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Flu Vaccine Benefits Go Beyond Effectiveness of One Strain

December 11, 2017 2 comments
LJ TanGuest post by Litjen (LJ) Tan, MS, PhD; co-chair and co-founder of the National Adult and Influenza Immunization Summit.

 

There seems to be a lot of speculation recently about how effective the influenza (flu) vaccine will be at preventing cases of influenza this season.

We have heard suggestions that the vaccine may only be 10% effective against flu this year, that there may be mismatches in the vaccine compared to the influenza strains that are circulating, and thus, that the vaccine is not worth getting.

To address these concerns I will start with a basic explanation of flu and flu vaccines, and then discuss the factors that play into vaccine effectiveness.

First, let me say that influenza is a serious respiratory infection that is responsible for about 30% of all the respiratory infections during the winter season. When I say serious, I mean that flu can keep you down for a week or more, and you will feel completely miserable. Additionally, each year thousands of people of all ages die from flu in the U.S.; it can be very dangerous. So, that office colleague who said that he was out with the flu yesterday very likely did not have influenza. Not fully understanding the dangers of flu is why some people fail to see the value of flu prevention.  

Flu is caused by multiple strains of influenza viruses that circulate during the winter season; specifically, we have influenza type A (with the H3N2 and H1N1 strains) and influenza type B (there are two type B strains that can circulate and currently 90% appear to be the Yamagata lineage, but since it is still so early in the season and sample sizes are small, this data point may not be statistically significant). Because these strains of flu viruses can switch every season in terms of dominance, and can also mutate, manufacturers need to develop a new influenza vaccine every year and people need to be re-vaccinated each year.

To be clear, the vaccine development process is the same every year, it is just that the starting, or “seed”, vaccine virus that we immunize against has to be identified before it can be used to develop our country’s annual vaccines.

When that seed virus is identified, it is then amplified (or passaged) to develop more seed virus. Then that seed virus is further amplified to create the large quantities of vaccine virus that we ultimately need to prepare an adequate supply of vaccines to protect our population. That amplification of the seed virus, and the making of large amounts of vaccine virus, can occur in eggs, which is the more traditional way, or it can also occur in cell cultures. So there needs to be four seed viruses developed and amplified to create influenza vaccines – an H3N2 seed, an H1N1 seed, and the two B seed viruses.

So why do we keep hearing people say that this year’s flu vaccine may only be 10% effective? Where did that suggestion come from?

When we say that a flu vaccine is 10% effective, what we usually mean is that it was effective in preventing 10% of cases of influenza in those who were vaccinated. This 10% number that you may have heard is actually a data point from Australia, and it’s not against all strains of flu, but specifically against the H3N2 strain that dominated the southern hemisphere this past flu season. If you look at the Australian data for all influenza, the vaccine effectiveness goes up to 33%. Agreed, that’s not great for Australians (although, it’s still better than no protection), but is looking at the Australian data truly reflective of what might happen in the US?

It’s unlikely, and here’s why. Read more…

Vaccine Hesitancy Often Tied to Moral Foundations of Liberty and Purity

December 5, 2017 Leave a comment

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We often try to overcome vaccine hesitancy with education, hoping that the scientific evidence will be enough to change people’s minds.  The hope is that if we can just provide people with the facts about the dangers of diseases, and the benefits of vaccines, than they will be encouraged to vaccinate.  But research shows that it’s not that easy, and this may not even be the right approach.

Today, Washington Post reporter, Lena Sun, published an article that explains that vaccine hesitancy is not just an issue of education.  Recent behavioral research suggests that there is often a moral difference between people who accept vaccines and people who refuse them.  The point is that people don’t make decisions based solely on fact.  Rather, parents who are most reluctant to vaccinate appear to be strongly concerned with two powerful moral values that influence their attitudes and judgments: individual liberty and purity.

In this framework, liberty is associated with belief in personal responsibility, freedom, property rights and resistance to state involvement in citizens’ lives, while concerns about purity focus on boundaries and protection from contamination.

One new study out of Emory University, published recently in Nature Human Behaviour, used a social psychology theory known as Moral Foundations Theory to determine the underlying moral values most strongly associated with vaccine-hesitant parents. They assessed the parents’ level of vaccination hesitancy and explored how important different moral values were to them when deciding if something was right or wrong. Their findings correspond with the reasons many vaccine-hesitant parents give for delaying or refusing some vaccines.

