Lakeside Medical Musings

Just a Shot in the Arm

And now for some lakeside musings on vaccines in general, and the flu vaccine, in particular…

Over the past twenty years or so there has been a potent anti-vaccine movement (AVM – it even has a name!) that is spreading in the US and abroad. This AVM has a strong correlation with a more generalized anti-government movement.  When I was growing up in the 1950’s and 1960’s, vaccines were held in the highest esteem because of their newly discovered ability to eradicate diseases that previously had seemed insurmountable.  Everyone knew someone whose child had been felled by polio, and when Jonas Salk announced his discovery in March of 1953, there was, literally, dancing in the streets.  The resulting government-led campaign against polio was an uplifting national endeavor.

As medical science continued its fight against childhood disease, more vaccinations were discovered and subsequently became commonplace.  In 1964, more than 20,000 babies were born in the US with birth defects caused by maternal exposure to rubella.  The rubella vaccine was licensed in 1969, and our government’s effort to vaccinate children – the major carriers of the illness — and educate people about the high risk of these birth defects was hugely successful with its nationwide “Rubella Umbrella” ad campaign.   But today, regardless of boatloads of scientific data, there are many who believe vaccines are innately dangerous and an insidious component of a government conspiracy.  There are many who believe that anything the government does is wrong, inept, dishonest, and corrupt. In 1969, when the US Space Program put a man on the moon, there were groups of conspiracy theorists who believed the landing was faked in a television studio and never really happened.  Conspiracy theorists have almost become mainstream in our country, and their beliefs that anything having to do with government programs is, by definition, suspect, have also become mainstream.  So when public schools (run by the government) require children to have up-to-date vaccination records in order to enroll, there is a much-publicized outcry against “government controlling our lives.”  We live in very different times today from those when I was growing up in Woodbridge, Connecticut. In 1962, everyone in our town came to the Central School cafeteria to gratefully take our polio-vaccine- laced sugar cubes because, as I said, everyone knew someone who had a  child who was crippled by polio.

For you followers of governmental conspiracy theories, Robert F. Kennedy, Jr., and Dr. Oz, (see this link) among other well-known proponents of AVM, I wish you the best of luck with your health, but I worry constantly about your beliefs causing the rest of society to become ill. Here are some facts about the flu vaccine that I have taken mostly from the CDC (see here) and which I wholeheartedly endorse.

  1. The flu vaccine cannot give you the flu.   You can get a sore or red arm after a flu vaccination, but that is all.  In a double-blind study that compared people who received the flu vaccine to people who received a placebo salt water injection, the only increased side effect from the flu vaccine was a sore or red arm.  The same number of people, post-injection, got runny noses, achiness, fever or cough, i.e., the symptoms of a cold – regardless of whether they received the flu vaccine or the placebo.
  2. You do need to get the vaccine every year. The virus typically changes, or mutates, every year and immunity obtained from the vaccine wanes over time.
  3. There are some people who say that getting the flu is not so bad. If you have a fever of 100 degrees and a runny nose, how bad is that? Whatever that illness is, it’s NOT the flu!  If you have a fever of 103 degrees, a backache, a cough, and you feel like you have been run over by a truck—that is the flu!  You will definitely not be able to go to work or school when you have the flu, and you will oftentimes wish you were dead rather than living with the seven days of the discomfort, misery, and exhaustion that the flu always brings.  There can also be severe complications from the flu such as pneumonia, and there are a large number of deaths each year from these complications. Harvard Medical School Publications reports that over 36,000 people die in the US every year from the flu, and more than 200,000 are hospitalized from flu complications. I, as well as many other medical personnel, was amused at the horror the media engendered over the recent Ebola scare when the statistics about the flu – every single year — are so much more alarming.
  4. Getting the flu vaccine will help prevent you from getting the flu and, if you don’t get the flu, you can’t spread it to someone else, such as your family, your friends, your co-workers, and if you work in a hospital, your patients. Carolinas Healthcare System made it mandatory for its employees to either take the flu vaccine or wear a mask at work for the entire flu season. That’s not a government conspiracy – that’s just medical science common sense.
  5. If you do catch the flu, in spite of having been vaccinated, it’s been shown that your illness – both the duration and the severity — is lessened by having taken the vaccine.
  6. A recent study showed that flu vaccine reduced children’s risk of flu-related pediatric intensive care unit admission by 74% during flu seasons from 2010-2012.
  7. Another study showed that flu vaccination was associated with a 71% reduction in flu-related hospitalizations among adults of all ages, along with a 77% reduction among adults 50 years of age and older, during the 2011-2012 flu season.
  8. Flu vaccination has been shown to be associated with reduced hospitalizations among people with diabetes (79%) as well as chronic lung disease (52%).
  9. Vaccination helps protect women during pregnancy as well as their babies for up to 6 months after they are born. One study showed that giving flu vaccine to pregnant women was 92% effective in preventing the hospitalization of infants for flu.

