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Welcome to the conversation Forum of Flu Wiki

This is an international website intended to remain accessible to as many people as possible. The opinions expressed here are those of the individual posters who remain solely responsible for the content of their messages.
The use of good judgement during the discussion of controversial issues would be greatly appreciated.

Get Your Flu Shot

by: DemFromCT

Wed Sep 19, 2007 at 21:29:56 PM EDT


( - promoted by DemFromCT)

[UPDATE]: My arm is sore from yesterday's jab.  ;-)

[UPDATE]:

WASHINGTON - After years of shortages and confusion, this fall promises plenty of flu vaccine to go around - up to 132 million doses, more than the nation has ever produced.

The ample supplies have the government urging vaccination not just for those at highest risk of dying from complications of influenza, but for anyone wanting to avoid a week of misery.

http://www.philly.co...

DemFromCT :: Get Your Flu Shot
It's mid-September and time to prepare for the upcoming flu season. If Australia is any indication, it could get nasty. That's not a prediction, of course... there's a lot that's unpredictable about flu from season to season.
Who Should Get Vaccinated

In general, anyone who wants to reduce their chances of getting the flu can get vaccinated. However, it is recommended by ACIP that certain people should get vaccinated each year. They are either people who are at high risk of having serious flu complications or people who live with or care for those at high risk for serious complications. During flu seasons when vaccine supplies are limited or delayed, ACIP makes recommendations regarding priority groups for vaccination.

People who should get vaccinated each year are:

People at high risk for complications from the flu, including:

  • Children aged 6 months until their 5th birthday
  • Pregnant women
  • People 50 years of age and older
  • People of any age with certain chronic medical conditions
  • People who live in nursing homes and other long term care facilities.
  • People who live with or care for those at high risk for complications from flu, including:
    • Household contacts of persons at high risk for complications from the flu (see above)
    • Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)
    • Healthcare workers.

Flu vaccines may not work as perfectly as we'd like, particularly in the elderly, but the preponderance of the evidence is that they are effective enough to justify their widespread use.

From year to year, high risk populations including children and health care workers do not get vaccinated at very high rates (35% of HCW get vaccinated, which, frankly, is embarrassingly low.) From the AP:

"Flu is a formidable foe," Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention, said Wednesday. "It is not an illness we should be complacent about."

But new CDC data show only a fraction of people who need flu shots the most get them, including just one in five babies and toddlers. And there's wide geographic variation, with Rhode Island reporting the most high-risk adults vaccinated and Nevada the fewest.

Shots aren't the only option. Wednesday, the government ruled that it's safe for younger kids than ever before to try a nasal-spray vaccine called FluMist. Once only an option for people ages 5 to 49, FluMist now can be used by children as young as 2.

Talk to your health care provider or contact your local public health agency for more information. Children under the age of 9 may need two shots, one month apart. And getting back to Australia:
Perhaps of more concern, CDC is closely monitoring whether a new strain that emerged near the end of Australia's flu season will cause illness here - a strain that this year's vaccine doesn't specifically target.

Each year's vaccine contains protection against three influenza strains - two Type A strains, an H1N1 and an H3N2 version, plus a milder Type B - that experts predict will cause the most illness. The vaccine isn't always a perfect match, and this year's contains a different H3N2 version than the newly emerging one, nicknamed H3N2/Brisbane-like.

Get vaccinated anyway, Gerberding stressed. The other two strains in the vaccine are causing illness around the world, and even if the newer one travels here, too, the vaccine should provide some cross-protection.

Oh, and for those of you paying attention, cross-protection might (I say might) be useful for - er - other strains of flu, too.

So, talk to your doctor or health care provider, and while you are at it, ask them if they got their flu shot this year.

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Get Your Flu Shot | 110 comments
in case you are wondering
I have gotten one every year for the last 25.

People who care for people - get vaccinated.
They are either people who are at high risk of having serious flu complications or people who live with or care for those at high risk for serious complications.

What are the assumptions involved with including people who "care for those at high risk for serious complications".

What kind of exposure do they believe justifies including these folk (including informal care-givers) on the list of people who should get vaccinated? 

I assume "care for" does not mean "provide medical care" but extends to providing all kinds of different care that puts the person in contact with someone on the high risk from complications list.

Would this extend to people who go into nursing homes on a regular basis to visit (or help out with) a relative or family friend?

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 


yes
as well as those who live with those folks.

[ Parent ]
flu vaccine
Is there a link to the flu varieties included in this years vaccine?
jim

yes
http://www.cdc.gov/f...

Both LAIV [nose spray] and TIV [jab] contain strains of influenza viruses that are antigenically equivalent to the annually recommended strains: one influenza A (H3N2) virus, one influenza A (H1N1) virus, and one influenza B virus. Each year, one or more virus strains might be changed on the basis of global surveillance for influenza viruses and the emergence and spread of new strains. Only the H1N1 strain was changed for the recommended vaccine for the 2007-08 influenza season, compared with the 2006-07 season (see Recommendations for Using TIV and LAIV During the 2007-08 Influenza Season). Viruses for both types of currently licensed vaccines are grown in eggs. Both vaccines are administered annually to provide optimal protection against influenza virus infection (Table 3) Both TIV and LAIV are widely available in the United States. Although both types of vaccines are expected to be effective, the vaccines differ in several aspects (Table 3).

and specifically http://www.cdc.gov/m...

