By Sarah A LoBisco, ND

It’s a common question that I’ve been discussing a lot lately with  my patients—“what is your opinion on the flu vaccination?” In 2010, I discussed the combined seasonal and swine flu vaccine. I reviewed some statistics on its efficacy, detailed its ingredients, and discussed the rationale beyond it’s mode of action.  I also provided some tips on how to remain healthy in the coming winter months, with or without the needle.

Due to the fact that the flu vaccination does not provide long-lasting protection, the contemplation of an influenza vaccine is a yearly quandary for the public. However, this year, the CDC (Center for Disease Control) has made this flu vaccine blog a little easier for me, because the same vaccination for seasonal influenza from 2010 remains unchanged for 2011. This means it is containing the same strains for influenza as well as the swine flu (H1N1 and H3N2). The CDC reports:

Although influenza vaccine strains for the 2011–12 season are unchanged from those of 2010–11, annual vaccination is recommended even for those who received the vaccine for the previous season. Although in one study of children vaccinated against A/Hong Kong/68 (H3N2) virus, vaccine efficacy remained high against this strain 3 years later, the estimated efficacy of vaccine decreased over the seasons studied (6). Moreover, several studies have demonstrated that postvaccination antibody titers decline over the course of a year (7–10). Thus, annual vaccination is recommended for optimal protection against influenza.

In my previous blog on the Swine Flu scare, I mentioned that 35,000 out of the 36,000 annual deaths related to influenza are actually complications from pneumonia, and mostly the bacterial form. This fact, along with the continued media coverage amongst pro and anti-vaccination activists, leads this topic to be one heated discussion. In 2008, CBS released a report questioning the medical biases that exist when reporting vaccinations efficacy. Therefore, let’s look at the argument behind this vaccination’s use.

How do we measure how well influenza vaccines work? (CDC)

Two types of studies are used to determine how well influenza vaccines work. The first type of study is called a randomized control trial (RCT). In a RCT, volunteers are assigned randomly to either a group that receives vaccine or a group that receives a placebo (e.g., a shot of saline), and vaccine efficacy is measured by comparing the frequency of influenza illness in the vaccinated and the unvaccinated groups. RCTs are required before a new vaccine is licensed for routine use by a national regulatory authority, such as the Food and Drug Administration (FDA) in the United States. The second type of study is called an observational study. In observational studies the study participants make their own decisions about whether or not to be vaccinated. In this type of study, vaccine effectiveness is measured by comparing the frequency of influenza illness in the vaccinated and unvaccinated groups, usually with adjustment for factors (like presence of chronic medical conditions) that may vary between the groups.

According to a commentary in the British Medical Journal, the effectiveness of the vaccinations based on research is highly questionable for several reasons:

  1. The first is heavy reliance on non-randomised studies (chiefly cohort studies), especially in the elderly. A metaanalysis of inactivated vaccines in elderly people showed a gradient from no effect against influenza or influenza-like illness to a large effect (up to 60%) in preventing all-cause mortality. These findings are both counterintuitive and implausible, as other causes of death are far more prevalent in elderly people even in the winter months. (This makes one wonder about selection bias to favor results, meaning comparing an unhealthy non-vaccinated population with a healthy one or vice versa).
  2. The second problem is either the absence of evidence or the absence of convincing evidence on most of the effects at the centre of campaign objectives (table 2). In children under 2 years inactivated vaccines had the same field efficacy as placebo,8 and in healthy people under 65 vaccination did not affect hospital stay, time off work, or death from influenza and its complications.9
  3. The third problem is the small and heterogeneous dataset on the safety of inactivated vaccines, which is surprising given their longstanding and widespread use.

