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Flu Vaccine(2 Posts)
I know there's been some debate about the flu vaccine, so I thought I would post this article I read which I think gives a massively balanced view. I hope you don't mind? It's written by a pharmacist, as well as someone who promotes natural health, so well researched. I am really pro-vaccine, but this is a vital read if you're thinking about it, or undecided.
I’ve felt compelled to write this article as a mother and as a Pharmacist. As a mother, I’m very clear about my position on the flu vaccine. Intuitively, I don’t see the need for the flu vaccine for or me or my family. We’re all relatively healthy. We don’t get ill too often. We try to lead a healthy life and overall our health is good. If we do get ill, we rest and trust our bodies to take care and heal itself. We may help it along with home or natural treatment and sometimes even medicine. But any approach would be as gentle as possible with minimal side effect. After all, we don’t want the treatment or prevention remedy to result in more sickness. By staying at home, we aim to look after ourselves and protect others too.
If any of us had an underlying health condition, I may take a different view.
The difficulty lies in being a Pharmacist. I have a duty to public health and of course the population are not all healthy. So the question is, does the flu vaccine protect the population from getting flu? As much as I trust my intuition with my own family, I would always want to approach this with a Scientific point of view when dealing with the general public, from a position of not knowing and then letting the evidence present itself. I wanted to find out how effective the vaccine is in preventing flu and whether the benefits outweigh the risks (i.e. the side effect profile of the vaccine)? In order to do this we must look at various factors. From my personal knowledge and research these are some of my findings.
What is seasonal flu?
Flu is a common infectious viral illness spread by coughs and sneezes. The symptoms can be unpleasant and can include a high temperature (fever) of 38C (100.4F) or above, tiredness and weakness, a headache, general aches and pains, a dry, chesty cough. A healthy individual will usually recover after a week. Flu can be caught all year round, but is especially common in winter and this is known as seasonal flu.
Why is flu more common in the winter?
Some suggest it’s because we spend more time indoors where germs can breed.
Lack of vitamin D can weaken the immune system hence making us more susceptible
The flu virus thrives in the cold, dry air of winter, but suffers in the warm, humid air of summer. 
If you are fit and healthy there is no need to see a doctor, the best thing to do is to stay at home at rest. This is particularly important to prevent the spread of flu. According to the NHS website, flu is usually most infectious from the day symptoms start and for a further three to seven days. Children and people with a lowered immune system may be infectious for a few days longer .
Flu like symptoms are usually mistaken for the flu. A scientific study carried out in China and published by Imperial College London showed adults over 30 typically get the actual flu about twice a decade. Whereas children get it more often typically once every two years but as they get older their immunity to the virus increases. Suggesting the virus builds up a person’s immunity to future variant flu viruses.  
Dr Adam Kucharski, who worked on the study at Imperial College London said: “There’s a lot of debate in the field as to how often people get flu, as opposed to flu-like illness caused by something else. These symptoms could sometimes be caused by common cold viruses, such as rhinovirus or coronavirus. Also, some people might not realise they had flu, but the infection will show up when a blood sample is subsequently tested.” 
The flu vaccine available in the UK
In the UK, doctors surgeries and certain pharmacies get paid a fee of around £9 to administer the flu vaccination per person, to an at risk person e.g. over 65, pregnant women, children and adults with certain long term health conditions e.g diabetes, asthma etc. and severely immunocompromised patients. The vaccine is available free of charge to these patients, because it is thought they are more likely to suffer from complications of the flu e.g pneumonia.
It is important to note that these complications can also be caused by other viruses, that the flu vaccine doesn’t offer any protection towards.
Adults over 18 and children aged 6 months to less than 2 years in these groups are given an annual injection, while children aged two to 17 are given an annual nasal spray.
The annual nasal spray is also available to healthy children aged two, three and four years old, and to children in school years one, two and three. These are being rolled out in schools as part of the school vaccination programme.
The vaccine is also available in certain pharmacies to healthy adults who want to be vaccinated, at a cost to the person.
What is the flu vaccine?
The injectable flu vaccine-contains the inactivated form of the virus.
The nasal spray contains live attenuated influenza vaccine (LAIV, Q/LAIV), which contains the attenuated or weakened form of the virus.
How does it work?
Flu vaccines cause the body to produce antibodies, which provide protection against the viruses in the vaccine. The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season.
However this research is not always accurate and as Dr Richard Pebody, Public Health England’s head of flu surveillance says “It takes from February through to August / September to produce sufficient quantities of the flu vaccine. If a change in the virus is detected once production has started it is not possible to change it”. .
My problem with the vaccine
The flu vaccine is not always effective, as shown in February 2015, it helped prevent flu in 3 out of 100 people.
According to the department of health the flu vaccine has had a typical effectiveness of 50%. However, in 2015 it was shown to be only 3% effective in a study conducted on 1,314 patients in primary care across the UK. So in a population of 100 people it prevented flu in merely 3 people. This is because every year the world health organisation predict which viruses they think are going to be circulating in the following flu season. If the match is wrong once the vaccines are in production, nothing can be done about it. 
According to the department of health website
“The UK findings follow the recent publication of the US and Canada’s mid-season vaccine effectiveness estimates, both of which also revealed the vaccine had unfortunately provided little protection against circulating A(H3N2) viruses this season in these countries. This was also linked to drift observed in H3N2 viruses. 
