Posts Tagged ‘influenza vaccine’

Flu Vaccine Benefits Go Beyond Effectiveness of One Strain

December 11, 2017 3 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…

5 Ways to Keep Your College-Bound Student Healthy

August 10, 2016 2 comments

Preparing a kid for college is akin to preparing for their arrival at birth.  There are so many details to think about, choices to consider and preparations to be made that it’s easy to become completely overwhelmed.  As parents, we want nothing more than to ensure that our children are well prepared – both physically and emotionally – for all the challenges they are about to face.

While it’s natural to focus on the dorm items your child might need, parents should also help prepare their teen for the responsibilities they will have in managing their own health. Once they move into that dorm, you will no longer be there to fill their prescriptions, fetch their medicine, make their doctor’s appointments, or otherwise ensure they are getting the medical attention they need.  It will be up to them to maintain a healthy diet, get adequate rest, and protect themselves from the dangers of alcohol, drugs and unwanted or unsafe sex.  They will need to know when to seek professional medical attention if they should get sick, injured or find themselves struggling with mental or physical needs.

Before your child heads off to college, here are five things you can do to help them stay healthy:

1.) Get your child a physical exam.  

When kids are young, parents are accustomed to bringing them in for well-visits.  However, it’s not uncommon for kids to miss yearly check-ups in lieu of sports physicals and sick visits.  Before your child heads to campus, make sure to schedule a comprehensive health exam.  The conversation your child has with the doctor should help prepare them to manage their current health conditions while away at school (such as any known allergies, specialist appointments and regular medications) while also opening the discussion to the dangers of stress, poor diet, inadequate sleep, binge drinking, drug experimentation and unsafe sex.  If their provider fails to cover these issues completely, it’s important that parents weigh in on these concerns as well.  You can let your child know that while you trust them to make responsible decisions, you are always available for advice and support.

2.) Get all the recommended vaccines, not just those required by the school.  

For many students, college can be a time of significant stress.  Students don’t always eat a healthy diet or get the proper rest. They live in close quarters and have a tendency to share cups and eating utensils.  At some point your child may travel, or engage with fellow students and faculty members who have traveled, to areas where diseases are more prevalent.  And studies show that college students are more likely to engage in risky behavior. All these conditions make students more susceptible to illness.  It is also what contributes to the chances of outbreaks occurring on collegiStock_000078067721_Double.jpge campuses.

Making sure your child is up-to-date on all the recommended vaccines, not just those required by the school, can help them avoid dangerous and sometimes even deadly illnesses.  While there are several immunizations that are recommended for college-age students, each state and college may have different admission requirements.

To best protect your college-bound student from preventable diseases, parents should consider the following vaccines for students before they arrive on campus: Read more…

Public Health’s March Madness: Flu Activity Remains High

March 18, 2015 3 comments

Even as temperatures climb, daylight extends and the promise of Spring lingers around the corner, the United States is still facing the threat of the flu.

usmap09While influenza activity has begun to decline across the United States in recent weeks, the CDC’s influenza surveillance systems still show elevated activity as we enter the month of March.  Although the average length of a flu season for the past 13 seasons has been 13 weeks, flu activity has been elevated this season for 16 consecutive weeks so far.  As of March 7, 2015 there were still 9 states reporting widespread activity, 29 states reporting regional activity and 11 states reporting local activity. Even though the season started early this year, it is expected to continue for several more weeks and  we can already see that it has been dangerous, deadly and unpredictable this season.

Flu Remains Deadly

As of February 21, 2015, the proportion of deaths attributed to pneumonia and influenza remains above the epidemic threshold and has exceeded that threshold for eight consecutive weeks.  Additionally, seven children have died of influenza between March 1-7, 2015, bringing the total number of flu-associated pediatric deaths reported so far this season to 104.