Both TIV and LAIV prepared for the 2007--08 season will include A/Solomon Islands/3/2006 (H1N1)-like, A/Wisconsin/ 67/2005 (H3N2)-like, and B/Malaysia/2506/2004-like antigens. These viruses will be used because they are representative of influenza viruses that are anticipated to circulate in the United States during the 2007--08 influenza season and have favorable growth properties in eggs.


[ Parent ]
I have a question: Is it just me
or does the CDC use the same number, 36,000, every flu season, to get their point across about getting flu shots?

Every year I see that same number. Now I know that some years the number will be lower, and some years it might be 36,000, or slightly higher. Is that just a rough "guess" on their part, because no flu season is the same as the one before with mortality rates.

 

United we stand: Divided we fall
www.flunewsnetwork.com


36,000...It's the roughly guesstimated "average"
I noticed yesterday that all of the "Get your flu shot" posters had been taken down at my place of work. Uhm...that would be the Dept. of Health! I really hope they put some new posters up...

[ Parent ]
CDC has redesigned their web page for flu
and there is a new campaign coming, so hopefully new posters.

http://www.cdc.gov/f...


[ Parent ]
New posters would be good...
The ones that were pulled down were a few years old...

[ Parent ]
U.S. Annual Influenza Related Deaths
The U.S. Centers for Disease Control and Prevention ("CDC") says that "In the United States, . . . an annual average of approximately 36,000 deaths during 1990-1999 . . . have been associated with influenza epidemics."1 This is not the number of deaths classified as due to influenza in the mortality data. Rather, it comes from a mathematical model that estimated that during the respiratory seasons from 1990-1991 through 1998-1999, influenza viruses were associated with an annual average of 36,155 underlying respiratory and circulatory deaths.2 Thus, the 36,000 number is a historical estimate of influenza-associated deaths within the total deaths classified as respiratory and circulatory (including influenza classified deaths) in the actual mortality data from 1990-1999.

Notes
1. Fiore, A., Shay, D., Haber, P., Iskander, J., Uyeki, T., Mootrey, G., Breese, J., Cox, N. (U.S. Centers for Disease Control and Prevention), "Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP)," MMWR (13 Jul 2007) 56(RR06):1-54, p.1 (footnotes omitted).

2. Thompson, W., Shay, D., Weintraub, E., Brammer, L., Cox, N., Anderson, L., Fukuda, K. (U.S. Centers for Disease Control and Prevention), "Mortality Associated With Influenza and Respiratory Syncytial Virus in the United States," JAMA (2003) 289:179-186.


[ Parent ]
it's been challenged
but nonetheless seems to be on firm epidemiological ground (if that's not an oxymoron). ;-)

(My favorite epi guy is fond of saying 'it's so obvious even an epidemiology study can show it'. )


[ Parent ]
As flu season looms, a record amount of vaccine is available
WASHINGTON - After years of shortages and confusion, this fall promises plenty of flu vaccine to go around - up to 132 million doses, more than the nation has ever produced.

The ample supplies have the government urging vaccination not just for those at highest risk of dying from complications of influenza, but for anyone wanting to avoid a week of misery.

http://www.philly.co...

Or
in my case, 2 weeks of misery! :-)  No one needs the flu, high risk or not so...get that flu shot!  I plan to call my Dr. this week for an appointment.

[ Parent ]
hey
ask your doc if they got one, and why not?

[ Parent ]
To help make it easier....
Since so many can't get vaccianted through their regular docs, here are some places you can try (if I don't screw this up!)

http://www.fluclinic...

http://www.findaflus...

http://www.flu.massp... (for Massachuessetts)

http://www.health.ri... (for Rhode Island)

Some locators will tell you if they'll do children or not, but I've found that most are only for adults and you have to go through your ped to get your children vax'd. 



children
Try a confident, strong smile and say "I was told this kid should get one.  Child has respiratory issues."  (Don't they all at some point?"  ). 

When you get told that they only do adults/the elderly/whatever ask to speak with the manager and pleasantly say "I saw on the news that there is NO vaccine shortage this year, so we're not keeping anyone else from getting their vaccine.  I KNOW this child needs one, what can you do to help us?"  and stand there, pleasant, solution oriented, and not going anywhere.  (I learned SO much from Obiwan kenobi).  Pleasant persistence is as strong as a light saber. 


there are two kinds of flu shots
split vaccine (for kids and adults) and whole vaccine (adults and kids over 12). FLUARIX[tm] by GlaxoSmithKline is the latter, but is not sold in the US afaik.

So, if the clinic just purchased whole vaccine they will be loath to give it to kids 11 and younger. Also, the nurse may not be comfortable giving shots to kids. In the US, the latter is usually the issue.

Intramuscular influenza vaccines are inactivated preparations of either whole virus or subvirion components ("split product"). Split product vaccines cause fewer adverse reactions and are preferred for use in children less than or equal to 12 years of age. Only split product vaccines are available in the United States.

from an online medical service called UpToDate.