Another group of researchers out of Loyola University in Chicago were able to validate these finding, but then went one step further.  They found that purity and liberty values also seem to influence the belief in false or misleading statements that often appear on websites that adamantly oppose vaccines.

In another study recently published in the Personality and Social Psychology Bulletin, researchers at the University of Amsterdam and University of Kent explored science skepticism as it relates to various issues such as climate change, vaccination and genetic modification in food.  They determined that “religiosity”, as well as concerns about moral purity, were also a common predictor of vaccine skepticism.

The insight that we get from this type of behavioral research can certainly help us better understand those who are vaccine hesitant.  If we can take the moral foundation concerns and incorporate them into our messaging, we may be able to persuade parents that vaccines do fulfill their desire to maintain both liberty and purity.

As an example, to address the purity concerns, one suggested intervention may be to explain that vaccinating is a way of  boosting a child’s natural defenses against disease and keeping the child “pure of infections”.  Whereas a liberty-oriented message might suggest that vaccines can help parents to take personal control of a child’s health so that they are free to live a happy and healthy life.

While such messaging has yet to be tested, these studies, and others like this, are critical to helping us develop more effective communication, and should be a consideration for all of us who engage with vaccine hesitant parents in the doctor’s office, on the internet or at the playground.

 

In “The Pathological Optimist” Wakefield Profits From False Hope and a Disproved Autism-MMR Hypothesis

October 23, 2017 33 comments

This guest post has been written by Every Child By Two Board Member, Dr. Paul A. Offit, who is a professor of pediatrics and Director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. 

The Pathological Optimist, which had its theatrical release on September 29, 2017, is a movie about Andrew Wakefield, the British doctor who claimed that the measles-mumps-rubella (MMR) vaccine caused autism.

Although much has been written about this man and his discredited hypothesis, one question remains unanswered. And it’s this question that makes Andrew Wakefield such an interesting character study.

Among scientists, Andrew Wakefield is unique.  He’s not unique because his explanation for why MMR caused autism was nonsensical. (MMR vaccine doesn’t overwhelm the immune system; measles vaccine virus doesn’t damage the intestine; and brain-damaging toxins don’t then enter the body and cause autism). And he’s not unique because 17 studies performed in seven countries on three continents showed that those who received MMR weren’t at greater risk of autism. (Four thousand studies are published in the scientific and medical literature every day; not surprisingly, false claims are published all the time). He’s not unique because the Lancet, the medical journal that published his original paper, retracted it when the editor learned that Wakefield had misrepresented biological and clinical data. (Researchers who falsify data are an occasional problem in science—a human endeavor). And he’s not unique because several of the families mentioned in his paper were in the midst of suing pharmaceutical companies, essentially laundering their legal claims through a medical journal. (Conflicts of interest occasionally confound medical research). Finally, he’s not unique because his misrepresentations and falsehoods caused him to lose his medical license. (Every year some doctors lose their license to practice medicine).

No. What makes Andrew Wakefield unique is that unlike many of the discredited, defrocked, and humiliated scientists who have preceded him, he continues to insist that he is right and that the rest of the world is wrong.

The question is: Why? In The Pathological Optimist, executive producer Miranda Bailey pulls back the curtain.

Between 2011 and 2016, Bailey, who is best known for her work in Swiss Army Man, The Diary of a Teenage Girl, and Norman, embedded herself in Andrew Wakefield’s life. Bailey is no novice. She’s spent a lot of time working around people who act for a living. She’s not easily fooled. And she’s not fooled here.

Throughout the movie, Andrew Wakefield’s grandiosity, his exaggerated sense of self-importance, his fantasies of brilliance, his sense of entitlement, his need for constant admiration, and his arrogance are on full display.

The Pathological Optimist follows Wakefield on what appears to be a cross-country, money-seeking tour targeting parents of children with autism. Wakefield isn’t raising money for research on autism’s causes or cures. And he isn’t raising money to promote better services or better educational tools for children with the disorder. Rather, he’s raising money for himself; specifically, to pay legal fees for his lawsuits against Brian Deer, the investigative journalist who had exposed Wakefield’s falsifications in the Lancet paper, and Fiona Godlee, the editor-in-chief of the British Medical Journal who had called Wakefield’s paper fraudulent and challenged the Lancet to retract it.

