Re: Flu shot effectiveness

September 30, 2009

The Sept 24 2009 issue of NEJM has the study you are referring to. http://nejm.highwire.org/cgi/content/abstract/361/13/1260•1952 adults enrolled•Jan-Apr 2008 flu season•Inactivated vaccine 68% effective against Types A & B, 72% effective against Type A•Live attenuated vaccine 36% effective against Types A & B, 29% effective against Type AI also found this 2007 study looking at the vaccines in children, also from NEJM:http://content.nejm.org/cgi/content/full/356/7/685•7852 children enrolled, ages 6-59 months•2004-2005 flu season•54.9% fewer cases of culture-confirmed influenza in the group receiving live attenuated virus than inactivated vaccine (153 vs 338)So is there a difference in kids vs adults getting live vaccine or a difference in the flu strains during the different years, or both? SetoSouth Pasadena, CAJust saw a study somewhere nasal mist attenuated virus around 35% effective, IM inactivated virus 75% effective. José

October 6, 2009

Graham,You asked for evidence.Vaccine effectiveness against laboratory-confirmed influenza in children 6 to 59 months of age during the 2003-2004 and 2004-2005 influenza seasons.Pediatrics. 2008 Nov;122(5):911-9.http://www.ncbi.nlm.nih.gov/pubmed/18977968?ordinalpos=1 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA & linkpos=2 & log$=relatedarticles & logdbfrom=pubmedCONCLUSIONS: Receipt of all recommended doses of influenza vaccine was associated with halving of laboratory-confirmed influenza-related medical visits among children 6 to 59 months of age in 1 of 2 study years, despite suboptimal matches between the vaccine and circulating influenza strains in both years.-----Effectiveness of inactivated influenza vaccine in children less than 5 years of age over multiple influenza seasons: a case-control study. Vaccine. 2009 Jul 16;27(33):4457-61. Epub 2009 May 31.http://www.ncbi.nlm.nih.gov/pubmed/19490957?ordinalpos=28 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumThe children vaccinated against influenza accordingly to the 2007 ACIP guidelines had a lower risk of laboratory-confirmed medically attended influenza illness (Odds Ratio: 0.14, 95% Confidence Interval: 0.03-0.71) than the unvaccinated children. -----Effectiveness of live, attenuated intranasal influenza virus vaccine in healthy, working adults: a randomized controlled trial.JAMA. 1999 Jul 14;282(2):137-44.http://www.ncbi.nlm.nih.gov/pubmed/10411194?ordinalpos=1 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA & linkpos=2 & log$=relatedarticles & logdbfrom=pubmedHowever, vaccination significantly reduced the numbers of severe febrile illnesses (18.8% reduction; 95% confidence interval [CI], 7.4%-28.8%) and febrile upper respiratory tract illnesses (23.6% reduction; 95% CI, 12.7%-33.2%). Vaccination also led to fewer days of illness across all illness syndromes (22.9% reduction for febrile illnesses; 27.3% reduction for severe febrile illnesses), fewer days of work lost (17.9% reduction for severe febrile illnesses; 28.4% reduction for febrile upper respiratory tract illnesses), and fewer days with health care provider visits (24.8% reduction for severe febrile illnesses; 40.9% reduction for febrile upper respiratory tract illnesses). -----Effectiveness of influenza vaccine in the community-dwelling elderly.N Engl J Med. 2007 Oct 4;357(14):1373-81http://www.ncbi.nlm.nih.gov/pubmed/17914038?ordinalpos=25 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumCONCLUSIONS: During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons. SetoSouth Pasadena, CALots of posts about seasonal flu vaccinations on this list.Is there any recent conclusive evidence that they are beneficial except amongst rest home residents?Last time I looked there wasn't.

October 6, 2009

Thank you for posting these. I collect articles from the research so I can run copies to give to people who are vaccine averse. I didn't have the JAMA 1999. Vaccine Quarterly and Needle Tips have posted good stuff as well.I am amazed at the nonchalance or downright opposition from people who normally have good sense. I have an acquaintance in California who has thus far refused to have her 5 yo vaccinated for anything even though he started school this year. This woman has two college degrees and has the wherewithal to fly to Florida to seek the care of a traditional practitioner who also does not believe in vaccination. It's not a religious issue, but a conscious decision to refuse. She has all kinds of 'information' on the 'dangers' and the 'questionable necessity'. Evidently there is a growing group in the greater LA area, where she lives. They hold 'immunity' parties. When one of their kids get sick, they expose the others kids in the play group to give them natural immunity. She really is a lovely and thoughtful person otherwise. I have told her that LA is a large international community with polio perhaps just one plane ride away. Anyone have any other advice to help people with this anti-vaccine position, become better informed with the science of communicable diseases? k Graham,You asked for evidence.Vaccine effectiveness against laboratory-confirmed influenza in children 6 to 59 months of age during the 2003-2004 and 2004-2005 influenza seasons.Pediatrics. 2008 Nov;122(5):911-9.http://www.ncbi.nlm.nih.gov/pubmed/18977968?ordinalpos=1 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA & linkpos=2 & log$=relatedarticles & logdbfrom=pubmedCONCLUSIONS: Receipt of all recommended doses of influenza vaccine was associated with halving of laboratory-confirmed influenza-related medical visits among children 6 to 59 months of age in 1 of 2 study years, despite suboptimal matches between the vaccine and circulating influenza strains in both years.-----Effectiveness of inactivated influenza vaccine in children less than 5 years of age over multiple influenza seasons: a case-control study. Vaccine. 2009 Jul 16;27(33):4457-61. Epub 2009 May 31.http://www.ncbi.nlm.nih.gov/pubmed/19490957?ordinalpos=28 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumThe children vaccinated against influenza accordingly to the 2007 ACIP guidelines had a lower risk of laboratory-confirmed medically attended influenza illness (Odds Ratio: 0.14, 95% Confidence Interval: 0.03-0.71) than the unvaccinated children. -----Effectiveness of live, attenuated intranasal influenza virus vaccine in healthy, working adults: a randomized controlled trial.JAMA. 1999 Jul 14;282(2):137-44.http://www.ncbi.nlm.nih.gov/pubmed/10411194?ordinalpos=1 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA & linkpos=2 & log$=relatedarticles & logdbfrom=pubmedHowever, vaccination significantly reduced the numbers of severe febrile illnesses (18.8% reduction; 95% confidence interval [CI], 7.4%-28.8%) and febrile upper respiratory tract illnesses (23.6% reduction; 95% CI, 12.7%-33.2%). Vaccination also led to fewer days of illness across all illness syndromes (22.9% reduction for febrile illnesses; 27.3% reduction for severe febrile illnesses), fewer days of work lost (17.9% reduction for severe febrile illnesses; 28.4% reduction for febrile upper respiratory tract illnesses), and fewer days with health care provider visits (24.8% reduction for severe febrile illnesses; 40.9% reduction for febrile upper respiratory tract illnesses). -----Effectiveness of influenza vaccine in the community-dwelling elderly.N Engl J Med. 2007 Oct 4;357(14):1373-81http://www.ncbi.nlm.nih.gov/pubmed/17914038?ordinalpos=25 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumCONCLUSIONS: During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons. SetoSouth Pasadena, CALots of posts about seasonal flu vaccinations on this list.Is there any recent conclusive evidence that they are beneficial except amongst rest home residents?Last time I looked there wasn't.

October 6, 2009

People do not trust medicine Sometimes for good reasonsThe medical environemnt does not treat people as if they amtterIt makes mistakesI read Autism's False Prophets and was reminded of some things

1 people turn to unconventional even wacko treaments becasue noone listens to and validates the concerns thatthe patietn is trying to express .So in trying to be heard they go where they are lisitend to, which may not be a source of valid treamtent

2 Medicne is inconsitent and therefore looks untrustworthy Eg Thimerserol shows no evidcne of doing any harm BUt it is off the market f or kids' vaccines AHah! what are we really hiding ,people say?

3 Leaders often do not lead well Autism's false Prohets gives some good examples of how the reveiw of good science was there to be seen ,yet people- MDs- in authority subverted the facts This is also seen in GAryTaubes book Good calories BAD calories.

Hence people do not trust and make the decsions t hat to us look wacko but to them feel supporting.That's my take on itAdd to all that a country that lives too fast eats toomuch bad food and spends littel time just talking and thinking Waddya expect?

JeanYou knew all that

Thank you for posting these. I collect articles from the research so I can run copies to give to people who are vaccine averse. I didn't have the JAMA 1999. Vaccine Quarterly and Needle Tips have posted good stuff as well.

I am amazed at the nonchalance or downright opposition from people who normally have good sense. I have an acquaintance in California who has thus far refused to have her 5 yo vaccinated for anything even though he started school this year. This woman has two college degrees and has the wherewithal to fly to Florida to seek the care of a traditional practitioner who also does not believe in vaccination. It's not a religious issue, but a conscious decision to refuse. She has all kinds of 'information' on the 'dangers' and the 'questionable necessity'.

Evidently there is a growing group in the greater LA area, where she lives. They hold 'immunity' parties. When one of their kids get sick, they expose the others kids in the play group to give them natural immunity.

She really is a lovely and thoughtful person otherwise. I have told her that LA is a large international community with polio perhaps just one plane ride away. Anyone have any other advice to help people with this anti-vaccine position, become better informed with the science of communicable diseases?

k

Graham,You asked for evidence.Vaccine effectiveness against laboratory-confirmed influenza in children 6 to 59 months of age during the 2003-2004 and 2004-2005 influenza seasons.

Pediatrics. 2008 Nov;122(5):911-9.http://www.ncbi.nlm.nih.gov/pubmed/18977968?ordinalpos=1 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA & linkpos=2 & log$=relatedarticles & logdbfrom=pubmed

CONCLUSIONS: Receipt of all recommended doses of influenza vaccine was associated with halving of laboratory-confirmed influenza-related medical visits among children 6 to 59 months of age in 1 of 2 study years, despite suboptimal matches between the vaccine and circulating influenza strains in both years.

-----Effectiveness of inactivated influenza vaccine in children less than 5 years of age over multiple influenza seasons: a case-control study.

Vaccine. 2009 Jul 16;27(33):4457-61. Epub 2009 May 31.http://www.ncbi.nlm.nih.gov/pubmed/19490957?ordinalpos=28 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

The children vaccinated against influenza accordingly to the 2007 ACIP guidelines had a lower risk of laboratory-confirmed medically attended influenza illness (Odds Ratio: 0.14, 95% Confidence Interval: 0.03-0.71) than the unvaccinated children.

-----

Effectiveness of live, attenuated intranasal influenza virus vaccine in healthy, working adults: a randomized controlled trial.