[ Parent ]
U.S. 2007-2008 Flu Vaccines
The following is some basic information about 2007-2008 formulations of "Influenza Virus Vaccine" and "Influenza Virus Vaccine, Live, Intranasal" approved by the U.S. Food and Drug Administration ("FDA") for use in the U.S.1 The list below is in alphabetical order of trade name.

Proper name: Influenza Virus Vaccine
Trade name: FLUARIX®
Manufacturer (FDA licensee): GlaxoSmithKline Biologicals ("GSK")
Type of vaccine: Inactivated split virus
Route of administration: Intramuscular injection
Preservatives: Preservative-free. Thimerosal is used in manufacturing and then reduced to a trace amount ?1 mcg mercury per 0.5 mL dose.
Indicated for: Adults (18 years of age and older). Not indicated for use in children.2
Reference: GlaxoSmithKline, "Prescribing Information: Influenza Virus Vaccine, FLUARIX®, 2007-2008 Formula," package insert (Aug 2007).

Proper name: Influenza Virus Vaccine
Trade name: FLULAVAL?
Manufacturer (FDA licensee): ID Biomedical Corporation of Quebec ("IDB" is a subsidiary of GSK)
Type of vaccine: Inactivated split virus
Route of administration: Intramuscular injection
Preservatives: Thimerosal. Supplied in 5 mL multi-dose vial containing ten 0.5 mL doses with each dose containing 25 mcg mercury.
Indicated for: Adults (18 years of age and older). Not indicated for use in children.3
Reference: GlaxoSmithKline, "Prescribing Information: FLULAVAL? (Influenza Virus Vaccine), Suspension for Intramuscular Injection, 2007-2008 Formula," package insert (Aug 2007).

Proper name: Influenza Virus Vaccine, Live, Intranasal
Trade name: FluMist®
Manufacturer (FDA licensee): MedImmune Vaccines, Inc.
Type of vaccine: Live attenuated influenza virus
Route of administration: Intranasal spray
Preservatives: None
Indicated for: Persons 2-49 years of age. Not indicated for use in children <2 years of age, and persons ?50 years of age.
Reference: MedImmune Vaccines, Inc., "Prescribing Information: FluMist® Influenza Virus Vaccine Live, Intranasal, Intranasal Spray, 2007-2008 Formula," package insert (Sep 2007).

Proper name: Influenza Virus Vaccine
Trade name: FLUVIRIN®
Manufacturer (FDA licensee): Novartis Vaccines and Diagnostics Limited
Type of vaccine: Inactivated split virus
Route of administration: Intramuscular injection
Preservatives: Depends on presentation supplied, viz.
  (1) 5 mL vial - thimerosal 0.01% (mercury derivative, 24.5 mcg mercury per 0.5 mL dose)
  (2) 0.5 mL prefilled syringe - Preservative-free. Thimerosal is used in manufacturing and then reduced to a trace amount ?0.98 mcg mercury per 0.5 mL dose.
Indicated for: Persons 4 years of age and older. Not indicated for use in children under 4 years of age.
Reference: (1) For 5 mL vial, see Novartis Vaccines and Diagnostics Limited, "INFLUENZA VIRUS VACCINE, (FLUVIRIN®), Purified Surface Antigen Vaccine, 2007-2008 FORMULA," package insert (Apr 2007).
  (2) For 0.5 mL prefilled syringe, see Novartis Vaccines and Diagnostics Limited, "INFLUENZA VIRUS VACCINE, (FLUVIRIN®), Purified Surface Antigen Vaccine, 2007-2008 FORMULA," package insert (Apr 2007).

Proper name: Influenza Virus Vaccine
Trade name: Fluzone®
Manufacturer (FDA licensee): Sanofi Pasteur Inc.
Type of vaccine: Inactivated split virus
Route of administration: Intramuscular injection
Preservatives: Depends on presentation supplied, viz.
  (1) 5 mL vial - thimerosal (mercury derivative, 25 mcg mercury per 0.5 mL dose)
  (2) 0.25 mL prefilled syringe - No Preservative: Pediatric Dose (for 6-35 months of age). No thimerosal used in manufacturing.
  (3) 0.5 mL prefilled syringe - No Preservative (for 36 months of age and older). No thimerosal used in manufacturing.
  (4) single dose vial: No Preservative (for 36 months of age and older). No thimerosal used in manufacturing.
Indicated for: Persons 6 months of age and older
Reference: Sanofi Pasteur Inc., "Influenza Virus Vaccine, Fluzone®, 2007-2008 Formula," package insert (31 May 2007).

Notes
1. See Center for Biologics Evaluation and Research, "Product Approval Information," U.S. Food and Drug Administration online (updated 19 Sep 2007).
2. FDA's accelerated approval was based on Fluarix clinical trials involving only adults. FDA's Approval Letter for Fluarix indicates that GSK is pursuing a pediatric (children less than 18 years of age) use. Fluarix® in the UK is used in adults and children over 6 months of age.
3. FDA's accelerated approval was based on FluLaval? clinical trials involving only adults. FDA's Approval Letter for FluLaval? indicates that IDB is pursuing a pediatric (children less than 18 years of age) use.


[ Parent ]
thank you!
whereas it is helpful to have more vaccine, and the accelerated approval is great, it will make clinics this year extremely reluctant to give pediatric vaccinations if the 18 and up version is what's been purchased, and may explain some of the resistance in flu clinics.

