OT MOH cautious on flu shot fears

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http://www.healthzone.ca/health/newsfeatures/article/700026

MOH cautious on flu shot fearsSeptember 23, 2009

*Helen Branswell*

THE CANADIAN PRESS

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Unpublished Canadian data are raising concerns about whether it's a good

idea to get a seasonal flu shot this season.

Drawn from a series of studies from British Columbia, Quebec and Ontario,

the data appear to suggest that people who got a seasonal flu shot last year

are about twice as likely to catch swine flu as people who didn't.

A scientific paper has been submitted to a journal and the lead authors –

Dr. Danuta Skowronski of the British Columbia Centre for Disease Control and

Dr. Gaston De Serres of Laval University – won't speak to the media.

Journals bar would-be authors from discussing their results publicly before

they go through peer review.

While few people appear to have actually seen or read the study, the

puzzling findings have been a poorly kept secret and many in the public

health community in Canada have heard about them.

Ontario's chief medical officer of health Dr. Arlene King said she is

concerned about the study but cautions that it is too early to jump to

conclusions.

" We are obviously concerned about the information that has occurred and we

have certainly seen no higher illness or death rates here in Ontario or

anywhere else in the country compared to the rest of the world, so it's very

important for that information to be peer reviewed. "

She said the province has been reviewing the preliminary information from

the study for the past few weeks and will continue to do so. She emphasized

that Ontario is well-prepared for a second wave of H1N1 influenza.

Concern about the unconfirmed findings is playing into calls from Quebec and

possibly other jurisdictions to delay or even cancel this year's seasonal

flu shot campaigns across the country.

The findings are causing consternation abroad as well, with officials at

public health agencies and even at the World Health Organization worried the

alleged link will deter people from getting vaccinated in a fall when many

people are being asked to get both seasonal and pandemic flu shots.

The Public Health Agency of Canada knows of the findings and has been

seeking help here and internationally to try to figure out if the effect is

real or if the studies are flawed.

" An arms-length review of the various methods is currently underway to

assess the validity of the studies relative to that observation, " Dr.

-, Canada's chief public health officer, said by email.

" We are also examining other data that will help to understand what if any

association there is. We look forward to the results of the review and other

data to inform our recommendations as we go forward. "

The U.S. Centers for Disease Control also knows of the work. It said it has

looked for similar evidence in the United States but sees none.

" It is difficult to speak about a study that has yet to be published,

however, as this is an important issue involving the subject of seasonal

influenza and the fast moving global pandemic of 2009 H1N1 influenza it is

important to note the scientists at the Centers for Disease Control and

Prevention have not seen this effect in systems we have reviewed in the

United States, " spokesperson Joe Quimby said by email.

A number of influenza and infectious diseases experts know of but are

unwilling to speak publicly about the paper. But several were quick to note

that British and Australian researchers haven't seen the phenomenon either.

The lack of corroboration in other jurisdictions is " a red flag, " said one

expert, who does not believe the findings are true.

Another flu expert who was willing to speak on the record said they do not

make sense to him either.

" I cannot think of a good reason why this is biologically likely, especially

since we have sufficient evidence now that ... there is priming in the

population by the way the vaccine is working, " said Dr. Arnold Monto, of the

University of Michigan.

He was referring to the fact that studies of swine flu vaccine show a single

dose induces a strong and likely protective response in teens and adults.

That suggests humankind's long exposure to seasonal H1N1 viruses has

" primed " or awakened our immune systems to recognize the new virus and fight

it off.

Dr. Low, chief microbiologist at Toronto's Mount Sinai Hospital, was

reserving judgment on the findings. But he said this kind of effect of

previous exposure raising the risk of future illness is seen in some

diseases, like dengue fever.

" We don't see that in flu, " Monto countered.

Low said it is important to get to the bottom of the issue, but in the

meantime, delaying the use of seasonal flu vaccine makes sense for

logistical reasons. Swine flu activity is on the upswing in the U.S. and in

parts of British Columbia, and focusing on speeding delivery of that vaccine

makes more sense now, he said.

" If we're going to try to protect people, this is the virus we should be

trying to protect them against, " he said.

Low admitted the controversy could undermine the public's willingness to be

vaccinated against influenza.

" This is obviously difficult for public to be able to digest this, " he said.

" There's a crying need here for a prospective randomized controlled study. "

That type of study – which is not the kind on which the findings are based –

is considered the gold standard of medical evidence.

*With a file from Toronto Star health reporter Theresa Boyle. *

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