blamebrampton | I'm going on about vaccines again!

I'm going on about vaccines again!

I had my H1N1 vaccine this morning. No side effects so far, and it didn't even hurt! I far prefer flu vaccines to tetanus!

But the most exciting thing for me was reading the government information leaflet -- it's really good! Along with a section explaining that Panvax is not a live vaccine, so it's perfectly safe for foetuses (H1N1 influenza disproportionately causes miscarriage and serious maternal illness), it had a section addressing Guillain-Barré syndrome (GBS). GBS is a serious neurological syndrome that unexpectedly affected about 500 people in New Jersey after a mass vaccination programme in the US in 1976. Since then, there has not been another proven connection between flu vaccines and GBS, and the research done on the event suggests that it was probably a single batch infected with campylobacter, a known precursor to GBS (and a REALLY horrible stomach illness, trust me!)

Since 1976, although GBS has been raised as a concern by people who are not in favour of mass vaccination, there has not been any proof of a subsequent link between GBS rates and flu vaccination. Nevertheless, because governments and scientists generally err on the side of caution, a risk of 1 additional case of GBS per million vaccinations is given, and is stated on the Australian information sheet. Something aside from campylobacter that is known to cause GBS is influenza, and, as the info sheet says: "you are four to seven times more likely to contract GBS after an attack of the actual influenza than after the vaccination".

In actual fact, the risk of GBS from influenza seems to be more in the realm of forty times more likely, as rates are around 4 to 7 per 100,000 cases of influenza.

However, reading that paragraph in the surgery, I gave a little cheer. FINALLY a statement of risk that contextualises it sanely!

Why does this matter? Because people are being told by bad media reports and social networking scares that flu vaccine is not safe, that it contains chemicals that are known to cause harm and that it is not tested. In fact, H1N1 vaccines around the world are being made by the same companies that make seasonal flu vaccines, using the exact same methods. Flu vaccines save tens, if not hundreds, of thousands of lives every year, with excellent safety records. Most, like Panvax, contain no live vaccine -- people who are allergic to eggs are offered a version with live vaccine in many places, including the US, as it is safer for them.

H1N1, on the other hand, is not a safe nor mild disease. It has had a very serious impact on people between 20 and 50, who are normally minimally affected by seasonal flus. In fact, the death toll for old people, the usual flu victims, is statistically low for H1N1. And the people aged 20-50 being affected are not the usual immune-compromised set, either, but both the healthy and those whose only health issue is being overweight. If you're up for it, check out this excellent article from New Scientist on swine flu myths and how they are endangering people's health.

Having seen the incredible impact of H1N1 on the health system in Australia last year -- a warm country in which flu is not as dangerous as it is in cold countries -- I had no hesitation in getting the jab. Well, aside from my usual disorganisation delay ... Fourteen hours later, not even localised swelling. And if you're in Australia and have a Medicare card, it's free! Obviously, talk to your doctor and read the info from your health authorities if you have concerns.

You can read the Australian info sheet as a PDF, downloaded from here, it's available in several languages in the vaccination information sheet category down at the bottom right.

Flat | Top-Level Comments Only

I realise my position against flu and swin flu vaccination has to do with the different social and cultural scene in Germany in regards to mass vaccinations. Many German doctors warn against mass vaccination, because long-term effects on the immune system are unknown. What is known is that one possible (and more and more probable) cause of auto-immune illnesses (like MS, Hashimoto-Thyreoiditis, Wegener's granulomatosis etc.) are effects of vaccinations.

You may find this article on historical flu outbreaks and the role mass vaccinations had in their spread interesting: http://content.nejm.org/cgi/content/full/NEJMra0904322

And here's the Arzneimitteltelegramm for doctors and health care workers with information about why flu mass vaccinations are not necessary and potentially harmful in Germany. Unfortunately it's only in German (I include it in this post only for the German-speaking of your flist, Brammers, in case they are interested.)

I don't want to get into a huge discussion about vaccination - I am no expert and could not argue on a medical level. My comment is only meant to convey that there are other opinions out there.