Wakefield is out to restore his reputation. And he’s taking advantage of vulnerable parents who believe in him to do it. For Andrew Wakefield, it’s all about Andrew Wakefield.

Read more…

Five Things I’ve Learned About Vaccines Through 21 Years of Parenting

April 24, 2017 35 comments

niiw-blog-a-thon-badgeI gave birth to five children in the span of nine years. My oldest daughter will soon be 21.  My youngest, 12.  Over the years, I’ve learned a few things about childhood illnesses and infectious diseases.  Like most parents, I’ve received plenty of unsolicited advice about how to care for my children and how to keep them healthy.  However, when I make health decision for my children, I rely on evidence based research and credible information from reputable sources.

That is why I agreed to partner with Every Child By Two (ECBT) as the editor and primary contributor to this Shot of Prevention blog.  Seven years ago, when we started this blog, parents seeking vaccine information on the internet often encountered a web of lies, deception, misinformation and fear mongering. Today, Shot of Prevention is one of many blogs that provide parents with evidence based information to help them make informed immunization decisions for their families.

Today, in recognition of National Infant Immunization Week, I’m sharing five of the most important things I’ve learned about vaccines through my journey as a parent and immunization blogger and it begins with science and it ends with action.

1.) Don’t Let Your Emotions Cloud Your Scientific Judgment.

Visit any online parenting forum and there are fewer topics that can get as heated and emotional as vaccines.  The majority of these conversations illicit fear and sympathy, and you’ll often hear parents say that they had to trust their gut or rely on their parental instinct. While we can’t deny our emotions, when it comes to vaccines we must not let emotions cloud our scientific judgment. Instead, we must look to peer-reviewed research and sound science to make educated and informed immunization decisions for our children.

When we do that, we realize that vaccines are some of the most rigorously tested medical interventions available today. And they should be because they are administered to almost every healthy child born in the U.S.  The four different surveillance systems we have in the U.S. serve as back-up systems to ensure the ongoing safety of vaccines.

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While it’s true that no medical intervention comes without risk, the chances that your child will suffer a serious adverse reaction from a vaccine are documented to be less than one in a million.

When you compare that risk to the risk of injury or death from the diseases that we prevent, vaccines win the benefit/risk ratio hands down.  So, brush up on your science and take the time to understand how vaccines work.

Listen to immunization experts address some of the most frequently asked questions about vaccines in these Q&A videos available on our Vaccinate Your Family Facebook page here and our YouTube channel here.  You can also check out these other resources to learn more:
Immunity and Vaccines Explained; video from PBS, NOVA 
How Vaccines Work; video embedded on Immunize For Good website 
Vaccines: Calling the Shots; Aired on PBS, NOVA 
Ensuring the Safety of Vaccines in the U.S.; PDF document from the CDC 
The Journey of Your Child’s Vaccine; Infographic from the CDC 
Vaccine Ingredients Frequently Asked Questions; Healthy Children, AAP
Vaccine Education Center Website; Children’s Hospital of Philadelphia 

2.) Appreciate Vaccines For Their Life-Saving Quality.  

Thankfully, science is advancing and newer, safer vaccines are enabling us to prevent more needless suffering, hospitalizations & death. However, it’s not uncommon for parents to question why their child may need so many shots.

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Admittedly, the method of administering vaccines can be painful at times.  I’m beginning to think that the reason parents are concerned about the number of vaccines their children receive is because it’s even painful for parents to watch their child suffer from the discomfort of a needle. And worst yet, there are often multiple shots at each visit during those first two years of life.  If vaccines were administered orally, through an adhesive patch, or through a way that didn’t involve pain, I believe parents might not have nearly as much concern.

Unfortunately, one of the hardest things to accept as a parent is watching your child suffer from things you can’t prevent.  But the reality is that with vaccines, you are preventing something, even if you may never see that disease which you are preventing. The reality is that some brief discomfort, a few pricks of a needle and even a mild fever, swelling, rash or big crocodile tears are far better than suffering from any one of the 14 different diseases we can now safely prevent through childhood immunizations.