The regulatory side of this is a morass, but that's a topic for another day.

Thanks again for this!!


[ Parent ]
U.S. 2007-2008 Flu Vaccine II
The following is some basic information about a 2007-2008 formulation of "Influenza Virus Vaccine" approved by the U.S. Food and Drug Administration ("FDA") for use in the U.S. on 28 Sep 2007.1

Proper name: Influenza Virus Vaccine
Trade name: AFLURIA®
Manufacturer (FDA licensee): CSL Limited ("CSL")
Type of vaccine: Inactivated split virus
Route of administration: Intramuscular injection
Preservatives: Depends on presentation supplied, viz.
  (1) 5 mL vial - thimerosal (mercury derivative, 24.5 mcg mercury per 0.5 mL dose)
  (2) 0.5 mL prefilled syringe - Preservative-free. No thimerosal used in manufacturing.
Indicated for: Adults (18 years of age and older). Not indicated for use in children (not expressly stated in package insert).2
Reference: CSL Limited, "Prescribing Information: AFLURIA®, Influenza Virus Vaccine, Suspension for Intramuscular Injection, 2007-2008 Formula," package insert (Sep 2007).

Notes
1. See Center for Biologics Evaluation and Research, "Product Approval Information," U.S. Food and Drug Administration online (updated 28 Sep 2007).
2. FDA's accelerated approval was based on AFLURIA® clinical studies involving only adults. FDA's Approval Letter for AFLURIA® indicates that FDA denied CSL's request for a partial waiver for the pediatric age group birth to 6 months of age, and deferred all pediatric (children less than 18 years of age) studies until June 30, 2010.


[ Parent ]
bottom line
see your pediatirican or child's doctor in your 'medical home' for shots. Clinics may or may not hep you.

[ Parent ]
pneumonia vaccination?
Is it safe to conclude that a pneumonia vaccination is not really all that important?

it is helpful if you can get one
but it is most important to high risk groups. Most people need just one in their lifetime.

Also, review this about pneumovax indications and efficacy in adults:

http://www.acsu.buff...



[ Parent ]
Web site for finding FLU shots by ZIP CODE
Here is a web sight that locates flu shots by zip code.

http://www.findaflus...

Darwin

LOGIC. ABOVE ALL, LOGIC !


Uh....oops! This from NIH?!?
http://sfgate.com/cg...

Study finds flu shots do little to help most vulnerable elderly

A team of National Institutes of Health researchers has concluded that the often-touted benefits of flu shots to people over the age of 70 are highly exaggerated - there is no real proof they provide protection to the frail elderly.

The conclusion published Monday in an online edition of the British journal The Lancet Infectious Diseases is unwelcome news for public health officials in the United States who are preparing to launch the annual flu shot campaign.

[snip]

"There absolutely should be no change in the recommendations," said Dr. Tony Fauci, director of the National Institute of Allergy and Infectious Diseases, where part of the latest study was carried out. The study's lead author, Lone Simonsen, is a former epidemiologist at the National Institute of Allergy and Infectious Diseases and is now a professor at George Washington University. She and her colleagues stressed in their study that "even a partly effective vaccine would be better than no vaccine at all."


as I stated in the diary
Flu vaccines may not work as perfectly as we'd like, particularly in the elderly, but the preponderance of the evidence is that they are effective enough to justify their widespread use.
They work better for kids than they do in the elderly.

[ Parent ]
I saw that...
I was just surprised that NIH would actually publish a report and release it to MSM, especially after all these years of pushing to get the young and elderly their shots!

[ Parent ]
well
you can have your own opinion but you can't have your own facts. They belong to everyone. ;-0

[ Parent ]
But...but...but.... n/t


[ Parent ]
Thanks...excellent post from revere...
And I love your comment! LOL  :-)

[ Parent ]
I can't even set up the appointment yet!
Yesterday, I called my Dr. to set up an appointment for a flu shot.  I was told they can't make appointments until at least the 2nd week in October, or when the vaccine arrives!  Has anyone ever heard of this?  I know it wasn't that way last year (my 1st flu shot ever). 

Flu shots in August
I was told by the office staff that our doc usually gets his flu shots in August, but that August was too early to start handing them out.  I was in there this week to pay a bill and was able to get one. I went home and sent DH in right away and he got his too.  Last year I started asking to late and they were always out, waiting for a new shipment. 

Not silver or sage, just a blend of colors!

[ Parent ]
batches are just coming in now
and usually the shots are started in october.

[ Parent ]
Yes WhiteSwan, I got the same response last week when I called.
I know if I were to call again today, I would get the same answer.  Last year, it was the same for me and I was in upstate NY.  I got on the list to get the shot, they were giving it on weekends, at the Dr.'s office.  My shot was in the beginning of November.

Dem, thanks for letting us know.

I am not like other birds of prey....


[ Parent ]
new strain ?
have there been mutations in Australia ?
can we expect those strains in Febr./March ?

are there sequences from this year in America already ?
are Australian H3N2 from this year available,
or at least comments about them ?

