to enforce their religious beliefs (that piggies are “unclean”).

    I kinda think the anti-vax thing will work itself out. A bunch of people will not vaccinate their kids. The kids die from easily preventable diseases. We roll our eyes. The parents realize what a horrible mistake it was and tell their story.

  14. Steven

    @#4: “yes, normal flu kills 36,000 people per year”

    Is that in the US alone?
    What ages are we talking?

    I’m interested because I’ve never had a flue vaccine and only had a few vaccinations when I was a kid.
    To be clear: I’m not anti vaccinations, I just happen to come from a family where they were not the norm and so, now that I come to look into it, I find this blog and the links provided quite useful. But saying that flue kills 36,000 people a year? How many of those are young kids or older people and, for that matter, how many of them were vaccinated?

  15. John Baxter

    Got my seasonal flu shot yesterday. Earliest ever for me. (Local urgent care clinic where I’m known had a sandwich board out front.)

    H1N1 (let’s stop blaming swine for this, OK?) shot comes later.

  16. Dave H

    To clarify my comment that people with healthy immune systems also died in great numbers:
    Their bodies likely experienced a Cytokine Storm.
    When the immune system is fighting pathogens, cytokines signal antibodies to the site of infection. Sometimes the introduction of a new strain of a virus causes the cytokines to overreact. If a cytokine storm occurs in the lungs fluids and immune cells accumulate and the victim suffocates. This was usually described as the flu turning to pneumonia.

    I have worked in the blood/plasma industry for 13 years and and am the safety coordinator in my facility. As a result I have a fairly good working knowledge of and respect for what pathogens such as H1N1 can do. Personally, I don’t think it is worth the risk. Get the shot. Wash your hands. Take precautions for yourself and those around you.

    I also happen to live near Washington State University. Pop. 18,000 students. Two weeks ago there were six cases of flu that were likely H1N1. A week later, there were almost 2,500 cases. No fatalities yet.

  17. @Steven,

    I got my 36,000 figure from a CNN article (heard it from other sources as well). That just includes the US. I believe that the normal flu typically kills older folks. That’s one of the odd things about H1N1 is that it’s killing younger folks.

    From http://www.wrongdiagnosis.com/f/flu/deaths.htm (not linked to avoid moderation delay):

    “Deaths from Flu: 63,730 annual deaths for influenza and pneumonia (NVSR Sep 2001); estimated 20,000 deaths from flu (NIAID)”

    “Cause of death rank: 7th leading cause of death in 1999 and 2000 is ‘pneumonia/influenza’ (CDC)”

    “36,655 female deaths for Influenza and Pneumonia in the USA 2000 (American Heart Association, 2002)”

    (There’s lots more data on that page include breakouts by age.)

  18. @Todd W.,

    Thanks for the Science-Based Medicine recommendation. Their H1N1 article has a section all about the “Vaccine Rush” (just what my wife rails against). Turns out the vaccine isn’t really being rushed to market, skipping testing along the way. It normally takes 9 months from picking which flus to target in the vaccine to making mass quantities of the vaccines. With H1N1 we had some good timing. The flu vaccine manufacturers were just finishing up their seasonal flu vaccines so they were primed and ready to mass produce H1N1 vaccines. Also, the flu vaccine manufacturers knew just what virus to target (H1N1). If they “skimped” on anything, it was the usual 3 month “what should we target” phase and only then because it was pretty obvious. (crosses fingers that my wife will listen)

  19. Oh, and just to nip it in the bud, in case anyone decides to bring up the 1976 issue before reading Dr. Albietz’s’ article, keep in mind the following items:

    * In 1976, very little was known about the virulence of the novel influenza strain when it first appeared and even after vaccine production began. The current strain has been very well studied before development of the vaccine began.
    * Due to similarities to the 1918 strain and fears still fresh from the epidemic of 1957, which killed about 70,000 in the U.S., there was a lot of fear and pressure from both the public and government to get a vaccine out ASAP.
    * Changes were made to the vaccine after safety trials were completed. (can’t remember my source for this tidbit)
    * The 1976 strain never spread beyond the initial 25 or so infected individuals at Fort Dix. The current strain has already spread throughout the world, so we know that it spreads pretty easily.
    * By the time the 1976 vaccination program was halted, over 40 million people had received the vaccine. Out of those, about 532 individuals (or around 1 per 100,000 individuals) developed Guillain-Barre syndrome(GBS), and there were 25 deaths (<1 per 1 million people vaccinated). GBS in the general population has a rate of about 1 per 100,000, regardless of vaccination, so the numbers involved are actually not out of the ordinary.
    * Seasonal flu regularly kills about 36,000 people per year in the U.S.

    So, while the 1976 case was an example of bad organization and poor handling of a potential emergency situation, the adverse health impact was significantly less than the seasonal flu and even the GBS cases were no different from the normal yearly incidence rate.

    Resources:
    http://www.cdc.gov/ncidod/eid/vol12no01/05-1007.htm
    http://en.wikipedia.org/wiki/Swine_influenza
    http://www.cdc.gov/h1n1flu/vaccination/gbs_qa.htm
    http://www.cdc.gov/flu/keyfacts.htm

  20. NewEnglandBob

    I already got my flu shot, as I have for several years. I will get the swine flu shot as soon as it is available in my area.

  21. kingnor

    I think i’m slowly convincing my GF that vaccines arn’t evil, I sort of explained how they work for the umpteenth time the other day and this time she seemed to take it serious.

    The trick is to be firm but not pushy, and the message will get through.

  22. @TechyDad, the other URL that has all of Todd’s info (as well as the other hot topic here) is http://factsnotfantasy.com/vaccines.html I need to get in and do some updates and and such, I have just been incredibly busy with work, so I am slacking. I also attempt to blog in news and articles about the topics f vaccines, autism, and evolution there, but that busy thing creeps up.

    Not only is Todd’s info there, but IVAN3MAN made some tables and collected some info so folks can see the number of people who used to DIE from these preventable diseases. Also “stole” knuigget’s entry on why it seems that thousands of people find out their child is autistic right after getting a shot.

    And I don’t mind folks leaving comments there. Just play nice. If you get unruly, we’ll mock you in public and tell everyone you were wrong on the internets. ;)

  23. Just got my shot. I’m on a college campus, so usually a high priority for me.

  24. Luke

    Does anyone have a good resource re: where to get vaccinated? My local government health websites aren’t being very forthcoming. Is this the sort of thing you just go to your doctor for? Or are there clinics and such around that will do it for free? I’m in Chicago.

  25. MadScientist

    So we need something fortuitous like Jenny McCarthy contracting and dying of the swine flu. I’d pray for it if praying weren’t a waste of time. Also, she’s in the low risk category anyway – now if she were undergoing chemotherapy or organ transplant and got the swine flu that’d be a different story. Unfortunately silicone bag replacement isn’t really an organ transplant.

  26. Chambered

    “Some doctors I know are seeing far more flu cases than usual for this time of year, and so when the real season hits we may be in for quite a ride.”

    Would it be unreasonable to theorize that a larger number of people are seeking their doctor’s advice when they come down with flu-like symptoms? For me personally, in years past, when I have had the flu (which hasn’t happened at all in the past few years), I didn’t go to my doctor. If I got one this year, I probably would due to the wanting to know if it’s ‘regular’ flu or H1N1 flu.

    So I would guess that people that would not normally visit a doctor for a flu are doing so now out of fear of Swine Flu.

  27. John Baxter

    One of the “annoyances” this year in describing things is that the regular seasonal flu shot has an H1N1 component, which is NOT the same thing as the (sorry) “swine flu” H1N1 (which seemingly is being called something like 2009 H1N1). Per the Science Based Medicine post, not me: I’m just a parrot in this case.

  28. Caleb Jones

    I came down with type-a influenza this past weekend which gave me symptoms I’ve never had before with the flu.