Death isn’t the Only Detrimental Outcome of Flu

While it’s true that the majority of individuals who suffer with the flu will survive, the CDC also monitors hospitalizations that are associated with influenza infection.  So far this season the most affected age group has been adults 65 years of age and older, and they’ve accounted for more than 60% of reported influenza-associated hospitalizations.  This supports the need for wide-spread vaccination among older individuals and their caregivers, to include nursing home employees and health care workers.  As of February, 21, 2015, the most commonly reported underlying medical conditions among hospitalized adults were cardiovascular disease, metabolic disorders, and obesity.

Children, especially those under 5  years of age, have the second-highest hospitalization rate this season, with the most commonly reported underlying medical conditions to be asthma, neurologic disorders, and immune suppression. Among hospitalized women of childbearing age, 26% were pregnant. However, while certain medical conditions can increase your risk of complications from influenza, seven percent of adults and 39% of hospitalized children had no identified underlying medical conditions, illustrating the fact that flu can be life-threatening even to a previously healthy individual.

The Flu Came On Early, Strong and With It’s Share of Surprises

Read more…

New ACIP Recommendations for Meningococcal, Influenza and HPV Vaccines

March 10, 2015 4 comments
Photo Credit: James Gathany, Centers for Disease Control and Prevention

Photo Credit: James Gathany, Centers for Disease Control and Prevention

written by: Amy Pisani, MS, Executive Director, Every Child By Two

The Advisory Committee on Immunization Practices (ACIP) conducted an abbreviated meeting on February 26, 2015 due to the threat of a winter storm in the Atlanta, Georgia region.  The ACIP, which consists of 15 voting members who have expertise in vaccinology, immunology, healthcare and public health, makes recommendations to the Centers for Disease Control and Prevention (CDC) regarding vaccinations approved for use by the Food and Drug Administration (FDA).  The recommendations pertain to the timing and intervals of vaccines which are included on the childhood, adolescent and adult immunization schedules.   At this February meeting, the ACIP conducted three important votes which altered or created new recommendations for meningococcal vaccine, influenza vaccine and HPV vaccine.  

Meningococcal Serogroup B Vaccine

Two new vaccines to protect against meningococcal serogroup B, which has been spreading through college campuses in recent years, were recently approved by the FDA. The Trumenba vaccine is developed by Pfizer Pharmaceuticals and requires three doses and the Bexsero vaccine has been developed by Novartis Vaccines and Diagnostics requiring two doses.  The ACIP has previously recommended one dose of MCV4 vaccine at ages 11-12, and a booster at age 16 to protects against the A, C, W and Y strains of meningococcal bacteria   Nearly 80% of teens between the ages of 13 and 17 have received at least one dose of the MCV4 vaccine, which is fairly remarkable considering the fact that it is recommended, but not mandated for use within states nationwide.  However, because of the complicated nature of the virus, the new meningococcal serogroup B vaccine would require a separate series of shots, in addition to those recommended for MCV4 vaccine.

The serogroup B strain of meningococcal is considered the most common cause of meningococcal disease  among adolescents here in the U.S. with a fatality rate of 12 percent in 11-19 year olds and 17 percent in 20 year olds over the last 14 years.  While the number of meningococcal cases have declined since 1996, many advocates believe that the aggressive nature of this disease, which often kills or maims it’s victims within hours, necessitates a broad recommendation for the vaccine.  However, the ACIP discussion at the February meeting was limited to recommendations for those at high risk for serogroup B infection, with a follow up vote anticipated at the upcoming June meeting where the Committee will review data and make a determination on whether to recommend the vaccine for a broader population. Authors note-  added June 2015: At the June ACIP meeting the following recommendation was made “A serogroup B meningococcal (MenB) vaccine series may be administered to adolescents and young adults 16 through 23 years of age to provide short term protection against most strains of serogroup B meningococcal disease. The preferred age for MenB vaccination is 16 through 18 years of age.”

