Talk:Influenza vaccine

"Killed virus"

"Flu vaccines are available both as an injection of killed virus..." One can't actually kill a virus because they're generally not alive to begin with. (There probably could be an organism that puts its genetic material into a host cell the same way, but influenza is not that organism.) Can anyone write up the actual manufacturing process? --Nate3000 (talk) 22:19, 1 January 2008 (UTC)

• I think they mean "attenuated"--ZayZayEM (talk) 03:58, 3 January 2008 (UTC)
• or not.--ZayZayEM (talk) 03:59, 3 January 2008 (UTC)

Just to lend my opinion, today when I got my 'flu shot, a brochure said the same thing about a "Killed specimen suspended in a chicken embreyo' (Something like that) I thought back to my biology lectures.... RNA creatures cant live without a host cell... but the embreyo... could that be the virus's host? I know too little to be of help, but too much to be dangerous63.136.112.36 (talk) 02:50, 11 December 2008 (UTC)

I'm not an expert in the field, however killed viruses are not attenuated. They are strains of the virus which would normally be able to cause flu in humans. However, they are killed (often by treatment with formaldehyde, though I'm not sure what the standard way is for the flu vaccine) making them unable to replicate in the human cells. Attenuated viruses can also be used to vaccinate, these viruses are still able to infect cells, but are not 'virrulent' strains. They are either unable to replicate very efficiently, or aren't able to infect the cells where they cause the disease symptoms. Also, the definition of life gets a bit blurred when you get the the viral level. A virus can't replicate on its own without cells to help it, but it can replicate and evolve. If you don't like the commonly used term "killed" then use "inactivated" --163.1.159.98 (talk) 14:09, 15 February 2009 (UTC)

Side effects?

I was hoping to find some information here about the contents of the vaccine (beyond it being grown in eggs), and peoples' adverse reactions to it. The CDC says (http://www.cdc.gov/flu/protect/keyfacts.htm) that the only mild side effects are low-grade fever and aches (and pain where the shot was given). The CDC has a program to compensate people with worse reactions to the vaccine, but what are these reactions? Also, does the vaccine lower one's immune system for a time? Thanks. - unsigned and a vaccination can kill manys diseases

The annually updated trivalent flu vaccine for the 2006-2007 season consists of hemagglutinin (HA) surface glycoprotein components from influenza H3N2, H1N1, and B influenza viruses (sometimes called killed or purified virus). Flu vaccines are also available as nasal spray of live attenuated influenza virus (LAIV) (sold as FluMist). Both types of flu vaccines are contraindicated for those with severe allergies to egg proteins and people with a history of Guillain-Barré syndrome. See Thiomersal controversy regarding the mercury content in the standard annually updated trivalent flu vaccine. It was listed as part of the contents on the bottle containing the flu vaccine I was injected with this month. I had zero negative reaction, as do most people. See Allergy for the meaning of "worse reactions to the vaccine". The point of a vaccine is to improve the immune system with regard to the specific thing being vaccinated against. WAS 4.250 22:48, 26 November 2006 (UTC)

Giant quote without paragraph marks

The quote in the section Flu vaccine virus selection is over a screen long without any paragraph indentations. It's unreadable! Pigkeeper 17:00, 4 April 2006 (UTC)

Good point I'll modify it. Tell me if you like the modification. WAS 4.250 17:17, 4 April 2006 (UTC)

NPOV?

Is this NPOV? Parts of this article, in particular, "Injected flu vaccine was grown in fertilized chicken eggs as is the new FluMist nasal spray vaccine produced by MedImmune. FluMist causes a more durable immune response and is therefore more effective than injected vaccine was. It is the recommended type of flu vaccination for all healthy people ages 5 to 49 and contraindicated for those with allergy to egg proteins." read like a press release. -Unknown

This passage is very poorly written. "vaccince was grown" "as is the new" "and is therefore" "injected vaccine was". Holy verb tense Batman! -Unknown

Risks

I'm not disputing whether there are risks or not, but there's no citation for "However, flu vaccine is not routinely administered to children under the age of 2". Where I live (BC, Canada), the flu vaccine is recommended and funded for all children between 6 months and two years. --Westendgirl 21:27, 2 November 2005 (UTC)

This page is biased towards vaccination, and does not inform of the proven link to Guillaine Barre syndrome, quiet apart from the many articles showing the total ineffectiveness of flu vaccination. 86.128.169.252 20:38, 11 December 2005 (UTC)

Mercury content in flu shots?

I keep hearing this, but I fail to see any studies showing mercury content, or even if there is, that it's unnecessary for conveying the drug. I'm researching this for the Joseph Mercola article I'm expanding. Tyciol 15:12, 7 March 2006 (UTC)

I changed the see also reference to read "Thimerosal is controversial mercury-containing organic compound used as an antiseptic and antifungal agent in vaccines." WAS 4.250 16:15, 7 March 2006 (UTC)

Efficacy of pre-pandemic H5N1 vaccines

Actually the chances are that current H5N1 vaccines would give a fair bit of protection, all the experts say so, but governements have been exaggerating the potential for mutations to arise rendering the vaccines ineffective, as they do not want to pay for widespread vaccination if they can avoid it and they do not want the general public to panic and demand vaccinations that have not been fully developed yet. John Oxford, one of the UKs top experts was quoted on the BBC's Newsnight programme saying that although there was a chance that current vaccines wouldn't work on the pandemic flu, there was a good chance they would and that he would jump at the chance to have a pre-pandemic H5N1 vaccination. - unsigned

A prepandemic vaccine is better than no vaccine, and that is why prepandemic vaccines are undergoing clinical trials as we speak. No one is exaggerating the potential for mutations to render vaccines ineffective; the fear is rational and based on facts covered in our articles. You might care to read Flu research and H5N1 clinical trials. WAS 4.250 14:39, 23 May 2006 (UTC)

I basically agree, I guess it depends on the way in which H5N1 mutates to infect humans, if it is through hybridisation there could be a dramatic change (though I guess one would hope that there might be some immunity left in the population to the human half) whereas if there are just a few changes in RNA, immunity arising from existing vaccines would have a much better chance of providing some degree of protection against pandemic H5N1. NB I slightly re-worded that sentence again, what do you think?--Hontogaichiban 00:29, 24 May 2006 (UTC)

I have zero problem with your latest change. Thanks for helping out. It is a big burden to try to keep current and accurate for no pay. I welcome even more help (just be sure to provide sources). WAS 4.250 02:10, 24 May 2006 (UTC)

History

When I read this I was really hoping to hear about the history of the vaccine. When it first came around, who invented it, or what country first started using it. Also when it became standard to distribute and administer it in the various countries that have access to it. How long it took to become accepted and trusted. None of those questions are answered. It's as though it fell from the sky one day. Could someone with some knowledge create a section about the vaccine's history please? Thanks in advance. - User talk:Quadzilla99

I'll add something. WAS 4.250 17:49, 27 July 2006 (UTC)

Wow, that's great. Nice to have people like you around. User talk:Quadzilla99 18 July 2006.

Bracket around the p

User:WAS 4.250: On my computer I saw

1918, "[p]hysicians tried

with an unnecessary set of square brackets around the p. What do you see? What browser do you use? I use Firefox. Paul Studier 20:34, 8 September 2006 (UTC)

The source says:

"Physicians tried everything they knew, everything they had ever heard of, from the ancient art of bleeding patients, to administering oxygen, to developing new vaccines and sera (chiefly against what we now call Hemophilus influenzae—a name derived from the fact that it was originally considered the etiological agent—and several types of pneumococci). Only one therapeutic measure, transfusing blood from recovered patients to new victims, showed any hint of success."

Our paragraph says:

"In the world wide Spanish flu pandemic of 1918, "[p]hysicians tried everything they knew, everything they had ever heard of, from the ancient art of bleeding patients, to administering oxygen, to developing new vaccines and sera (chiefly against what we now call Hemophilus influenzae—a name derived from the fact that it was originally considered the etiological agent—and several types of pneumococci). Only one therapeutic measure, transfusing blood from recovered patients to new victims, showed any hint of success.""