But how does that tally with the fact that viral attacks such as influenza are major triggers for autoimmune diseases? I acknowledge that in some cases vaccination may be a trigger, which has been under intense investigation by many researchers without yet establishing clear links, but we know that severe illness IS a trigger for many if not all autoimmune diseases, plus, in this case, influenza itself kills people.

Was that first link to the correct paper? If it is, I would strongly disagree with your conclusion on what it shows: the Fort Dix incident was an extremely special case and, as the paper's conclusion says, the H1N1 release came from a research laboratory, not from the vaccination programme. That vaccination programme had its own issues, due to limited contamination according to the best sources available, but that is a separate issue.

Fact: Influenza kills hundreds of thousands of people worldwide, every year.

Fact: Influenza leads to TENS OF MILLIONS of lost work days world wide every year.

Fact: Vaccination prevents influenza infection. THIS IS UNDISPUTABLE.

Fact: Mass vaccination reduces disease spread through a population, a state known as "herd immunity." (Flu vaccine has NEVER had sufficient penetration to achieve this... but herd immunity is how smallpox was eradicated.)

Fact: No one has ever proven (or even generated a statistical trend suggesting) a link between vaccination and any other condition. Every single time, either no association could be found, or another agent (i.e. Campylobacter in the GBS case in 1976) has been identified.

Opposing vaccinations is fearmongering based on bad (or no) science. It is contrary to the most basic principles of public health.

As I said in my comment, I am not going into a discussion about this, because I am not qualified. All I want to point is that there may be cultural attitudes towards public health playing into it. So-called scientic "facts" usually have a whole lot of cultural baggage behind them. I am just pointing to the HIV debate a couple of years ago.

Fact is: in Germany health care officials and doctors talk more about "panicmongering" than the supposed deaths that could be avoided with mass vaccinations.

I am stepping away from this now.

I'm in strong agreement with the facts you list, but I think that there is a more complex issue than fearmongering or bad science underlying the strong German anti-mass vaccination movement (which is in itself both ideologically and practically distinct from the UK/US anti-vaccine movement).

'Alternative' medicine has a strong tradition in Germany, with the country's medical tradition having its roots in public health and quasi-moral injunctions concerning hygiene. This was a fabulous step to take in the 19th century and has produced more good than bad overall.

Out of this democratisation of health came movements like homeopathy, which was but the first of the big CAM approaches to reach a mass audience in Germany.

Now I think that the science of homeopathy is bollocks, but treatment by a homeopath can be very successful, for all the same reasons that the original public health focus of modern German medicine saw dramatic improvements in the German populace: it puts a focus on wellbeing and deals with many minor issues through the concern shown by practitioners to patients, and by the time and ritual of being concerned with the patient's health (most conditions being self-healing).

CAM models fall down when looked to as a focus for acute and serious conditions, such as menigicoccal or cancer, but the German approach on the whole does not see an either/or situation there and has a strong reliance on using contemporary medicine with CAM adjuncts for wellbeing, or, eventually, for palliative care if needed.

All of this means that the debate in Germany is one in which the population is actively involved and where a lot of medical professionals are as focussed on what could be seen as 'healer' modes of thought as on 'science' modes (a dear friend, when studying for her MBBS, described her career as 'part science, part art, part village priest', which I think is very accurate). This sees less emphasis placed on bare hard science and statistics, and more placed on broad concerns regarding a well population.

While I disagree with this approach for issues such as vaccination in which herd immunities are important and the specific issues raised against them are not strong, overall, the German approach is quite successful when looked at in terms of key indicators including life expectancy, satisfaction, overall health and so on.

A world based on science would be more to my taste, but I am also very prepared to admit that such a world would leave itself open to significant problems, too, as history has shown several times. So while I disagree with the German approach on this issue, I do think that it has a lot to recommend it as a way of delivering health care to a populace.