Several advocates traveled to the meeting to provide their testimonials.  These included parents of those lost to the disease as well as survivors who have suffered amputations and serious life-long health consequences of this invasive disease.  Dr. Mary Ferris, who helped lead efforts to contain the 2014 meningococcal outbreak at University of California’s Santa Barbara campus, provided compelling testimony regarding the impact of the outbreak on the university.  Ferris noted that four cases, one of which led to the amputation of a student, spread panic throughout the campus and the local community.  Students were banned from volunteering at the on-campus daycare and attempts were made by the local community to close the campus entirely.   Dr. Ferris urged the Committee to consider the broadest recommendation Read more…

Flu Vaccine Mandates Work to Boost Immunization Rates

March 26, 2014 15 comments

There is plenty of evidence that demonstrates the value of vaccines – from reducing hospitalizations and deaths to saving money.  And it’s frightening to imagine what would happen if we stopped vaccinating.

Vaccine_benefit-cost_ratio_-_3Yet, we are often reluctant to mandate vaccines. Instead, we prefer that people decide for themselves how best to ensure their good health. But we can’t ignore the data that proves vaccine mandates are an effective tool in boosting immunization rates.

Take for instance a mandate created in September 2010, in which Connecticut became the second state in the U.S. that requires children, age six months to six years, to receive an annual influenza vaccine in order to attend a state-licensed childcare program. According to a study conducted at the Yale School of Public Heath, Connecticut’s vaccination rate for children aged six months to six years increased significantly after the mandate, spiking from 67.8% during the 2009–2010 influenza season to 84.1% during the 2012–2013 flu season.   And better yet, the number of children hospitalized for the flu plummeted.  In fact, compared to nine other states without mandates, Connecticut saw the largest percentage decrease in the influenza-associated hospitalization rate among children aged four years and younger.

MNchildrens_infographic_fluAnd there have been indirect societal benefits as well.  James Hadler, lead study author and clinical professor of epidemiology at the Yale School of Medicine explains that hospitalization rates for the entire community likely decreased as well. He goes on to say that although the mandate applied only to young children, other studies have demonstrated that protecting a subset of the population decreases circulation of the virus more generally. Which translates to this simple concept: less disease circulating means vaccination is impacting a larger population than can even include those who haven’t been vaccinated.

Read more…

What We’ve Learned From Flu Vaccination Data

June 14, 2013 95 comments

Although the 2012-2013 influenza season may be behind us, there were several studies released this week that offered some interesting considerations for future flu seasons.

First, there was discussion pertaining to the fact that young adults and children in school are responsible for the vast majority of flu transmission.  It’s no surprise really.  These populations often spend hours of the day in extremely close quarters.  But even though there have been 152 pediatric deaths from the flu this past season, and sadly 90% of those children were not vaccinatedflu deaths are typically highest among the elderly.

Image courtesy of Jeroen van OostromIn the past, the emphasis has typically been to concentrate vaccination efforts among those who are most likely to suffer the most.  However, in a recent study published in the journal Vaccine, a computer modeling analysis suggested it could be more effective to reduce the impact of the flu by increasing vaccination amongst those most likely to spread it – a population that consists mainly of young adults and school children.  The model suggests that if we could break the cycle of transmission with increased vaccination among the young, we could effectively reduced the incidence of flu circulating in our communities, which will benefit everyone from the elderly to those too young to be vaccinated.

This idea leads to another consideration.  What efforts can be made to boost vaccination rates among children?  Since we know influenza vaccination rates among children are historically low, (with approximately 40% of children receiving a flu vaccine during the 2012-2013 season), would it be beneficial to offer vaccination clinics in the schools?In another study, conducted from research in 2009 of elementary schools in Rochester, NY, area, the journal Vaccine reported that flu vaccination rates were indeed higher among students at schools where vaccination clinics were held.  In fact, they were 13% higher than among students at the schools that did not have vaccination clinics.  Of the 32 elementary schools included in the data, two  flu vaccination clinics were held four weeks apart at 21 of the schools, while no vaccination clinics were held at the 11 other schools.  While these kinds of clinics may not be commonplace across the country at this point in time, the data suggests that they could be very cost-effective and beneficial.  Now it’s just a matter of determining the barriers that are preventing these kinds of school based influenza clinics so that we can help reduce the impact of seasonal influenza.