The brackets denote something within the quote that is not quoted.

We could use:

"In the world wide Spanish flu pandemic of 1918, physicians "tried everything they knew, everything they had ever heard of, from the ancient art of bleeding patients, to administering oxygen, to developing new vaccines and sera (chiefly against what we now call Hemophilus influenzae—a name derived from the fact that it was originally considered the etiological agent—and several types of pneumococci). Only one therapeutic measure, transfusing blood from recovered patients to new victims, showed any hint of success.""

or:

"In the world wide Spanish flu pandemic of 1918, "Physicians tried everything they knew, everything they had ever heard of, from the ancient art of bleeding patients, to administering oxygen, to developing new vaccines and sera (chiefly against what we now call Hemophilus influenzae—a name derived from the fact that it was originally considered the etiological agent—and several types of pneumococci). Only one therapeutic measure, transfusing blood from recovered patients to new victims, showed any hint of success.""

Any choice that does not misrepresent the source is fine with me. WAS 4.250 23:49, 8 September 2006 (UTC)

I misunderstood the purpose of the bracket. It looked like someone tried to wikify the letter p. I prefer "Physicians ...", so I left it that way. Paul Studier 00:39, 9 September 2006 (UTC)

Criticism on studies

I added, once again, the criticism on the flu vaccine studies. A user delted this with the comment "revert people saying OMG maybe you need to pay us to study how effective this stuff is"... if you have real arguments against this study published in the October 28, 2006 issue of the British Medical Journal or arguments why this should not be stated here (remember, its a scientific study published in a famous medical journal and fitting to this subject, so I think it should be stated in this article) please post it here and let us all decide together... thx. Ogno 07:02, 30 October 2006 (UTC)

I reverted your unencyclopedic adition. Add a section on known limitations of flu vaccine if you wish, but adding "this report says it needs more study" is for a newspaper not an encyclopedia. Scientists want to study everything more. And to the extent vaccines match expectations depends on your expectations and the experts are well aware of the limitations of flu vaccines. The fact that most people are not recommended to get one and most people don't, indicates the limitations are well known. WAS 4.250 17:46, 30 October 2006 (UTC)

I did not add "this report says it needs more study", I wrote "a study was published which challenges the conclusiveness of Flu vaccination studies"... this sounds very encyclopedian to me. Anyway... I'm very sorry you simply ignore the wikipedia rules and again change the article in this matter without further discussion... I'll try and setisfy you with a new version and hope you won't simply change it again or I'll be forced to inform an admin. Ogno 21:56, 30 October 2006 (UTC)

Add a section on known limitations of flu vaccine if you wish. "A study was published which challenges the conclusiveness of Flu vaccination studies" is GARBAGE because it is a straw man because no expert claims "conclusiveness" in the first place. The right thing to do with GARBAGE is throw it away. Which I did and will do again. WAS 4.250 23:58, 30 October 2006 (UTC)

Since you simply delete the section again and again without discussion and do not accept a scientific study to be entered into wikipedia, you have been warned that you violate the WP:3RR. If you delete the section once more I will report you to the admins. Ogno 00:54, 31 October 2006 (UTC)

May I recommend a third party get involved? Mediation? WAS 4.250 01:06, 31 October 2006 (UTC)

Violation of WP:3RR by User WAS 4.250 was reported at WP:AN/3RR. Third party is involved now, as wished... Ogno 01:43, 31 October 2006 (UTC)

Moving towards consensus on clinical studies of influenza vaccination

Hi everybody. Rather than produce a unstable article with reverting, could we reach a consensus wording on the talk page and then insert it into the article? TimVickers 02:05, 31 October 2006 (UTC)

The editorial under discussion is here There are several clinical trials it references, three of the most recent are Study 1, Study 2 Study 3

Unfortunately I can't get access to the third study at home, but I should be able to download the Pdf tomorrow and e-mail it to everybody.

I'll be happy to work on a consensus and I have no problem with other versions of the text! Please post your proposals here and I'm pretty sure I will be happy with it as long as the study simply is mentioned in some way in this article as I think it is a scientific opinion that should not be ignored and at least made avaliable to people who are interested in flu vaccine for them to make up their own opinion. greetings Ogno 02:14, 31 October 2006 (UTC)

I'll agree to whatever Tim thinks is the right solution to our disagreement. WAS 4.250 08:30, 31 October 2006 (UTC)

Something I found confusing reading these studies was the difference between efficacy and effectiveness. I've looked it up and Efficacy is the relative reduction in susceptibility to infection, given a specified exposure to infection under ideal controlled conditions. Effectiveness is the expected reduction in infection, when an individual decides to undergo vaccination under ordinary field conditions of public health program. TimVickers 02:31, 31 October 2006 (UTC)

Text under discussion

Define outcomes - Vaccines are measures in terms of the reduction of the risk of disease produced by vaccination, their efficacy.

Meta-analyses of clinical studies - Findings of studies.

Limitations of studies - Studies on the effectiveness of flu vaccines are uniquely difficult. The vaccine may not be matched to the virus in circulation, virus prevalence may vary widely between years and influenza may be confused with other flu-like illnesses. Thus high-quality clinical trials are difficult in patient populations under normal conditions.

Future work - Improved surveillance to give more accurate picture of incidence and which strains are causing disease; better trials using randomised, double-blind placebo-controlled protocols.

Source check

Where does the 40% efficacy for the 2007 vaccine come from? Who is Dr. Larsen? This source is questionable. —Preceding unsigned comment added by 24.9.62.31 (talk) 05:39, 28 March 2008 (UTC)

http://www.cdc.gov/od/oc/media/transcripts/2008/t080208.htm says that 42% of the flu cases where caused by (H1N1) and that 96% of those were "well covered by the vaccine strain". Seems to me that the 40% probably comes from that CDC claim. Sound ok to me. WAS 4.250 (talk) 07:40, 28 March 2008 (UTC)

Quackery

Since the benefits of flu vaccines (effectiveness) are largely unproven under real life conditions, it seems to me that flu vaccines qualify under quackery as Stephen Barrett defines them. I realize this will be immediately deleted, and I have no wish to get into an edit war about it, but if the area of medical intervention is to employ a meaning of quackery consistently, then we should do a thorough review of all medical claims that are of dubious merit, even if the intentions (as with flu vaccines) surely are good. --Leifern 22:01, 29 November 2006 (UTC)

Some would say the intentions are to make enormous profits.24.5.188.169 (talk) 01:06, 9 December 2008 (UTC)

If you read the data, flu vaccines do have benifits to some groups of people. Just because they are often misprescribed does not make the treatments themselves quackery. After all, doctors often prescribe antibiotics for colds, but this does not make antibiotics a quack remedy. I would recommend removing this categorisation. TimVickers 22:11, 29 November 2006 (UTC)

I removed the category myself, without any prompting and feel bad that I in a moment of ill temper, resorted to making a point. But, the point is still valid. The flu vaccine is proven to be effective provided the strain is accurate, which it hardly ever is. But still, lots of health care professionals recommend the flu to all kinds of people and overpromise on the benefits, which according to Barrett and others, amounts to quackery. --Leifern 22:26, 29 November 2006 (UTC)

You know, it may not be the right strain for this year, but ten years from now it may be. This has happened in the past. So you may not see the immediate result, but you may not get sick ten years from now when onthers are. Will you recall all the strains you have been vaccinated against or even know what strain others are getting that year, perhaps not. The value is still there. The fewer times these viruses have to be treated with antibiotics that they become imune to the better.