The CDC also echoes the problems with determining unbiased rationale for efficacy and effectiveness:

How well the flu vaccine works (or its ability to prevent influenza illness) can range widely from season to season and also can vary depending on who is being vaccinated. At least two factors play an important role in determining the likelihood that influenza vaccine will protect a person from influenza illness: 1) characteristics of the person being vaccinated (such as their age and health), and 2) the similarity or “match” between the influenza viruses in the vaccine and those spreading in the community. During years when the viruses in the vaccine and circulating viruses are not well matched, it’s possible that no benefit from vaccination may be observed. During years when the viruses in the vaccine and circulating viruses are very well matched, it’s possible to measure substantial benefits from vaccination in terms of preventing influenza illness. However, even during years when the vaccine match is very good, the benefits of vaccination will vary across the population, depending on characteristics of the person being vaccinated and even, potentially, which vaccine was used.

Researchers try to determine how well a vaccine works in order to continually assess and confirm the value of influenza vaccines as a public health intervention. Study results about how well a flu vaccine works can vary based on study design, outcome(s) measured, population studied and the season in which the vaccine was studied. These differences can make it difficult to compare one study’s results with another’s.

While determining how well a flu vaccine works is challenging, in general, recent studies have supported the conclusion that influenza vaccination benefits public health, especially when the viruses in the vaccine and circulating viruses are well-matched. (That’s the catch)

Is the flu vaccine effective against all types of flu and cold viruses?

Influenza vaccines protect against infection and illness caused by the three influenza viruses in the vaccine that research indicates will be most common this season. Flu vaccines will NOT protect against infection and illness caused by other viruses that can also cause influenza-like symptoms. There are many other viruses besides influenza that can result in influenza-like illness* (ILI) that spread during the flu season.

One of the major populations of concern regarding the flu vaccination is the elderly. One study from The Lancet on elderly populations in long-term facilities analyzed the outcomes of influenza, influenza-like illness, hospital admissions, complications, and deaths and found only moderate results. Another meta-analysis and review also demonstrated less than exciting evidence on the influenza vaccines efficacy:

Influenza vaccines can provide moderate protection against virologically confirmed influenza, but such protection is greatly reduced or absent in some seasons. Evidence for protection in adults aged 65 years or older is lacking. LAIVs consistently show highest efficacy in young children (aged 6 months to 7 years). New vaccines with improved clinical efficacy and effectiveness are needed to further reduce influenza-related morbidity and mortality.

What about the Risks?

Vaccinations are not without risks, and many are questioning the balance between its questionably accepted benefits vs. publicized side effects. Yet another topic with heated sides of controversy.

Recently, the NVIC (National Vaccine Information Center) partnered with Delta to provide the public with an informational video explaining the facts on the flu and how to prevent its spread, including hand washing and covering your mouth. According to Barbara Fisher’s recent newsletter:

On Nov. 7,  Forbes magazine published an article with a copy of a letter signed by the AAP President Robert Block, MD, accusing Delta of “putting children’s lives at risk” by showing travelers the NVIC sponsored video because it contains “harmful messages.”

In an effort to present the public with answers, The Health Resource and Service Administration (HRSA), of the Department of Health, requested that the Institute of Medicine analyze the adverse effects of 8 of the 12 vaccinations covered under the National Vaccination Injury Compensation Program (VICP). The IOM conclusions on the influenza vaccination were as follows:

  • Six types of vaccines—MMR, varicella zoster, influenza, hepatitis B, meningococcal, and tetanus-containing vaccines—are linked to anaphylaxis. The committee also found convincing evi­dence of a causal relationship between injection of vaccine, independent of the antigen involved, and two types of adverse events, including syncope, or fainting, and deltoid bursitis, or frozen shoulder, characterized by shoulder pain and loss of motion.
  • certain trivalent inactivated influenza vac­cines used in Canada in some recent years and a mild and temporary oculorespiratory syndrome, which is characterized by con­junctivitis, facial swelling, and upper respi­ratory symptoms, including coughing and wheezing.

This year, there’s also the question of the live attenuated vaccine nasal vaccination vs. the inactivated virus. Although the LAIV does not contain thimersol, it does contain its own precautions and warnings.