Another avenue that has been discussed is the effort to reduce flu transmission through vaccination of healthcare workers.  Although the CDC recommends that all healthcare personnel receive a seasonal flu vaccine, the national average for 2011-2012 was only 67%.   But just this week, reports of a four-year analysis of Chicago’s Loyola University  Medical Center, one of the first hospitals to adopt an influenza vaccination mandate, indicated that mandatory influenza vaccination, as a condition of employment, did not lead to excessive voluntary termination.

It is reported that the Loyola University Medical Center had a 67% flu vaccination rate among employees before adopting a mandatory vaccination policy.  However, compliance among their 8,008 workers is now exemplary with 98.7% vaccinated last year and 99% the year before.  In total, the hospital allowed 97 employees an exemption on religious or medical grounds last year, and only five employees were terminated for refusing vaccination.  Interestingly enough, three of those five were unpaid volunteers who later reconsidered, got vaccinated and returned to work.  As many hospitals, clinics and health facilities across the country have begun to make flu vaccination a stipulation of employment, we continue to hear some vocal dissent.  However, the data seems to indicate that mandatory flu vaccination as a condition of employment has not lead to excessive termination.  Instead, it appears to be effective in increasing influenza vaccination rates among an important population.

Jorge Parada, MD,  professor of medicine at Loyola, MD and author of a report on the Loyola effort to immunize workers, explained that while there was some “pushback” to their policy, the reasons workers were objecting to the vaccines were typically overcome through town hall  meetings and educational initiatives at the hospital.  The most effective argument, he says, was the reasoning that the virus can make healthcare workers sick and that they can transmit it to their vulnerable patients.

“But at the end of the day my number one answer is that it’s not about you, the healthcare worker. It’s not about the worker’s right to get the vaccine or not get the vaccine. It’s about the responsibility to make sure that I don’t make my patients sick.”

In looking ahead to next year’s influenza season, we will certainly see lots of changes, to include the introduction of  quadrivalent influenza vaccines that will cover four influenza strains as opposed to the three that previous vaccines have been limited to.  Back in April, I participated in a special VIC Network webinar that discussed concerns about the effectiveness of 2012-2013 influenza vaccine and reviewed the new vaccine options that will be available next season.  It was very informative and something that readers can download for more specifics about the new influenza vaccines we’ll be seeing in the year ahead.

Once again, I’m encouraged by the public health community and their effort to evaluate influenza vaccination policies and find ways to reduce the impact of seasonal flu upon on our society.   Hopefully, as we continue to promote a universal influenza vaccination policy, we will continue to see a reduction in the number of flu-related illnesses and deaths, as well as an emphasis on better health among everyone within our communities.

Fear and Funnies During our Family Flu Shots

November 2, 2012 6 comments

I did it.  I finally did it.  I got all my kids their flu shots last week, despite the many obstacles we encountered along the way.  While it involved some anticipated anxiety, in the end, enduring humor conquered irrational fear.

For the past few years, we’ve been able to walk into a nearby clinic without an appointment, get the FluMist and within 15 minutes walk out knowing that we were doing our part to help prevent the spread of the flu.

Unfortunately, this year hasn’t been so easy.  Having recently moved, I had to establish new care before a doctor would administer a flu shot for my kids.  Since the earliest appointments I could make were over two months away, I spent September and most of October worried that my children would fall victim to influenza before having the chance to be vaccinated. (This actually happened the last time we moved, when my then 8-year-old daughter fell sick with the flu in September).

At first I figured I could just take the kids to the local pharmacy for their shots.  But then I learned that pharmacies in the state I live in can only vaccinate children over the age of fourteen.  Since four of my five kids fall within that category, I was out of luck.

But last week, our day at the doctor’s had finally come and I was relieved to know that my entire family would soon be vaccinated against the flu.

On the way to the appointment, I was chuckling inside as my seven-year old daughter tried to reassure my sixteen year old daughter who was expressing reservations about the shot.  I heard my own mantra repeated in her words of comfort as she explained, “It’s just a pinch and then it’s over.” Read more…