It may cause flu like symptoms in as many as 1 in 10 people
This is an excerpt from the nasal spray flu vaccine leaflet ;
Very common (may affect more than 1 in 10 people):
runny or stuffy nose
loss of appetite
feeling generally unwell
Common (affecting up to 1 in 10 people):
high temperature (fever)
Less common (affecting up to 1 in 100 people):
nose bleed (it is thought these are unlikely to be caused by the vaccine itself)
The flu vaccination can cause flu like symptoms in as many as 1 in 10 people. So last year it prevented flu in 3 in a 100 people but could have given flu like symptoms to 10 out of a 100 people. These figures make me feel incredibly uncomfortable. Last year we gave more people flu like symptoms then preventing flu itself.
The nasal spray is not recommended by the Centers for Disease Control and Prevention (CDC)
The centers for disease control and prevention don’t recommend the nasal flu vaccine because of data showing lack of efficacy , so why are we pushing it in our schools?
The nasal spray is a black triangle medicine
This means it is a relatively new drug, with relatively limited information about its safety from clinical trials available. Trials that have been conducted are relatively small numbers with short time scales and identify more common adverse affects. Any black triangle drug requires more surveillance to establish rare or long term adverse affects. Therefore, effective surveillance after marketing is essential for the identification of rare adverse effects, and to ensure that appropriate action is taken .
I strongly believe schools are not a place to be given these types of medication. We don’t know long term side effects and have limited information on the full side-effect profile. If parents are interested in vaccinating their children, I feel a more appropriate setting would be a doctors surgery where all the information regarding effectiveness, side effects along with the fact it is a black triangle drug should be given. It is then up to parents to decide what is best for their children.
The injectable vaccine is most effective in healthy adults subgroup
The flu vaccine works best on healthy adults and older children and isn’t as effective in the at risk groups e.g older people, young children, people with certain chronic illnesses. It also doesn’t protect a patient from other viruses, which can still lead to complications in these groups.
In summary, the whole flu immunisation programme seems counter intuitive to me. On one hand we are saying it’s best to vaccinate at risk groups because they are more susceptible to flu and complications, but it is actually less effective in these groups. It is most effective in healthy adults and older children who if they got flu, typically once every five years would most likely recover well, with a low probability of complications.
My feeling on this is that people should very much be given the choice of what they want. If you or your family are at risk you may want all the protection you can get.
All the information should be provided and then a personal decision should be made. As healthcare professionals, we should not be coercing or making individuals feel guilty about not vaccinating. We should be providing true informed consent, despite any financial benefit we may receive.
Lastly, I don’t think schools are an appropriate setting for children to get vaccinated with what I can gather is an ineffective vaccine, which still has much safety data to be collected as demonstrated by it’s black triangle status.
For anyone who doesn’t want the flu vaccine
My recommendation would be;
Practice good health habits-get plenty of sleep, be physically active, get outdoors in the fresh air, manage your stress, drink plenty of water and eat nutritious food.
As most people are low in vitamin D in the winter months, supplementation is recommended.
Take good quality probiotics and multivitamins in case you are deficient.
Wash your hands regularly.
Avoid close contact with people who are sick by keeping your distance.
Clean and disinfect frequently touched surfaces at home, work or school, especially when someone is ill.
Avoid touching your eyes, nose and mouth as this can be how germs are spread.
Stay at home and rest if you are sick. This will help get you better and prevent the flu from spreading.
Cover your mouth and nose with a tissue when coughing or sneezing. Encourage small children to catch their sneeze/cough in a tissue. It can prevent others from getting sick.
Much of the above advice can also be found on the CDC website .
I’d be very interested in hearing your thoughts. I’m open to comments, feedback and any research you may have done. I look forward to hearing your comments.
I largely agree with the premise that the benefits of the flu vaccine are generally overstated and the risks, particularly of the nasal spray, are glossed over by a lot of HCPs. I also agree that it's morally very dubious (to put it mildly) to vaccinate healthy children with the nasal spray, and all its incumbent risks, when there's very little benefit to the child. There have been a number of Drs who have expressed the same opinion in the BMJ for example, and if HCPs are pressuring parents into agreeing to this without being honest about the risks and limitations I would consider that professional misconduct.
A couple of minor inaccuracies will probably be picked up on in due course (this is Mumsnet after all!). I think at the end of the 2015 season the effectiveness had been revised upwards from 3% (but still nowhere near the 50% mark). Also, the ineffectiveness of the nasal spray in the US and the CDC recommendation to withdraw it were discussed by the JCVI in an emergency meeting:
These were the concluding comments:
18. The Committee agreed that there was strong evidence from the data presented that the UK childhood flu immunisation programme was working and continued to protect the health of both children and the wider population. JCVI therefore continued to
recommend the use of LAIV for preventing flu in children.
19. The Committee agreed that the consistently lower VE for LAIV against flu A/H1N1pdm09 was a concern and advised and supported a number of research initiatives to provide further insight into the virology, immunology and effectiveness of the nasal spray flu vaccine.
20. The Committee noted that the US programme had been using LAIV for longer than the UK and that the reduced efficacy observed there may be a function of the duration of the programme. It would therefore be important to continue to keep the programme under close review and monitor the programme over the longer term.
21. The Committee agreed it would consider any relevant new evidence and developments on the impact of the nasal spray flu vaccine as it emerges but strongly supported the continuation of this important public health programme in the UK.
22. The Committee agreed that a statement should be published as early as possible and ahead of the annual flu campaign summarising JCVI’s conclusions and its continued support of the childhood flu immunisation programme (see below).
I have highlighted what I think is an interesting point in bold. (This part wasn't in the official JCVI release.) This acknowledges that the LAIV programme was initially effective in the US, but they have seen declining effectiveness over the last few years, and they don't know why. The highlighted part acknowledges the possibility that the LAIV effectiveness might also decline here, and that it should continue to be monitored. I think there are a few admissions in the document that we don't really understand what's going on with the vaccine as well as the official material might suggest.
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