It's a subtle point, but if an effective treatment is misused, this certainly doesn't make the treatment itself a quack remedy. The actions of doctors can either be argued to be ill-informed, or to be an example of a precautionary approach, but even here it seem stretching a point to describe their actions as quackery. TimVickers 22:36, 29 November 2006 (UTC)

Flu vaccines are used in prized horses as well as in commercial chicken farming. And those aren't even as high quality as the ones made for humans. WAS 4.250 00:38, 30 November 2006 (UTC)

Need section on safety

This article needs a section of safety. We should not have any article in Wikipedia on medicine without discussing both safety and efficacy, and in this case effectiveness. --Leifern 20:36, 1 December 2006 (UTC)

Safety, efficacy, and effectiveness of medine deserves mention at medicine; of vaccines (as a particular medicine) deserves mention at vaccine; of flu vaccines (but not vaccines in general) deserves mention at flu vaccine. Extended details need their own articles. "See also" is good for linking to issues that affect all vaccines. WAS 4.250 21:28, 1 December 2006 (UTC)

I think just putting Vaccine controversy in Flu vaccine#See also is not sufficient (and therefore NPOV). I added a Template:For to Flu vaccine#Who should get it, but I'm not sure that's the best place for a link. Vagary 07:25, 7 November 2007 (UTC)

Side Effects

I don't see a section on side effects of the flu vaccine ! Octopus-Hands 00:29, 5 December 2006 (UTC)

Point Of The Article

I just finished reading this entry and I must say that the general feeling that I perceived from the article is that the Flu Vaccine is not effective. I found this shocking and honestly, this article is probably not written in the best interest of public health. It seems that the article was written with an extreme bias against the vaccine and I just can't comprehend why. Anyone can produce studies that show the ineffectiveness of anything, but at the same time, an encyclopedia should try its best to ignore opinions and bias and report the facts. I mean, there has got to be a reason that 50-100 million (or more) people in the United States alone every year are encouraged to get the shot. After reading this article it's as if all these people are just wasting their time, and i'm pretty sure that is simply not the case.(68.161.188.144 02:53, 15 December 2006 (UTC) AR)

Getting a flu shot is like looking both ways before you cross a street. Please identify any passage that makes getting a flu shot seem less useful than that. WAS 4.250 05:11, 15 December 2006 (UTC)

Reported deaths per year

I would like to see the statistics that contribute to this statement regarding "people killed by annual flu" statement heading the "flu vaccine" entry:

"The annual flu kills an estimated 36,000 people in the United States each year."

Not only is the wording redundant (annually each year), the "Influenza" wiki page mentions those deaths are "associated" directly with influenza, but not flat out due to the flu.

Being my first wiki clarification, I'm not geared for any citation or wiki-writing. I came across this page http://www.lightparty.com/Health/FluScare.html which has many articles and citation titles from both the CDC and various medical and statistical organizations (which are no doubt still in circulation and can be found with the dates and titles given), that demonstrates a breakdown of the numbers of deaths typically attributed to merely the flu, and how many are in fact from pneumonia, whether caught due to flu or otherwise. I'd rather this article provide a more neutral perspective than repeat the CDC's and WHO's media numbers. Thank you. —The preceding unsigned comment was added by 64.92.166.187 (talk) 02:54, 17 March 2007 (UTC).

The CDC and WHO are as neutral as neutral gets. The numbers cited are based on the best known evidence according to the best known experts such as CDC and WHO accredited experts. On the other hand if you have people who dispute their expertise, what actual real world results do they have to prove their so called expertise? Did they end smallpox???? WAS 4.250 04:03, 17 March 2007 (UTC)

The first entry raises a very good point. The numbers DO NOT add up. Here is a quote from the page that is referenced above: "The flu kills fewer than 1,000 people on average, not 36,000 • Flu Vaccine is of highly dubious effectiveness • The CDC and Vaccine Manufacturers are in closed door sessions with the primary stated purpose of boosting vaccination numbers by spreading fear" (lightparty.com/Health/FluScare.html). The CDC and WHO are NOT disinterested, objective parties but are big players on the world-wide stage and interested ONLY in the BOTTOM LINE. Please read and become educated. Here is an article I found relaying the same information: http://www.bmj.com/cgi/content/full/331/7529/1412. —Preceding unsigned comment added by Driftingash (talk • contribs) 03:57, 25 November 2007 (UTC)

flu vaccine grown in insect cells shows promise

“While we certainly hoped and expected the vaccine to be protective, you don’t know that until you actually test it. We’ve shown that the vaccine does work in the real world.” [1] Brian Pearson 02:43, 12 April 2007 (UTC)

You could put a sentence or two about their human trial results at flu research if you like. WAS 4.250 10:55, 12 April 2007 (UTC)

I've added a bit to cell culture[2] in flu research. Brian Pearson 14:39, 15 May 2007 (UTC)

Universal vaccine, human trials

The goal for this vaccine is that two inoculations would suffice to protect people against all ‘A’ strains of flu. [3] Brian Pearson 18:53, 17 July 2007 (UTC)

Read H5N1 clinical trials#Current Status of H5N1 Candidate Vaccines WAS 4.250 20:44, 17 July 2007 (UTC)

I see it, thanks. I do hope it works. Brian Pearson 01:57, 18 July 2007 (UTC)

"Discovery may help defang viruses"

By replacing this key residue with different amino acids, the researchers were able to generate mutants of the virus that are essentially harmless. "We found that very subtle changes in the chemistry at this location of the polymerase has dramatic effects on weakening the virus," said Cameron (Craig Cameron, the Paul Berg professor of biochemistry and molecular biology at Penn State), who has a provisional patent on the technique. [4] Brian Pearson 01:57, 29 August 2007 (UTC)

Proposed move → Influenza vaccine

Part of an effort to expand these titles where appropriate.--ZayZayEM 03:34, 13 September 2007 (UTC)

Support Vagary 07:28, 7 November 2007 (UTC)

Ordinary seasonal flu vaccination might provide some protection in an H5N1 pandemic

"Seasonal Flu Vaccination May Offer Partial Immunity to H5N1" reports Eric Toner, M.D. summarizing research studies revealing the protective effect of seasonal flu vaccinaton against H5N1. Dr. Toner reports for Clinitians' Biosecurity Network. Dr. Toner's report is available at: http://www.upmc-cbn.org/report_archive/2007/02_February_2007/cbnreport_02212007.html

At least two separate human studies to date indicate that annual flu shots may be protective against H5N1. In one, scientists from St. Jude's, summarize findings in animals and humans and conclude that

"Overall, these findings raise the possibility that seasonal influenza vaccination may provide some protection against pandemic H5N1l."

RESEARCH ARTICLE

Cross-Reactive Neuraminidase Antibodies Afford Partial Protection against H5N1 in Mice and Are Present in Unexposed Humans http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0040059&ct=1&SESSID=1386b277eb2b6128495454737b76f5d2

These studies suggest that it is prudent for individuals to seek vaccination for themselves and their families, and for governments to promote wide vaccination to create a herd immunity effect to slow contagion until more specific vaccines can be developed.

Seasonal flu vaccines (including FluMist) include an H1N1 strain with its N1 antigen, and "bird flu" H5N1 also has an N1 antigen. Italian scientists were curious whether the inclusion of an N1 antigen from each season's H1N1 might result in protection against the N1 antigen in an H5N1 strain. An experiment was done exposing the blood of vaccinated and unvaccinated humans to H5N1 (in a test tube) and the blood of vaccinated humans showed more immune response. "We also observed that seasonal vaccination is able to raise neutralizing immunity against influenza (H5N1) in a large number of donors." http://www.cdc.gov/eid/content/14/1/121.htm

An in vivo test found that mice immunized against the seasonal influenza developed substantial immunity against H5N1.http://www.newscientist.com/channel/health/bird-flu/mg19626273.700-drug-brings-hope-for-a-universal-flu-vaccine.html In this experiment, dead influenza A viruses from the H1N1 and H3N2 families in combination with Ampligen was administered nasally to mice. These are seasonal flu antigens, not pandemic H5N1 antigens. When the researchers then infected the mice with H5N1, the unvaccinated mice all died, but half or more of the nasally vaccinated mice lived. Immune response developed from nasal administration of ordinary seasonal flu antigens with Ampligen was protective against H5N1. By extension, one could hope that FluMist's inclusion of seasonal antigens taken from each season's H1N1 and H3N2 might result in immunity broad enough (and long-lasting enough) to provide FluMist-vaccinated persons with at least some protection against an H5N1 strain. This animal study supports breadth of immunity, particularly perhaps that elicited by an N1 antigen, as a third possible mechanism by which seasonal FluMist inoculation might provide at least some protection against an H5N1 "bird flu" pandemic when one emerged, and without the long delay inherent in current vaccination schemes. Such pre-existing immunity might protect the vaccinated individuals and their families, and a large percentage of vaccinated in the population might also slow the progression of a pandemic through the population while specific vaccines were being developed.

bias?

this page practically screams "get the flu shot". just thought I'd let you know. A little fact on the downside might me nice. --Toyboxmonster (talk) 14:30, 20 January 2008 (UTC)toyboxmonster

Universal Influenza vaccine

At the moment, a universal influenza vaccine is also being developed. Please describe it in all article sections and do a rewrite. See this site for more information. Thanks.

KVDP (talk) 09:16, 7 February 2008 (UTC)

Low hospital staff vaccination rates kill patients

• please add cites to prepare this stub for inclusion among advantages of vaccination.

A study announced in around 2006 that hospitals that increased vaccination rates among Health Care Workers (HCW) sharply decreased all-cause disease complications and deaths in inpatients.

Influenza vaccination of HCWs not only reduces the disease burden in those vaccinated, but also has been shown to reduce the rate of influenza disease and overall mortality in the patients under their care.[1,3]

Despite this study, health care worker (HCW) vaccination rates remain abysmally low.

Despite local and national efforts to encourage influenza vaccination, the overall vaccination rate among HCWs in the United States remains unacceptably low at approximately 40%.[4]

Patients have little access to hospital staff vaccination rates, which strongly affect expected outcomes.

Staff providing vaccination refusal forms often write that they show no symptoms, and so believe themselves immune. But symptomless isn't necessarily the same as non-infectious. Recent research showed that a substantial percentage (18%?) of those exposed to flu have no symptoms, and hence fail to realize they are infected, but are nonetheless contagious to those around them. For hospital staff with strong immune systems, those around them would mean unknowingly infecting patients and family members who might not have such strong immunity.

Anonymous polls of hospital staff also revealed shocking ignorance about the basics regarding the well-established effectiveness of influenza vaccination, the comparatively infrequent experience of side effects, and the mildness of effects when compared to influenza symptoms.

As we move through 2008, patients, hospital staff, and administrators probably don't realize that two exceptionally nasty seasonal influenza strains -- H1N1 Brisbane and H3N2 Brisbane -- are expected this year, are highly contagious, and are covered by this year's shot or Flumist vaccination.

Almost no hospital staff or administrators are aware of a number of recent studies suggesting that the seasonal influenza vaccination causes heightened immunity to H5N1, which can be seen when the blood of the vaccinated volunteers is tested in vitro. Only 85% of hospital staff claimed to have heard of pandemic influenza at all, but those that have would likely recognize even slight protection for themselves, their families, and their patients (and co-workers) as advantageous. In this regard, some studies indicate that immunization with live vaccines (Flumist) produce a longer-lasting immunity than flu shots.

Since hospitals were epicenters for infection during the less-contagious SARS outbreak, having any immune advantage in place that might reduce contagion during a pandemic is a public health issue beyond the usual advantages of vaccination in non-pandemic years.

If staff and hospital administrators were generally aware of these studies, they might increase vaccination rates for altruistic motives, family protection, and self protection. Individual HCW are protected when co-workers are vaccinated, so that all benefit from overall high vaccination rates. A hospital could also gain a competitive advantage against other hospitals with low vaccination rates by providing and publicizing superior patient outcomes.

—Preceding unsigned comment added by 69.3.11.88 (talk) 15:40, 10 April 2008 (UTC)

GA review

Regrets, but this is a quick fail due to NPOV issues. See the review for a few easy things that can be done to help the article, apart from fixing the NPOV. --Una Smith (talk) 02:47, 4 September 2008 (UTC)

NPOV dispute

Due to more than one editor commenting that this article is biased toward one point of view, I've marked the article with a POV tag. To help focus improvements to the article, I'd like to ask editors who feel this way to volunteer 1) what the other points of view are, 2) who holds those points of view, and/or 3) sources to use as references for those points of view. Per WP:UNDUEWEIGHT the article should give proper weight to minority points of view, but only if they're significant. For example, there is no NPOV problem with the article on Earth "screaming" that the Earth is round, because the opposing viewpoint is held by an insignificant minority. Matt Fitzpatrick (talk) 06:20, 4 September 2008 (UTC)

No claims backed by reliable sources about the subject of this article have been identified as missing from the article as of yet. Do you have a reliable source for a claim that is not adequately represented in this article? It is a fact that flu vaccines have limited uses, but we say that. There are controversies and we point readers to article about those controversies (at least we did last time I looked). Original research and popular misconceptions are inappropriate for this article. Correcting popular misconceptions is appropriate. Most people that I have seen write about problems with flu vaccination, other than the scientists paid to do research on the subject, do not have an adequate grasp of the facts involved. Many are simply frauds trying to get people to buy their quack medicine. People who have undue skepticism about flu vaccination should research animal flu vaccination and see what happens when billions of dollars are at stake. WAS 4.250 (talk) 02:19, 5 September 2008 (UTC)

Nope, anti-vaccine stuff really isn't something I'm familiar with, which is why I'm asking for clarification from the people who are saying the article is biased. I was the one who gave the article a good article nom, but perceived bias was standing in the way. There's also at least one old claim of bias on this discussion page. Matt Fitzpatrick (talk) 09:31, 6 September 2008 (UTC)

To understand some of the POV issues with this article, let's first take a step back and look at the big picture. In each country, government recommendations to use or not use a vaccine are based on a detailed cost benefit analysis. Usually that analysis is published in a major medical journal. Factors that go into the analysis include the cost of the vaccine, cost of administering the vaccine, cost of obtaining the vaccine (eg, hours away from work to get the vaccine) and the cost of care and lost work due to the many low grade infections that may result from the vaccine. On the other side of the equation, there is the cost of lost work due to wild influenza flu infection, etc. etc. This article jumps right into the benefits of vaccination without any discussion of the costs, and without regard for the fact that results of cost benefit analyses can vary significantly between countries. In that respect, the article also fails GA on the grounds that it is not sufficiently broad; the article could do to be tagged {{globalize}}. Look at some of the other vaccine-related articles that are GAs. --Una Smith (talk) 20:18, 7 September 2008 (UTC)

To whit, these:

• Polio vaccine (GA class)
• Rotavirus vaccine (Start class, split off Rotavirus during its successful push to FA)

I do not support this articles GA nom - but I do not think throwing in anti-vaccination material will be appropriate to fixing its issues (WP:FRINGE, WP:UNDUE). Along the lines of Una Smith - this article needs further globalization, more background on steps in pre-production and production of vaccines, and a little less sounding like a WHO/CDC fact sheet/propoganda piece on why you should vaccinate. Not sure it should be done in a analytical way of cost/benefit (that sound like OR). Just the facts ma'am.--ZayZayEM (talk) 01:30, 8 September 2008 (UTC)

Published cost/benefit analyses exist for rotavirus vaccine, chickenpox vaccine, and others. Surely they exist for influenza virus as well. --Una Smith (talk) 03:34, 8 September 2008 (UTC)

Just making sure edits will report the outcomes of these analyses, not try and perform analysis themself (or cherrypick positive analyses only).--ZayZayEM (talk) 07:17, 8 September 2008 (UTC)

The globalize and ad tags are valid. The article would be better with additional sourced data reflecting the less developed world; toning down some of the ad like language (we regularly get flu mist promotional edits); and copy-editing by someone with excellent article writing skills. WAS 4.250 (talk) 07:31, 8 September 2008 (UTC)

I don't think tagging the entire article as reading like an advertisement will help focus the NPOV efforts any better than the vague POV complaints already stated. I tentatively moved the tag to the "efficacy" section, the only section that mentions mist; if that's not the right place for it, or other specific sections also have POV problems, please add tags as needed. Matt Fitzpatrick (talk) 05:08, 20 September 2008 (UTC)

On second glance, I copied the advertisement tag to the "who should get it" section, which, on its face, appears to have at least some element of unattributed POV. Matt Fitzpatrick (talk) 05:15, 20 September 2008 (UTC)

Somewhere, the information needs to be include about who vaccination is included for (including, by necessary inference, who it's not recommended for). The article begins with a cross reference to controversy, and the next section is about side effects.

