Guest post by British doctor DeeTee. See more by DeeTee here.
As the swine flu pandemic tightens its global grip, antivaccinationists far and wide are gearing up for their propaganda war against the H1N1 vaccine. Their objections, predictably enough, conform to the usual diet of antivaccine canards that they always employ to frighten people about vaccines, but the novelty of the current pandemic offers them unlimited scope for scaremongering among the millions of worried potential vaccine recipients.
Are there any valid reasons to have concerns over this flu vaccine? Well, possibly, but not to the extent the antivaccination lobby would have us believe. There are still issues that need to be resolved, some of which are strategic rather than scientific in nature such as whether the vaccine should be mandatory or not. Regarding the science it is as yet unclear exactly how protective the vaccine will be, and studies are under way to determine the correct balance between HA antigen dose and immunogenicity, which will influence both the incidence rate of reactions and also determine how effective it will be in the groups most in need of it. It may be that two doses are required for optimum protectiveness, and studies to look at this are under way. The technology used to produce vaccine is not new; essentially all that is being done is to tweak the antigenic components of the seasonal vaccine, which has a very good safety track record.
But the antivaccine lobby are indicating that they are deeply concerned, and they wish all of us to share their concern to the point of refusing vaccination. Now any rational person with the slightest modicum of common sense will be able to dismiss as irrelevant their usual froth about “toxic” ingredients in the vaccines, but there are some reading their diatribes against flu vaccine who might be worried, particularly when “real science” is disingenuously quoted by the antivaccine crew to support their case. One such “valid” concern is the link between influenza vaccination and an uncommon neurological disorder, Guillain-Barré Syndrome (GBS).
Of all the side effects reported after flu vaccine, GBS holds sway as the most prominent in the minds (and mouths) of the antivaccinationists. A direct causal relationship has never been clearly established between flu vaccines and GBS, but the link is biologically plausible and the available epidemiological evidence points to an association. The concerns about swine flu vaccine in particular first came to light when GBS affected over 500 people following a mass influenza vaccination programme that took place in the USA in 1976.
So what are the true facts about GBS? Firstly, it must be made clear that the most common causes of the syndrome are naturally acquired infections (although other triggers are reported). Now all infections can trigger a host immunological response, but rarely in certain individuals this host response is misdirected to cause damage to the myelin coating of nerve cells, causing GBS. This process of demyelination results in weakness and paralysis, which can take months to resolve, and it can rarely be fatal (although much less so nowadays with the advent of treatments such as plasmapharesis and immunoglobulin infusions). There are a number of infections known to trigger GBS, Campylobacter jejuni gastroenteritis being the best-known example.
Vaccines, containing as they do microbiologically active agents, might reasonably be assumed to pose some risk since their action mimics that of the natural infections, hence the concerns about vaccine-induced GBS. This immune-mediated process might operate either through molecular mimicry, or through “bystander activation”, but clear evidence that these actually occur with flu vaccines is weak and inconsistent.
In 1976 there was an outbreak of influenza among US servicemen stationed at Fort Dix in New Jersey that resulted in several hundred clinical cases and one death. The strain identified was a novel Hsw1N1 “swine flu” virus, similar to the 1918 pandemic Spanish flu strain which killed half a million people. Fear that another 1918-type pandemic was about to occur prompted the authorities to begin mass vaccination and a total of 45 million Americans were vaccinated against swine flu. In fact there never was a significant outbreak, not because the population was protected by vaccine, but because transmission of the virus remained confined to Fort Dix by the infection control measures implemented at the time.
Following the vaccination campaign, there was a rise in the numbers of GBS recorded that year, with 581 cases being reported by the CDC in Atlanta. This led to speculation that the vaccinations were responsible, but the number of reported cases was disputed since there was felt to be some bias in the collation of data and the criteria for diagnosing GBS. Subsequent reanalysis conducted by the CDC’s Immunisation Safety Branch rejected 29% of the reported cases of GBS. One of the possible theories as to why the vaccine might have caused GBS was that the vaccine had been contaminated with Campylobacter jejuni, since at that time this infection was common in poultry and the vaccine was produced in chick embryos.
Ever since, there has been concern that influenza vaccines given for seasonal flu might cause the same problem, particularly when in the USA in 1994 when the numbers of cases of GBS rose to 74, having been only 37 the year before. These reports prompted The Institute of Medicine to set up a Safety Review Committee to study the links between influenza vaccines and neurological syndromes. The IOM reviewed all available evidence regarding GBS post vaccination, for which there were many detailed analyses available. In 2003 they reported “the evidence favored acceptance of a causal relationship between the 1976 Swine Influenza vaccine and GBS in adults.” However, the evidence for other years was “inadequate to accept or reject a causal relationship”. The estimated risk of GBS after flu vaccine is currently thought to be around 1 to 2 cases per million vaccinated persons per year.
An association between influenza season and a rise in the incidence of GBS has been noted before, with the suggestion that influenza infection itself might be a cause. However, it is often difficult to dissociate what might be due to influenza infection from what might be due to influenza vaccination – obviously both are common during flu season. As the authors of the study commented: “Whether the associations [of GBS] with influenza are real or whether they reflect seasonal patterns in influenza vaccination is unclear.”
The role of influenza was clarified in a recent French study published as a major article in the in-house journal of the Infectious Diseases Society of America. This not only looked at epidemiological data on GBS but also tested all the cases microbiologically to establish the causative agent. In 18% of GBS cases they investigated, influenza infection was shown to be the cause. They also estimated that the incidence of influenza-related GBS to be 4-7 cases for every 100,000 cases of influenza.
So where does this evidence leave the antivaccine lobby’s claims about GBS and swine flu vaccine? Essentially nowhere. That GBS might be triggered by flu vaccine is possible; it certainly seems as though 33 years ago it may have done so with the vaccine produced at that time. Whether the current swine flu vaccine will do anything similar is questionable; flu vaccines produced since 1976 do not appear to have significantly raised the risks of GBS above the background noise level, and any epidemiological rise in GBS cases during the flu season may not be due to the vaccine but actually caused by influenza. In fact the most powerful argument in favour of continuing to have flu vaccine (thereby running a tiny, one or two in a million risk of GBS) is that flu itself is a relatively common cause of GBS, and would appear to cause it once in every 14,000 to 25,000 episodes of flu. Running the risks of a rare vaccine side effect is perfectly acceptable when the risks from not having the vaccine are much worse.
I predict that the supposed risk of GBS will be one of the more specious reasons bandied about by the antivaccine lobby in the coming months as a reason why we should avoid the flu vaccine. And it’s not just the rabid antivaccine websites promoting this view, there have already been articles in the “quality” UK papers questioning the value of vaccination, as exemplified by this one in the Times by Dr Halvorsen, a prominent antivaccine proponent with his own new antivaccine book to promote (and profit from). He claims: “The case for vaccinating millions of healthy adults against a disease that is no more unpleasant than a bad cold is questionable”. This completely ignores the evidence that for certain susceptible groups, influenza infection may be extremely serious. Now I have looked after many patients who have died from influenza, but never anyone who died of “a bad cold”.
Halvorsen goes on to say this about widespread vaccination: “We could expect hundreds of people to get GBS, some of whom will suffer permanent paralysis or die.” If as many as 30% of the UK population receive the vaccine, and if the rates of GBS compare with those experienced after the USA 1976 flu vaccine programme (which is unlikely as there is no reason to anticipate the same rate of reactions now as there were in 1976), there might be between 166 and 200 cases attributable to vaccine (based upon the described risk of one case in 100,000-120,000 vaccinated persons). But if the rate of vaccine-associated GBS conforms to that thought to occur with more current flu vaccines (1-2 per million), we could expect only between 20 and 40 cases.
However, any estimates of vaccine-associated GBS cases must be set against the risks of flu-associated GBS. If as many as 30% of the UK population get swine flu this autumn (as is widely predicted), we might anticipate around 800 cases of flu-induced GBS. One might reasonably conclude that, given all the available scientific evidence, having flu vaccine is actually a very logical and effective way to prevent GBS in a pandemic flu scenario. But I don’t expect antivaccine proponents like Halvorsen to appreciate this fact, since they only ever look at risks from the vaccine and never the risks from the disease.
The reasoning behind this antivaccine propaganda is entirely spurious, and like all of the other risks we are so solicitously warned about, the fears are manifestly unjustified. Of course vaccines can and will cause reactions; after all they are biologically active products. But the potential benefits of the influenza vaccine, particularly for those in higher risk groups, far outweigh the potential harm from reactions. The risks of problems such as vaccine-associated GBS are significantly less than the risk of influenza-induced GBS, and are miniscule compared to the serious risks that can arise from influenza and its other complications.
Come the autumn, when are flu vaccine is offered to health care workers, I hope to be at the front of the queue. I just hope that in the interim I can avoid catching swine flu from one of my patients, since I cannot predict whether I will be one of the 800 or so in whom the infection might trigger GBS, and I cannot predict if I will be one of the many thousands who will die from complications of influenza. Or perhaps for Halvorsen’s benefit I should rephrase that to read: “I cannot predict if I will be one of the many thousands who will die of a bad cold.”
This is a guest post by British doctor DeeTee.
Firstly, not all concerns about vaccine safety, or even the debate about GBS, are antivaccine propaganda. The publications on GBS are not like those on MMR which were in large part a response to disprove a hoax. The GBS studies are an attempt to understand the nature/likelihood of a possible association that there have been real concerns about. This isn't to say the balance you are suggesting isn't right, there are other studies casting doubt on the association. GBS could well be a spurious temporal association.
That said, it's obvious what the anti-vaccine is up to. Frankly, after the media's poor performance over the years with MMR vaccine, I think they should be issued with a list of people who should be approached with extreme caution when it comes to the debate about vaccine safety during this outbreak. Halverson should be about the last person on their list. Why not ring Professor Frederick Hayden at the Wellcome Trust instead. It was frankly shocking that The Times went to Halverson; my jaw literally dropped. When they want someone to talk about the Large Hadron Collider, do they wander off to interview some guy in his shed who has been dabbling with some electromagnets, or do they ring up Brian Cox?
My concern about the GBS risk, is that if a number of cases of GBS (or another rare but serious adverse event) do arise from a vaccination campaign that has already been described as "rushed" by the media, then those cases will be powerful if temporally associated. We've already seen how some papers have over-reacted to oseltamivir adverse effects, HPV vaccine, etc. It will give the anti-vaccine lobby another myth they can misrepresent in future years, and epi studies published five years later showing no association would not put the Genie in the bottle. That is particularly problematic if the public perception of the influenza outbreak becomes one that it was a relatively mild disease (although that could change) for the vast majority of people. That could have knock on effects for future vaccination campaigns. I think the key is for policy makers to be open and transparent about the benefit/harm decisions they are making and why. The anti-vaccine movement might jump on some aspects of this, but they should be ignored.
Personally, at the moment I'm relatively unworried by the risks of receiving either the vaccine or catching the H1N1 virus in its current form. I'd deliberately avoid the later of course, but wouldn't have any problem having the former.
I would like to comment on the link between swineflu-tamiflu and GBS, my husband has been in hospital for 2 weeks now paralysed with GBS and he was treated for suspected swine flu and prescribed the Tamiflu tablets only 9 days before, he is normally fit and healthy and his imune system is always very strong, I would like to ask the question, if it is not only the vaccine that can cause GBS but also the tamiflu tablets as well as this seems to be very strange. Be aware of taking this medication as it may lead to devestating results................
Anthony Cox wrote:
"It was frankly shocking that The Times went to Halverson; my jaw literally dropped. When they want someone to talk about the Large Hadron Collider, do they wander off to interview some guy in his shed who has been dabbling with some electromagnets, or do they ring up Brian Cox?"
--------------------------------------------
The cynical view would be that this is a case where the choice of (non) "expert" is entirely determined by the story they have already decided to run (i.e. a scare story). The paradigm for this is the use of the amateur-with-a-lab-in-his-garden-shed, the late Chris Malyszewicz "PhD", to validate "shock horror MRSA in our hospitals" stories - see Ben Goldacre columns passim.
If you want to run a "fear and unease about vaccines" story, you call Halvorsen.
Which says to me that whoever took the decision at the Times is unfit for their job, since they cannot distinguish "balance" from "wind up".
Unless, of course, they think that selling papers, even by whipping up unfounded fear, is more important than informing people.
Oh dear...
Emma,
Sorry to hear about your husband and I hope he makes a full recovery (which virtualy all do). The nature of GBS is that it is an abnormal immunological response to an antigenic stimulus. Drugs only very occasionally behave in this manner (some antibiotics rarely do this such as bystander effects with penicillins).
I have never heard of GBS being caused by a drug. It seems more likely that the GBS is the result of influenza itself; as I pointed out this happens and nearly a fifth of GBS cases in the French study I mentioned were due to flu.
However, it is always important to keep an open mind, and I recommend you report the problem to the MHRA by their yellow card scheme. With the pandemic flu, the MHRA suggest people report reactions through this site which forms a parallell site to the yellow card scheme.
http://swineflu.mhra.gov.uk/
Thanks Dee Tee,
A very informative post. I've been unsure about this flu jab. I'm in a high risk group and will be one of the first to be offered it. I was not aware of the GB risk, as I don't bother reading any papers.
A couple of Doctor Bloggs I read, seem to be of the opinion that they wouldn't give it to their children. I suppose if they are fit and healthy, that may be the right decision.
I've made my mind up now. Rather than be another who dies from underlying complications, I'll take the jab.
Cheers
Too many notes and too little sincerity. You're no musician DT, and you sing tunelessly.
http://www.youtube.com/watch?v=vqMK_yu8APg
http://www.youtube.com/watch?v=PbSpPs05YAc&feature=related
http://www.youtube.com/watch?v=PbSpPs05YAc&feature=related
http://www.youtube.com/watch?v=PbSpPs05YAc&feature=related
There is plenty of truth out there Martin and the public are a lot more educated than you "lay scientists" who think you know it all. Problem is you dont and your theories are disproven time and time again.
Get yourslef jabbed like the rest of the sheep you follow.
The rest of us will sit on the sideline and laugh at you muppets.
Most likely your husband had the GBS triggered from the natural infection that he contracted. The reason that the flu vaccine can trigger GBS is because it mimics the symptoms of the actual infection which can in itself trigger GBS.
I don't think it is the tamiflu as that just allievates symptoms - no infections come from it.
I hope your husband is doing better!
@pete
well thanks for showing me that, now i am totally not going to get the vaccine. Who knew that a crackpot conspiracy theorist, who doesn't seem to understand human immunology properly, and 3 postings of a song are much better than scientific evidence. End of sarcasm.
Thanks DT, for an informative article that appears to take some basis in real scientific evidence. Having had one of my crazy conspiracy theorist friends tell me that the swine flu vaccine is going to give me GBS, i searched pubmed for evidence of this to find it is a possible theory, but the evidence of this is never conclusive, as you say in this article. However the evidence of flu-associated GBS rates against vaccine-associated rates, is something else i can now bring to my anti-vac friend. Cheers.
Just because I want to independently evaluate the risk of taking the vaccine doesn't make me an "Anti-Vaccinationists". I could just as easily say that those who insist I must take it are "Anti-Prudents".
The UK Mail is running an article that reminds me that some 80,000 people came down with GBS-like symptoms in the mass innoculations in 1976. More people died from GBS than from the flu.
By my calculation, if I get the vaccine, the odds of contracting GBS are better than winning the lottery no matter what the flu does. If I don't get the shot I still probably won't contract the flu. If I contract the flu, the odds of me, having excellent health and a great immune system, being killed by it are less than lotter-like. So, it seems like it is just prudent to not be in any hurry to get the vaccine.
If the empidemic is bad, or if I get infected, I'll just stay home for a few weeks.
Sorry if being prudent makes me a troll in your world view. It is just too easy for self-appointed elites to think it is their job to tell me what is best for me. I am happy to listen to sound advice, but only as long as the people giving it know their proper role.
Giving vaccines to healthy, low risk, people for things like the flu or chicken pox simply doesn't make as much sense from a medical perspective as it makes from a financial perspective. Some parents simply couldn't afford to stay home for 2 weeks due to the flu; for them, the vaccine is well-needed insurance. Let's remember as well that these vaccines do make a lot of money for the pharmaceutical industry so it is in their financial interest to get as many of us as possible to take it. Moreover, one of the biggest fears about the H1N1 virus expressed by government agencies in the US has been that, in this pressed economy, a major outbreak of flu could seriously hamper recovery or cause a real depression.
Even supposing the vaccine is perfectly safe, the question for most of us is still whether a healthy person who is not in a group that increases his or her risks from the actual disease should get the vaccine. What is going to tip the scales for many may be money.
I've read a lot of information on this subject from all over the spectrum of reliability, but, the serious, positive articles I've read on this vaccine have simply not convinced me that it is in my personal best interest to take the vaccine, since I'm not in a risk group of any kind, staying home sick from work will not put me in dire financial straits, I don't believe that the virus is so contagious or serious that it could cause an economic downturn, and I don't own stock in the pharmaceutical industry. The projected health and financial risks of the actual disease aren't enough to persuade me to brave the vaccine or to recommend that anyone in a situation similar to mine do so either.
DeeTee's gone very quiet. But listen! If you listen very carefully, you will hear some outraged snuffling and snorting and the unmistakeable flapping of hogs wings. Of course, DeeTee is a professional test pilot and is about to become a flying guinea-pig in the great British swine-flu trial.
http://www.dailymail.co.uk/news/article-1206807/Swine-flu-jab-link-kille...
The Mail says,
"Top priority will be given to everyone aged six months to 65 with an underlying health problem, pregnant women and health professionals. The British Neurological Surveillance Unit (BNSU), part of the British Association of Neurologists, has been asked to monitor closely any cases of GBS as the vaccine is rolled out. One senior neurologist said last night: ‘I would not have the swine flu jab because of the GBS risk."
But Squadron Leader DeeTee is a health professional ... and expected to head the queue for the swine flu jab. Of course, DeeTee will do his duty for King and country ... and all pigs that fly.
PS. Why is the UK destined to repeat American mistakes?
@buckthewheat:
I explained why the 1976 flu didn't kill many people. Not many people got it. Read the references for yourself. Where you get the figure of 80,000 with GBS is a mystery. Even the Mail says 500.
http://www.dailymail.co.uk/news/article-1206807/Swine-flu-jab-link-kille...
A headline entitled: "Swine flu link to killer nerve disease" would at least have had the benefit of being more accurate. Emma explains in her post above how her husband got GBS after swine flu.
If anyone would actually like to discuss some of the science and medical evidence, go ahead.
@DivaG:
You can make up your own mind about whether to be vaccinated or not; the choice will be yours. All I am trying to do is to provide further scientific commentary to inform that view.
I agree the risks of flu causing serious ill health in someone who is healthy are low, but not zero. If predictions are correct, there will be a second wave and a surge in cases in the autumn/winter. The fewer people who get flu the better. If vaccines can limit the spread and protect vulnerable groups, that's a positive outcome. I am not particularly worried about the personal health consequences of getting flu myself, but I would seriously inconvenience family and work colleagues if I were off, particularly if as many as 15% of the NHS could be off sick at one time. I am also reluctant to have flu and expose others who are at greater risk, such as older members of my family who do have risk factors and pregnant friends; I'm not that thoughtless and selfish.
A tiny flying guinea-pig with its scientific snout in the trough, DeeTee says "I'm not that thoughtless and selfish".
LOL!
But "trust me, I'm a doctor" sounds a little like something a flying-pig might say.
PS. Being a health professional with a big stake in the Battle for Britain taking place in the skies over the GlaxoBay of Pigs ... will Squadron Leader DeeTee be dodging the paralysing flak sent up by those millions of tiny jabs of swine-flu vacc this Autumn?
"the odds of contracting GBS are better than winning the lottery"
Those are some good odds! Quick make a bet now, odds of greater than 14 million to one are not to be missed!
"If I don't get the shot I still probably won't contract the flu."
A potential infection rate of 30% are not odds I'd want to gamble with.
"having excellent health and a great immune system"
You are aware that swine flu has generally been worse in people with good health and immune systems?
And you have heard of cytokine storm?
"being killed by it are less than lotter-like"
Evidence for this claim?
It's nearly impossible to convince people you're right by insulting them, so I have to wonder what you are trying to accomplish by implying that I am selfish and thoughtless for not getting a vaccine or that my family and colleagues could be so uncaring and callous as to see my rare temporary illnesses as an inconvieninece to them.
But, you did convince me.
In fact, I'd like to thank you for your snide, condescending comments, they served to remind me that old-fashioned good manners are the best way to deal with most situations; when in doubt, be polite. As such, I'll keep showing my consideration for my colleagues and friends, whatever their conditions, using something I learned as a young child: Good hygiene including frequent, proper hand-washing is the best way to avoid getting and spreading viruses.
DivaG wisely recommended,
"Good hygiene including frequent, proper hand-washing is the best way to avoid getting and spreading viruses."
And Tom Nolan, blogging this week for the BMJ on swine flu, has highlighted the anti-influenzal properties of 'Milton'.
http://blogs.bmj.com/bmj/2009/08/20/tom-nolan-on-historic-flu-remedies/
And perhaps Milton will eventually be shown to have potent anti-DeeTee properties too. Those anti-contagion propensities would be a valuable added bonus in the war against swine.
PS. And while you speak of "snide, condescending comments", I am reminded of Professor David Salisbury, the head of all British things vaccinatory, (and referred to in Dr Nolan's blog) and how Dr DeeTee and He have such a lot in common including a fabulous range in all things arrogant and dutiful - in fact I'll bet DeeTee and He are best mates.
DivaG, you are correct in saying that good infection control measures such as handwashing are important in preventing infections.
Sorry if you thought my statement was insulting; it was just a comment that I personally would view action on my part not to be immunised as being selfish, and I clearly explained why. Nowhere have my comments to you been snide or condescending.
The BMJ today recounts the Australian experience with swine flu. Paradoxically it seems to be mild on the one hand in the vast majority of cases, but small subgroups become disproportionately ill such as the obese and the pregnant. ITU services have been severely strained by the number of seriously ill young adults with flu. I have pregnant friends and doubt any would thank me for bringing swine flu home from work and infecting them. Getting vaccinated seems a logical and correct course of action.
A twit at the BMJ is twittering that doctors and nurses should be forced to have the upcoming swine-flu vac.
http://www.bmj.com/cgi/eletters/339/aug25_2/b3398#219332
I think this is a case where 'fascist tit' shakes hand with 'socialist arse' and gets a hefty dose of Guillain-Barre of the todger into the bargain.
There seems to be an invasion of the Web by anti-vaccine people, some of whom at least claim to be physicians. I've had a lot of experience in EMS as I was USN Hospital Corps, worked regular ambulance, then was a neonate transport tech, but the medicine I've studied for the past quarter of a century is related to chronic pain, my own bull having gored some time ago and still bleeding. I don't have the medical knowledge to evaluate some of these claims, including:
1) A (possible) doctor who claims that vaccines in general are dangerous; claims the biggest epidemics correlate with the biggest vaccine drives, happening after the vaccines are given. Quoted some tracking studies, esp. in Australia. Also says that there's no proof that antibody production confers immunity, and claims that it actually blocks the body from developing an immunity.
2)Claims by alleged witnesses that the new vaccine has killed a handful of test animals (ferrets - ?), and 30% of homeless people who were vaccinated.
3)Claims by alleged witnesses that at least one trucker found he was transporting live virus for DHS in secret night runs. Other related claims that large batches of (officially untested) vaccine were somehow contaminated by live virus and were to be used anyway under the claim by DHS that the vaccine would confer immunity to the live virus (I don't think it works that way).
There are just so many of these weird claims out there, and I do NOT trust this government. There are also concerns about the adjuvant used in the vaccine (and are they using squalane as some claim, or aluminum salts?) and other things. Almost all of it requires a microbiology and/or biochem knowledge base I do not have. Took the classes thirty-five years ago but haven't used it. It's really frustrating, because current law allows a forced inoculation program if the government chooses to do it that way. To refuse would doubtless have official consequences if FDA/DHS were to take that route, but if getting vaccinated is a likely death sentence, there are better deaths to choose.
Any comments or suggestions would be appreciated.
Ian MacLeod
Activist PRN, Nonprofit, Nonpartisan, 501(C)(3) Corporation.
Veteran, Disabled, Chronic Intractable Pain Patient, 25 years
Oathkeeper.
Primum, non nocere!
Illegitimis non carborundum!
I do not know anyone personaly who has died from the flu, I did however know a person who died with in hours of getting his flu shot and had know known health problems. Unfortunatly as far as I know the last major event that occurred before and was not even investigated and is not included in any stats for vaccine injury which appears to be greatly under recorded.
Do not listen to people who bully intimidate and insult people who don't want to get vaccinated, nobody has the right to tell you that you have to inject foriegn substances into your body.
They are welcome to my flu vaccine and they can be twice as protected it will be cheaper because demand is down and we who are "anti vaccine" might be eliminated and allow for the wise people who know whats best for everyone else to proliferate.
I went through this with a pediatrician who was beligerant about my daughter getting a hepatitus B vaccine which she was virtually at no risk of contracting. I actually am thankful that he was so arrogant and obnoxious about it because it was his dogmatic attitude hat prompted me to research both sides and become "anti vaccine". Yes and the vaccine he was trying to bully us into getting was recalled, I am sure because it was safe. Do some research yourself and look at facts not meaningless statements like science supports this or that.
Sorry for the rant but the authors arrogance struck a nerve.
Methinks luneballoon is probably cybertiger aka celtic leopard aka Dr M Str*th*rs, an ex-GP with a weird anti-vaccine agenda and proclivity for playground insults (thats primary school level) for those who question his acidic dogma.
Am I right luneballoon?
Why do you assume it was the Tamiflu that caused the GBS and not the suspected swine flu? Sounds much more likely that it was the infection that caused the GBS and not the drug.
Hi Martin,
Just realised you are the MJRobins who was commenting on the Badscience form.
There are several problem as regards the swine flu immunisation, and one of the greatest ones is that the medical profession has a whole has not been persuaded of the efficacy and safety of the vaccine when put in the context of proper risk assessment. Rightly or wrongly, a large number of doctors (and nurses) do not wish to have the immunisation themselves. The data on this are anecdotal but nonetheless worrying. The anonymous poll on DNUK currently shows that 48% of the doctors who responded will not have it.
On current information, I am one of them. Unlike many others, I have stuck my head above the parapet and said so rather than discussing it in the relative secrecy of DNUK. (I agree, by the way, that my emotive points about cost, and about the lack of interest in malaria deaths are not strictly relevant...but they do concentrate the mind.) The public has a right to know about this unease. It should not be hidden away.
It is sad that you, as a scientist, seem to approach the question of government immunisation policy in a binary, yes/no, way. It is just as absurd to be totally in favour of all immunisations just as it is to be against all immunisations. This is why the JABS brigade consistently make fools of themselves.
I am not convinced by Dee Tee's post. I find this bit in particular worrying:
"There are still issues that need to be resolved, some of which are strategic rather than scientific in nature such as whether the vaccine should be mandatory or not. Regarding the science it is as yet unclear exactly how protective the vaccine will be, and studies are under way to determine the correct balance between HA antigen dose and immunogenicity, which will influence both the incidence rate of reactions and also determine how effective it will be in the groups most in need of it. It may be that two doses are required for optimum protectiveness, and studies to look at this are under way."
He is considering COMPULSORY immunisation? Wow!
And he discusses the question of antigen dose balance/immunogenicity and so on.
All decisions that have to be made ASAP. In a rush. And PRECISELY why might we need two doses rather than the more normal one?
Then we hear that the American government is given blanket immunity to the drug companies so that they cannot be sued if the vaccine causes damage. And our neurologists have been "confidentially" briefed to be on the look out for GBS. I agree, it's rare, and the flu itself might cause it. But that is not the point.
You have to accept that a very substantial number of doctors are uneasy about this immunisation and will not have it themselves. Most of them are keeping quiet. I am merely telling people what is going on. By doing so, I have been subjected to foul mouthed abuse on the Badscience column. It was the kind of monomaniacal abuse I expect from JABS when I try to argue against them about MMR, thiomersal/autism and other guff.
I hope it won't happen here.
You may say that the doctors who are uneasy about the swine flu vaccine do not understand the science behind it. I don't think that is the case. Fact is, inevitably, there is not a sufficient evidence base on the swine flu immunisation. It is based on best guess science. If we were dealing with smallpox and diphtheria it would be a different matter. But we are not.
John
John, there are two points which really strike me about your comment.
Firstly you say that: "It is sad that you, as a scientist, seem to approach the question of government immunisation policy in a binary, yes/no, way." On what basis have you come to that conclusion about me?
Secondly, this is about the umpteenth time that you've criticized this vaccine without actually providing us with any evidence or information. Both here, on your blog and in your Guardian article you've mentioned nothing about the make-up of the vaccine, or why you feel this vaccine in particular is so problematic. Until you're willing to actually explain what your criticisms are, it's difficult to understand what your point is.
Martin is the editor of layscience.net.
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Well, the point I would have thought is both obvious and straightforward.
It's about balancing risks. It's about immunising several million people with a vaccine that has inevitably been manufactured in haste for a condition that, as yet, presents less of a threat than seasonal flu. Even now, no one is certain what the immunisation programme - if there is one - is going to be. We are currently booking people for the "routine" flu immunisation and are being bombarded with questions about, "will this cover swine flu?" "when will the swine flu jab be ready?" "will it be one or two jabs?" "is it safe?" "will you be having it, doctor?". And the answers are no, I don't know, I don't know, probably and probably not.
Oddly, the onus of proof seems to have been shifted. Normally, when a new drug comes out, there will have been clinical trials demonstrating both efficacy and safety. Now you are saying to me, "prove that the immunisation is not safe". It's hard to prove a negative. The immunisation may be safe. I don't know for certain. And that is the point.
You prove to me that it is safe.
Then, when you have done that, you have to address the vexed question of why a lot of doctors will not have it. We are not JABS loonies. If the DNUK survey is representative, and 48% of doctors (all of whom fully immunise their children including MMR etc) are not going to have it, it is incumbent on you to explain that.
Would you expect an intelligent patient to immunise his teenage children with a vaccine that the doctor says "is, as far as we can tell from preliminary tests, almost certainly safe"? The herd immunity argument is strong for doctors but, let me tell you, it cuts no ice at all with an intelligent parent struggling to decide if his children should be immunised.
And, if Dr Dee Tee's suggestion that the immunisation should be compulsory every happens, there will be civil rights demonstrations of an unprecedented level and a lot of doctors, including those who are 100% in favour of the immunisation, will be in the front line. You will also put the JABS loonies on the map.
Finally, do you think the best way forward is not to tell the general public that a lot of doctors are uneasy about this immunisation? Should there instead be a cover up?
John
John,
just to clear up any misunderstanding about mandatory vaccination. My original wording was perhaps clumsy; I was not suggesting that it should be compulsory and indeed I have gone on record as saying it should not be and that it will be down to individual choice, which is how things should be with all vaccines.
The vaccine is not "new". Different companies worldwide are producing vaccine; the UK supply will come from 2 different companies. The technology used to produce the vaccine is slightly different for each, but it is standard technology and is essentially no different a product to the usual seasonal flu vaccine.
In this regard there should not be additional concerns about safety, or one might as well take the view every single year that the flu vaccine for that season is "new" and might turn people into the incredible hulk or make their heads drop off.
Those with prior exposure to H1N1 may have a degree of underlying immunity and these in theory might just require a single dose of vaccine, but in practice it is going to be 2 doses. Part of the reason for this is that the vaccines will not contain an adjuvant. In Canada, an adjuvant based vaccine is proposed which would mean only one shot, but the tests for that vaccine are taking a bit longer than the efficacy and safety testing of the non-adjuvant vaccine, and introduction of the one shot vaccine may be a bit delayed as a result. Globally, everyone is taking vaccine safety seriously, and an unsafe vaccine will not hit the streets, let me assure you.
The vaccine production process kicks into gear each season in the early part of the year. There is a period of around 4-5 months to identify the anticipated antigens, get a vaccine on line and test it. That process has been no different with the swine flu vaccine and I gather that the safety testing has been more extensive with this (including children).
One really has no need to go scare-mongering about this particular vaccine, unless you wish to do so with flu vaccines every single year. Many doctors chose not to be vaccinated against flu in past seasons. The risks of them encountering the virus were not that high and the consequenses if they did were usually not serious either for them or the healthservice. But this year things are rather different and vaccination for healthcare staff is I believe a duty and is the responsible thing to do. In my Trust I will be trying to encourage vaccination as best I can, but I would never support any strategy of compulsory vaccination.
My questions to you about your own practices strategy for coping with a flu surge remain unanswered. What will you do if all eleven of you are off with flu, and how will your buddy practice react to that possibility?
Just for information about testing of the vaccine in the USA, here is a link to a CDC report/update.
http://www.cdc.gov/media/transcripts/2009/t090821.htm
Essentially the trials in adults and elderly were fully enrolled and there appear to be no short term safety concerns. Information about efficacy comparisons between one and two doses are expected later this month. They commenced paediatric trials in August and trials in pregnant women commenced in early September.
They also confirm there is no intent to mandate vaccine for healthcare workers in the US.
John, just to briefly respond to some other bits in your last post.
I can't tell you or your patients when the vaccine will be ready. But isn't that the case every year? Surely you should be saying to patients that some of them are at greater clinical risk and therfore it is prudent for them to do everything possible to reduce the chance of infection, one aspect of which is vaccination. I would expect that your practice should be looking at systems for identifying these patients so as to issue a vaccine call-up. I don't know how it will work in practice in GP land, sorry, even in hospital we are in the dark about when vaccine will be ready for any staff. Uncertainty about the logistics should not translate into scorn about the value of vaccination.
"You prove to me that it is safe"
I can only indicate that there is no reason to suspect reactions will be any different to those experienced with seasonal vaccines. Data from the US shows no significant problems so far for their tests. Further safety data will no doubt emerge from the ongoing studies in the UK, and one can assume that complication rates will be revealed. As to GBS, I can only say that 1976 was as far as I am concerned a unique anomaly. Safety studies cannot determine the anticipated rate of GBS (it is too rare), but we know that flu itself is likelier to cause GBS than even the 1976 vaccine was. The risk/benefit equation favours vaccination. The French study I mentioned in my post actually went as far as to suggest flu vaccine could be a way to reduce the incidence of GBS in the population.
"...address the vexed question of why a lot of doctors will not have it"
I think few of them know the true facts. Most, including you obviously, have got their information straight from the front pages of the Daily Mail, with its insinuations of shady cover-ups and conspiracies and "killer nerve disease" scare stories. Need I say more?
Dr Crippen,
I think that you are very silly to assume that the DNUK survey is representative of anyone other than those who opted to answer a survey on doctorsnet. It's as valid as any other self-selecting survey - hardly valid at all.
As for safety, over a year ago I attended the first meeting at the EMEA of a special pandemic influenza taskgroup who were concerned solely with the safety and efficacy of the vaccine (primarily the safety). If memory serves, this group has been meeting approximately monthly since then, discussing avian and swine flu vaccine safety and efficacy too. Back then there were preliminary discussions on precisely how best to monitor any adverse events arising from such vaccines, ensuring that (a) signals from vaccine-related events weren't missed and (b) if there was a serious problem with a vaccine that the signals from this did not drown out the sginals from all other medicines that people were still taking. These discussions have progressed and I know that all regulators are taking this very seriously and are considering all the angles to ensure that their systems can cope if there is a global vaccination campaign and if this causes a big spike in cases.
In short, safety is most definitely being considered and will be exceptionally closely monitored by all the relevant authorities, if only because this is an issue of such importance.
I am a freelance writer and a mother of 3 children. I was debating about the vaccination. Working as an investigative reporter for many years (later as Editor), I learned to NEVER trust the news media. That may sound odd, but when you work and see what goes on inside the arena it changes your opinion about the accuracy of what you read and hear on TV.
Working as a reporter, you realize that selling newspapers is more important than providing a good, honest service to the public. That is why I quit and started freelance writing.
I wanted to provide articles based on facts and my desire was to share accurate, fair articles with people so they could learn something. I provide links to my resources and scientific studies so they are given the tools to read further and form their own opinions. I don't care about the money or the readership. I DO care about my reputation as a writer and at the end of the day I don't ever want to feel guilty about swaying someone into believing something to line my pockets or sell headlines.
To decide whether I should personally give my children those vaccinations I did some homework. Then I shared it in an article. I discovered some interesting things in several scientific studies regarding swine flu and the normal every day flu bug and studies that looked into whether any flu shots really work or not. Are they worth it? You decide. Read the article AND the studies conducted.
The homepage is a direct link to the article for those who wish to read it. It's called, "Swine Flu: Mass Media Scare or Real Threat?" I will post link here as well.
http://www.bukisa.com/articles/181914_swine-flu-mass-media-scare-or-real...
Hope everyone stays healthy and safe.
Go to davidicke/swineflu which has an enormous amount of information on what is in the swine flu jab and about the companies that have produced it.
Hi sorry I mispelt the website address it is:
davidicke.com/swineflu
i had the shot yesterday with my daughter we are fine they couldnt use it if it wasnt safe
oh i got it as i have asthma and im pregnant so i had to do it my daughter is 9 and has asthma id rather save our lives then risk it
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Although now the vaccination available against swine flu but peoples should care much to prevent themselves to be protected from virus. I think for this kinds of affection there should be insurance policy as like life insurance policies and we need much preparation and protection again them.
"The data on this are anecdotal but nonetheless worrying. The anonymous poll on DNUK currently shows that 48% of the doctors who responded will not have it." Dr John Crippen on Wed, 09/09/2009 - 20:39
I'll state from the start, I am an immunologist and a I work on vaccines. Thus, I am clearly pro-vaccination. However, I also have the unique position of working with both medics (by this I mean medical doctors as opposed to PhDs in immunology), medical students, and non-medical students.
Even with in the immunology community I am exposed to, there are a small number (the vast minority) of clinical immunologists and trainee doctors who are in doubt about vaccines in general, not just the flue vaccine. So it does not surprise me that up to 48% of medics would not have the vaccine, given that the majority of medically trained people have a minimal level of immunology. I can't blame anyone for choosing not to have a vaccine if their own GP chooses not to.
So why do these individuals who understand the immunology and the pro's of vaccinations still choose not to have vaccines? The answer is "I have a gut feeling it's not good" -or something to that effect. Have they looked at any data? Sometimes no, more worrying are the"yes, but still...". Do they have any evidence for their position? So far no one I have met can provide any.
My conclusion; there is a complete lack of trust in any sort of organisation by a large swath of the population regardless of their understanding of the evidence, even if they work for that organisation. Thus, you can argue until you are blue in the face about the data and evidence, but until the "gut feeling" is lost, or trust in the system is restored, you are wasting your time. It is during these times of lost trust that people will turn to other sources for their information, and hence the growing voice of the anti-vaccinationists.
Fortunately, if you choose not to have the vaccine this won't effect those that do choose to have it. Unfortunately, by not having the vaccination you leave those you are unable to have the vaccine exposed to possible infection.
C