So, what’s the solution?

As a Naturopathic and Functional Medicine Practioner, it’s all about the terrain for me. Tis not the bug, but the body’s ability to deal with the bug that makes one sick or well. Therefore, my advice is to become educated about anything you put in your body. Whether you decide to vaccinate or not, you should always boost your terrain. Click here to read my recommendations on boosting your immunity for a safe, happy, healthy, holiday season.

 

References:

CDC. Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 20ll. MMWR. August 26, 2011 / 60(33);1128-1132 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6033a3.htm

CDC. 2011-2012 Seasonal Flu. http://www.cdc.gov/flu/about/season/

Fisher, B. NVIC Calls Out AAP for Censorship & Intimidation. NVIC. Org. November 15, 2011.

American Academy of Pediatrics Committee on Infectious Diseases. Recommendations for influenza immunization of children. Pediatrics 2004;113: 1441–7. FREE Full Text

Jefferson, T. Public health. Influenza vaccination: policy versus evidence. BMJ 2006; 333:912 doi: 10.1136/bmj.38995.531701.80 (Published 26 October 2006). http://www.bmj.com/content/333/7574/912.full

Institute of Medicine. Adverse Effects of Vaccinations: Evidence and Causality. August 2011. http://iom.edu/~/media/Files/Report%20Files/2011/Adverse-Effects-of-Vaccines-Evidence-and-Causality/Vaccine-report-brief-FINAL.pdf

Thomas RE, Jefferson T, Lasserson TJ. Influenza vaccination for healthcare workers who work with the elderly. Cochrane Database Syst Rev. 2010 Feb 17;(2):CD005187.

Prof Michael T Osterholm PhD, Nicholas S Kelley PhD, Prof Alfred Sommer MD, Edward A Belongia MD. Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. The Lancet Infectious Diseases, Early Online Publication, 26 October 2011. doi:10.1016/S1473-3099(11)70295-X

Dr T Jefferson FFPHM, D Rivetti MD, A Rivetti BSc, M Rudin BSc, C Di Pietrantonj MSc, V Demicheli MD. Efficacy and effectiveness of influenza vaccines in elderly people: a systematic review. The Lancet, Volume 366, Issue 9492, Pages 1165 – 1174, 1 October 2005. doi:10.1016/S0140-6736(05)67339-4. Published Online: 22 September 2005

Attkinson, Shirly. How Independent Are Vaccine Defenders? CBS News. July 25, 2008 6:20 PM. http://www.cbsnews.com/stories/2008/07/25/cbsnews_investigates/main4296175.shtml

Be sure to check out my informational blog on Saratoga.com which includes:

1. Naturopathic Philosophy Highlight Fun Facts:

  1. Radiation for the Holidays
  2. Coffee and Parkinson’s

2. New Office Help!!

  1. Welcome to Emmajean Rombach, LAc! Emmajean will be my new virtual assistant: helping me with office administration, emails, phone calls, and such! Emma Jean is a wonderful practitioner herself, and will be available to me part time to help out with all my wonderful patients!

3. Upcoming Events!

  • November 20th: The Healthy Living Expo in Saratoga, NY
  • Upcoming Essential Oils Workshops with Terry Quigley and Lori Mershon at the Healing Garden. Contact Terry at 518-831-9469

4. Radio For Your Body–Mind-Soul:

February 24, 2010: How Your Mind Can Heal Your Body
In this one hour radio special, Dr. Hamilton explains the power of thought and belief in the healing process and shows you how to effectively learn how to combat disease, pain, and illness.

Flourish!
Dr. Christiane Northrup
November 16, 2011 Healing the Heart of Your Life
Over 25 years ago, Greg Anderson was diagnosed with terminal lung cancer and given six months to live. His life turned around through the power of radical forgiveness.

5. Book of the week: How Your Mind Can Heal Your Body, David Hamilton

6. Don’t miss out: