AAP Policy Statement Recommends Flu Vaccine For All Living Persons 6 Months and Older, Health Care Workers, and Promotes Rapid Use of Antiviral Medication for Identified Flu Cases

flubugThe “Recommendations for Prevention and Control of Influenza in Children, 2015–2016” by the Committee on Infectious Diseases makes the following points:

  • Annual influenza immunization for “for all people 6 months and older, including all children and adolescents”
  • No preference for trivalent or quadrivalent vaccine
  • “Trivalent vaccine contains an A/California/7/2009 (H1N1) pdm09-like virus; an A/Switzerland/9715293/2013 (H3N2)-like virus; and a B/Phuket/3073/2013-like virus (B/Yamagata lineage)
  • “Quadrivalent vaccine contains an additional B virus (B/Brisbane/60/2008-like virus [B/Victoria lineage])”
  • “All health care personnel should receive influenza vaccine each season and fully promote influenza vaccine use and infection-control measures”
  • “Promptly identify children clinically presumed to have influenza disease for rapid antiviral treatment, when indicated”.

The challenge I have with these recommendations, is that they are a sweeping endorsement of a new vaccine with new strains, which have never been tested on a large scale. Obviously, by the very nature of this annual drill of guessing which strains will be the worst, rushing a vaccine to market, and then the huge media campaign to get people to use the vaccine well before there can be any outcome data of efficacy or side effects, no one can really know if this year the vaccine will be worth it or not. Because the flu can be extra deadly for those with underlying health challenges and those with asthma or lung disease, it certainly makes sense for these individuals to roll the dice and get this vaccine. For otherwise healthy individuals with a healthy immune system, I remain neutral. Some year they will get it right and those of us who get the vaccine will be the lucky ones. Most years it seems the flu vaccine is not effective enough to really make that much of a difference on an individual basis. Statistically, the numbers always look impressive, since the flu seems to infect much of the population most years.

From the table below, released by the CDC, you can see that over the last 10 years the flu vaccine has been 10-60% effective. We know last year, effectiveness was at 23%.

 Adjusted vaccine effectiveness estimates for influenza seasons from 2005-2015

Influenza Season† Reference Study Site(s) No. of Patients‡ Adjusted Overall VE (%) 95% CI
2004-05 Belongia 2009 WI 762 10 -36, 40
2005-06 Belongia 2009 WI 346 21 -52, 59
2006-07 Belongia 2009 WI 871 52 22 ,70
2007-08 Belongia 2011 WI 1914 37 22, 49
2009-10 Griffin 2011 WI, MI, NY, TN 6757 56 23, 75
2010-11 Treanor 2011 WI, MI, NY, TN 4757 60 53, 66
2011-12 Ohmit 2014 WI, MI, PA, TX, WA 4771 47 36, 56
2012-13 McLean 2014 WI, MI, PA, TX, WA 6452 49 43, 55
2013-14 Unpublished WI, MI, PA, TX, WA 5990 51 43, 58
2014-15 ACIP presentation, Flannery WI, MI, PA, TX, WA 9329 23 14, 31

The recommendation to treat with antivirals when indicated is interesting in light of the recent 2014 comprehensive Cochrane review of the literature “Neuraminidase inhibitors for preventing and treating influenza in adults and children.” You can read this here…

 

This is the most comprehensive review of the relevant research done to date on zanamivir and oseltamivir, the two major antivirals that have been most used and most recommend for use against the flu. They reviewed 107 clinical studies.

 

Here is what they found:

 

  • Reduction of symptoms was less than a day in adults and a day for oseltamivir and no reduction for zanamivir.
  • Neither drug had an effect in reducing hospitalizations
  • Neither drug reduced serious complications of the flu
  • Neither drug reduced pneumonia in children
  • Neither drug reduced otitis or sinusitis in children or adults
  • Oseltamivir:  “there was a significantly lower proportion of children (and adults) on oseltamivir with a four-fold increase in antibodies”
  • Oseltamivir increased nausea, vomiting, psychiatric events, headaches, and renal events

Authors concluded, “statements made on the capacity of oseltamivir to interrupt viral transmission and reduce complications are not supported by any data we have been able to access.” You can read this study for yourself here…

At this point, the overwhelming data suggest that these drugs have minimal if any benefit and clearly can cause harm. Your best defense against the flu is a healthy immune system. Eat healthy organic produce with lots of colorful fruits and vegetables (fresh or frozen). They only work if started within the first 48 hours. I would only consider their use if you have a rapid and very serious case of proven influenza, especially if you have underlying health risks that would make having the flu more dangerous. It seems these drugs actually reduce your ability to mount a good immune response, and may actually be doing more harm than good.

You can read about the prevention and treatment of influenza here…

 

Dr. Paul

 

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