(and if not, why ?)

ask experts for their subjective
panflu death expectation values
and report the replies


7 mutations
OK, I found a sequence from Brisbane June 2007 at lanl.
7 protein-mutations compared to the vaccine strain in HA

nucleotides:

  000000000001
  133445568890
  469115865805
  949297175263
-codon-position--------------------------------21 12221 
  1 >A/Brisbane/10/2007,2/6/2007,H3N2  ......T....T
  2 >A/Brisbane/10e/2007,2/6/2007  ............
  3 >A/Brisbane/10/2007(eggpassage),2/6/2007  ............
  4 >A/Wisconsin/67/2005(H3N2))  GGTTATTATTT-

amino-acids:
  0111222
  6355013
  6846209

1 >A/Brisbane/10/2007,2/6/2007,H3N2  ENAIGLV
  2 >A/Brisbane/10e/2007,2/6/2007  ENAIGPI
  3 >A/Brisbane/10/2007(eggpassage),2/6/2007  ENAIGPI
  4 >A/Wisconsin/67/2005(H3N2))  GDSKVLI

epitope-region  eAbBddd

HA:19+21+27+41+22=

Epitope A:19
122,124,126,130,131,132,133,135,137,138,140,142,143,144,145,146,150,152,168

Epitope B:21
128,129,155,156,157,158,159,160,163,165,186,187,188,189,190,192,193,194,196,197,198

Epitope C:27
44,45,46,47,48,50,51,53,54,273,275,276,278,279,280,294,297,299,300,304,305,307,308,309,310,311,312

Epitope D:41
96,102,103,117,121,167,170,171,172,173,174,175,176,177,179,182,201,203,207,
208,209,212,213,214,215,216,217,218,219,226,227,228,229,230,238,240,242,
244,246,247,248

Epitope E:22
57,59,62,63,67,75,78,80,81,82,83,86,87,88,91,92,94,109,260,261,262,265

NA:
Epitope A: 383-387,389-394,396,399,400,401,403
Epitope B: 197-200,221,222
Epitope C: 328-332,334,336,338,339,341-344,346,347,357-359,366-370

ask experts for their subjective
panflu death expectation values
and report the replies


[ Parent ]
better formatting
http://www.setbb.com...

ask experts for their subjective
panflu death expectation values
and report the replies


[ Parent ]
there are two news references to this
"different H3N2 version than the newly emerging one, nicknamed H3N2/Brisbane-like" but absolutely no news follow-up.

[ Parent ]
Brisbane
OK, I found it here:
http://www.who.int/c...
with antibody titers.

however, the current vaccine should be not much worse for the Brisbane strain
than it was for the strains circulating last season.

---------------------------------
This year, the CDC is keeping a close eye on a strain called H3N2/Brisbane-like that has make an appearance at the end of Australia's flu season. It is too late to incorporate it into this year's vaccine batch, so if it makes an appearance in the US the vaccinations will not give full protection against it but it will give some, said the CDC, so it is still worth getting vaccinated.
-------------------------------

here is a table with the US-excess deaths 1968-2000
with Serfling model
http://archinte.ama-...

ask experts for their subjective
panflu death expectation values
and report the replies


[ Parent ]
promed
http://www.flutracke...

ask experts for their subjective
panflu death expectation values
and report the replies


no, MMWR ;-)
Source MMWR Weekly, Vol.56. No. 38 [edited]


[ Parent ]
"Myths about flu shots"
Today's  "Ask the doctor" segment on Sunday morning news program with Dr. Mary Ann Malloy answered viewers' questions, regarding reluctance to get the flu shot.  The message: Everyone who doesn't want to get the flu should have the shot. (except babies under 6 months, but all who are in contact with the babies should have the shot)

http://www.nbc5.com/...

"The truth does not change according to our ability to stomach it."  Flannery O'Connor


for those who hate shots
ask about the nose spray or an EMLA patch on the skin to numb the area pre-shot.

[ Parent ]
Emla patch
And if you don't have or can't have an emla patch, keep a frozen item (ice cubes for example, though my preference goes to a bag of frozen peas which I keep especially for applying on sprains or various aches) for 10 minutes on the spot where you'll be injected. Cold insensitizes and it'll be just as effective as an Emla patch, it costs nothing, and will prevent a potential bruise.

Let me be blind to wicked text, deaf to wicked words, mute to wicked comments.

[ Parent ]
waiting room
it also depends, how likely you'd get the flu, not only
if/how_much you dislike it.
The waiting room of the doctor could be a source for flu-infection,
(and others)so better get your shot delivered by mail and shoot it yourself.

ask experts for their subjective
panflu death expectation values
and report the replies


[ Parent ]
eh, just get it now
before flu season starts.

[ Parent ]
degrading
isn't it too early now ?
peak is usually in Feb,Mar and protection degrades.
I guesstimate 50% in 6 months

ask experts for their subjective
panflu death expectation values
and report the replies


[ Parent ]
protection does not degrade
where did you hear that? Find a link.

there's never been advice not to get it too early.


[ Parent ]
not too early
http://www.biz.uiowa...

  Because antibody titers can drop significantly in the months immediately following vaccination, giving the vaccine too early may also be problematic.

http://www.anellomed...

Don't give vaccine too early in season because antibody titers may begin to decline before flu season.



ask experts for their subjective
panflu death expectation values
and report the replies


[ Parent ]
ah....
"normal usage". Your reference recommends giving the vaccine in October, which is NOW.

What they mean is don't give in July if you ever get your hands on it and expect 100% efficacy in 9 months (next January).