I wish some of the guardians against ad copy would take a look at Wikipedia'sSmokingarticle, which actually is ad copy. All mention of health effects are moved to a separate article on "Health Effects of Smoking" and all links to that separate article are removed.

Given that the Vaccine is general given with the sole purpose of inducing a health effect, I do not think transferring such material to another page would be entirely useful.--ZayZayEM (talk) 07:16, 22 September 2008 (UTC)

It's NOT ad copy -- tagger has problems with the truth

Note the tagger takes no issue with the rather overwhelming advantages of vaccination relative to the costs and risks. Instead, the implication is this: since this article notes that the benefits outweigh the costs, then therefore, the article must surely be ad copy.

To the contrary, since the benefits in fact greatly outweigh the costs, the tagger is angling to gin up fake controversy by tagging it as lacking neutrality. The "all vaccine bad" quacks have their own profit models. The truth is their enemy. The "this is advertising" tag attacks the truth here. It should be removed. —Preceding unsigned comment added by 68.166.204.226 (talk) 21:41, 5 October 2008 (UTC)

I've removed the "reads like an advertisement" tag. I can't say for sure if both sides are presented with optimal fairness, however the section does not have the tone of an advertisement and is not entirely one-sided. Clayoquot (talk | contribs) 00:14, 20 October 2008 (UTC)

If it read like blatant advertising it would be blanked. There is no issue with the facts being presented. they are presented in a manner, tone, and selective fashion (i.e. focusing overwhelming on Flumist) that seems more relevant to a advertisement (albeit one that conforms to necessary codes) than an encyclopedic article.--ZayZayEM (talk) 00:43, 20 October 2008 (UTC)

Here's a cost-benefit analysis by specialized experts at the CDC

Here's a discussion of a number of cost-benefit analyses by a panel of specialized experts at the CDC, excerpted from a longer document regarding vaccination recommendations at:

(HT -W3 etc) cdc.gov/mmwr/preview/mmwrhtml/rr57e717a1.htm

The analyses discussed seem in general to conclude that influenza vaccination is cost-beneficial, although some studies seem to consider primarily illness/mortality and others primarily economic costs.

I know of no studies that have considered the added cost-effectiveness of the possible preventive benefits of ordinary seasonal vaccine against later outbreaks of pandemic influenza (and these experts cite none).

---

Cost-Effectiveness of Influenza Vaccination

Economic studies of influenza vaccination are difficult to compare because they have used different measures of both costs and benefits (e.g., cost-only, cost-effectiveness, cost-benefit, or cost-utility). However, most studies find that vaccination reduces or minimizes health care, societal, and individual costs, or the productivity losses and absenteeism associated with influenza illness. One national study estimated the annual economic burden of seasonal influenza in the United States (using 2003 population and dollars) to be $87.1 billion, including $10.4 billion in direct medical costs (303).

Studies of influenza vaccination in the United States among persons aged >65 years have documented substantial reductions in hospitalizations and deaths and overall societal cost savings (186,187). Studies comparing adults in different age groups also find that vaccination is economically beneficial. One study that compared the economic impact of vaccination among persons aged >65 years with those aged 15--64 years indicated that vaccination resulted in a net savings per quality-adjusted life year (QALY) and that the Medicare program saved costs of treating illness by paying for vaccination (304). A study of a larger population comparing persons aged 50--64 years with those aged >65 years estimated the cost-effectiveness of influenza vaccination to be $28,000 per QALY saved (in 2000 dollars) in persons aged 50--64 years compared with $980 per QALY saved among persons aged >65 years (305).

Economic analyses among adults aged <65 years have reported mixed results regarding influenza vaccination. Two studies in the United States found that vaccination can reduce both direct medical costs and indirect costs from work absenteeism and reduced productivity (306,307). However, another United States study indicated no productivity and absentee savings in a strategy to vaccinate healthy working adults, although vaccination was still estimated to be cost-effective (139).

Cost analyses have documented the considerable cost burden of illness among children. In a study of 727 children at a medical center during 2000--2004, the mean total cost of hospitalization for influenza-related illness was $13,159 ($39,792 for patients admitted to an intensive care unit and $7,030 for patients cared for exclusively on the wards) (308). Strategies that focus on vaccinating children with medical conditions that confer a higher risk for influenza complications are more cost-effective than a strategy of vaccinating all children (309). An analysis that compared the costs of vaccinating children of varying ages with TIV and LAIV indicated that costs per QALY saved increased with age for both vaccines. In 2003 dollars per QALY saved, costs for routine vaccination using TIV were $12,000 for healthy children aged 6--23 months and $119,000 for healthy adolescents aged 12--17 years, compared with $9,000 and $109,000 using LAIV, respectively (310). Economic evaluations of vaccinating children have demonstrated a wide range of cost estimates, but have generally found this strategy to be either cost-saving or cost-beneficial (311--314).

Economic analyses are sensitive to the vaccination venue, with vaccination in medical care settings incurring higher projected costs. In a published model, the mean cost (year 2004 values) of vaccination was lower in mass vaccination ($17.04) and pharmacy ($11.57) settings than in scheduled doctor's office visits ($28.67) (315). Vaccination in nonmedical settings was projected to be cost saving for healthy adults aged >50 years and for high-risk adults of all ages. For healthy adults aged 18--49 years, preventing an episode of influenza would cost $90 if vaccination were delivered in a pharmacy setting, $210 in a mass vaccination setting, and $870 during a scheduled doctor's office visit (315). Medicare payment rates in recent years have been less than the costs associated with providing vaccination in a medical practice (316).

—Preceding unsigned comment added by 67.101.142.218 (talk) 21:33, 10 October 2008 (UTC) 30

This section is NOT written as an advertisement. Please DON'T rewrite to advertise the tagger's anti-science views.

This section is NOT written as an advertisement. Please DON'T rewrite to advertise the tagger's anti-science views.

If the tagger has studies with contradicting the well-conducted studies showing vaccines work, let him list them. (Dr. Salk might be surprised).

In the absence of such studies, I suggest taking down the tag, rather than departing from the science to write the "vaccines bad" article necessary to please the tagger. —Preceding unsigned comment added by 68.166.204.30 (talk) 15:37, 11 November 2008 (UTC)

When Are Flu Shots Given?

My impression is that flu shots are available only during a window of time. That window may not be official or precise, but it would be good to discuss it in the article. (I actually came to the article to learn roughly when flu shots start each year, and I was surprised that I could not find an answer here.) 68.106.184.113 (talk) 18:17, 11 December 2008 (UTC)

Vaccine Research Center

I've reverted the summary removal of a link recently added. This was to the Dale and Betty Bumbers Vaccine Research Center at NIH. It seems to be relevant to the issue and is a reliable source on the subject. --TS 11:34, 7 January 2009 (UTC)

In a normal year, hundreds to thousands of Canadians, mostly older, die from flu-related complications.