JAMA. 1999 Jul 14;282(2):137-44.http://www.ncbi.nlm.nih.gov/pubmed/10411194?ordinalpos=1 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA & linkpos=2 & log$=relatedarticles & logdbfrom=pubmed

However, vaccination significantly reduced the numbers of severe febrile illnesses (18.8% reduction; 95% confidence interval [CI], 7.4%-28.8%) and febrile upper respiratory tract illnesses (23.6% reduction; 95% CI, 12.7%-33.2%). Vaccination also led to fewer days of illness across all illness syndromes (22.9% reduction for febrile illnesses; 27.3% reduction for severe febrile illnesses), fewer days of work lost (17.9% reduction for severe febrile illnesses; 28.4% reduction for febrile upper respiratory tract illnesses), and fewer days with health care provider visits (24.8% reduction for severe febrile illnesses; 40.9% reduction for febrile upper respiratory tract illnesses).

-----Effectiveness of influenza vaccine in the community-dwelling elderly.N Engl J Med. 2007 Oct 4;357(14):1373-81

http://www.ncbi.nlm.nih.gov/pubmed/17914038?ordinalpos=25 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

CONCLUSIONS: During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons.

SetoSouth Pasadena, CA

Lots of posts about seasonal flu vaccinations on this list.Is there any recent conclusive evidence that they are beneficial except amongst rest home residents?

Last time I looked there wasn't

..

-- If you are a patient please allow up to 24 hours for a reply by email/Remember that e-mail may not be entirely secure/ MD

ph fax impcenter.org

October 6, 2009

5 yo local girl died in 2003 from encephalitis from the flu. One case doesn't

prove anything to us. However, our patients are frequently sold by this tactic.

Her father spoke at a flu informational meeting at our library last night. It

was very sobering. He started a foundation in her memory:

http://www.alanasflufoundation.org/about.html

The site has brochures: http://www.alanasflufoundation.org/materials.html

They recently came out with a public service announcement that they put on a CD.

We aren't supposed to act based on one case, but our patients may be swayed more

by a picture of a girl killed by flu than telling them that 35,000 Americans die

each year from influenza.

Good luck.

Craig

> >

> >> Lots of posts about seasonal flu vaccinations on this list.

> >>

> >> Is there any recent conclusive evidence that they are beneficial

> >> except amongst rest home residents?

> >>

> >> Last time I looked there wasn't

> >

> >> .

> >>

> >

>

October 6, 2009

So very true. I don't think that collectively medicine has treated people with respect. People will go to someone who will listen to them. Now collectively we are reaping what was sown. I have colleagues who have refused to see some patients because the parents refuse vaccination. I do understand my colleagues' concern that an unvaccinated kid with a naive immune system, could be a real risk in a pediatric waiting room. But I'm thinking that it makes it very difficult to even have the ongoing conversation that is needed. I'm hoping I didn't come off harsh or uncaring when I told my acquaintance that polio could be a plane ride away. I did tell her to make sure she has a good FP or pedi who is willing to discuss the vaccination issues and help with decisions as they come up. I dunno. Sometimes it feels like swimming up hill to maintain that Unconditional Positive Regard. I think that most of the time when parents are opposed to vaccination, it's really because they are fearful. I can relate to fear, every parent can.I haven't read Good Calories, Bad Calories yet. But Autism's Prophets was a sobering account of how information and misinformation can be usedKathleenPeople do not trust medicine Sometimes for good reasonsThe medical environemnt does not treat people as if they amtterIt makes mistakesI read Autism's False Prophets and was reminded of some things1 people turn to unconventional even wacko treaments becasue noone listens to and validates the concerns thatthe patietn is trying to express .So in trying to be heard they go where they are lisitend to, which may not be a source of valid treamtent2 Medicne is inconsitent and therefore looks untrustworthy Eg Thimerserol shows no evidcne of doing any harm BUt it is off the market f or kids' vaccines AHah! what are we really hiding ,people say?3 Leaders often do not lead well Autism's false Prohets gives some good examples of how the reveiw of good science was there to be seen ,yet people- MDs- in authority subverted the facts This is also seen in GAryTaubes book Good calories BAD calories.Hence people do not trust and make the decsions t hat to us look wacko but to them feel supporting.That's my take on itAdd to all that a country that lives too fast eats toomuch bad food and spends littel time just talking and thinking Waddya expect?JeanYou knew all that On Tue, Oct 6, 2009 at 2:07 PM, Kathleen Patton <krpattoncomcast (DOT) net> wrote: Thank you for posting these. I collect articles from the research so I can run copies to give to people who are vaccine averse. I didn't have the JAMA 1999. Vaccine Quarterly and Needle Tips have posted good stuff as well.I am amazed at the nonchalance or downright opposition from people who normally have good sense. I have an acquaintance in California who has thus far refused to have her 5 yo vaccinated for anything even though he started school this year. This woman has two college degrees and has the wherewithal to fly to Florida to seek the care of a traditional practitioner who also does not believe in vaccination. It's not a religious issue, but a conscious decision to refuse. She has all kinds of 'information' on the 'dangers' and the 'questionable necessity'. Evidently there is a growing group in the greater LA area, where she lives. They hold 'immunity' parties. When one of their kids get sick, they expose the others kids in the play group to give them natural immunity. She really is a lovely and thoughtful person otherwise. I have told her that LA is a large international community with polio perhaps just one plane ride away. Anyone have any other advice to help people with this anti-vaccine position, become better informed with the science of communicable diseases? k Graham,You asked for evidence.Vaccine effectiveness against laboratory-confirmed influenza in children 6 to 59 months of age during the 2003-2004 and 2004-2005 influenza seasons.Pediatrics. 2008 Nov;122(5):911-9.http://www.ncbi.nlm.nih.gov/pubmed/18977968?ordinalpos=1 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA & linkpos=2 & log$=relatedarticles & logdbfrom=pubmedCONCLUSIONS: Receipt of all recommended doses of influenza vaccine was associated with halving of laboratory-confirmed influenza-related medical visits among children 6 to 59 months of age in 1 of 2 study years, despite suboptimal matches between the vaccine and circulating influenza strains in both years.-----Effectiveness of inactivated influenza vaccine in children less than 5 years of age over multiple influenza seasons: a case-control study. Vaccine. 2009 Jul 16;27(33):4457-61. Epub 2009 May 31.http://www.ncbi.nlm.nih.gov/pubmed/19490957?ordinalpos=28 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumThe children vaccinated against influenza accordingly to the 2007 ACIP guidelines had a lower risk of laboratory-confirmed medically attended influenza illness (Odds Ratio: 0.14, 95% Confidence Interval: 0.03-0.71) than the unvaccinated children. -----Effectiveness of live, attenuated intranasal influenza virus vaccine in healthy, working adults: a randomized controlled trial.JAMA. 1999 Jul 14;282(2):137-44.http://www.ncbi.nlm.nih.gov/pubmed/10411194?ordinalpos=1 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA & linkpos=2 & log$=relatedarticles & logdbfrom=pubmedHowever, vaccination significantly reduced the numbers of severe febrile illnesses (18.8% reduction; 95% confidence interval [CI], 7.4%-28.8%) and febrile upper respiratory tract illnesses (23.6% reduction; 95% CI, 12.7%-33.2%). Vaccination also led to fewer days of illness across all illness syndromes (22.9% reduction for febrile illnesses; 27.3% reduction for severe febrile illnesses), fewer days of work lost (17.9% reduction for severe febrile illnesses; 28.4% reduction for febrile upper respiratory tract illnesses), and fewer days with health care provider visits (24.8% reduction for severe febrile illnesses; 40.9% reduction for febrile upper respiratory tract illnesses). -----Effectiveness of influenza vaccine in the community-dwelling elderly.N Engl J Med. 2007 Oct 4;357(14):1373-81http://www.ncbi.nlm.nih.gov/pubmed/17914038?ordinalpos=25 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumCONCLUSIONS: During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons. SetoSouth Pasadena, CALots of posts about seasonal flu vaccinations on this list.Is there any recent conclusive evidence that they are beneficial except amongst rest home residents?Last time I looked there wasn't.-- If you are a patient please allow up to 24 hours for a reply by email/Remember that e-mail may not be entirely secure/ MD ph fax impcenter.org

October 6, 2009

That is so very sad.When I was a med student, vaccine for hflu wasn't mandatory, but was available. A beautiful 4 year old angel came into the PICU, comatose. She was fine in the morning. When I did the LP that evening, her csf was so thick with white cells it looked like clotted cream in the tube. I remember, before she was extubated, her parents, aunts and grandmothers washed her hair and dressed her in her own clean pajamas. After we pulled the tube, my attending carefully handed her to her mother who was sitting in a rocking chair. She breathed her last breath snuggled in a blanket in her mother's arms. These things I will never forget. k5 yo local girl died in 2003 from encephalitis from the flu. One case doesn't prove anything to us. However, our patients are frequently sold by this tactic.Her father spoke at a flu informational meeting at our library last night. It was very sobering. He started a foundation in her memory:http://www.alanasflufoundation.org/about.htmlThe site has brochures: http://www.alanasflufoundation.org/materials.htmlThey recently came out with a public service announcement that they put on a CD.We aren't supposed to act based on one case, but our patients may be swayed more by a picture of a girl killed by flu than telling them that 35,000 Americans die each year from influenza.Good luck.Craig> >> >> Lots of posts about seasonal flu vaccinations on this list.> >>> >>> >> Is there any recent conclusive evidence that they are beneficial > >> except amongst rest home residents?> >>> >> Last time I looked there wasn't> >> >> .> >>> >> >> >>

October 6, 2009

This is much more recent being published just a few months ago.http://aje.oxfordjournals.org/cgi/content/full/170/5/650

Many earlier studies were biased because vaccinees were more likely to be healthier than non vaccinees. The study by Nichol that you quote showed the reverse, but this study reports that the relationship is actually curvilinear ie. the very sick don't tend to get vaccinated.

Their estimate is of 4.6% effectiveness against all-cause mortality as a result of vaccination in this population.

Graham,You asked for evidence.Vaccine effectiveness against laboratory-confirmed influenza in children 6 to 59 months of age during the 2003-2004 and 2004-2005 influenza seasons.

Pediatrics. 2008 Nov;122(5):911-9.http://www.ncbi.nlm.nih.gov/pubmed/18977968?ordinalpos=1 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA & linkpos=2 & log$=relatedarticles & logdbfrom=pubmed

CONCLUSIONS: Receipt of all recommended doses of influenza vaccine was associated with halving of laboratory-confirmed influenza-related medical visits among children 6 to 59 months of age in 1 of 2 study years, despite suboptimal matches between the vaccine and circulating influenza strains in both years.

-----Effectiveness of inactivated influenza vaccine in children less than 5 years of age over multiple influenza seasons: a case-control study.