I will further research this.


[ Parent ]
from modern package inserts
Duration: Protective antibody titers persist approximately greater than or equal to 6 months. Elderly: Protective antibody titers may fall less than or equal to 4 months after vaccination.

Elderly is problematic, and vaccine does not work as well. For the rest of us, now is the ideal time.


[ Parent ]
oh,btw
Flu can hit any time between Oct and march. Peak is not always as late as Feb.

[ Parent ]
February,March
it won't start falling abruptly after 6 months.
I think, In Feb.,Mar are most often the seasonal peaks.
You could wait until the wave approaches neighboring areas/states/countries.
I vaguely remember that it declines 50% in 6 months, but I
might confuse with something else.
Also AFAIR this was used to explain why there was some protection in 1918
from wave 1 to wave 2 and wave 2 to wave 3 , but not from wave 1 to wave 3.
Pandemics often started in April
http://www.setbb.com...

hmm, do doctors prescribe 2 shots , one in Oct, one in Jan/Feb ?

ask experts for their subjective
panflu death expectation values
and report the replies


[ Parent ]
flu-peaks

[code]
peaks in weeks:
EU:04,05,52,11,06,03,05,06,10,50,08,10,07  average:5.6 ~ 10th Febr
US:--,--,--,--,--,01,04,08,07,50,08,09,07  average:5.3 ~  7th Febr.

[/code]

ask experts for their subjective
panflu death expectation values
and report the replies


[ Parent ]
look at the the range
the average is meaningless.

[ Parent ]
there is never a reason to give two shots
and there is never a reason to delay past october.

You are misreading the data.


[ Parent ]
Dem?
In view of the fact that the efficacy of the vaccine does lessen over a period of months (at least, that's what I've always been told), as well as the fact that it is not as effective in older people as it is in younger ones, why would it not be helpful for some people, particularly those past 50 with underlying problems, to get a flu vaccine early in the season (such as early October) and then another one 3-4 months later? 

The first clinics are going to be held in this area next week - I plan on being one of the first ones vaccinated. 


[ Parent ]
I have forwarded the question to CDC for a response
(I do not treat the elderly, but at age 53, I can guarantee you that 50 is not the elderly"). ;-)

everyone under 65 needs one shot only. For over 65, as stated in the original post, things are more problematic. For long term care facilities, they might have different policy (such as waiting till december or outbreak reports, whichever comes first).



[ Parent ]
perhaps a better way to phrase it
is that there are no data to support delayed shots or two shots per season that I am aware of, but I am making inquiries of the experts.

[ Parent ]
CDC confirms that there is no need for two shots or delayed
vaccination in the elderly (my question was forwarded to subject matter experts, answer confirmed) and says to expect a comprehensive study on the topic to be released soon confirming this.

see also:

http://content.nejm....

Effectiveness of Influenza Vaccine in the Community-Dwelling Elderly


[ Parent ]
Thanks
But, you know, I didn't use the word "elderly" - my question was specific to an age range (over 50) with the addition of underlying medical problems.

At 56, I'm hoping 50s aren't too 'elderly' either, believe me!  So - they say two shots would never be advised?  Why not?  I'm trying to understand if it wouldn't be medically beneficial, or would be financially disadvantageous.  If the answer is "no" because they don't think there's enough vaccine for people to want two shots, that's a whole lot different from saying that the 2nd shot wouldn't give significant additional resistance to the virus.  (Sometimes the reason for an answer is at least as important as the answer.)


[ Parent ]
elderly
some German doctors recommend 2 shots for the elderly:

http://www.arzt-ayin...
Der Impfschutz hält nur 3-5 Monate an.
Wegen der kurzen Wirkdauer sollte nicht vor Oktober geimpft werden, um auch bei den Grippewellen im Januar/Februar noch Schutz zu bieten - eventuell muss zweimal pro Saison geimpft werden
Ca. 2 Wochen nach der Impfung beginnt die Schutzwirkung

http://www.aerztezei...
Professor Georg E. Vogel, niedergelassener Internist aus München
Ã?lteren Patienten empfiehlt Vogel die Impfung zweimal pro Saison

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[ Parent ]
30 days halftime ?
uhh, here they say titers half every 30 days :

http://www.aerztezei...

Is a second inoculation necessary for the flu protection in one season?
Madrid (ice). The flu inoculation protection decreases in the process of one flu season considerably. The former director/conductor of the Robert Koch Institute in Berlin, professor Werner Lange one, guesses therefore humans with particularly high risk - after a first vaccination in September - to a second
inoculation in January. In old and nursing homes should besides absolutely also the personnel against flu are inoculated, in order to protect inhabitants against infections, stresses the infectiologist. During the flu inoculation mainly the humoral immune system and thus the education are stimulated by anti-bodies, like Lange with a press conference of the company Hoffmann La-Roche with 9. Yearly congress of the European Respiratory Society in Madrid reminded. After the inoculation the anti-body titers however every 30 days halved themselves, and the protection decreases/goes back fast. In the scientific adviser of the working group influenza it was therefore discussed whether with high risk should be inoculated particularly late, in order to ensure the protection over the season. For a long time still continues and guesses/advises to a second inoculation in January, for example in homes for the elderly. There is besides the inoculation protection with the personnel particularly importantly. The flu inoculation protects 90 per cent of the seed nuclei heavy flu complications. According to data of Lange halves it with inoculation however only the illness rate. It should be avoided therefore as far as possible that home inhabitants could be infected with male nurses gotten sick. True "brewing kitchens for flu viruses" called long medical practices. Old humans and other risk persons should come with flu epidemic diseases as few as possible into the practice; also places with many humans are to be avoided.