There is a growing recognition of physician-as-healer (a very interesting semantic distinction, and one I intend to adopt in my teaching) in the US over the past... twenty? thirty? years, but even then, it is very solidly described in the language of science and social science: it's called "the biopsychosocial model of medicine." Of course, such things are extraordinarily difficult to study in any concrete scientific fashion, being rooted in subjective assessments of individuals' health and wellbeing, and in cultural canalizations of which the patient may not even be aware. However, I find the wholesale rejection of CENTURIES of historical evidence in favor of mass vaccination (can you say "Edward Jenner"? I knew you could) on the part of the German medical establishment entirely inexplicable.

(NB: Having just recalled that you are not American, I will point out that the parenthetical insertion in the last sentence is not intended to be condescending, but rather a humorous reference to an American Public Television children's show called Mister Rogers' Neighborhood. The "Can you say... I knew you could" construction was one of Fred Rogers' trademark verbal tics.)

You know that Jenner's success in eradicating smallpox in innoculated communities led to several countries declaring that there was no longer a need for mass-vaccination through the 19th century, and hence the return of smallpox in those areas?

At the heart of the matter these days is the fact very few people have seen the devastation that can be wrought by diseases including measles, polio and so on. With very little history taught these days, and even less history of science or medicine, it is incredibly easy to forget.

Additionally, science and health are very badly reported by most journalists, but also very badly communicated to those journos by many universities and medical professionals. So something such as GBS is reported as being an increased risk of vaccination, but not in context of being a debated increase, nor of being a substantial lowering of risk compared to influenza.

One of the most common furphies I have heard regarding H1N1 is that it only affects the old and weak. I even photocopied graphs for my workmates on a best-selling magazine -- with health pages -- that showed the atypical distribution of serious and fatal cases in Australia and the US, which they looked at, and then in several cases said 'Yeah, but ...'

It works the other way, too. My passion for vaccination (and prophylactic treatment) was formed entirely from experience: a childhood friend died of measles, then in India and especially in Mozambique and Tanzania, I saw astonishing illness caused by pathogens that were unknown back in my developed-world home. I also caught a malaria-like fever and was seriously ill in Mozambique because my father was a dreadful hippy when it came to things like preventative measures. (I was fine, and in the small hospital I was sent to became a minor celebrity for being the very whitest person they had seen in years; deserved, I was ridiculously pale in those days.)

I did know that! But then again, I am a physician with an interest in the history of medicine, and a student of public health. Jenner and Snow are heroes in the arena of public health. :D

To once again reference that unforgettable sentiment of George Santayana (which no one ever quotes precisely correctly, but the sense is what matters here anyway): those who fail to remember their history are doomed to repeat it.

You are clearly "in the know," but it bears repeating: H1N1 is worrisome particularly BECAUSE it does NOT only target the young, old, and infirm; deaths have been fairly uniformly distributed across all age groups, which is VERY atypical of flu.

I am a general internist; prophylactic/preventative care is what we're supposed to DO.

I need a "doctor" icon for occasions when I am pontificating on subjects medical. In the meantime, have a Doctor icon.

deaths have been fairly uniformly distributed across all age groups, which is VERY atypical of flu.

Actually, I am not sure if this is true, the New Scientist and Australian Dept of Health and Ageing have both reported unusually low incidences in the v young and elderly, with completely disproportionate cases among the 'prime of life' population.

Which is why I keep banging on about it, as you note, preventative care is important on this one.

The last data I saw from our Centers for Disease Control and Prevention showed a nearly flat distribution; the very youngest and very oldest were only slightly lower than the middle age groups.

Could that be because you might have under-reporting in the uninsured middle age groups? I would be a crazy person if I was working on health policy of statistics gathering in the US ...

Perhaps, but CDC has made H1N1 a "mandatory reportable" disease.

You are probably aware that I am working on my Masters in Public Health degree in Health Policy and Management; clearly, I AM a crazy person.

Yes! And I admire you for it even though I fear for your sanity.

How do you mandate reporting in a population that has statistically high under-use of medical resources due to un- or under-insurance? I'd be seriously interested to know if there are secondary means of information gathering, such as pharmacists.

The laboratories themselves are obligated to report, when a positive case appears. You're right, if there is no encounter with a health care practitioner, there is no possible way to initiate the sequence of events that leads to a report.

Flat | Top-Level Comments Only

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