Vaccine. 2009 Jul 16;27(33):4457-61. Epub 2009 May 31.http://www.ncbi.nlm.nih.gov/pubmed/19490957?ordinalpos=28 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

The children vaccinated against influenza accordingly to the 2007 ACIP guidelines had a lower risk of laboratory-confirmed medically attended influenza illness (Odds Ratio: 0.14, 95% Confidence Interval: 0.03-0.71) than the unvaccinated children.

-----

Effectiveness of live, attenuated intranasal influenza virus vaccine in healthy, working adults: a randomized controlled trial.

JAMA. 1999 Jul 14;282(2):137-44.http://www.ncbi.nlm.nih.gov/pubmed/10411194?ordinalpos=1 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA & linkpos=2 & log$=relatedarticles & logdbfrom=pubmed

However, vaccination significantly reduced the numbers of severe febrile illnesses (18.8% reduction; 95% confidence interval [CI], 7.4%-28.8%) and febrile upper respiratory tract illnesses (23.6% reduction; 95% CI, 12.7%-33.2%). Vaccination also led to fewer days of illness across all illness syndromes (22.9% reduction for febrile illnesses; 27.3% reduction for severe febrile illnesses), fewer days of work lost (17.9% reduction for severe febrile illnesses; 28.4% reduction for febrile upper respiratory tract illnesses), and fewer days with health care provider visits (24.8% reduction for severe febrile illnesses; 40.9% reduction for febrile upper respiratory tract illnesses).

-----Effectiveness of influenza vaccine in the community-dwelling elderly.N Engl J Med. 2007 Oct 4;357(14):1373-81

http://www.ncbi.nlm.nih.gov/pubmed/17914038?ordinalpos=25 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

CONCLUSIONS: During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons.

SetoSouth Pasadena, CA

Lots of posts about seasonal flu vaccinations on this list.Is there any recent conclusive evidence that they are beneficial except amongst rest home residents?

Last time I looked there wasn't

..

-- Graham Chiuhttp://www.synapsedirect.comSynapse - the use from anywhere EMR.

October 6, 2009

Just tell them what I tell people... Sure you live here and feel comfortable trying to avoid this. I dare you to get on a plane and take your child to some un-vaccinated third world country and let him play, and swap bugs with all the kids over there while they are all sneezing and wiping their noses on the sleeves.... Go ahead, you know what you are doing....

To: Sent: Tue, October 6, 2009 2:07:41 PMSubject: Re: Flu shot effectiveness

Thank you for posting these. I collect articles from the research so I can run copies to give to people who are vaccine averse. I didn't have the JAMA 1999. Vaccine Quarterly and Needle Tips have posted good stuff as well.

I am amazed at the nonchalance or downright opposition from people who normally have good sense. I have an acquaintance in California who has thus far refused to have her 5 yo vaccinated for anything even though he started school this year. This woman has two college degrees and has the wherewithal to fly to Florida to seek the care of a traditional practitioner who also does not believe in vaccination. It's not a religious issue, but a conscious decision to refuse. She has all kinds of 'information' on the 'dangers' and the 'questionable necessity'.

Evidently there is a growing group in the greater LA area, where she lives. They hold 'immunity' parties. When one of their kids get sick, they expose the others kids in the play group to give them natural immunity.

She really is a lovely and thoughtful person otherwise. I have told her that LA is a large international community with polio perhaps just one plane ride away.

Anyone have any other advice to help people with this anti-vaccine position, become better informed with the science of communicable diseases?

k

Graham,

You asked for evidence.

Vaccine effectiveness against laboratory-confirme d influenza in children 6 to 59 months of age during the 2003-2004 and 2004-2005 influenza seasons.

Pediatrics. 2008 Nov;122(5):911- 9.

http://www.ncbi. nlm.nih.gov/ pubmed/18977968? ordinalpos= 1 & itool=EntrezSystem2 .PEntrez. Pubmed.Pubmed_ ResultsPanel. Pubmed_Discovery Panel.Pubmed_ Discovery_ RA & linkpos=2 & log$=relatedarticle s & logdbfrom=pubmed

CONCLUSIONS: Receipt of all recommended doses of influenza vaccine was associated with halving of laboratory-confirme d influenza-related medical visits among children 6 to 59 months of age in 1 of 2 study years, despite suboptimal matches between the vaccine and circulating influenza strains in both years.

-----

Effectiveness of inactivated influenza vaccine in children less than 5 years of age over multiple influenza seasons: a case-control study.

Vaccine. 2009 Jul 16;27(33):4457- 61. Epub 2009 May 31.

http://www.ncbi. nlm.nih.gov/ pubmed/19490957? ordinalpos= 28 & itool=EntrezSystem2 .PEntrez. Pubmed.Pubmed_ ResultsPanel. Pubmed_DefaultRe portPanel. Pubmed_RVDocSum

The children vaccinated against influenza accordingly to the 2007 ACIP guidelines had a lower risk of laboratory-confirme d medically attended influenza illness (Odds Ratio: 0.14, 95% Confidence Interval: 0.03-0.71) than the unvaccinated children.

-----

Effectiveness of live, attenuated intranasal influenza virus vaccine in healthy, working adults: a randomized controlled trial.

JAMA. 1999 Jul 14;282(2):137- 44.

http://www.ncbi. nlm.nih.gov/ pubmed/10411194? ordinalpos= 1 & itool=EntrezSystem2 .PEntrez. Pubmed.Pubmed_ ResultsPanel. Pubmed_Discovery Panel.Pubmed_ Discovery_ RA & linkpos=2 & log$=relatedarticle s & logdbfrom=pubmed

However, vaccination significantly reduced the numbers of severe febrile illnesses (18.8% reduction; 95% confidence interval [CI], 7.4%-28.8%) and febrile upper respiratory tract illnesses (23.6% reduction; 95% CI, 12.7%-33.2%) . Vaccination also led to fewer days of illness across all illness syndromes (22.9% reduction for febrile illnesses; 27.3% reduction for severe febrile illnesses), fewer days of work lost (17.9% reduction for severe febrile illnesses; 28.4% reduction for febrile upper respiratory tract illnesses), and fewer days with health care provider visits (24.8% reduction for severe febrile illnesses; 40.9% reduction for febrile upper respiratory tract illnesses).

-----

Effectiveness of influenza vaccine in the community-dwelling elderly.

N Engl J Med. 2007 Oct 4;357(14):1373- 81

http://www.ncbi. nlm.nih.gov/ pubmed/17914038? ordinalpos= 25 & itool=EntrezSystem2 .PEntrez. Pubmed.Pubmed_ ResultsPanel. Pubmed_DefaultRe portPanel. Pubmed_RVDocSum

CONCLUSIONS: During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons.

Seto

South Pasadena, CA

Lots of posts about seasonal flu vaccinations on this list.

Is there any recent conclusive evidence that they are beneficial except amongst rest home residents?

Last time I looked there wasn't

..

__________________________________________________

October 6, 2009

Thanks .

To: Sent: Tuesday, October 6, 2009 12:52:47 PMSubject: Re: Flu shot effectiveness

Graham,

You asked for evidence.

Vaccine effectiveness against laboratory-confirme d influenza in children 6 to 59 months of age during the 2003-2004 and 2004-2005 influenza seasons.

Pediatrics. 2008 Nov;122(5):911- 9.

http://www.ncbi. nlm.nih.gov/ pubmed/18977968? ordinalpos= 1 & itool=EntrezSystem2 .PEntrez. Pubmed.Pubmed_ ResultsPanel. Pubmed_Discovery Panel.Pubmed_ Discovery_ RA & linkpos=2 & log$=relatedarticle s & logdbfrom=pubmed

CONCLUSIONS: Receipt of all recommended doses of influenza vaccine was associated with halving of laboratory-confirme d influenza-related medical visits among children 6 to 59 months of age in 1 of 2 study years, despite suboptimal matches between the vaccine and circulating influenza strains in both years.

-----

Effectiveness of inactivated influenza vaccine in children less than 5 years of age over multiple influenza seasons: a case-control study.

Vaccine. 2009 Jul 16;27(33):4457- 61. Epub 2009 May 31.

http://www.ncbi. nlm.nih.gov/ pubmed/19490957? ordinalpos= 28 & itool=EntrezSystem2 .PEntrez. Pubmed.Pubmed_ ResultsPanel. Pubmed_DefaultRe portPanel. Pubmed_RVDocSum

The children vaccinated against influenza accordingly to the 2007 ACIP guidelines had a lower risk of laboratory-confirme d medically attended influenza illness (Odds Ratio: 0.14, 95% Confidence Interval: 0.03-0.71) than the unvaccinated children.

-----

Effectiveness of live, attenuated intranasal influenza virus vaccine in healthy, working adults: a randomized controlled trial.

JAMA. 1999 Jul 14;282(2):137- 44.

http://www.ncbi. nlm.nih.gov/ pubmed/10411194? ordinalpos= 1 & itool=EntrezSystem2 .PEntrez. Pubmed.Pubmed_ ResultsPanel. Pubmed_Discovery Panel.Pubmed_ Discovery_ RA & linkpos=2 & log$=relatedarticle s & logdbfrom=pubmed

However, vaccination significantly reduced the numbers of severe febrile illnesses (18.8% reduction; 95% confidence interval [CI], 7.4%-28.8%) and febrile upper respiratory tract illnesses (23.6% reduction; 95% CI, 12.7%-33.2%) . Vaccination also led to fewer days of illness across all illness syndromes (22.9% reduction for febrile illnesses; 27.3% reduction for severe febrile illnesses), fewer days of work lost (17.9% reduction for severe febrile illnesses; 28.4% reduction for febrile upper respiratory tract illnesses), and fewer days with health care provider visits (24.8% reduction for severe febrile illnesses; 40.9% reduction for febrile upper respiratory tract illnesses).

-----

Effectiveness of influenza vaccine in the community-dwelling elderly.

N Engl J Med. 2007 Oct 4;357(14):1373- 81

http://www.ncbi. nlm.nih.gov/ pubmed/17914038? ordinalpos= 25 & itool=EntrezSystem2 .PEntrez. Pubmed.Pubmed_ ResultsPanel. Pubmed_DefaultRe portPanel. Pubmed_RVDocSum

CONCLUSIONS: During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons.

Seto

South Pasadena, CA

Lots of posts about seasonal flu vaccinations on this list.

Is there any recent conclusive evidence that they are beneficial except amongst rest home residents?

Last time I looked there wasn't

..

October 6, 2009

Threads are getting all mixed up.I thought we were talking about the effectiveness of flu vaccination for which there has been some debate in the medical journals for some years now and not all vaccinations.

Thanks .

To:

Sent: Tuesday, October 6, 2009 12:52:47 PMSubject: Re: Flu shot effectiveness

Graham,

You asked for evidence.