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[ Parent ]
I wish i could read it ;-)


[ Parent ]
wel, if we are not talking elderly, the data suggests
clinical effectiveness for 6 months, therefore oct shot covers through march.

If the vaccine matches well, that should cover you. if the vaccine doesn't match, 10 shots won't help ;-0 Clinical effectiveness varies from individual to individual.

The answer to the answer: if there is no data to suggest clinical efficacy, no one will recommend a second shot. The expense and logistics will be concentrated on getting everyone that first shot, especially those considered high risk (especially since not enough of those people get them, including HCW). So, understanding that 'there's no data to suggest that it helps' is not the same as 'data suggest it doesn't help', that's where it stands.

gs' German practice info (if I understand it) is very interesting but it doesn't mean the practice is based on data.


[ Parent ]
discrepancy
http://content.nejm....

this discrepancy between studies showing effectiveness of vaccine
and those showing lack of reduction in supposed flu-related
excess mortality despite increased overall vaccination
should be resolved.

are they even up to 44000 flu-deaths (from 36000) now ?
(despite increased vaccination)

So, what are "cohorts of community dwelling elderly members of
one US-health maintenance organization" ?
are those representative for the elderly US-population ?
are those more likely to receive vaccine ?

disqualifying previous studies, because they only covered
1 year is not supported by Figure 2, which shows vaccine-effects
for all years.

for (IMO) better graphics see:
http://magictour.fre...
http://magictour.fre...

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[ Parent ]
tthere's a canadian study to be released
shortly. Let's see if it sheds light, but the <65 should be more straightforward, especially in kids who are the vector of disease into the home.

[ Parent ]
hospitalization counts in 1993-1997
could the gap in deaths/hospitalizations in 1993-1997
be due to political changes (Hillarycare ?)or due to a change in
classification (pneumonia+influenza vs. other causes ) ?

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[ Parent ]
the data
they don't give us the data, they could easily upload those
700000 records as is common in other science.
So, can we ever know whether they maybe falsified the whole
thing ? I wouldn't have been so distrustful 2 years ago,
before I entered flublogia...

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[ Parent ]
adjusted odds ratio

I don't understand, what they calculate, how they get
this 27%,48% reduction.
According to table 1 outpatient visits and hospitalizations
were larger in the vaccinate group contrary to what they write under
"results".

Now, vaccinated people had more risk-factors (55.6% vs. 45.6%),
so what I would do is picking some vaccinated records with high risk
at random and discarding them until the ratios are equal.

Maybe that's what they did, I don't know.
They speak about some "adjusted odd-ratio".
I'd like to have the records, so I could check.

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[ Parent ]
flu deaths vs. vaccine coverage
http://www.healthsen...

looks as if vaccine is dangerous...

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panflu death expectation values
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[ Parent ]
discussion
some discussion about that paper is here:

http://content.nejm.org/cgi/co...

seems that the experts can't agree on how effective
the vaccine is...

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[ Parent ]
waning effectivity
new studies from Europe:

http://www.cidrap.umn.edu/cidr...

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[ Parent ]
Antibody Persistence From Fluarix
A study of FluarixTM, a trivalent inactivated split virus vaccine, indicated that it induced a protective level of antibodies in adults (18-60 years) and the elderly (over 60) that peaked 21 days after vaccination, and then declined over time but remained well above the level deemed protective for at least 12 months.

Reference
Hehme, N.W., Künzel, W., Petschke, F., Türk, G., Raderecht, C., van Hoecke, C., Sänger, R., "Ten Years of Experience With the Trivalent Split-Influenza Vaccine, FluarixTM," Clinical Drug Investigation (2002) 22(11):751-769 (abstract).


[ Parent ]
protective
what level did who deem "protective" and how (much) ?

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[ Parent ]
Fluarix Study Standard, Results
The Committee for Proprietary Medicinal Products of the European Agency for the Evaluation of Medicinal Products set the European Union standard for what is deemed protective in this study.

The minimum level of antibody titer deemed to be seroprotective is a geometric mean titer of 40.

Antibody levels achieved compared to the minimum standard are displayed in Figure 3 of the Hehme et al. paper. No data for antibody levels are shown at 12 months from vaccination. The authors state that the results will be presented in greater detail in a separate publication. However, I have not found this second paper.

Reference
Hehme, N.W., Künzel, W., Petschke, F., Türk, G., Raderecht, C., van Hoecke, C., Sänger, R., "Ten Years of Experience With the Trivalent Split-Influenza Vaccine, FluarixTM," Clinical Drug Investigation (2002) 22(11):751-769. (The full article is available for free with registration at Medscape.)


[ Parent ]
titres
thanks. So titres half every 6 months.
But this is probably not linear to the probability
to become infected. That probability may fall by only
10-20% when you are vaccinated in time rather than in
early October.
There should also be some protection from last year's
vaccine. Maybe 20-50% of that o the actual vaccine ?

