5 ms·

The Dystonia Flu-Shot Case

22 points by MikeCapone 17y ago

VMG 17y ago
I knew Steve would write something about this
fnid 17y ago
In the nearest large town to me, they had 2800 doses for a metro area of almost a million. Even if it is effective and even if it doesn't do anything bad, the vaccine is probably going to do little good on the grand scale.
- KirinDave 17y ago
  Well then let's do a universal vaccine campaign. Education is a first step towards that. Given the state of things right now, people would avoid their shots and weaken the approach. First we have to get people comfortable with vaccines and get people to stop fighting them because of imagined health issues.
  - gojomo 17y ago
    I strongly believe in vaccines. I get a seasonal flu vaccine almost every year, just to spare the risk of a few days' misery/seclusion. But, I wouldn't be first in line for any new vaccine. Anything that's rushed, and anything that's new, has added risks.
    - KirinDave 17y ago
      What bearing does that have on the current discussion? Are you implying the H1N1 vaccine was rushed? Neither the seasonal nor H1N1 vaccines were particularly "rushed," anymore than they usually are. We were lucky with the H1N1 being easy to predict, which is why we have a fair amount of it. Calling it "rushed" in any way that significantly increases the vaccine's risk factors seems to be unsupported, accordig to the experts I've heardtalk on the subject.
      - electromagnetic 17y ago
        Agreed, the flu vaccines every year are modified and changed, they have never been clinically trialled before they're issued to the general public. The flu changes every year. The main seasonal flu strains are H3N2 and H1N1, a 'swine flu' actually hits us every single year. The thing that's novel about the new H1N1, I believe it's 'A/Mexico/2009', is the mixture of strains it comes from. However with a basic reproduction rate (in a non-immune population, this is the secondary infection rate for every 1 infected person) of ~1.7 it is likely that just basic hygiene countermeasures could defeat it. Even marginal immunisation of the population could do enough to bring the infection rate below 1.0 and cause the virus to die out. For comparison the Spanish Flu had basic infection rates between 2-3. HIV/AIDS has 2-5 and measles, for example, is between 12-18. Smallpox had an infection rate of 5-7 and was wiped from the face of the earth. Simply put immunization and hygiene programs are only intended to decrease the reproduction rate to near-1. When summer hits, the reproduction rate of influenza decreases dramatically.
        duncanj 17y ago
        I agree, except the seasonal "H1N1" flus are not "swine" flus per se. They don't tend to infect swine, and are best considered human flus. All type A flus are, originally, duck flus.
      - gojomo 17y ago
        Yes, the new vaccine is novel and it was rushed. That's not saying it was imprudently rushed, but producers have been racing to get these new-strain vaccines ready on a schedule more compressed and on a scale much larger than the usual seasonal process. For example, reports indicate: - Vaccine producers haven't been able to accurately predict the yields, as is typical of a new process. - At first it was thought the new vaccine would require two shots, now it's thought one is enough. - Different nations are preparing the vaccines differently -- for example in their varying use of adjuvants. - Much of the initial supplies are a nasal vaccine which uses a weakened virus. Nasal vaccines are themselves a newer technology than traditional dead-virus shots. (Nasal vaccines have a good 6-year record; I prefer a safety record of decades.) Advocates of universal vaccination can't have it both ways: that this virus is so new and unpredictable we should hurry to be vaccinated, but the vaccine based on that same virus is so old and reliable we can treat it, after just a few months' of trials, as having the exact same risk profile as decades of seasonal shots. If the new vaccines were identical to seasonal vaccine plus the new strain, created completely via normal processes and schedules, then there would be just one seasonal shot, and 2009-H1N1 would be one of the added strains. (Last year's seasonal shot already included another H1N1 strain.) They chose not to follow that process, so they don't get the same decades-of-safety presumption. No amount of short-term studies or expert assessment can replace years of aggregated experience. Medicine takes decades to converge on definitive answers, and has called many things wrong for years before correction. So please, take my place at the front of the line. There's no right answer for everyone; searching the solution space requires a diversity of individual strategies. I'm not pregnant and I'm old enough that I've almost certainly had cases of, and vaccinations for, lots of cousins of the new virus. (I may have even already had one of the "so mild treatment isn't even sought" cases earlier this year, which is the best vaccination of all.)
- cperciva 17y ago
  With a 0.28% coverage rate, you're not going to do much to stop the spread of the virus; but you can still do a lot to reduce the impact of the virus. Members of high risk groups (mainly pregnant women, people with weakened immune systems, and people with existing respiratory conditions) can be hundreds of times more likely to be hospitalized due to H1N1 -- so vaccinating those specific groups can significantly reduce the impact of H1N1, even if it doesn't reduce the total number of cases significantly.