It is important to realize that the influenza vaccine is not 100% effective.  As I have always told my patients, “If you want a guarantee, go to Sears.  Medical care just doesn’t work that way.” The effectiveness of the vaccine depends on two factors:  the ability of the individual person to develop a good immune response from the vaccine, and the fact that the virus that causes the flu changes every year. How closely the vaccine that is made matches the virus for that particular year directly affects its effectiveness.  It takes a long time to make the flu vaccine, so many months before the first case of any year’s flu is diagnosed, the experts “guess” what that year’s flu will be.  Sometimes they are very close, and the match is great, and sometimes they totally miss.  Unfortunately, the manufacturers don’t know whether it will be a hit or a miss until it is too late to make a different one.  When there is a miss, the vaccine doesn’t work as well or even at all.  When the vaccine makers have a good match, there is a reduction in influenza infection of between 70% and 90%.

The flu vaccine is safe.  Other than the minor arm discomfort, there can be some rare, but significant, side effects.  Guillian Barre Syndrome (GBS) is a rare neurologic disorder where a person’s immune system attacks their nerves causing weakness and, in severe cases, paralysis.  This is usually reversible with treatment.  There are somewhere between 3,000 and 6,000 cases of GBS per year, but very little of that number is related to the influenza vaccine. See here.  In 1976, there was a more statistically significant risk for GBS from the influenza vaccine (1:100,000 people.) The reason for this is not clear, but we might as well blame President Jimmy Carter for that, too.

One of the AVM bandwagon themes relates to thimerosal, a preservative used in very little of the influenza vaccines.  Starting in the 1990’s, a significant increase in the incidence of autism was observed.  This prompted some, without any scientific basis at all, to blame this increase on childhood vaccinations prepared with thimerosal.  Other than the multi-dose vials of influenza – which are very rarely used as almost everyone gets the single-dose injection — no other childhood vaccine has contained thimerosal since its use was removed from vaccines in 2002, and the incidence of autism continues to rise.  AVM proponents decline to engage in debate around that topic.

There are large groups of anti-vaccine people who continue to believe that vaccines are government-initiated poisons, and they refuse to vaccinate their children for such once-common illnesses as measles, mumps, rubella, and whooping cough. It is simply not possible to refute “beliefs” with data. When seemingly sane and competent adults say to me, “I believe vaccines to be bad,” I just do not know what to say back to them.  People will “believe” whatever they choose to believe, which is the nature of beliefs, and medical recommendations change over time, but for me and my family, I want to make health decisions based on the best available scientific statistically-based data, not “beliefs.” In 2014, there was a record number of measles cases directly related to unvaccinated children. See here.  There are new generations of parents who never personally witnessed the ravages of measles, small pox, polio, and other diseases that occurred in the pre-vaccine days, so these diseases are just not realities for them.  Here is an interesting article from a young mother who was recruited into the AVM camp. Uneducated celebrities and self-promoting hucksters such as the Dr. Oz’s of the world can convert a surprisingly large number of people to what is unflinching quackery.  To those people, I say good luck, and I hope you don’t live to regret getting your life-or-death medical advice from a celebrity or someone with either a political or a financial agenda.

So the bad news about the2014-2015 influenza vaccine is that the vaccine is a miss.  The vaccine isn’t nearly as effective this year, evidenced by the epidemic we are in the middle of now, and the great number of hospitalizations in Charlotte as well as other locales.  The vaccine probably will have some effect, and it is still not too late to get vaccinated.

For those of you who say, “I never get the flu shot, and I never get the flu,”, again I wish you good luck.  If you don’t get vaccinated, you will get the flu one day.  If the flu shot kept me from contracting the flu in just one of the ten years that I’ve been getting vaccinated–it would have been worth it to me.  I work in a hospital and, if getting the flu shot keeps me from being a patient in that hospital just once in the next twenty years–it will have been worth it for me.  If getting the flu shot keeps my children from missing a week or two of school—it will have been worth it to me.   If getting the flu shot reduces suffering, critical care hospitalizations, and death—it will be worth it to me.  But that is just me.  Oh, and in the years that the flu vaccine is well matched and you decide not to get vaccinated, give me a call to say hello, but please, don’t visit.






3 thoughts on “Just a Shot in the Arm

  1. John Post author

    John, Thanks for reading and commenting. Yes I did mean Robert Kennedy not John and corrected the post. Thanks. I knew if I was at this long enough I would write on something that we could agree. I don’t really know what to make of the JFK assassination story, but I do know that at least in 1979 JFK was not being kept alive on the 10th floor of Parkland Hospital. I was an intern at Parkland at that time and looked for him. Happy New Year to you and all my readers.

  2. johnadams1782

    Thanks John for another interesting article. I equate people who refuse to believe in vaccines with those who prefer witch doctors to accepted medical care. While I do believe that many things the government does is wrong, inept, dishonest, and corrupt, it does perform some valuable services. I would certainly hope so, considering the ridiculous amount of money we spend on it. The CDC didn’t help bolster confidence in government with its recent comments regarding the Ebola matter. The agency needs a better spokesman than the guy we heard. That was unfortunate, because, in my opinion, CDC is vital for the nation’s interests, unlike much of the federal government.

    Now, I happen to be a proponent of the John K. Kennedy conspiracy theory. I have read many books and essays about the subject and while I have not made any conclusion, I can’t swallow the “lone gunman theory.” When you referred to the proponents of AVM, did you mean to say Robert Kennedy Jr., instead of John?

    I will keep tuned in, for your next article. Happy New Year.