Since we are privileged to live in a country where we have such easy access to vaccines, parents don’t often see just how dangerous vaccine preventable diseases can be. And while we may not have ever seen polio in our lifetime, we must never forget the fear that parents experienced before a vaccine was available. Sadly, most parents in the U.S. probably don’t even realize that polio still exists in other countries and that globally, measles remains one of the top five killers of kids under the age of five.

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In fact, our country is currently battling yet another measles outbreak in Minnesota. This outbreak appears to be direct result of anti-vaccine advocates wrongfully convincing members of the Somali community not to vaccinate due to the dispelled myth that vaccines were linked to autism.  Now unvaccinated children are being hospitalized with measles and public health professionals are hard at work trying to contain the spread of this extremely infectious disease.

Perhaps if parents were to learn more about the dangers of the diseases that vaccines help to prevent, they may feel less anxious about the shots their child is recommended to receive.  Screen Shot 2017-04-24 at 9.16.16 AM.png

To learn about the 14 different diseases that we can prevent with today’s childhood immunization center, check out our Every Child By Two’s Childhood Vaccine Preventable Disease eBook.

Read more…

John Stone and the “Best of Age of Autism”: Wrong About Everything

February 23, 2017 2 comments
JoelHarrisonEvery Child By Two is pleased to launch another article in their Expert Commentary series featuring guest writer Joel A. Harrison, PhD, MPH, a retired epidemiologist who has worked in the areas of preventive medicine, infectious diseases, medical outcomes research, and evidence-based clinical practice guidelines. Today we will feature Dr. Harrison’s latest paper, John Stone and the “Best of Age of Autism”: Just Plain Wrong About Everything.


by Joel A. Harrison, PhD, MPH

John Stone is listed as the UK Editor for Age of Autism, a daily web newspaper. He is author of numerous articles posted on Age of Autism as well as an active writer of comments, not only to Age of Autism articles; but to articles on other websites, including this blog I have written a number of commentaries on John Stone and his antivaccinationist views, but after seeing Stone’s article “Paul Offit’s 10,000 Vaccines and the Milgram Experiment, ” now being posted for the fourth time, I just had to get out my pen and pad once more.

In his article, Stone discusses four topics:

  1. Using the Milgram Experiment as an explanation for why doctor’s vaccinate
  2. Profits made on the manufacture and sale of vaccines
  3. Paul Offit’s oft out-of-context quoted by antivaccinationists “10,000 vaccines”
  4. The Cutter Incident

In my paper, John Stone and the “Best of Age of Autism”: Just Plain Wrong About Everything, I show that not one of his claims has any validity; but, rather, clearly display many of the flaws in Stone’s thinking as well as other antivaccinationists, including: poor scholarship, a deficient understanding of scientific thinking and methodology, deficient knowledge of immunology, microbiology, and epidemiology, deficient understanding of basic economics, the illogic of false analogies, as well as a lack of common sense, plus a blatant hypocrisy.

Stone’s knowledge of the Milgram Experiments appears to be based only on one article he found in a popular magazine and on a movie clip. Based on his writings on the Milgram Experiments, it does not appear that he even bothered to read the original articles, and isn’t aware that it wasn’t the Milgram Experiment; but Experiments. If he had accessed the original articles, he would have found the study procedures and results to be quite different from the description in Psychology Today. Different enough to make him guilty of the False Analogy Fallacy, a logical fallacy that occurs when applying facts from one situation to a substantially different situation, precluding the ability to draw a logical conclusion (Rational Wiki. “False analogy”)

Stone repeats the antivaccinationists’ trope of 10,000 vaccines, ignoring context and a clear display of lack of common sense. As an analogy, imagine a 15 – 20 minute lecture or 2,500 word article about research into potentially almost limitless energy. The last sentence states: “Our research indicates we could theoretically put 10,000 gallons of gasoline in your car tank.” The average gas tank holds probably up to 25 gallons. Given Stone’s lack of common sense, I assume he would take the 10,000 gallons literally. Most rational people would understand, even without context, that the 10,000 gallons did not refer to actual gallons of gasoline but to the energy/mileage equivalent. The physical impossibility of giving 10,000 vaccines at once to an infant or anyone together with the exponential leap from the current 17 vaccines, there not even being remotely so many microbes that vaccines would ever be developed for, says it all.