In a normal year, upwards of 1,500 Canadians, mostly older, die from the flu. Hundreds to thousands of others die from flu-related complications.

http://www.montrealgazette.com/Health/Mexican+virus+could+throw+wrench+into+pandemic+planning/1531750/story.html Mexican virus could throw a wrench into pandemic planning By Ian MacLeod, Ottawa CitizenApril 24, 2009 7:02 PM —Preceding unsigned comment added by 69.3.11.131 (talk) 19:17, 25 April 2009 (UTC)

Track record?

Has anyone done an analysis of the track record of the predicting entities, i.e., comparing the recommended vaccine strains with the actual outbreaks that year? How often are the prevalent strains predicted accurately? —Preceding unsigned comment added by 65.212.108.131 (talk) 19:49, 30 April 2009 (UTC)

They are pretty good, generally, but far from perfect. From memory, they get it right 60-80% of the time, and even when they miss the shot commonly gives at least some protection.

Dodgy source

One of the linked sources for flu vaccines causing deaths is "http://articles.mercola.com/sites/articles/archive/2008/07/31/12-babies-die-during-vaccine-trials-in-argentina.aspx?source=nl?aid=CD12" I've had a look around the website, and it advertises it's self as "The World’s Most Popular Natural Health Newsletter". Some examples of things said on this website are "Ever Wonder Why Homeopathy Works? " and "One of the ways homeopathy works is by helping to balance your body’s energy, or chi as it’s called in traditional Chinese medicine. This energy is circulated through your body along specific meridians, and when this circulation gets disrupted -- something you can test for using electrodermal screening -- illness can result.". I think this and other content on the website is ample evidence of this source being of low quality, and probably should be removed as a source. -OOPSIE- (talk) 23:19, 7 May 2009 (UTC)

Very dodgy. Removed. Tim Vickers (talk) 23:21, 7 May 2009 (UTC)

An early 2009 study in the US armed forces found injected vaccine more effective than Flumist.

For adults with vigorous immune systems, at least, it appeared that the shot was more effective in the year given and also had a more robust lingering effect. For children new to flu, Flumist was better. Perhaps a general population exposed to a new flu might get a similar benefit. - unsigned

Interesting. I'll add something from http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/mar0209flumist-jw.html - WAS 4.250 (talk) 00:54, 27 June 2009 (UTC)

Efficacy vs Effectiveness

In the section "Clinical Trials of the Vaccine" the article spends a lot of time carefully spelling out the distinction between efficacy and effectiveness. Unfortunately, this careful writing seems to break down in the section following it, "Effectiveness of vaccine." That is, there are several places were it seems to use the words interchangeably. It's not clear whether this is a mistake or on purpose. Someone more knowledgeable than me about these studies should look these passages over. Here's an example:

""full immunization against flu provided about a 75 percent effectiveness rate in preventing hospitalizations from influenza complications in the 2005-6 and 2006-7 influenza seasons."[38] The group most vulnerable to flu, the elderly, is also the least affected by the vaccine, with an average efficacy rate ranging from 40-50% at age 65, and 15-30% past age 70." --Beala (talk) 21:03, 23 September 2009 (UTC)

Anti-Vaccine Bias?

I think this article has some severe anti-vaccine bias. It seems to understate and downplay the vaccine's effectiveness. Here's one example:

"In adults, vaccines show high efficacy against the targeted strains, but low effectiveness overall, so the benefits of vaccination are small, with a one-quarter reduction in risk of contracting influenza but no effect on the rate of hospitalization.[33]"

The 1/4 reduction in risk seems to conflict with other studies I've found. Multiple other sources, including the CDC say that the effectiveness is much higher:

"For example, a study by Bridges et al. (JAMA 2000) among healthy adults found that the inactivated influenza was 86% effective against laboratory-confirmed influenza, but only 10% effectiveness against all respiratory illnesses in the same population and year."

So, as long as we're talking about only influenza and not all respiratory illnesses, the effectiveness of the vaccine would seem to be much higher than only 1/4.

Even in years when the vaccine and the wild strains are not optimally matched, the effectiveness against influenza was still quite high:

"For example, in a study among persons 50-64 years during the 2003-04 season, when the vaccine strains were not optimally matched, inactivated influenza vaccine effectiveness against laboratory-confirmed influenza was 60% among persons without high-risk conditions, and 48% among those with high risk conditions, but it was 90% against laboratory-confirmed influenza hospitalization (Herrera, et al Vaccine 2006)."

Here are a few other quotes from the CDC that suggest this article is biased:

• "The study was conducted during the 1997--98 influenza season, when the vaccine and circulating A (H3N2) strains were not well-matched. Vaccination was associated with reductions in severe febrile illnesses of 19%, and febrile upper respiratory tract illnesses of 24%."
• "Vaccination was also associated with fewer days of illness, fewer days of work lost, fewer days with healthcare provider visits, and reduced use of prescription antibiotics and over-the-counter medications."

If the CDC page isn't convincing, here's another study which concludes that the vaccine is ~50% effective against influenza: Estimation of Influenza Vaccine Effectiveness from Routine Surveillance Data Here's a quote from the intro:

"We used a retrospective case control design in five consecutive influenza seasons, and estimated influenza vaccine effectiveness (VE) for patients of all ages to be 53% (95% CI 38–64), but 41% (95% CI 19–57) adjusted for age group and year. The adjusted VE for all adults aged at least 20 years, the age groups for whom a benefit of vaccination could be shown, was 51% (95% CI 34–63). Comparison of VE estimates with vaccine and circulating strain matches across the years did not reveal any significant differences."

--Beala (talk) 23:02, 23 September 2009 (UTC)

The most up-to-date review I can find on the topic is PMID 17443504 from the Cochrane Collaboration. This took all the evidence and assessed it as a group - it was a meta-analysis. This concluded that vaccination of healthy adults is efficacious against influenza, but have much less impact on the risk of an influenza-like illness. High efficacy, but poor overall effectiveness. The plain-language summary of the meta-analysis concludes

There is not enough evidence to decide whether routine vaccination to prevent influenza in healthy adults is effective. Influenza is a virus which causes symptoms of fever, headache, aches and pains, cough and runny noses. It can last for weeks and lead to serious illness, even death. It spreads easily and new strains develop regularly. The World Health Organization recommends each year which strains should be included in vaccinations for the forthcoming season. The review of trials found vaccinations against influenza avoided 80% of cases at best (in those confirmed by laboratory tests, and using vaccines directed against circulating strains), but only 50% when the vaccine did not match, and 30% against influenza-like illness, in healthy adults. It did not change the number of people needing to go to hospital or take time off work.

They have also released a recent review of vaccination in the elderly - PMID 16856068. This concludes that this might be a good idea in institutions like care homes, but has little effectiveness in the community. The plain-language summary of this meta-analysis concluded:

The review looked at whether vaccines prevented seasonal influenza and its complications in people aged 65 or older. Influenza vaccination of elderly individuals is recommended worldwide as people aged 65 and older are at highest risk for complications, hospitalisations and deaths from influenza. The review looked at evidence from experimental and non-experimental studies carried out over 40 years of influenza vaccination. Seventy-one studies were included and were grouped first according to study design and then to setting (community or long-term care facilities). The results of the review are mostly based on non-experimental (observational) studies, which are at greater risk of bias, as not many good quality trials were available. Trivalent inactivated are the most commonly used influenza vaccines. Best effectiveness of current vaccines in preventing clinical illness and its complications was seen in long-term care facilities (for example nursing homes) where vaccines prevented about 45% of pneumonia cases, hospital admissions and influenza-related deaths. This compared to about 25% vaccine efficacy in preventing hospitalisation from influenza or respiratory illness in open community settings. The public health safety profile of the vaccines appears to be acceptable.