Vaccine effectiveness against laboratory-confirme d influenza in children 6 to 59 months of age during the 2003-2004 and 2004-2005 influenza seasons.

Pediatrics. 2008 Nov;122(5):911- 9.

http://www.ncbi. nlm.nih.gov/ pubmed/18977968? ordinalpos= 1 & itool=EntrezSystem2 .PEntrez. Pubmed.Pubmed_ ResultsPanel. Pubmed_Discovery Panel.Pubmed_ Discovery_ RA & linkpos=2 & log$=relatedarticle s & logdbfrom=pubmed

CONCLUSIONS: Receipt of all recommended doses of influenza vaccine was associated with halving of laboratory-confirme d influenza-related medical visits among children 6 to 59 months of age in 1 of 2 study years, despite suboptimal matches between the vaccine and circulating influenza strains in both years.

-----

Effectiveness of inactivated influenza vaccine in children less than 5 years of age over multiple influenza seasons: a case-control study.

Vaccine. 2009 Jul 16;27(33):4457- 61. Epub 2009 May 31.

http://www.ncbi. nlm.nih.gov/ pubmed/19490957? ordinalpos= 28 & itool=EntrezSystem2 .PEntrez. Pubmed.Pubmed_ ResultsPanel. Pubmed_DefaultRe portPanel. Pubmed_RVDocSum

The children vaccinated against influenza accordingly to the 2007 ACIP guidelines had a lower risk of laboratory-confirme d medically attended influenza illness (Odds Ratio: 0.14, 95% Confidence Interval: 0.03-0.71) than the unvaccinated children.

-----

Effectiveness of live, attenuated intranasal influenza virus vaccine in healthy, working adults: a randomized controlled trial.

JAMA. 1999 Jul 14;282(2):137- 44.

http://www.ncbi. nlm.nih.gov/ pubmed/10411194? ordinalpos= 1 & itool=EntrezSystem2 .PEntrez. Pubmed.Pubmed_ ResultsPanel. Pubmed_Discovery Panel.Pubmed_ Discovery_ RA & linkpos=2 & log$=relatedarticle s & logdbfrom=pubmed

However, vaccination significantly reduced the numbers of severe febrile illnesses (18.8% reduction; 95% confidence interval [CI], 7.4%-28.8%) and febrile upper respiratory tract illnesses (23.6% reduction; 95% CI, 12.7%-33.2%) . Vaccination also led to fewer days of illness across all illness syndromes (22.9% reduction for febrile illnesses; 27.3% reduction for severe febrile illnesses), fewer days of work lost (17.9% reduction for severe febrile illnesses; 28.4% reduction for febrile upper respiratory tract illnesses), and fewer days with health care provider visits (24.8% reduction for severe febrile illnesses; 40.9% reduction for febrile upper respiratory tract illnesses).

-----

Effectiveness of influenza vaccine in the community-dwelling elderly.

N Engl J Med. 2007 Oct 4;357(14):1373- 81

http://www.ncbi. nlm.nih.gov/ pubmed/17914038? ordinalpos= 25 & itool=EntrezSystem2 .PEntrez. Pubmed.Pubmed_ ResultsPanel. Pubmed_DefaultRe portPanel. Pubmed_RVDocSum

CONCLUSIONS: During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons.

Seto

South Pasadena, CA

Lots of posts about seasonal flu vaccinations on this list.

Is there any recent conclusive evidence that they are beneficial except amongst rest home residents?

Last time I looked there wasn't

..

-- Graham Chiuhttp://www.synapsedirect.comSynapse - the use from anywhere EMR.

October 7, 2009

Graham,Thanks for pointing out this article. In my reading of it, it seems to be saying that:•If no one had been vaccinated for influenza at all, they estimated an excess mortality rate during flu season of 9.8%. •They found that flu shots reduced all-cause mortality during the flu season by 4.6% in a population with only 63% vaccination rate. "We infer that our 4.6% VE (vaccine effectiveness) estimate amounts to a 47% reduction (4.6/9.8 = 47%) in the number of flu-attributable deaths that would have occurred had none of the elderly been vaccinated."So while 4.6% fewer total deaths doesn't sound very impressive, a 47% drop in expected deaths seems like a pretty good thing to me. But maybe I'm reading it wrong.It goes on to say:•There were 326 deaths in vaccinees. •If there had been no flu shots, there would have been 342 flu-season deaths in this same population. •Thus, vaccination prevented approximately 16 flu-season deaths per 100,000 person-years in the Kaiser Permanente population, which amounted to approximately 25 deaths prevented per 100,000 people vaccinated. •The corresponding "number needed to treat" was 4,000; in other words, 1 death was prevented for every 4,000 elderly people vaccinated.OK, that doesn't sound so impressive. But for comparison, this article talks about how 2970 women must be screened once by mammography in order to save one life from breast cancer:http://www.biomedcentral.com/1472-6947/9/18/abstractIt seems like an appropriate time to bring out the famous quote: "There are 3 kinds of lies: lies, damned lies and statistics." SetoSouth Pasadena, CAThis is much more recent being published just a few months ago.http://aje.oxfordjournals.org/cgi/content/full/170/5/650Many earlier studies were biased because vaccinees were more likely to be healthier than non vaccinees. The study by Nichol that you quote showed the reverse, but this study reports that the relationship is actually curvilinear ie. the very sick don't tend to get vaccinated.Their estimate is of 4.6% effectiveness against all-cause mortality as a result of vaccination in this population. Graham,You asked for evidence.Vaccine effectiveness against laboratory-confirmed influenza in children 6 to 59 months of age during the 2003-2004 and 2004-2005 influenza seasons.Pediatrics. 2008 Nov;122(5):911-9.http://www.ncbi.nlm.nih.gov/pubmed/18977968?ordinalpos=1 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA & linkpos=2 & log$=relatedarticles & logdbfrom=pubmedCONCLUSIONS: Receipt of all recommended doses of influenza vaccine was associated with halving of laboratory-confirmed influenza-related medical visits among children 6 to 59 months of age in 1 of 2 study years, despite suboptimal matches between the vaccine and circulating influenza strains in both years.-----Effectiveness of inactivated influenza vaccine in children less than 5 years of age over multiple influenza seasons: a case-control study. Vaccine. 2009 Jul 16;27(33):4457-61. Epub 2009 May 31.http://www.ncbi.nlm.nih.gov/pubmed/19490957?ordinalpos=28 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumThe children vaccinated against influenza accordingly to the 2007 ACIP guidelines had a lower risk of laboratory-confirmed medically attended influenza illness (Odds Ratio: 0.14, 95% Confidence Interval: 0.03-0.71) than the unvaccinated children. -----Effectiveness of live, attenuated intranasal influenza virus vaccine in healthy, working adults: a randomized controlled trial.JAMA. 1999 Jul 14;282(2):137-44.http://www.ncbi.nlm.nih.gov/pubmed/10411194?ordinalpos=1 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA & linkpos=2 & log$=relatedarticles & logdbfrom=pubmedHowever, vaccination significantly reduced the numbers of severe febrile illnesses (18.8% reduction; 95% confidence interval [CI], 7.4%-28.8%) and febrile upper respiratory tract illnesses (23.6% reduction; 95% CI, 12.7%-33.2%). Vaccination also led to fewer days of illness across all illness syndromes (22.9% reduction for febrile illnesses; 27.3% reduction for severe febrile illnesses), fewer days of work lost (17.9% reduction for severe febrile illnesses; 28.4% reduction for febrile upper respiratory tract illnesses), and fewer days with health care provider visits (24.8% reduction for severe febrile illnesses; 40.9% reduction for febrile upper respiratory tract illnesses). -----Effectiveness of influenza vaccine in the community-dwelling elderly.N Engl J Med. 2007 Oct 4;357(14):1373-81http://www.ncbi.nlm.nih.gov/pubmed/17914038?ordinalpos=25 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumCONCLUSIONS: During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons. SetoSouth Pasadena, CALots of posts about seasonal flu vaccinations on this list.Is there any recent conclusive evidence that they are beneficial except amongst rest home residents?Last time I looked there wasn't.-- Graham Chiuhttp://www.synapsedirect.comSynapse - the use from anywhere EMR.

October 7, 2009

That's similar to what I read though I never got as far as the NNT numbers.Sure 47% sounds huge . but percentages are always misleading.So, basically this Kaiser study is saying that flu vaccination does have a measurable positive effect. But if all the IMPs on this list vaccinate all their elderly patients this flu season, it is not likely a single life will be saved as a result.

So, if you miss out on your allocation, don't fret it ...

Graham,Thanks for pointing out this article. In my reading of it, it seems to be saying that:•If no one had been vaccinated for influenza at all, they estimated an excess mortality rate during flu season of 9.8%.

•They found that flu shots reduced all-cause mortality during the flu season by 4.6% in a population with only 63% vaccination rate. " We infer that our 4.6% VE (vaccine effectiveness) estimate amounts to a 47% reduction (4.6/9.8 = 47%) in the number of flu-attributable deaths that would have occurred had none of the elderly been vaccinated. "

So while 4.6% fewer total deaths doesn't sound very impressive, a 47% drop in expected deaths seems like a pretty good thing to me. But maybe I'm reading it wrong.

It goes on to say:•There were 326 deaths in vaccinees. •If there had been no flu shots, there would have been 342 flu-season deaths in this same population. •Thus, vaccination prevented approximately 16 flu-season deaths per 100,000 person-years in the Kaiser Permanente population, which amounted to approximately 25 deaths prevented per 100,000 people vaccinated.

•The corresponding " number needed to treat " was 4,000; in other words, 1 death was prevented for every 4,000 elderly people vaccinated.OK, that doesn't sound so impressive. But for comparison, this article talks about how 2970 women must be screened once by mammography in order to save one life from breast cancer:

http://www.biomedcentral.com/1472-6947/9/18/abstractIt seems like an appropriate time to bring out the famous quote: " There are 3 kinds of lies: lies, damned lies and statistics. "

SetoSouth Pasadena, CA

This is much more recent being published just a few months ago.http://aje.oxfordjournals.org/cgi/content/full/170/5/650

Many earlier studies were biased because vaccinees were more likely to be healthier than non vaccinees. The study by Nichol that you quote showed the reverse, but this study reports that the relationship is actually curvilinear ie. the very sick don't tend to get vaccinated.

Their estimate is of 4.6% effectiveness against all-cause mortality as a result of vaccination in this population.

On Wed, Oct 7, 2009 at 5:52 AM, Seto wrote:

Graham,You asked for evidence.Vaccine effectiveness against laboratory-confirmed influenza in children 6 to 59 months of age during the 2003-2004 and 2004-2005 influenza seasons.