He continues to display faulty reasoning, actually a display of hypocrisy, when attacking the profit motive behind vaccines. He and other antivaccinationists seem to have NO problem with the purveyors of complementary and alternative medicines making profits, so it seems that the making of profits is only unacceptable when selling something Stone and other antivaccinationists disagree with. Of course doctors get paid for giving vaccinations. Should they give them for free? As a further display of his ignorance, Stone doesn’t seem to be aware that the profit margin for vaccines pales in comparison to other pharmaceuticals and that the amount doctors make on administering vaccines is, at best, marginal. In fact, some doctors take a loss on vaccinations.

Finally, Stone goes back 60 years in time to the Cutter Incident where approximately 200 people, mainly children, were paralyzed from an inadequately killed vaccine and thousands more exposed. Stone is either unaware of or intentionally ignores that this incident led to ever-increasing safety regulations and surveillance of vaccines. If one were to use Stone’s approach to medicine, since many beneficial medicines and interventions had problems years ago, much of modern medicine would be rejected. In fact, historically, one can find problems with much of modern technology. Is Stone’s approach even rational? And, again, Age of Autism chooses to repost Stone’s article as an example of “The Best of Age of Autism.”

And there you have John Stone and the Best of Age of Autism in a NUTshell!

Read Dr. Harrison’s full article, John Stone and the “Best of Age of Autism”: Just Plain Wrong About Everything, click here.  

Please note: The opinions in this article reflect the views of the author who is not an employee of Every Child By Two and do not necessarily reflect the views of Every Child By Two.  Dr. Harrison volunteers his time to provide in-depth, well-researched analysis of articles which ultimately make false claims about the safety of vaccines.  His articles are summarized here on Shot of Prevention with links to the full response on the Every Child By Two website.

Sorry Kennedy, Being Anti-Vaccine Does Not Mean You’re Pro-Safe Vaccine

February 21, 2017 2 comments

Last week, Robert F. Kennedy Jr., of the World Mercury Project, orchestrated a major publicity stunt designed to question the safety of vaccines.  Since he had no real evidence to present, and the same accusations which have been repeatedly refuted for years, he attempted to garner attention by offering journalists a glimpse at a new anti-vaccine celebrity and the promise of a $100,000 challenge. 

During an hour-long press event on Wednesday, Kennedy was joined by other vaccine critics such as ‘Vaxxed’ movie producer Del BigTree, San Antonio District Attorney Nico LaHood, Tony Muhammed of the Nation of Islam and celebrity actor, filmmaker and father of an autistic child, Robert DeNiro.

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Robert F. Kennedy, Jr. addressed a small gathering of people at last week’s  press conference.

While each had their turn to suggest there was a worldwide scientific conspiracy to lie about vaccine safety, Kennedy concluded by announcing that he would give a $100,000 award to any American journalist who could produce a study that proved that the level of thimerosal used in vaccines was deemed to be safe.

(Of course, since he failed to mention the fee required to participate in the challenge, made no reference to a scientific expert(s) who would assist in evaluating the science, and refused to accept the mountains of studies that already exist on the subject, his promise of a payout was seen by many as an elaborate publicity scam.)

On Thursday, Kennedy continued his crusade on Capitol Hill by renting out a Congressional briefing room and attempting to lure legislators with the involvement of celebrity Robert DeNiro. While staunch vaccine refusers were invigorated by these meetings, hanging on the hope that Kennedy could possibly make inroads with the current administration and put an end to vaccine injury once and for all, the reality is that hardly anyone was listening.

With about 40 people in attendance on Wednesday, and not one member of Congress showing up on Thursday, it’s safe to say that Kennedy’s message is only echoing among those who already support him.  Even DeNiro appeared to have lost interest since he was notably absent from Thursday’s event on Capitol Hill.

As expected, there have already been dozens of commentary that address Kennedy’s misinformation.  However, there is still one statement he made that I feel the need to address.

Kennedy claimed, “I’m not anti-vaccine.  I’m pro-safe vaccines.”  