    It started somewhat typical: sudden fever and body aches. But the fever fell off after one night and the majority of my symptoms were acute muscle pains over most of my body for the next three days. It was bad enough that simply closing my fists would cause almost unbearable pain up the muscles in my arms. Even walking, sitting down, or standing up were draining tasks due to the pain they caused.

    I ended up being tested for swine flu since I have a pregnant wife and little kids at home, but that came back negative, fortunately.

  29. Kim

    @5 Dan
    That is the same reason I’m going to get a flu shot. I have a very good immune system. But, my husband had a transplant so is immunosupressed. My parents are in their sixties. Also, my MIL is 75 – and had a very stressful summer where my FIL was ill and passed away. So I am very concerned her stress level makes her immune system weaker.
    A friend of mine got ‘regular’ flu 2 years ago. She is normally very healthy, active and eats well. Certainly not in a risk group. She spent a couple days in the hospital
    I figure herd immunity can help combat the flu also.

  30. K

    I’ve had the flu once in my life. It was no big deal. It was just the flu.
    I don’t work with or live with the elderly or small children or otherwise immune compromised.
    A healthy adult running out and getting a flu shot sure looks like a hysteric to me.
    If my immune system can’t fight through a simple bout of the flu, then by all means, let me make way.

  31. Kim

    The flu hits with different hardness for different people and different strains. My friend said she had never felt so bad in her life, she needed to spend a few days in the hospital. I’ve known other people who have had the flu and they could barely even make it between the bathroom and bedroom. A healthy adult can get it and it can be a very big deal. And I would guess there are people who wouldn’t want to lose you to something that could be treated and/or prevented.

  32. Diane

    Hysterical or not, healthy adults are at the bottom of the priority list for swine flu vaccinations.

  33. alfaniner

    I’ve had the flu a few times. The first few were unmemorable — then I got THE FLU. For some reason a particularly nasty strain that had me moaning for two days straight. And this was when I was in prime physical health (training for a Marathon). Ever since, I’ve never missed the opportunity to get a flu shot.

    Perhaps since the anti-vaxxers have co-opted the word “vaccinate”, proponents should use “immunize” instead? (It’s the same thing, right?) It puts a more positive spin on it, anyway. Especially for the people who think you can get “swine flu” from eating pork products.

  34. DreamDevil

    Had swine flu a few weeks ago, so no worries here.

  35. Tinaa

    We have been having an average 10% absentee rates since the first week of school. VERY unusual. Many of these students have tested positive for a flu virus. I’m getting my seasonal flu shot tomorrow. And the H1N1 as soon as it is available. Schools are breeding grounds for bugs. I’ve become a bit obsessive about washing my hands.

  36. coryy

    @techy dad—I am sorry that your children have febrile seizures, my youngest two have had them as well, and they are horrible. Mine was lucky enough to restart breathing on his own after his third seizure but i was very lucky to have had my midwife (an ex- EMT ) present at the time. I am grateful we did not need her help but glad she happened along when she did!

    I’m not sure what age your son was when he seized, but according to my pediatrician (a teaching doc at Rainbow Babies and Children’s in Cleveland), he reassures me that most children grow out of them (true febrile seizures, not epilepsy) around 5 or so. If you’ve gotten to first grade, then I’m assuming you’ve hit age 5 and can allow yourself to breath a little more easily on that account. Neither of mine has had any after age 4, if that’s at all comforting.

  37. Ceryle

    Being from Australia, we have almost finished flu season here. I had a flu shot through work in May (for the first time) – thank goodness I did – I am sure it made my symptoms much less severe when I got it. When swine flu first came to our state, they were testing everyone who had been overseas, and all of their contacts. As the season progressed, and it got more prevalent, they stopped testing for everyone who was not in a high risk group – they were just asked to quarantine themselves for 7 days, and present to a doctor/hospital if it got severe. I was in high risk group (14 weeks pregnant when I got symptoms), so I was tested, and came back positive for H1N1, and went onto Tamiflu. My husband got the same symptoms, and also got the medication (his high risk was asthma). Luckily my (nearly) 3 year old got shipped off to my mum’s and had almost no contact with us. The H1N1 vaccine is now available here.