Pediatrics. 2008 Nov;122(5):911-9.http://www.ncbi.nlm.nih.gov/pubmed/18977968?ordinalpos=1 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA & linkpos=2 & log$=relatedarticles & logdbfrom=pubmed

CONCLUSIONS: Receipt of all recommended doses of influenza vaccine was associated with halving of laboratory-confirmed influenza-related medical visits among children 6 to 59 months of age in 1 of 2 study years, despite suboptimal matches between the vaccine and circulating influenza strains in both years.

-----Effectiveness of inactivated influenza vaccine in children less than 5 years of age over multiple influenza seasons: a case-control study.

Vaccine. 2009 Jul 16;27(33):4457-61. Epub 2009 May 31.http://www.ncbi.nlm.nih.gov/pubmed/19490957?ordinalpos=28 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

The children vaccinated against influenza accordingly to the 2007 ACIP guidelines had a lower risk of laboratory-confirmed medically attended influenza illness (Odds Ratio: 0.14, 95% Confidence Interval: 0.03-0.71) than the unvaccinated children.

-----

Effectiveness of live, attenuated intranasal influenza virus vaccine in healthy, working adults: a randomized controlled trial.

JAMA. 1999 Jul 14;282(2):137-44.http://www.ncbi.nlm.nih.gov/pubmed/10411194?ordinalpos=1 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA & linkpos=2 & log$=relatedarticles & logdbfrom=pubmed

However, vaccination significantly reduced the numbers of severe febrile illnesses (18.8% reduction; 95% confidence interval [CI], 7.4%-28.8%) and febrile upper respiratory tract illnesses (23.6% reduction; 95% CI, 12.7%-33.2%). Vaccination also led to fewer days of illness across all illness syndromes (22.9% reduction for febrile illnesses; 27.3% reduction for severe febrile illnesses), fewer days of work lost (17.9% reduction for severe febrile illnesses; 28.4% reduction for febrile upper respiratory tract illnesses), and fewer days with health care provider visits (24.8% reduction for severe febrile illnesses; 40.9% reduction for febrile upper respiratory tract illnesses).

-----Effectiveness of influenza vaccine in the community-dwelling elderly.N Engl J Med. 2007 Oct 4;357(14):1373-81

http://www.ncbi.nlm.nih.gov/pubmed/17914038?ordinalpos=25 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

CONCLUSIONS: During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons.

SetoSouth Pasadena, CA

Lots of posts about seasonal flu vaccinations on this list.Is there any recent conclusive evidence that they are beneficial except amongst rest home residents?

Last time I looked there wasn't

..

-- Graham Chiuhttp://www.synapsedirect.com

Synapse - the use from anywhere EMR.

-- Graham Chiuhttp://www.synapsedirect.comSynapse - the use from anywhere EMR.

October 7, 2009

thank you guys I appreciate this discussionI do not know where I would be without you guys thanksyou remind me that when mainecare pays me 47% more wow 47% of nothin g is ...nothing :)jean

That's similar to what I read though I never got as far as the NNT numbers.Sure 47% sounds huge . but percentages are always misleading.

So, basically this Kaiser study is saying that flu vaccination does have a measurable positive effect. But if all the IMPs on this list vaccinate all their elderly patients this flu season, it is not likely a single life will be saved as a result.

So, if you miss out on your allocation, don't fret it ...

Graham,Thanks for pointing out this article. In my reading of it, it seems to be saying that:•If no one had been vaccinated for influenza at all, they estimated an excess mortality rate during flu season of 9.8%.

•They found that flu shots reduced all-cause mortality during the flu season by 4.6% in a population with only 63% vaccination rate. " We infer that our 4.6% VE (vaccine effectiveness) estimate amounts to a 47% reduction (4.6/9.8 = 47%) in the number of flu-attributable deaths that would have occurred had none of the elderly been vaccinated. "

So while 4.6% fewer total deaths doesn't sound very impressive, a 47% drop in expected deaths seems like a pretty good thing to me. But maybe I'm reading it wrong.

It goes on to say:•There were 326 deaths in vaccinees. •If there had been no flu shots, there would have been 342 flu-season deaths in this same population. •Thus, vaccination prevented approximately 16 flu-season deaths per 100,000 person-years in the Kaiser Permanente population, which amounted to approximately 25 deaths prevented per 100,000 people vaccinated.

•The corresponding " number needed to treat " was 4,000; in other words, 1 death was prevented for every 4,000 elderly people vaccinated.OK, that doesn't sound so impressive. But for comparison, this article talks about how 2970 women must be screened once by mammography in order to save one life from breast cancer:

http://www.biomedcentral.com/1472-6947/9/18/abstractIt seems like an appropriate time to bring out the famous quote: " There are 3 kinds of lies: lies, damned lies and statistics. "

SetoSouth Pasadena, CA

This is much more recent being published just a few months ago.http://aje.oxfordjournals.org/cgi/content/full/170/5/650

Many earlier studies were biased because vaccinees were more likely to be healthier than non vaccinees. The study by Nichol that you quote showed the reverse, but this study reports that the relationship is actually curvilinear ie. the very sick don't tend to get vaccinated.

Their estimate is of 4.6% effectiveness against all-cause mortality as a result of vaccination in this population.

On Wed, Oct 7, 2009 at 5:52 AM, Seto wrote:

Graham,You asked for evidence.Vaccine effectiveness against laboratory-confirmed influenza in children 6 to 59 months of age during the 2003-2004 and 2004-2005 influenza seasons.

Pediatrics. 2008 Nov;122(5):911-9.http://www.ncbi.nlm.nih.gov/pubmed/18977968?ordinalpos=1 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA & linkpos=2 & log$=relatedarticles & logdbfrom=pubmed

CONCLUSIONS: Receipt of all recommended doses of influenza vaccine was associated with halving of laboratory-confirmed influenza-related medical visits among children 6 to 59 months of age in 1 of 2 study years, despite suboptimal matches between the vaccine and circulating influenza strains in both years.

-----Effectiveness of inactivated influenza vaccine in children less than 5 years of age over multiple influenza seasons: a case-control study.

Vaccine. 2009 Jul 16;27(33):4457-61. Epub 2009 May 31.http://www.ncbi.nlm.nih.gov/pubmed/19490957?ordinalpos=28 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

The children vaccinated against influenza accordingly to the 2007 ACIP guidelines had a lower risk of laboratory-confirmed medically attended influenza illness (Odds Ratio: 0.14, 95% Confidence Interval: 0.03-0.71) than the unvaccinated children.

-----

Effectiveness of live, attenuated intranasal influenza virus vaccine in healthy, working adults: a randomized controlled trial.

JAMA. 1999 Jul 14;282(2):137-44.http://www.ncbi.nlm.nih.gov/pubmed/10411194?ordinalpos=1 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA & linkpos=2 & log$=relatedarticles & logdbfrom=pubmed

However, vaccination significantly reduced the numbers of severe febrile illnesses (18.8% reduction; 95% confidence interval [CI], 7.4%-28.8%) and febrile upper respiratory tract illnesses (23.6% reduction; 95% CI, 12.7%-33.2%). Vaccination also led to fewer days of illness across all illness syndromes (22.9% reduction for febrile illnesses; 27.3% reduction for severe febrile illnesses), fewer days of work lost (17.9% reduction for severe febrile illnesses; 28.4% reduction for febrile upper respiratory tract illnesses), and fewer days with health care provider visits (24.8% reduction for severe febrile illnesses; 40.9% reduction for febrile upper respiratory tract illnesses).

-----Effectiveness of influenza vaccine in the community-dwelling elderly.N Engl J Med. 2007 Oct 4;357(14):1373-81

http://www.ncbi.nlm.nih.gov/pubmed/17914038?ordinalpos=25 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

CONCLUSIONS: During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons.

SetoSouth Pasadena, CA

Lots of posts about seasonal flu vaccinations on this list.Is there any recent conclusive evidence that they are beneficial except amongst rest home residents?

Last time I looked there wasn't

..

-- Graham Chiuhttp://www.synapsedirect.com

Synapse - the use from anywhere EMR.

-- Graham Chiuhttp://www.synapsedirect.comSynapse - the use from anywhere EMR.

-- If you are a patient please allow up to 24 hours for a reply by email/Remember that e-mail may not be entirely secure/ MD

