The 2013 influenza season is well underway with most of the United States reporting a greater than average volume at most hospitals. Many of those seeking medical attention are doing so with Influenza like symptoms. I have compiled a list of FAQs that have recently come up:
Myths of immunization
This lecture was presented at the recent fall nursing symposium. Depending on your connection it may take a few moments to load.
References and links
- Inflammation described by Celsus
- What is an antigen?
- Types of immunity
- Plague in the middle ages
- How India has defeated Polio, a BBC report
- Edward Jenner – the man who saved more lives than any other man
- Herd immunity
- Algorithm for immunizing persons with egg allergies
- Influenza vaccination in individuals with egg allergies
- Ileal-lymphoid nodular hyperplasia, non-specific colitis and pervasive developmental disorder in children, Lancet 1998- the original article by AJ Wakefield that started the controversy over vaccination in the late 1990s
- Wikipedia article on Andrew Wakefield
- My comments on Wakefield findings dated January 2011
- Article in The Telegraph reporting on the outbreak of Measles in Liverpool
- Risk of seizures after whole cell pertussis or Measles, Mumps, and Rubella vaccine
- Gates foundation and vaccination
As we head into another influenza season we are trying to improve our hospital staff vaccination rates. The goal of vaccinating hospital staff is two fold. First to keep the staff from getting influenza themselves and second by keeping the staff from getting ill they do not become involuntary spreaders of disease to hospitalized patients. Thereby protecting the chronically ill patients at the hospital. The second reason described is often forgotten and overlooked. I cannot begin to count the number of times I have been told that they do not need a flu shot because they don’t sick from the “flu”.
Remember it is more about protecting patients, the weak and infirm who may not have the ability to tolerate a respiratory tract infection
After that discussion the next heard is concerns over vaccinating patients and how the vaccine can or will make them ill. Often cited is a concern that a post vaccination fever is not discern able from a post op fever. Archives of Internal Medicine published this study in 1996 by Nichol et al. The study, a randomized placebo controlled prospective trial looked at the number of symptoms including minor ones such as injection site pain and fever post vaccination compared to placebo. Their findings include that fever post vaccination is no more common than placebo.
Update on the 2010-11 annual influenza vaccination season related adverse effects.
Some of the notable highlights include no increase in febrile seizures in children, no increase in post vaccine fever in adults when compared to placebo (the main hesitation to give it in hospitalized patients).
Anaphylaxis or immediate hypersensitivity is estimated to be rare (1.5 case per million doses) No cases of anaphylaxis was reported in the 2010-11 season.
Botton line: adverse events related to trivalent influenza vaccine (TIV) are very rare for all age groups. It is a safe and cost effective means to reduce influenza related morbidity and mortality.
This review was published in the Nov 18th, 2010 issue of the New England Journal of Medicine. It does a great job detailing the vaccine production and some of the pitfalls in developing newer universal vaccines; influenza vaccines that do not require annual shots. It is a must read.
Lately I have been approached several times about the incidence of fever post vaccination. Data suggests that it is a rare and benign issue at best. In a placebo controlled trials it was no more frequent than in the control group.
Placebo-controlled trials demonstrated that among older persons and healthy young adults, administration of TIV is not associated with higher rates for systemic symptoms
Therefore the presence of low grade fever or the concern for fever should not be a contraindication for vaccination.
Also of interest is the recurring concern for Guillian-barre. In this series there were no cases in over 4 million doses administered.