I'd be overjoyed if influenza vaccines were more effective, but the evidence for this is still pretty weak. Tim Vickers (talk) 23:48, 23 September 2009 (UTC)

Thanks Tim! Very informative! I guess I just don't understand why they concluded that "There is not enough evidence to decide whether routine vaccination to prevent influenza in healthy adults is effective." It seems that they go on to say that they are at least somewhat effective. Are the percentages simply not high enough? 80% and 50% seem high. The 30% seems low, but not so low that it should be called ineffective! In fact, in the article you linked to, they say:

"Influenza vaccines are effective in reducing cases of influenza, especially when the content predicts accurately circulating types and circulation is high. However, they are less effective in reducing cases of influenza-like illness and have a modest impact on working days lost."

So, the author seems to think that they are effective, but then goes on to say that there isn't enough evidence to say whether they are effective or not. Is there some subtlety I'm missing, or is the author contradicting himself? --Beala (talk) 00:14, 24 September 2009 (UTC)

The problem probably comes from not being able to measure the effects accurately. We know the vaccines "work", since they provide immunity against the strains they target (they are efficacious). However, when you go out into the community and ask "did you get 'flu?" people tell you if they got an influenza-like illness. Since these illnesses can be produced by many different viruses and several different strains of influenza, it is probably unsurprising that vaccinating against a few strains of influenza produces little measurable benefit in terms of the risk of falling ill. I've reworded this section a bit more and added a brief discussion of the effects on pandemic influenza where the benefit is very clear (although this strictly doesn't belong in a section on clinical trials). Tim Vickers (talk) 00:27, 24 September 2009 (UTC)

Influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly patients.

Influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly

PMID 8985189

Potter J, Stott DJ, Roberts MA, Elder AG, O'Donnell B, Knight PV, Carman WF.

Division of Virology, Institute of Biomedical and Life Sciences, University of Glasgow, United Kingdom.

J Infect Dis. 1997 Jan;175(1):1-6.Links

Comment in: ACP J Club. 1997 Jul-Aug;127(1):1.

Vaccination of health care workers (HCWs) is recommended as a strategy for preventing influenza in elderly patients in long-term care. However, there have been no controlled studies to show whether this approach is effective. During the winter of 1994-1995, 1059 patients in 12 geriatric medical long-term-care sites, randomized for vaccination of HCWs, were studied. In hospitals where HCWs were offered vaccination, 653 (61%) of 1078 were vaccinated. Vaccination of HCWs was associated with reductions in total patient mortality from 17% to 10% (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.40-0.80) and in influenza-like illness (OR, 0.57; 95% CI, 0.34-0.94). Vaccination of patients was not associated with significant effects on mortality (OR, 1.15; 95% CI, 0.81-1.64). Results of this study support recommendations for vaccination against influenza of HCWs in long-term geriatric care. Vaccination of frail elderly long-term-care patients may not give clinically worthwhile benefits.

PMID 8985189 —Preceding unsigned comment added by 68.165.11.34 (talk) 21:19, 1 October 2009 (UTC)

Influenza vaccination for health care workers: A duty of care

Influenza vaccination for health care workers: A duty of care

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2094777

Can J Infect Dis. 2000 Sep–Oct; 11(5): 225–226.

PMCID: PMC2094777 Copyright © 2000, Pulsus Group Inc. All rights reserved

Pamela Orr, MD MSc FRCPC Pamela Orr, Department of Medicine, University of Manitoba and Member, National Advisory Committee on Immunization;

[EXCERPT]

The medical literature has amply documented the transmission of influenza from patients to health care workers (HCWs) (1,2), from HCWs to patients (3) and between HCWs (4-9). The consequences of influenza transmission within the health care environment include morbidity and mortality among patients, most of who are at high risk for the complications of infection, and illness and absenteeism among health care providers. When outbreaks occur in health care facilities, absenteeism among HCWs may approach 30% to 40%, resulting in severe staff shortages, increased employment costs and the potential endangerment of health care delivery due to the scarcity of replacement workers (10-13).

Individuals who are clinically or subclinically infected may transmit influenza virus to others (14). HCWs who are ill frequently continue to work, thereby risking transmission of infection to patients and colleagues (10,15). Peer pressure from overworked colleagues, dedication to patient care, and concerns regarding financial and employment security may motivate HCWs to work despite illness. HCWs may also experience subclinical infection; these individuals continue to work, potentially transmitting infection to their patients. In a recent British study 59% of HCWs with serological evidence of recent influenza infection could not recall having influenza (16).

Vaccination of HCWs has been shown to reduce serologically confirmed influenza and influenza-like illness among the workers, as well as total mortality in the patients for whom they care (10,17-19). A randomized, double-blind, controlled trial was conducted over three successive epidemic seasons to determine the effectiveness of influenza vaccine given to health care professionals working in two American, acute care, urban teaching hospitals. Vaccine efficacy against serologically defined infection among HCWs was 88% for influenza A and 89% for influenza B (10). A recent randomized trial of influenza vaccination of HCWs in urban, geriatric, long term care facilities (LTCF) in Glasgow showed significant reductions not only in influenza-like illness among the vaccinated HCWs but also in the total mortality of the patients for whom they cared (18). Influenza vaccine programs for HCWs may also result in the saving of health care dollars and reduced work absenteeism, depending on factors that include the match between infecting strain and vaccine, strain virulence, and the presence of disincentives for staff to take sick time off work (11,13,16,20-22).

... —Preceding unsigned comment added by 68.165.11.34 (talk) 03:05, 2 October 2009 (UTC)

Vaccination of health-care workers was associated with a substantial decrease in mortality among patients PMID 10675165

Carman WF, Elder AG, Wallace LA, McAulay K, Walker A, Murray GD, Stott DJ.

Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial.

Lancet. 2000 Jan 8;355(9198):93-7.Click here to read Links

Comment in: Lancet. 2000 Apr 1;355(9210):1187. Lancet. 2000 Apr 1;355(9210):1187-8. Lancet. 2000 Jan 8;355(9198):83-4.

Institute of Virology, University of Glasgow, UK.

BACKGROUND: Vaccination of health-care workers has been claimed to prevent nosocomial influenza infection of elderly patients in long-term care. Data are, however, limited on this strategy. We aimed to find out whether vaccination of health-care workers lowers mortality and the frequency of virologically proven influenza in such patients. METHODS: In a parallel-group study, health-care workers in 20 long-term elderly-care hospitals (range 44-105 patients) were randomly offered or not offered influenza vaccine (cluster randomisation, stratified for policy for vaccination of patients and hospital size). All deaths among patients were recorded over 6 months in the winter of 1996-97. We selected a random sample of 50% of patients for virological surveillance for influenza, with combined nasal and throat swabs taken every 2 weeks during the epidemic period. Swabs were tested by tissue culture and PCR for influenza viruses A and B. FINDINGS: Influenza vaccine uptake in health-care workers was 50.9% in hospitals in which they were routinely offered vaccine, compared with 4.9% in those in which they were not. The uncorrected rate of mortality in patients was 102 (13.6%) of 749 in vaccine hospitals compared with 154 (22.4%) of 688 in no-vaccine hospitals (odds ratio 0.58 [95% CI 0.40-0.84], p=0.014). The two groups did not differ for proportions of patients positive for influenza infection (5.4% and 6.7%, respectively); at necropsy, PCR was positive in none of 17 patients from vaccine hospitals and six (20%) of 30 from no-vaccine hospitals (p=0.055). INTERPRETATION: Vaccination of health-care workers was associated with a substantial decrease in mortality among patients. However, virological surveillance showed no associated decrease in non-fatal influenza infection in patients. —Preceding unsigned comment added by 68.165.11.34 (talk) 03:12, 2 October 2009 (UTC)

Hospital interns & other HCWs who received flu vaccine spent fewer days out sick with fever

Wilde JA, McMillan JA, Serwint J, Butta J, O'Riordan MA, Steinhoff MC.

Effectiveness of influenza vaccine in health care professionals: a randomized trial.

Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Childrens Hospital, Cleveland, Ohio, USA. jwilde@mail.mcg.edu

PMID 10078487

http://jama.ama-assn.org/cgi/content/abstract/281/10/908 —Preceding unsigned comment added by 68.165.11.34 (talk) 03:25, 2 October 2009 (UTC)

JAMA. 1999 Mar 10;281(10):908-13.

Comment in:

JAMA. 1999 Mar 10;281(10):944-5.

JAMA. 2001 Jan 17;285(3):290-1; author reply 292.

CONTEXT: Data are limited and conflicting regarding the effectiveness of influenza vaccine in health care professionals. OBJECTIVE: To determine the effectiveness of trivalent influenza vaccine in reducing infection, illness, and absence from work in young, healthy health care professionals. DESIGN: Randomized, prospective, double-blind, controlled trial over 3 consecutive years, from 1992-1993 to 1994-1995. SETTING: Two large teaching hospitals in Baltimore, Md. PARTICIPANTS: Two hundred sixty-four hospital-based health care professionals without chronic medical problems were recruited; 49 participated for 2 seasons; 24 participated for 3 seasons. The mean age was 28.4 years, 75% were resident physicians, and 57% were women. INTERVENTION: Participants were randomly assigned to receive either an influenza vaccine or a control (meningococcal vaccine, pneumococcal vaccine, or placebo). Serum samples for antibody assays were collected at the time of vaccination, 1 month after vaccination, and at the end of the influenza season. Active weekly surveillance for illness was conducted during each influenza epidemic period. MAIN OUTCOME MEASURES: Serologically defined influenza infection (4-fold increase in hemagglutination-inhibiting antibodies), days of febrile respiratory illness, and days absent from work. RESULTS: We conducted 359 person-winters of serologic surveillance (99.4% follow-up) and 4746 person-weeks of illness surveillance (100% follow-up). Twenty-four(13.4%) of 179 control subjects and 3 (1.7%) of 180 influenza vaccine recipients had serologic evidence of influenza type A or B infection during the study period. Vaccine efficacy against serologically defined infection was 88% for influenza A (95% confidence interval [CI], 47%-97%; P=.001) and 89% for influenza B (95% CI, 14%-99%; P=.03). Among influenza vaccinees, cumulative days of reported febrile respiratory illness were 28.7 per 100 subjects compared with 40.6 per 100 subjects in controls (P=.57) and days of absence were 9.9 per 100 subjects vs 21.1 per 100 subjects in controls (P=.41). CONCLUSIONS: Influenza vaccine is effective in preventing infection by influenza A and B in health care professionals and may reduce reported days of work absence and febrile respiratory illness. These data support a policy of annual influenza vaccination of health care professionals. —Preceding unsigned comment added by 68.165.11.34 (talk) 03:19, 2 October 2009 (UTC)

Seasonal Flu Shot Some Help vs. Swine Flu?

Seasonal Flu Shot Some Help vs. Swine Flu?

Mexican Study: Some H1N1Swine Flu Protection in Seasonal Shot; U.S. Data Show No Support for This Conclusion

By Daniel J. DeNoon WebMD Health News Reviewed by Louise Chang, MD http://www.webmd.com/cold-and-flu/news/20091006/seasonal-flu-shot-some-help-vs-swine-flu?src=RSS_PUBLIC

...

The study, which looked at patients of a small respiratory disease hospital in Mexico City, showed that those who received a flu vaccine during the 2008-2009 flu season were 73% less likely to have been infected with H1N1 swine flu than unvaccinated patients.

Moreover, the study suggested that seasonal flu vaccine might make H1N1 swine flu less severe. There were no deaths among the eight vaccinated patients who came to the hospital with lab-confirmed H1N1 swine flu. But among 52 unvaccinated patients with H1N1 swine flu, 18 died.

...

"Notwithstanding this contribution to protection, a specific vaccine against A/H1N1 2009 [swine flu] is crucial," they conclude in their report, published in the advance online issue of BMJ.

...

An unpublished study from Canada reportedly showed just the opposite of the Mexican study -- that seasonal flu vaccine might make people more vulnerable to H1N1 swine flu. U.S. and Australian data offer no support for this hypothesis, either.

It's "biologically conceivable" that seasonal flu vaccine might offer some protection against H1N1 swine flu, says flu expert John Treanor, MD, chief of infectious diseases at the University of Rochester, N.Y.

"We would not predict the protection would be very robust," Treanor tells WebMD. "This does not suggest in any way that we don't need a vaccine for H1N1 [swine flu]."

There are CDC data suggesting that older people -- possibly due to exposure to a seasonal H1N1 virus that circulated before 1957 -- may have some slight protection against H1N1 swine flu.

And the fact that adults become protected against H1N1 swine flu after just a single dose of the new H1N1 swine flu vaccine suggests some kind of priming, either exposure to or vaccination against seasonal H1N1 virus.

... —Preceding unsigned comment added by 66.167.95.156 (talk) 01:34, 7 October 2009 (UTC)

There is also another study that says getting the seasonal flu vaccine may actually increase your chances of getting swine flu. n In other words they basically have no idea.. -Tracer9999 (talk) 17:31, 17 October 2009 (UTC)

Material from Vaccine controversy

The following material was recently placed into Vaccine controversy but is very specific to influenza vaccine as opposed to vaccine controversy in general, so I'm moving it here as a possible addition to this article:

"Modern influenza vaccines have been criticized for a lack of effectiveness demonstrated in controlled studies. A 2006 Cochrane review of influenza vaccination in the elderly stated "The apparent high effectiveness of the vaccines in preventing death from all causes may reflect a baseline imbalance in health status and other systematic differences in the two groups of participants<ref>doi:10.1002/14651858.CD004876.pub2</ref>. A 2005 cohort study found that the entirety of the protective effect of the influenza vaccine in the elderly could be accounted for by selection bias.<ref>doi:10.1093/ije/dyi274</ref> A 2008 Cochrane review of healthy children found "Influenza vaccines are efficacious in children older than two but little evidence is available for children under two." <ref>doi:10.1002/14651858.CD004879.pub3</ref>. The CDC recommends every child over 6 months be given the influenza vaccine.<ref>Children, the Flu, and the Flu Vaccine http://www.cdc.gov/flu/protect/children.htm</ref> A 2007 Cochrane review on influenza vaccines in healthy adults found that while vaccines were effective against the influenza strains they are designed to vaccinate against, this ended up translating to only a modest impact on working days lost due to influenza-like infections. <ref></ref>"

Eubulides (talk) 19:36, 22 October 2009 (UTC)

Added with some modifications of the wording. Originally this was in the vaccine controversy article, so it is slanted towards bringing out criticism- perhaps some of the other less negative conclusions should be pulled out of those reviews. I think the clinical trials and effectiveness section should be merged together. This addition has caused duplication, but there is no way around that- these sections are inherently duplicate because effectiveness is based off of clinical trials. If there is any division here, it might be better to divide information between efficacy and effectiveness. Gregwebs (talk) 22:01, 25 October 2009 (UTC)

Almost entirely original research

This section vaguely invokes, "various authorities." Literally.

"Various public health organizations, including the World Health Organization ...

And then proceeds to list a rather truncated, limited list of indications as though it were a comprehensive list:

... have recommended that yearly influenza vaccination be routinely offered to patients at risk of complications of influenza and those individuals who live with or care for high-risk individuals, including:

The list that follows is original research, replete with selective deletions of actual recommendations, and is far from comprehensive list of indications. The actual recommendations are quite a bit more extensive. The U.S. and U.K recommendations are summarized more credibly, with sources cited, at in an early section of this Wikipedia Article, "Purpose and benefits of annual flu vaccination" http://en.wikipedia.org/wiki/Influenza_vaccine#Purpose_and_benefits_of_annual_flu_vaccination

The misleading selective original research in this section should either be taken down as redundant, or else cleaned up to accurately reflect the actual " Vaccination recommendations" (per the section title) of the "various authorities" involved, each in turn and clearly sourced, without the systematic unrevealed omission of many of their actual recommendations.