ph fax impcenter.org

October 7, 2009

I second that thanks.I believe I was the one who segued into a single case of failure to vaccinate. But my heart was pure! I was heading toward using the information to help people make decisions about vaccination, when I had a flash back of a tragic case. Sorry.Thanks for re-directing the conversation.Kthank you guys I appreciate this discussionI do not know where I would be without you guys thanksyou remind me that when mainecare pays me 47% more wow 47% of nothin g is ...nothing :)jeanOn Tue, Oct 6, 2009 at 8:18 PM, Graham Chiu <compkarorigmail> wrote: That's similar to what I read though I never got as far as the NNT numbers.Sure 47% sounds huge . but percentages are always misleading.So, basically this Kaiser study is saying that flu vaccination does have a measurable positive effect. But if all the IMPs on this list vaccinate all their elderly patients this flu season, it is not likely a single life will be saved as a result.So, if you miss out on your allocation, don't fret it ... Graham,Thanks for pointing out this article. In my reading of it, it seems to be saying that:•If no one had been vaccinated for influenza at all, they estimated an excess mortality rate during flu season of 9.8%. •They found that flu shots reduced all-cause mortality during the flu season by 4.6% in a population with only 63% vaccination rate. "We infer that our 4.6% VE (vaccine effectiveness) estimate amounts to a 47% reduction (4.6/9.8 = 47%) in the number of flu-attributable deathsthat would have occurred had none of the elderly been vaccinated."So while 4.6% fewer total deaths doesn't sound very impressive, a 47% drop inexpected deaths seems like a pretty good thing to me. But maybe I'm reading it wrong.It goes on to say:•There were 326 deaths in vaccinees. •If there had been no flu shots, there would have been 342 flu-season deaths in this same population. •Thus, vaccination prevented approximately 16 flu-season deaths per 100,000 person-years in the Kaiser Permanente population, which amounted to approximately 25 deaths prevented per 100,000 people vaccinated. •The corresponding "number needed to treat" was 4,000; in other words, 1 death was prevented for every 4,000 elderly people vaccinated.OK, that doesn't sound so impressive. But for comparison, this article talks about how 2970 women must be screened once by mammography in order to save one life from breast cancer:http://www.biomedcentral.com/1472-6947/9/18/abstractIt seems like an appropriate time to bring out the famous quote: "There are 3 kinds of lies: lies, damned lies and statistics." SetoSouth Pasadena, CAThis is much more recent being published just a few months ago.http://aje.oxfordjournals.org/cgi/content/full/170/5/650Many earlier studies were biased because vaccinees were more likely to be healthier than non vaccinees. The study by Nichol that you quote showed the reverse, but this study reports that the relationship is actually curvilinear ie. the very sick don't tend to get vaccinated.Their estimate is of 4.6% effectiveness against all-cause mortality as a result of vaccination in this population. Graham,You asked for evidence.Vaccine effectiveness against laboratory-confirmed influenza in children 6 to 59 months of age during the 2003-2004 and 2004-2005 influenza seasons.Pediatrics. 2008 Nov;122(5):911-9.http://www.ncbi.nlm.nih.gov/pubmed/18977968?ordinalpos=1 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA & linkpos=2 & log$=relatedarticles & logdbfrom=pubmedCONCLUSIONS: Receipt of all recommended doses of influenza vaccine was associated with halving of laboratory-confirmed influenza-related medical visits among children 6 to 59 months of age in 1 of 2 study years, despite suboptimal matches between the vaccine and circulating influenza strains in both years.-----Effectiveness of inactivated influenza vaccine in children less than 5 years of age over multiple influenza seasons: a case-control study. Vaccine. 2009 Jul 16;27(33):4457-61. Epub 2009 May 31.http://www.ncbi.nlm.nih.gov/pubmed/19490957?ordinalpos=28 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumThe children vaccinated against influenza accordingly to the 2007 ACIP guidelines had a lower risk of laboratory-confirmed medically attended influenza illness (Odds Ratio: 0.14, 95% Confidence Interval: 0.03-0.71) than the unvaccinated children. -----Effectiveness of live, attenuated intranasal influenza virus vaccine in healthy, working adults: a randomized controlled trial.JAMA. 1999 Jul 14;282(2):137-44.http://www.ncbi.nlm.nih.gov/pubmed/10411194?ordinalpos=1 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA & linkpos=2 & log$=relatedarticles & logdbfrom=pubmedHowever, vaccination significantly reduced the numbers of severe febrile illnesses (18.8% reduction; 95% confidence interval [CI], 7.4%-28.8%) and febrile upper respiratory tract illnesses (23.6% reduction; 95% CI, 12.7%-33.2%). Vaccination also led to fewer days of illness across all illness syndromes (22.9% reduction for febrile illnesses; 27.3% reduction for severe febrile illnesses), fewer days of work lost (17.9% reduction for severe febrile illnesses; 28.4% reduction for febrile upper respiratory tract illnesses), and fewer days with health care provider visits (24.8% reduction for severe febrile illnesses; 40.9% reduction for febrile upper respiratory tract illnesses). -----Effectiveness of influenza vaccine in the community-dwelling elderly.N Engl J Med. 2007 Oct 4;357(14):1373-81http://www.ncbi.nlm.nih.gov/pubmed/17914038?ordinalpos=25 & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumCONCLUSIONS: During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons. SetoSouth Pasadena, CALots of posts about seasonal flu vaccinations on this list.Is there any recent conclusive evidence that they are beneficial except amongst rest home residents?Last time I looked there wasn't.-- Graham Chiuhttp://www.synapsedirect.comSynapse - the use from anywhere EMR.-- Graham Chiuhttp://www.synapsedirect.comSynapse - the use from anywhere EMR.-- If you are a patient please allow up to 24 hours for a reply by email/Remember that e-mail may not be entirely secure/ MD ph fax impcenter.org

October 7, 2009

I forgot where I saw it, but isn't there data showing that since we started

vaccinating children for influenza, we've finally started making a significant

impact in preventing deaths from influenza in the elderly?

> >>

> >>> Lots of posts about seasonal flu vaccinations on this list.

> >>>

> >>> Is there any recent conclusive evidence that they are beneficial

> >>> except amongst rest home residents?

> >>>

> >>> Last time I looked there wasn't

> >>

> >>> .

> >>>

> >>

> >> --

> >>

> >> Graham Chiu

> >> http://www.synapsedirect.com

> >> Synapse - the use from anywhere EMR.

> >>

> >

> > --

> > Graham Chiu

> > http://www.synapsedirect.com

> > Synapse - the use from anywhere EMR.

> >

> > --

> >

> > If you are a patient please allow up to 24 hours for a reply by

> > email/

> > Remember that e-mail may not be entirely secure/

> > MD

> >

> > ph fax

> > impcenter.org

> >

>

October 7, 2009

Craig,I believe you are referring to this 2001 article:The Japanese Experience with Vaccinating Schoolchildren against Influenzahttp://content.nejm.org/cgi/content/short/344/12/889From 1962 to 1987, most Japanese schoolchildren were vaccinated against influenza. For more than a decade, vaccination was mandatory, but the laws were relaxed in 1987 and repealed in 1994; subsequently, vaccination rates dropped to low levels. Results: The excess mortality from pneumonia and influenza and that from all causes were highly correlated in each country. In the United States, these rates were nearly constant over time. With the initiation of the vaccination program for schoolchildren in Japan, excess mortality rates dropped from values three to four times those in the United States to values similar to those in the United States. The vaccination of Japanese children prevented about 37,000 to 49,000 deaths per year, or about 1 death for every 420 children vaccinated. As the vaccination of schoolchildren was discontinued, the excess mortality rates in Japan increased. SetoSouth Pasadena, CAI forgot where I saw it, but isn't there data showing that since we started vaccinating children for influenza, we've finally started making a significant impact in preventing deaths from influenza in the elderly?> >>> >>> Lots of posts about seasonal flu vaccinations on this list.> >>>> >>>> >>> Is there any recent conclusive evidence that they are beneficial > >>> except amongst rest home residents?> >>>> >>> Last time I looked there wasn't> >>> >>> .> >>>> >>> >>> >>> >>> >>> >> -- > >>> >> Graham Chiu> >> http://www.synapsedirect.com> >> Synapse - the use from anywhere EMR.> >>> >> >> >> >> >> > -- > > Graham Chiu> > http://www.synapsedirect.com> > Synapse - the use from anywhere EMR.> >> >> >> > -- > >> > If you are a patient please allow up to 24 hours for a reply by > > email/> > Remember that e-mail may not be entirely secure/> > MD> > > > > > ph fax > > impcenter.org> >> >>

October 7, 2009

`Thanks GAry I heard this too This has begun to influcne me that we may be better off immunizing kids than older folks.....

Craig, I believe you are referring to this 2001 article:

The Japanese Experience with Vaccinating Schoolchildren against Influenza

http://content.nejm.org/cgi/content/short/344/12/889

From 1962 to 1987, most Japanese schoolchildren were vaccinated against influenza. For more than a decade, vaccination was mandatory, but the laws were relaxed in 1987 and repealed in 1994; subsequently, vaccination rates dropped to low levels.

Results: The excess mortality from pneumonia and influenza and that from all causes were highly correlated in each country. In the United States, these rates were nearly constant over time. With the initiation of the vaccination program for schoolchildren in Japan, excess mortality rates dropped from values three to four times those in the United States to values similar to those in the United States. The vaccination of Japanese children prevented about 37,000 to 49,000 deaths per year, or about 1 death for every 420 children vaccinated. As the vaccination of schoolchildren was discontinued, the excess mortality rates in Japan increased.

Seto

South Pasadena, CA

I forgot where I saw it, but isn't there data showing that since we started vaccinating children for influenza, we've finally started making a significant impact in preventing deaths from influenza in the elderly?

> >>

> >>> Lots of posts about seasonal flu vaccinations on this list.> >>>> >>>> >>> Is there any recent conclusive evidence that they are beneficial

> >>> except amongst rest home residents?> >>>> >>> Last time I looked there wasn't> >>> >>> .> >>>> >>> >>

> >>> >>> >>> >> -- > >>> >> Graham Chiu> >> http://www.synapsedirect.com

> >> Synapse - the use from anywhere EMR.> >>> >> >> >> >> >> > -- > > Graham Chiu> > http://www.synapsedirect.com

> > Synapse - the use from anywhere EMR.> >> >> >> > -- > >> > If you are a patient please allow up to 24 hours for a reply by

> > email/> > Remember that e-mail may not be entirely secure/> > MD> > > > > > ph fax

> > impcenter.org> >> >>

-- If you are a patient please allow up to 24 hours for a reply by email/Remember that e-mail may not be entirely secure/ MD

ph fax impcenter.org

October 9, 2009

Polio is just a plane ride away? Haha no , you did not come off too harsh. Well, it was harsh,but sometimes harsh is really, really needed. For adult travelers, sometimes a polio booster (one time as an adult) is recommended and we have told people that they don't want to be the American who got polio because they refused a vaccination when the country they were visting had a polio outbreak (Nigeria maybe?)

Wayne CoghillPractice ManagerMidtown Primary Carewww.doctorcoghill.com

To: Sent: Tuesday, October 6, 2009 4:24:49 PMSubject: Re: Flu shot effectiveness

So very true. I don't think that collectively medicine has treated people with respect. People will go to someone who will listen to them.

Now collectively we are reaping what was sown.

I have colleagues who have refused to see some patients because the parents refuse vaccination. I do understand my colleagues' concern that an unvaccinated kid with a naive immune system, could be a real risk in a pediatric waiting room. But I'm thinking that it makes it very difficult to even have the ongoing conversation that is needed.

I'm hoping I didn't come off harsh or uncaring when I told my acquaintance that polio could be a plane ride away. I did tell her to make sure she has a good FP or pedi who is willing to discuss the vaccination issues and help with decisions as they come up.

I dunno. Sometimes it feels like swimming up hill to maintain that Unconditional Positive Regard. I think that most of the time when parents are opposed to vaccination, it's really because they are fearful. I can relate to fear, every parent can.

I haven't read Good Calories, Bad Calories yet. But Autism's Prophets was a sobering account of how information and misinformation can be used

Kathleen

People do not trust medicine Sometimes for good reasonsThe medical environemnt does not treat people as if they amtterIt makes mistakesI read Autism's False Prophets and was reminded of some things1 people turn to unconventional even wacko treaments becasue noone listens to and validates the concerns thatthe patietn is trying to express .So in trying to be heard they go where they are lisitend to, which may not be a source of valid treamtent2 Medicne is inconsitent and therefore looks untrustworthy Eg Thimerserol shows no evidcne of doing any

harm BUt it is off the market f or kids' vaccines AHah! what are we really hiding ,people say?3 Leaders often do not lead well Autism's false Prohets gives some good examples of how the reveiw of good science was there to be seen ,yet people- MDs- in authority subverted the facts This is also seen in GAryTaubes book Good calories BAD calories.Hence people do not trust and make the decsions t hat to us look wacko but to them feel supporting.That's my take on itAdd to all that a country that lives too fast eats toomuch bad food and spends littel time just talking and thinking Waddya expect?JeanYou knew all that

On Tue, Oct 6, 2009 at 2:07 PM, Kathleen Patton <krpattoncomcast (DOT) net> wrote:

Thank you for posting these. I collect articles from the research so I can run copies to give to people who are vaccine averse. I didn't have the JAMA 1999. Vaccine Quarterly and Needle Tips have posted good stuff as well.