  - thaumaturgy 17y ago
    This has been an interesting turnabout in H1N1 news. I first started following it closely in the first days of its outbreak, because my girlfriend happened to be visiting family just outside Mexico City at the time. Initial reports said that one of the main concerns of H1N1, over "normal" influenza strains, was that it seemed to have a greater effect on those with healthy immune systems. At the time, there were some guesses that it might be triggering cytokine "storms". Since then, this has been subtly altered to the usual "most dangerous to the less healthy" property of normal influenza. I don't really have a point, it's just an observation that's made me go, "huh."
    - cperciva 17y ago
      Influenza causes death through two primary routes: 1. Cytokine storm causing respiratory failure; 2. Increasing the vulnerability of the respiratory tract to secondary infections. Route #1 is generally how healthy individuals (including the high-risk group of late-term pregnant women) die, while route #2 is generally how unhealthy individuals (people with weakened immune systems; people with existing respiratory conditions; the elderly) die. My understanding is that H1N1 is not causing significantly more deaths through route #1 than seasonal influenza, and that the early indications to that effect were due to (a) Mexican health authorities only identifying the most severe H1N1 cases (this is also why Mexico had a much higher reported death rate than the rest of the world), and (b) the elderly being resistant to H1N1 due to its similarity to the 1957 pandemic influenza. In short: Pandemics are complicated, and sometimes circumstances conspire to mislead researchers.
kakooljay 17y ago
"It is highly unlikely that whatever Jennings is suffering from now had anything to do with the flu vaccine she received in August. Unfortunately, this is not stopping irresponsible news coverage or exploitation by anti-vaccinationists... Jennings has now inserted herself in to the anti-vaccine movement, and is using her own case to 'warn about the dangers of vaccines.'" We need a vaccine to cure ignorance...
- thwarted 17y ago
  ... but those who need it wouldn't take it.
  - thaumaturgy 17y ago
    ... which is why it is best delivered from a rooftop, with darts, from a high-powered rifle. (I have often threatened to do exactly this if such a thing were possible.)
chrischen 17y ago
Part of the fear stems from thimerosal, mercury, and autism.
- MikeCapone 17y ago
  Yes, three things that have been debunked.
  - chrischen 17y ago
    Even if it has been debunked, the fact that thimerosal is banned in california, and being phased out just legitimizes the fear. Then California temporarily unbans it for the H1N1 vaccine. How does that make arguments towards its safety sound? It merely makes it seem as if the dangers of H1N1 for this case outweighs the suggested risk of thimerosal.
    - thaumaturgy 17y ago
      Well, that's exactly right. The (real) dangers of the flu are greater than the imaginary dangers of thimerosal. Since the anti-vax folks seem to love anecdotes: my entire father's side of my family has used thimerosal topically to treat cuts and wounds -- under its trade name Merthiolate -- for a very very long time, at least since my father was very young. There have been no ill side effects. Other than insanity. (I kid, I kid. Maybe.)
noonespecial 17y ago
Most of the anti-vax crowd I meet are so wrapped up in trying to convince everyone of the autism link that they don't stop to think if it matters. What if the worst is true and they are right? A small percentage of children vaccinated become autistic. Is that worse than 21,269 (American, many more globally) children per year left with mild to disabling paralysis from polio? Measles, mumps, rubella, Tetanus, Diphtheria? As hard as it might sound, even if the current vaccines actually are harmful to some very small number of children, we should still do it. The alternative is much worse.
- thaumaturgy 17y ago
  I agree with you, but I think I can also predict the responses of the anti-vax crowd. To them, they have a strong bias between "naturally-caused" and "human-caused" effects; they would see 21,000 cases of polio as, "Oh dear, well, that's nature (or God), and it's too bad we can't do anything about it." But, transform those 21,000 cases of polio into 2,000 cases of autism, and you get: "Someone did this! Someone inflicted this, this is someone's fault, see, we're not supposed to be messing with nature." From the outside looking in, it's a strange bias, but it's the peculiar result of a sort of comfort in helplessness combined with poor education and a preference for emotional responses over logical thinking.
Tichy 17y ago
How is debunking an anecdotal evidence better than anecdotal evidence? Unfortunately that article did not provide the numbers required to make a judgment: what is the probability for complications with the vaccine, and what is the probability for complications with the Flu? It mentions 36000 deaths, but it is not clear if that is a high number (possibly a lot of the deaths are people who are already sick and could have a higher risk with the vaccine, too). Some people will probably die from the vaccine, too, if only because they have some stupid allergy or whatever.