It’s understandable for people to say,“Yes, I vaccinate, but I don’t feel completely certain that vaccines are safe.” Since we’re unable to guarantee that vaccines will be 100% safe, this “pro-safe vaccine” battle cry is an effective way to appeal to parents who don’t have the time, the understanding or the inclination to delve into the science that supports the widespread use of vaccines.

cf8oebjwqaa6l2nBy using this “pro-safe vaccine” label, Kennedy and others like him play into the emotional need of parents to protect their children while dangerously misleading them into thinking that vaccines are far more dangerous than the diseases they prevent.  In essence, this statement is used to help anti-vaccine crusaders turn vaccine safety into a personal and anecdotal issue, when we should all be demanding that vaccine safety be investigated and addressed with scientific objectivity.

Kennedy continues to try to discredit his critics by questioning, “Why wouldn’t anyone be agreeable to studying vaccine safety?”  He seems to suggest that anyone who isn’t “with” him in arguing that vaccines aren’t safe, is simply against safe vaccines.

This couldn’t be further from the truth.  Vaccine experts ARE agreeable to studying vaccine safety. In fact, that is largely what they do. But unlike Kennedy, they don’t rely on anecdotal evidence.  They demand scientific evidence and they go to great lengths to get it. 

If we were to go back in history, we would see plenty of examples of how our current vaccine safety protocols have successfully identified problems and taken steps to address them.  Consider the history of the rotavirus vaccine.  The vaccine was withdrawn in 1999 after scientists associated it with a rare intestinal problem called intussusception.  This would not have been identified if it weren’t for the vaccine safety monitoring systems that we currently have in place.  And what about the nasal spry flu vaccine which was pulled just prior to this flu season?  The Advisory Committee on Immunization Practices (ACIP) decided not to recommend the vaccine based on low efficacy studies, especially among children.  Again, an example of action taken by one of our current vaccine oversight committees.  There are plenty of other examples of vaccines being pulled from the market – the whole cell pertussis vaccine (DTP), Lyme vaccine, and oral polio to name a few. These instances occurred because of the vaccine safety protocols in place. Read more…

Did the Flu Take Down the Packers & the Steelers in the NFL Playoffs?

January 23, 2017 1 comment

In the final weeks of NFL play, as the Green Bay Packers competed against the Atlanta Falcons and the Pittsburgh Steelers took on the New England Patriots, rumors circulated that several NFL players may have had the flu.  

screen-shot-2017-01-23-at-1-34-51-pmSome sources say the players had fallen ill with a flu-like bug, though it’s unclear what that’s supposed to mean.  It seems likely that a doctor’s exam, along with a flu test, could confirm, with relative certainty, whether these players were in fact suffering from influenza.

Some sources reported that the players have had the “stomach flu, which is confusing since there is really no such thing as a “stomach flu“. With flu, some people may have vomiting and diarrhea, though this screen-shot-2017-01-23-at-1-41-49-pmis more common in children than adults.  It is much more likely that these symptoms alone suggest gastrointestinal issues that are often referred to as stomach bugs, which again, should not be confused with influenza.

Then there’s the reference to the “24-hour flu in a report from ESPN Staff Writer, Jeremy Fowler.  The article leads with a statement that up to 15 people in the Pittsburgh Steelers facility suffered a setback from a “24-hour flu bug”.  To clarify, the flu is never a 24 hour ordeal.  Rather, the flu can last as long as 5-10 days.

In an interview on NFL.com, we hear sportscaster Charley Casserly and former general manager of the NFL’s Washington Redskins saying,

“Some of the best games I had players play in was when they were ill.  They had the flu. Hey, I don’t know what it is, but the flu, the flu could be good.  It could be good for those players.  A lot of them play well.”

I’m guessing Casserly doesn’t know much about the flu.  He has probably never had it himself or he wouldn’t suggest that players could play well while suffering with it.

This varied media coverage of these high-profile athletes and their suspected illnesses is just another example of how the public continues to be misinformed about the flu.

The flu is a serious illness, that kills and hospitalizes thousands of people in the U.S. each year.  Yet the majority of people I talk to, day after day, are unfamiliar with flu symptoms and the dangers of flu.

Yesterday I had dinner with a good friend – a friend who was only in town because she had traveled four hours to bring her college-aged son back to campus after he had been home suffering with the flu for over a week. She explained that she had never had the flu, nor had either of her two college-aged children.  Therefore, she had never even considered the need for a flu vaccine.  She then went on to explain that she never knew how bad it could be, until she saw her son lying in bed for days. He was very ill and lost 10 pounds in one week.  As he describes it, “It was the most awful thing and I’ve never been that sick ever.Read more…