I am amazed at the nonchalance or downright opposition from people who normally have good sense. I have an acquaintance in California who has thus far refused to have her 5 yo vaccinated for anything even though he started school this year. This woman has two college degrees and has the wherewithal to fly to Florida to seek the care of a traditional practitioner who also does not believe in vaccination. It's not a religious issue, but a conscious decision to refuse. She has all kinds of 'information' on the 'dangers' and the 'questionable necessity'.

Evidently there is a growing group in the greater LA area, where she lives. They hold 'immunity' parties. When one of their kids get sick, they expose the others kids in the play group to give them natural immunity.

She really is a lovely and thoughtful person otherwise. I have told her that LA is a large international community with polio perhaps just one plane ride away.

Anyone have any other advice to help people with this anti-vaccine position, become better informed with the science of communicable diseases?

k

Graham,

You asked for evidence.

Vaccine effectiveness against laboratory-confirme d influenza in children 6 to 59 months of age during the 2003-2004 and 2004-2005 influenza seasons.

Pediatrics. 2008 Nov;122(5):911- 9.

http://www.ncbi. nlm.nih.gov/ pubmed/18977968? ordinalpos= 1 & itool=EntrezSystem2 .PEntrez. Pubmed.Pubmed_ ResultsPanel. Pubmed_Discovery Panel.Pubmed_ Discovery_ RA & linkpos=2 & log$=relatedarticle s & logdbfrom=pubmed

CONCLUSIONS: Receipt of all recommended doses of influenza vaccine was associated with halving of laboratory-confirme d influenza-related medical visits among children 6 to 59 months of age in 1 of 2 study years, despite suboptimal matches between the vaccine and circulating influenza strains in both years.

-----

Effectiveness of inactivated influenza vaccine in children less than 5 years of age over multiple influenza seasons: a case-control study.

Vaccine. 2009 Jul 16;27(33):4457- 61. Epub 2009 May 31.

http://www.ncbi.nlm.nih.gov/ pubmed/19490957? ordinalpos= 28 & itool=EntrezSystem2 .PEntrez. Pubmed.Pubmed_ ResultsPanel. Pubmed_DefaultRe portPanel. Pubmed_RVDocSum

The children vaccinated against influenza accordingly to the 2007 ACIP guidelines had a lower risk of laboratory-confirme d medically attended influenza illness (Odds Ratio: 0.14, 95% Confidence Interval: 0.03-0.71) than the unvaccinated children.

-----

Effectiveness of live, attenuated intranasal influenza virus vaccine in healthy, working adults: a randomized controlled trial.

JAMA. 1999 Jul 14;282(2):137- 44.

http://www.ncbi.nlm.nih.gov/ pubmed/10411194? ordinalpos= 1 & itool=EntrezSystem2 .PEntrez. Pubmed.Pubmed_ ResultsPanel. Pubmed_Discovery Panel.Pubmed_ Discovery_ RA & linkpos=2 & log$=relatedarticle s & logdbfrom=pubmed

However, vaccination significantly reduced the numbers of severe febrile illnesses (18.8% reduction; 95% confidence interval [CI], 7.4%-28.8%) and febrile upper respiratory tract illnesses (23.6% reduction; 95% CI, 12.7%-33.2%) . Vaccination also led to fewer days of illness across all illness syndromes (22.9% reduction for febrile illnesses; 27.3% reduction for severe febrile illnesses), fewer days of work lost (17.9% reduction for severe febrile illnesses; 28.4% reduction for febrile upper respiratory tract illnesses), and fewer days with health care provider visits (24.8% reduction for severe febrile illnesses; 40.9% reduction for febrile upper respiratory tract illnesses).

-----

Effectiveness of influenza vaccine in the community-dwelling elderly.

N Engl J Med. 2007 Oct 4;357(14):1373- 81

http://www.ncbi.nlm.nih.gov/ pubmed/17914038? ordinalpos= 25 & itool=EntrezSystem2 .PEntrez. Pubmed.Pubmed_ ResultsPanel. Pubmed_DefaultRe portPanel. Pubmed_RVDocSum

CONCLUSIONS: During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons.

Seto

South Pasadena, CA

Lots of posts about seasonal flu vaccinations on this list.

Is there any recent conclusive evidence that they are beneficial except amongst rest home residents?

Last time I looked there wasn't

..

-- If you are a patient please allow up to 24 hours for a reply by email/Remember that e-mail may not be entirely secure/ MD ph fax impcenter.org

October 9, 2009

Thanks for the validation. :)I could have been more harsh. I did tell her that in the US, what enables her to make this choice to not vaccinate her 5yo for polio (or another disease), is that there is herd immunity from all of those who were vaccinated. She just sees the risk of the vaccine as higher than the risk of getting polio. This is a long standing conversation we've been having cross country for years. But we're still talking. I'm moving the conversation onward to the subject of collective responsibility. I hoping she may hear that above the din of the groups shouting the 'dangers' of vaccination. Probably not yet. In the mean time I hope her kid, who is just cutest little critter you ever saw, remains healthy. KathleenPolio is just a plane ride away? Haha no , you did not come off too harsh. Well, it was harsh,but sometimes harsh is really, really needed. For adult travelers, sometimes a polio booster (one time as an adult) is recommended and we have told people that they don't want to be the American who got polio because they refused a vaccination when the country they were visting had a polio outbreak (Nigeria maybe?) Wayne CoghillPractice ManagerMidtown Primary Carewww.doctorcoghill.comFrom: Kathleen Patton <krpattoncomcast (DOT) net>To: Sent: Tuesday, October 6, 2009 4:24:49 PMSubject: Re: Flu shot effectivenessSo very true. I don't think that collectively medicine has treated people with respect. People will go to someone who will listen to them. Now collectively we are reaping what was sown. I have colleagues who have refused to see some patients because the parents refuse vaccination. I do understand my colleagues' concern that an unvaccinated kid with a naive immune system, could be a real risk in a pediatric waiting room. But I'm thinking that it makes it very difficult to even have the ongoing conversation that is needed. I'm hoping I didn't come off harsh or uncaring when I told my acquaintance that polio could be a plane ride away. I did tell her to make sure she has a good FP or pedi who is willing to discuss the vaccination issues and help with decisions as they come up. I dunno. Sometimes it feels like swimming up hill to maintain that Unconditional Positive Regard. I think that most of the time when parents are opposed to vaccination, it's really because they are fearful. I can relate to fear, every parent can.I haven't read Good Calories, Bad Calories yet. But Autism's Prophets was a sobering account of how information and misinformation can be usedKathleenPeople do not trust medicine Sometimes for good reasonsThe medical environemnt does not treat people as if they amtterIt makes mistakesI read Autism's False Prophets and was reminded of some things1 people turn to unconventional even wacko treaments becasue noone listens to and validates the concerns thatthe patietn is trying to express .So in trying to be heard they go where they are lisitend to, which may not be a source of valid treamtent2 Medicne is inconsitent and therefore looks untrustworthy Eg Thimerserol shows no evidcne of doing any harm BUt it is off the market f or kids' vaccines AHah! what are we really hiding ,people say?3 Leaders often do not lead well Autism's false Prohets gives some good examples of how the reveiw of good science was there to be seen ,yet people- MDs- in authority subverted the facts This is also seen in GAryTaubes book Good calories BAD calories.Hence people do not trust and make the decsions t hat to us look wacko but to them feel supporting.That's my take on itAdd to all that a country that lives too fast eats toomuch bad food and spends littel time just talking and thinking Waddya expect?JeanYou knew all that On Tue, Oct 6, 2009 at 2:07 PM, Kathleen Patton <krpattoncomcast (DOT) net> wrote: Thank you for posting these. I collect articles from the research so I can run copies to give to people who are vaccine averse. I didn't have the JAMA 1999. Vaccine Quarterly and Needle Tips have posted good stuff as well.I am amazed at the nonchalance or downright opposition from people who normally have good sense. I have an acquaintance in California who has thus far refused to have her 5 yo vaccinated for anything even though he started school this year. This woman has two college degrees and has the wherewithal to fly to Florida to seek the care of a traditional practitioner who also does not believe in vaccination. It's not a religious issue, but a conscious decision to refuse. She has all kinds of 'information' on the 'dangers' and the 'questionable necessity'. Evidently there is a growing group in the greater LA area, where she lives. They hold 'immunity' parties. When one of their kids get sick, they expose the others kids in the play group to give them natural immunity. She really is a lovely and thoughtful person otherwise. I have told her that LA is a large international community with polio perhaps just one plane ride away. Anyone have any other advice to help people with this anti-vaccine position, become better informed with the science of communicable diseases? k Graham,You asked for evidence.Vaccine effectiveness against laboratory-confirme d influenza in children 6 to 59 months of age during the 2003-2004 and 2004-2005 influenza seasons.Pediatrics. 2008 Nov;122(5):911- 9.http://www.ncbi. nlm.nih.gov/ pubmed/18977968? ordinalpos= 1 & itool=EntrezSystem2 .PEntrez. Pubmed.Pubmed_ ResultsPanel. Pubmed_Discovery Panel.Pubmed_ Discovery_ RA & linkpos=2 & log$=relatedarticle s & logdbfrom=pubmedCONCLUSIONS: Receipt of all recommended doses of influenza vaccine was associated with halving of laboratory-confirme d influenza-related medical visits among children 6 to 59 months of age in 1 of 2 study years, despite suboptimal matches between the vaccine and circulating influenza strains in both years.-----Effectiveness of inactivated influenza vaccine in children less than 5 years of age over multiple influenza seasons: a case-control study. Vaccine. 2009 Jul 16;27(33):4457- 61. Epub 2009 May 31.http://www.ncbi.nlm.nih.gov/ pubmed/19490957? ordinalpos= 28 & itool=EntrezSystem2 .PEntrez. Pubmed.Pubmed_ ResultsPanel. Pubmed_DefaultRe portPanel. Pubmed_RVDocSumThe children vaccinated against influenza accordingly to the 2007 ACIP guidelines had a lower risk of laboratory-confirme d medically attended influenza illness (Odds Ratio: 0.14, 95% Confidence Interval: 0.03-0.71) than the unvaccinated children. -----Effectiveness of live, attenuated intranasal influenza virus vaccine in healthy, working adults: a randomized controlled trial.JAMA. 1999 Jul 14;282(2):137- 44.http://www.ncbi.nlm.nih.gov/ pubmed/10411194? ordinalpos= 1 & itool=EntrezSystem2 .PEntrez. Pubmed.Pubmed_ ResultsPanel. Pubmed_Discovery Panel.Pubmed_ Discovery_ RA & linkpos=2 & log$=relatedarticle s & logdbfrom=pubmedHowever, vaccination significantly reduced the numbers of severe febrile illnesses (18.8% reduction; 95% confidence interval [CI], 7.4%-28.8%) and febrile upper respiratory tract illnesses (23.6% reduction; 95% CI, 12.7%-33.2%) . Vaccination also led to fewer days of illness across all illness syndromes (22.9% reduction for febrile illnesses; 27.3% reduction for severe febrile illnesses), fewer days of work lost (17.9% reduction for severe febrile illnesses; 28.4% reduction for febrile upper respiratory tract illnesses), and fewer days with health care provider visits (24.8% reduction for severe febrile illnesses; 40.9% reduction for febrile upper respiratory tract illnesses). -----Effectiveness of influenza vaccine in the community-dwelling elderly.N Engl J Med. 2007 Oct 4;357(14):1373- 81http://www.ncbi.nlm.nih.gov/ pubmed/17914038? ordinalpos= 25 & itool=EntrezSystem2 .PEntrez. Pubmed.Pubmed_ ResultsPanel. Pubmed_DefaultRe portPanel. Pubmed_RVDocSumCONCLUSIONS: During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons. SetoSouth Pasadena, CALots of posts about seasonal flu vaccinations on this list.Is there any recent conclusive evidence that they are beneficial except amongst rest home residents?Last time I looked there wasn't.-- If you are a patient please allow up to 24 hours for a reply by email/Remember that e-mail may not be entirely secure/ MD ph fax impcenter.org