22 points by MikeCapone 17y ago

VMG 17y ago

I knew Steve would write something about this

fnid 17y ago

In the nearest large town to me, they had 2800 doses for a metro area of almost a million. Even if it is effective and even if it doesn't do anything bad, the vaccine is probably going to do little good on the grand scale.

KirinDave 17y ago
Well then let's do a universal vaccine campaign. Education is a first step towards that. Given the state of things right now, people would avoid their shots and weaken the approach. First we have to get people comfortable with vaccines and get people to stop fighting them because of imagined health issues.
- gojomo 17y ago
  I strongly believe in vaccines. I get a seasonal flu vaccine almost every year, just to spare the risk of a few days' misery/seclusion. But, I wouldn't be first in line for any new vaccine. Anything that's rushed, and anything that's new, has added risks.
  - KirinDave 17y ago
    What bearing does that have on the current discussion? Are you implying the H1N1 vaccine was rushed? Neither the seasonal nor H1N1 vaccines were particularly "rushed," anymore than they usually are. We were lucky with the H1N1 being easy to predict, which is why we have a fair amount of it. Calling it "rushed" in any way that significantly increases the vaccine's risk factors seems to be unsupported, accordig to the experts I've heardtalk on the subject.
    - electromagnetic 17y ago
      Agreed, the flu vaccines every year are modified and changed, they have never been clinically trialled before they're issued to the general public. The flu changes every year. The main seasonal flu strains are H3N2 and H1N1, a 'swine flu' actually hits us every single year. The thing that's novel about the new H1N1, I believe it's 'A/Mexico/2009', is the mixture of strains it comes from. However with a basic reproduction rate (in a non-immune population, this is the secondary infection rate for every 1 infected person) of ~1.7 it is likely that just basic hygiene countermeasures could defeat it. Even marginal immunisation of the population could do enough to bring the infection rate below 1.0 and cause the virus to die out. For comparison the Spanish Flu had basic infection rates between 2-3. HIV/AIDS has 2-5 and measles, for example, is between 12-18. Smallpox had an infection rate of 5-7 and was wiped from the face of the earth. Simply put immunization and hygiene programs are only intended to decrease the reproduction rate to near-1. When summer hits, the reproduction rate of influenza decreases dramatically.
      - duncanj 17y ago
        I agree, except the seasonal "H1N1" flus are not "swine" flus per se. They don't tend to infect swine, and are best considered human flus. All type A flus are, originally, duck flus.
    - gojomo 17y ago
      Yes, the new vaccine is novel and it was rushed. That's not saying it was imprudently rushed, but producers have been racing to get these new-strain vaccines ready on a schedule more compressed and on a scale much larger than the usual seasonal process. For example, reports indicate: - Vaccine producers haven't been able to accurately predict the yields, as is typical of a new process. - At first it was thought the new vaccine would require two shots, now it's thought one is enough. - Different nations are preparing the vaccines differently -- for example in their varying use of adjuvants. - Much of the initial supplies are a nasal vaccine which uses a weakened virus. Nasal vaccines are themselves a newer technology than traditional dead-virus shots. (Nasal vaccines have a good 6-year record; I prefer a safety record of decades.) Advocates of universal vaccination can't have it both ways: that this virus is so new and unpredictable we should hurry to be vaccinated, but the vaccine based on that same virus is so old and reliable we can treat it, after just a few months' of trials, as having the exact same risk profile as decades of seasonal shots. If the new vaccines were identical to seasonal vaccine plus the new strain, created completely via normal processes and schedules, then there would be just one seasonal shot, and 2009-H1N1 would be one of the added strains. (Last year's seasonal shot already included another H1N1 strain.) They chose not to follow that process, so they don't get the same decades-of-safety presumption. No amount of short-term studies or expert assessment can replace years of aggregated experience. Medicine takes decades to converge on definitive answers, and has called many things wrong for years before correction. So please, take my place at the front of the line. There's no right answer for everyone; searching the solution space requires a diversity of individual strategies. I'm not pregnant and I'm old enough that I've almost certainly had cases of, and vaccinations for, lots of cousins of the new virus. (I may have even already had one of the "so mild treatment isn't even sought" cases earlier this year, which is the best vaccination of all.)
cperciva 17y ago
With a 0.28% coverage rate, you're not going to do much to stop the spread of the virus; but you can still do a lot to reduce the impact of the virus. Members of high risk groups (mainly pregnant women, people with weakened immune systems, and people with existing respiratory conditions) can be hundreds of times more likely to be hospitalized due to H1N1 -- so vaccinating those specific groups can significantly reduce the impact of H1N1, even if it doesn't reduce the total number of cases significantly.
- thaumaturgy 17y ago
  This has been an interesting turnabout in H1N1 news. I first started following it closely in the first days of its outbreak, because my girlfriend happened to be visiting family just outside Mexico City at the time. Initial reports said that one of the main concerns of H1N1, over "normal" influenza strains, was that it seemed to have a greater effect on those with healthy immune systems. At the time, there were some guesses that it might be triggering cytokine "storms". Since then, this has been subtly altered to the usual "most dangerous to the less healthy" property of normal influenza. I don't really have a point, it's just an observation that's made me go, "huh."
  - cperciva 17y ago
    Influenza causes death through two primary routes: 1. Cytokine storm causing respiratory failure; 2. Increasing the vulnerability of the respiratory tract to secondary infections. Route #1 is generally how healthy individuals (including the high-risk group of late-term pregnant women) die, while route #2 is generally how unhealthy individuals (people with weakened immune systems; people with existing respiratory conditions; the elderly) die. My understanding is that H1N1 is not causing significantly more deaths through route #1 than seasonal influenza, and that the early indications to that effect were due to (a) Mexican health authorities only identifying the most severe H1N1 cases (this is also why Mexico had a much higher reported death rate than the rest of the world), and (b) the elderly being resistant to H1N1 due to its similarity to the 1957 pandemic influenza. In short: Pandemics are complicated, and sometimes circumstances conspire to mislead researchers.