  38. Stargazer

    I will get the swine flu shot as soon as it’s available. Good thing it’s entirely free for us.

  39. Nigel Depledge

    K (27) said:

    I’ve had the flu once in my life. It was no big deal. It was just the flu.
    I don’t work with or live with the elderly or small children or otherwise immune compromised.
    A healthy adult running out and getting a flu shot sure looks like a hysteric to me.
    If my immune system can’t fight through a simple bout of the flu, then by all means, let me make way.

    If flu were not contagious, I’d agree with you. If you choose, you can take your chances and see what transpires.

    The thing is, though, that there’s more to it than that (as has been pointed out already by other commenters). You can suffer no symptoms or very mild symptoms and still be a carrier of flu, so you expose everyone with whom you have close contact to the disease. If any of those people are immune-compromised for whatever reason, it is likely that they will contract a severe bout of flu which, in some cases, could be fatal.

    The same applies to all of the non-immune-compromised people with whom you have close contact, i.e. they can in turn become carriers without knowing it. It really is best all round if we stop this flu from having a chance to spread through the majority of the population. This is best done by immunisation.

  40. @K

    I would add to what Nigel Depledge wrote by noting that once you are infected with flu, you are potentially contagious for up to about two days before symptoms appear, if you have any at all, and are still contagious for about a day after the last of the symptoms disappear.

    And it’s not just the people you live or work with. I assume you go shopping, go out to eat, go to the movies and so on. If you ride a bus or subway, everyone else riding with you is also a potential target for the virus.

    The choice is, ultimately, up to you. I used to think like you, as well, as I mentioned earlier in the thread. Then I realized the impact of my choices and, really, how selfish I was being.

  41. Ken

    My daughter (just shy of 8 years old) has historically been a big problem for vaccinations – virtually all kids cry and resist, but she has elevated it to an art form. For her vaccinations last year, the first pair of nurses ended up running from the room! We eventually got her immunized but it was a major fight. Which of course made me feel great…

    Last week my wife and I were discussing the seasonal and H1N1 shots becoming available, and my daughter piped up with some questions. We explained more or less how diseases work, and how the shot “teaches” her body how to fight the disease, and how once her body learns how to fight the disease it not only will help her but also help keep her from giving it to her friends. It was a fairly long conversation, and a really good one – she surprised me with how much she understood for her age. We also discussed how fighting it makes the needle hurt worse, and that if at all possible we’ll get her the nose kind (flu-mist) instead of the shot kind.

    Even though the shots aren’t available yet near us (even the “regular” seasonal vax) she’s working on steeling herself up for it.

    My 5-year old son was also listening. I don’t think he’s able to understand everything we talked about, but he definitely got the sense it’s important and will help keep him and the people around him healthier!

    Here’s hoping this year’s vax visits goes more smoothly than before!

  42. longsmith

    So, I just got my first flu shot ever this morning and…..now I feel like crap. I probably got whatever this is at the gym and I know the virus is dead..but what a coincidence. An annoying one.

  43. If I hear one more time “its just the flu” I seriously think I am going to pop.

    I am one of those people who contracted H1Nerd1 as it is affectionally being labelled among as PAXers while at PAX.

    I have lupus and am on immuno-suppressants. For me it is not just the flu.

    My oldest asked me the other night “mom are you going to die… and don’t lie to me”

    I cannot be vaccinated as I am allergic to eggs. Neither can my youngest because of allergies. He cannot attend school right now because I am under quarantine and someone at his school had a heart transplant as a small child and is on immuno-suppressants as well. If my youngestbrings H1N1 to his school, the child who had the heart transplant could get it and die.

    Thank bob for Tamiflu because I think I would be a lot sicker than I am right now if it weren’t for it.

    So next time you want to say “its just the flu” or “I am a healthy adult” think of those around who are not and rely on you for them to stay healthy and alive.

  44. BlueNumber2

    I with the earlier posters who pointed out that we should be calling this H1N1.

  45. Erik

    His site is down – any one have any info on that?

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