October 9, 2009

Well, I'm in for it now. Just have to play devils advocate for a moment..Collective responsibility doesn't mean very much to some parents. They are really just interested in the health of their own child. Vaccines DO have some risks, and it is appropriate for parents to consider these risks. We are mandated by law to provide Vaccine Information Statements that list the risks. We are paid more for counseling regarding vaccines than just giving the shot because we are supposed to be discussing the risks as well as the benefits. We ask people to inject a material into their children that could cause encephalitis (or whatever), when the actual risk for many of the illnesses is quite low (yes, due to the herd being vaccinated). If THEIR child is the one who has some vaccine related injury (though rare, they DO occur), they will have

to wrestle with the concept that they sacrificed their child's health for the good of society. I'm not against vaccines, but I do think we need to try to understand and have compassion for our patients. Realistically, when was the last time there was a case of polio in a person who did not travel outside of the country? It could happen - say a child from a country where they use the OPV vaccine is immunized in their country, then gets on a plane and sheds virus all over the place in the US. Someone with a suppressed immune system could then acquire the virus and could potentially get paralytic polio. it's possible, but it IS unlikely. IPV is an extremely safe vaccine, but I can certainly understand the parent who feels the risk to their child not being immunized against the disease is minimal. Of course the same cannot be said for all vaccines/diseases.Here is a nice summary of what happens over

the course of an immunization program (italics are mint): http://www.cdc.gov/VACCINES/VAC-GEN/life-cycle.htm.

Parents

are constantly concerned about the health and safety of their children

and they take many steps to protect them. These preventive measures

range from child-proof door latches to child safety seats. In the same

respect, vaccines work to safeguard children from illnesses and death

caused by infectious diseases. Vaccines protect children by helping

prepare their bodies to fight often serious, and potentially, deadly

diseases.

When there is no vaccine for a disease, the number of

people getting the disease is usually high. People are worried about

the disease and its effects.When an immunization program for a disease begins, the number of people being vaccinated rises.At

the same time, there will be some adverse reactions associated with the

vaccine â€“almost always very few and very mild compared with illness and

complications associated with the disease.As the number of

people being vaccinated rises, the number of cases of disease drops.

Eventually, the number of people getting the disease may approach the

small number of people having adverse reactions. (This number remains

fairly constant because it is a percentage of the number of people

being vaccinated.).At this point, most people may never

have experienced the disease, and their attention turns from worry

about the disease to concern about possible side-effects of the

vaccine. People may start to question whether the vaccine is necessary

or safe, and some people will stop getting immunized.If enough people stop getting immunized, disease numbers will start to rise again, and there will be outbreaks.People

are reminded of how bad the disease can be, and turn back to

immunization to avoid it. Vaccinations increase once more and disease

declines.Ultimately, we hope that enough people get

immunized that the disease disappears altogether. (So far this has

happened only with smallpox, but it could happen with other diseases,

such as polio and measles, in the not-too-distant future.)When

there is no more disease, the immunization program can be stopped. The

numbers of vaccinations and adverse reactions drop to zero.

The graph below demonstrates the above items.

Lots of posts about seasonal flu vaccinations on this list.Is there any recent conclusive evidence that they are beneficial except amongst rest home residents?Last time I looked there wasn't.-- If you are a patient please allow up to 24 hours for a reply by email/Remember that e-mail may not be entirely secure/ MD ph fax impcenter.org

October 10, 2009

Lonna,That's a great graphic representation. We should all keep a copy of it in our files when parents need to talk about vaccine decisions. I've used the cdc graph to give talks on disease prevention and vaccines. You are right. We need to understand and respect that parents have to make decisions about safety and what's best for their children. I believe we need to keep the conversation going. As mentioned earlier some of our colleagues refuse to see the kids if the parents refuse vaccinations. I disagree with this position. Pretty difficult to have a conversation. Parents need the best information available. If we are not providing information, the anti-vaccination misinformation campaigns certainly are and may seem compelling to parents.KathleenWell, I'm in for it now. Just have to play devils advocate for a moment..Collective responsibility doesn't mean very much to some parents. They are really just interested in the health of their own child. Vaccines DO have some risks, and it is appropriate for parents to consider these risks. We are mandated by law to provide Vaccine Information Statements that list the risks. We are paid more for counseling regarding vaccines than just giving the shot because we are supposed to be discussing the risks as well as the benefits. We ask people to inject a material into their children that could cause encephalitis (or whatever), when the actual risk for many of the illnesses is quite low (yes, due to the herd being vaccinated). If THEIR child is the one who has some vaccine related injury (though rare, they DO occur), they will have to wrestle with the concept that they sacrificed their child's health for the good of society. I'm not against vaccines, but I do think we need to try to understand and have compassion for our patients. Realistically, when was the last time there was a case of polio in a person who did not travel outside of the country? It could happen - say a child from a country where they use the OPV vaccine is immunized in their country, then gets on a plane and sheds virus all over the place in the US. Someone with a suppressed immune system could then acquire the virus and could potentially get paralytic polio. it's possible, but it IS unlikely. IPV is an extremely safe vaccine, but I can certainly understand the parent who feels the risk to their child not being immunized against the disease is minimal. Of course the same cannot be said for all vaccines/diseases.Here is a nice summary of what happens over the course of an immunization program (italics are mint): http://www.cdc.gov/VACCINES/VAC-GEN/life-cycle.htm.Parents are constantly concerned about the health and safety of their children and they take many steps to protect them. These preventive measures range from child-proof door latches to child safety seats. In the same respect, vaccines work to safeguard children from illnesses and death caused by infectious diseases. Vaccines protect children by helping prepare their bodies to fight often serious, and potentially, deadly diseases.When there is no vaccine for a disease, the number of people getting the disease is usually high. People are worried about the disease and its effects.When an immunization program for a disease begins, the number of people being vaccinated rises.At the same time, there will be some adverse reactions associated with the vaccine –almost always very few and very mild compared with illness and complications associated with the disease.As the number of people being vaccinated rises, the number of cases of disease drops. Eventually, the number of people getting the disease may approach the small number of people having adverse reactions. (This number remains fairly constant because it is a percentage of the number of people being vaccinated.).At this point, most people may never have experienced the disease, and their attention turns from worry about the disease to concern about possible side-effects of the vaccine. People may start to question whether the vaccine is necessary or safe, and some people will stop getting immunized.If enough people stop getting immunized, disease numbers will start to rise again, and there will be outbreaks.People are reminded of how bad the disease can be, and turn back to immunization to avoid it. Vaccinations increase once more and disease declines.Ultimately, we hope that enough people get immunized that the disease disappears altogether. (So far this has happened only with smallpox, but it could happen with other diseases, such as polio and measles, in the not-too-distant future.)When there is no more disease, the immunization program can be stopped. The numbers of vaccinations and adverse reactions drop to zero.The graph below demonstrates the above items.Lots of posts about seasonal flu vaccinations on this list.Is there any recent conclusive evidence that they are beneficial except amongst rest home residents?Last time I looked there wasn't.-- If you are a patient please allow up to 24 hours for a reply by email/Remember that e-mail may not be entirely secure/ MD ph fax impcenter.org

October 12, 2009

I believe that the last case of naturally acquired polio in the US was >20 years ago. That is why we switched to giving the killed virus vaccine. The 7-9 cases/year for over a decade were from the oral vaccine. I found the CDC report :-) (Are you proud of me ?). I realize that this doesn't really solve the argument, but just to make sure all the facts are on the table.

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4905a1.htmLynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care

'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

October 13, 2009

There was a case in 2005 of a college student who acquired polio from a neighbor of the family with whom she was staying who had recently been vaccinated. Here is a link to the report: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5504a2.htm. I don't know of any cases of people in the US who have gotten polio from anyone who was recently vaccinated with OPV though. LonnaSubject: Re: Flu shot effectivenessTo: Date: Monday, October 12, 2009, 2:05 PM

I believe that the last case of naturally acquired polio in the US was >20 years ago. That is why we switched to giving the killed virus vaccine. The 7-9 cases/year for over a decade were from the oral vaccine. I found the CDC report :-) (Are you proud of me ?). I realize that this doesn't really solve the argument, but just to make sure all the facts are on the table.

http://www.cdc. gov/mmwr/ preview/mmwrhtml /rr4905a1. htmLynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care

'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

October 13, 2009

Actually, this from the editorial comment at the bottom of the report:"This report describes the first case of paralytic poliomyelitis identified in the United States since 1999 and the first imported VAPP case ever documented in the United States."From: Lynette Iles <liles64gmail (DOT) com>Subject: Re: [Practiceimprovemen t1] Flu shot effectivenessTo:

Practiceimprovement 1yahoogroups (DOT) comDate: Monday, October 12, 2009, 2:05 PM

I believe that the last case of naturally acquired polio in the US was >20 years ago. That is why we switched to giving the killed virus vaccine. The 7-9 cases/year for over a decade were from the oral vaccine. I found the CDC report :-) (Are you proud of me ?). I realize that this doesn't really solve the argument, but just to make sure all the facts are on the table.

http://www.cdc. gov/mmwr/ preview/mmwrhtml /rr4905a1. htmLynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care

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Re: Flu shot effectiveness

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