FLU VACCINATION: YES OR NO?

          Getting a flu vaccine is a personal decision.  This newsletter is intended to provide you with information that can help you make an informed decision.  This will include the official Canadian Government perspective (see http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/05vol31/asc-dcc-6/, Statement on Influenza Vaccination for 2005-2006 Season) as well as additional information from recent studies as well as my own clinical experience.  If you work at a company who insists you get the flu shot know that you have the legal right in Canada to refuse.  You can download an affidavit to that effect at http://vran.org/legacy/docs/form-2.pdf. 

          What is in your vaccine? Anyone getting the flu vaccine this year should be aware that several vaccines marketed in Canada contain mercury (thimerosal).  This is a known neurotoxin linked to brain damage and autoimmune diseases.  You might consider asking about the Thimerosal-free version of FluZone (the Sanofi Pasteur, Inc. vaccine). There will also be a preservative-free version of Fluvirin (Chiron’s product), but it still contains trace amounts of thimerosal, although far less than the more common flu shots. There is also a nasal spray vaccine that contains no mercury, but it is only approved for healthy, non-pregnant people between the ages of 5 and 49. The vaccine also contains formaldehyde, a known cancer-causing agent.  Aluminum is another ingredient which often replaces the equivalent amount of mercury in the mercury-free varieties.  Both mercury and aluminum have been linked to Alzheimer's and possibly other neuro-degenerative illnesses.

      What do most recent studies indicate about the efficacy of the flu vaccines?   Ninety percent  of people that develop complications or die from the virus are over 65 years of age. A 2005 study published in the Archives of Internal Medicine concluded the following: “We could not correlate increasing vaccination coverage after 1980 with declining mortality rates in any age group. Because fewer than 10% of all winter deaths were attributable to influenza in any season, we conclude that observational studies substantially overestimate vaccination benefit.”  I found it interesting that this study was not referenced in the Canadian government’s statement of vaccines for this year.  They did admit, however, that protection provided to the elderly may fall below protective levels within 4 months.  They also mention the following two studies.  First, Demicheli et al. estimated vaccine efficacy to be 24% in preventing Influenza like Illness and 68% in preventing laboratory confirmed influenza infections.  Fifteen randomized controlled studies of healthy children aged 6 months to 19 years showed a relative risk reduction of 31% to 83%. 

What are the risks of getting the flu? Millions develop the flu each year and experience just mild symptoms.  Symptoms usually subside after two to three days and disappear within a week.  Infection complications (pneumonia, hospitalization, death) are very rare and may occur in individuals with an underlying medical condition, those greater than 65 years of age, and young children with a predisposition to respiratory infections.  The Swine Flu or H1N1 has alarmed many people and makes the issue of flu vaccinations quite topical.  But let us put it into perspective:  this so-called pandemic has claimed the lives of about 322 people worldwide (116 in Mexico) over the past 7 months (April 2009 - October 2009).  The regular flu on the other hand has claimed the lives of 13,000 people since January of 2009 in the USA alone.  Put this way it seems to me that while we should be informed and vigilant, there is no need to panic. 

Does a vaccine guarantee immunity?  There are no guarantees that you will not get the flu if vaccinated.  While over 500 viruses can cause the flu, and these viruses are constantly evolving, the vaccine is based on the three most common strains seen in the previous year.  You are only protected against those strains selected.  Even those strains evolve very rapidly and you are not immune to their evolved subtypes.  These strains are decided by a panel of experts who boast 70% effectiveness rate.  They meet annually to predict which strains of influenza will invade their country in the future.  In 1993 a Dutch Article about a home for the elderly reported that 50% of the vaccinated population got the flu compared to 48% of the unvaccinated. (1) Dr. Zoltan Rhona, MD claims the flu vaccine effectiveness rate is only about 20% while placebo shots are at least 30% effective.  According to Dr. Rhona "there have been a number of very good scientific studies proving the flu shot is not better than placebo." 

         What is Health Canada’s View? Health Canada advises that vaccination programs should focus on those at high risk for influenza-related complications, those capable of transmitting influenza to individuals at high risk for complications, and those who provide essential community services.  These include the following:  (1) 65 and over, (2) serious long-term health problems , (3) travelers, (4) children six months or older with respiratory disorders, (5) persons with blood disorders,  lung disease (asthma, COPD) and/or heart conditions (angina, CHF), (6) anyone exposed frequently to nursing homes and chronic-care facilities, (7) and women more than 3 months pregnant.

      Who should avoid the vaccine? The vaccine is not recommended to anyone with acute infections or fevers, to those with egg or thimerosal (mercury) allergies, with unstable neurological disorders, with a history of Guillain-Barre Syndrome, with prior allergies to flu vaccines or those under six months.

      What are the potential side effects of the flu vaccine?   According to Health Canada, one may experience local short term irritation or systemic flu like symptoms for up to two days. Seizures are also possible in infants with high fevers caused by the vaccination.  Allergic reactions, including anaphylaxis and death, are rare but can occur.  In my clinical experience I have come across several cases of chronic illness, for example sinusitis, that began shortly after a flu vaccination.  I have also had cases of unusually frequent colds and flu after the vaccine.  

Recently, scientific data released suggested that those who received the flu shot last year (in 2008) have double the risk of catching swine flu compared with those who did not receive the flu vaccine.  This may suggest the effect of the flu shot on ones immune system, but this is only speculation. Nevertheless, this is something to consider when deciding if flu shots are the choice for you. 

Some vaccines may carry higher risks because of the urgency under which they are created.  The H1N1 vaccine which is about to be released in the near future is untested, with no safety evaluations done at all because of the claimed urgency of the pandemic.  

References

1. Beyer, W.E.P.; et. al. Influenza-epidemie in een verpleeghuis door een virus dat niet in het vaccin was opgenomen. Ned Tijdschr Geneeskd, 1993; 137/39:1973-7

2.  Vitality Magazine - October 2009, p. 44.