kakooljay 17y ago

"It is highly unlikely that whatever Jennings is suffering from now had anything to do with the flu vaccine she received in August. Unfortunately, this is not stopping irresponsible news coverage or exploitation by anti-vaccinationists... Jennings has now inserted herself in to the anti-vaccine movement, and is using her own case to 'warn about the dangers of vaccines.'" We need a vaccine to cure ignorance...

thwarted 17y ago
... but those who need it wouldn't take it.
- thaumaturgy 17y ago
  ... which is why it is best delivered from a rooftop, with darts, from a high-powered rifle. (I have often threatened to do exactly this if such a thing were possible.)

chrischen 17y ago

Part of the fear stems from thimerosal, mercury, and autism.

MikeCapone 17y ago
Yes, three things that have been debunked.
- chrischen 17y ago
  Even if it has been debunked, the fact that thimerosal is banned in california, and being phased out just legitimizes the fear. Then California temporarily unbans it for the H1N1 vaccine. How does that make arguments towards its safety sound? It merely makes it seem as if the dangers of H1N1 for this case outweighs the suggested risk of thimerosal.
  - thaumaturgy 17y ago
    Well, that's exactly right. The (real) dangers of the flu are greater than the imaginary dangers of thimerosal. Since the anti-vax folks seem to love anecdotes: my entire father's side of my family has used thimerosal topically to treat cuts and wounds -- under its trade name Merthiolate -- for a very very long time, at least since my father was very young. There have been no ill side effects. Other than insanity. (I kid, I kid. Maybe.)

noonespecial 17y ago

Most of the anti-vax crowd I meet are so wrapped up in trying to convince everyone of the autism link that they don't stop to think if it matters. What if the worst is true and they are right? A small percentage of children vaccinated become autistic. Is that worse than 21,269 (American, many more globally) children per year left with mild to disabling paralysis from polio? Measles, mumps, rubella, Tetanus, Diphtheria? As hard as it might sound, even if the current vaccines actually are harmful to some very small number of children, we should still do it. The alternative is much worse.

thaumaturgy 17y ago
I agree with you, but I think I can also predict the responses of the anti-vax crowd. To them, they have a strong bias between "naturally-caused" and "human-caused" effects; they would see 21,000 cases of polio as, "Oh dear, well, that's nature (or God), and it's too bad we can't do anything about it." But, transform those 21,000 cases of polio into 2,000 cases of autism, and you get: "Someone did this! Someone inflicted this, this is someone's fault, see, we're not supposed to be messing with nature." From the outside looking in, it's a strange bias, but it's the peculiar result of a sort of comfort in helplessness combined with poor education and a preference for emotional responses over logical thinking.

Tichy 17y ago

How is debunking an anecdotal evidence better than anecdotal evidence? Unfortunately that article did not provide the numbers required to make a judgment: what is the probability for complications with the vaccine, and what is the probability for complications with the Flu? It mentions 36000 deaths, but it is not clear if that is a high number (possibly a lot of the deaths are people who are already sick and could have a higher risk with the vaccine, too). Some people will probably die from the vaccine, too, if only because they have some stupid allergy or whatever.