To see a table of that probability to become infected
that would be really interesting !

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[ Parent ]
in general
for a herd or a population, the probabilities become more predictable than for an individual.

Now, starting to immunize on October 1 doesn't get everyone immunized by Oct 4. Immunization drives will continue in Nov and Dec. the logistics alone of trying to immunize everyone make this a drawn out process.

For that reason, I don't believe that the correlation you refer to is clinically relevant for deciding when to get immunized (although all data is interesting). October keeps you protected through March. Since most (not all) flu season peaks can be expected Jan-Feb, but some can happen as early as November in a non-predictable (from year to year) fashion, the recommendation to start immunizations in October makes the most sense, leading to the most immunized by flu season.


[ Parent ]
prescription laws
the problem are the prescription requirements.
If we could buy our flu-shot in the supermarket,
there would be no logistical problem and everyone
could decide when/whether it's time.

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[ Parent ]
you'd give the shot to yourself?
You'd expect others to? This suggestion is not especially practical.

[ Parent ]
Prescription/Self-Injection
1.
- In France you can purchase the seasonal flu shot at a pharmacist without a prescription (last year was about 13 Euros). One is supposed to make an appointment at the doctor's to have it administered.

- If one is going to wait until the right time to be injected, one could keep the flu shot in the fridge for some time. I had kept 3 flu shots/3 pneumonia shots last year, for my lodgers, just in case, even though I know it loses some efficiency after a while (how long does it take for it to become useless?). In fact, I wonder if I won't keep them another year, one never knows... As soon as I can get this year's in the pharmacist, I'll get a few of them... one for me to be injected with, the others for my lodgers in case of need, same as last year.

2.
- self-injection? I would. Not very practical, but doable.
- injecting my lodgers? Sure, no problem there; in case of emergency, I'd do it without the slightest hesitation.

3.
- suggesting others do like me? Hummm. Well, one should always take the advice of a doctor before proceeding to do any medical act, so, since I'm not a doctor, I will not suggest others do as I do... I can therefore only recommend those reading me discuss it with their doctor. :-)

Let me be blind to wicked text, deaf to wicked words, mute to wicked comments.


[ Parent ]
France

hmm, France is EU - so could I get flu-shots shipped from
France to Germany without prescription ? No custom in EU.

telefone or internet doctor-consultation are preferred.
So you need no appointment, no germ-ful
waiting room/doctor/nurse

Why isn't self-injection practicable ?

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[ Parent ]
split
you might even split the dose ...
1/2 now, 1/2 as "booster" some weeks/months later ??

Just a question, no advice. I don't know

Another idea were flu-shots for 2 years or more.
From marble's graphics, I estimate 1/4 titers after one year.
Better than nothing. I remember the paper which recommended
to split the existing pandemic vaccine into small
doses if there is not enough - rather than giving
full doses to a few.

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[ Parent ]
measure your titres
can you also measure, how much titres you have got
from the shot ?

What does it cost ?

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[ Parent ]
antibodies count, cost
From the little I remember from various health concerns of people around me, antibody counting, of other various illnesses, is not done by all labs and is expensive. And not always covered by insurance.

Let me be blind to wicked text, deaf to wicked words, mute to wicked comments.

[ Parent ]
Response 1/2 shot
I don't know if the antibodies build-up is linear or bell-shaped. So if you split your shot in 2 or 3, it may be that you don't get cover at all if the antibodies build-up is bell-shaped

Let me be blind to wicked text, deaf to wicked words, mute to wicked comments.

[ Parent ]
don't split the dose
Without data to show efficacy, you can't assume it'll protect you properly. OTOH, there were some studies looking at this:

http://www3.niaid.ni...

These data are of interest to determine if the vaccine supply might be extended during an emergency situation in the future, such as a substantial vaccine shortage possibly caused by manufacturing problems. However, it is likely that additional studies would be needed to confirm these results and answer other questions before a decision to use a half-dose influenza vaccine in healthy adults might be considered.

I am not aware of final conclusions.


[ Parent ]
herd immunity
hmm, about 20% of people get the flu-shot ...

if 90% would get a shot, would that
give herd-immunity and prevent the seasonal flu wave
in the country ?

it probably has been tested in some environment...
military ?

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[ Parent ]
Flu shots - F- EU - DE
I don't know if you can do that now. It's not a question of customs, but of health regulations. In addition to which, you'd need to provide for the shot to be refrigerated during transport. We could try, if you want, when they're on sale, I can send you one, with ice packs, and we'll see if it gets stopped at the border. Now, would a doctor accept to inject you with a French flu-shot that has not been ordered by him?

I do know some years ago I had to have a vaccine that was manufactured in Germany, not in France/Switzerland, the doctor ordered it and I had it, but then, it was with prescription and came through the pharmacists networks.

Self injection is not practical if you do it in the arm, just like in a doctor's office. Though I suppose S/C could be done elsewhere on the body, perhaps on the thigh, like insulin or anticoagulants? This would need to be checked with a doctor.

Let me be blind to wicked text, deaf to wicked words, mute to wicked comments.


[ Parent ]
3 doses ?
http://www.journals.uchicago.e...
Previously, we evaluated 2 doses of H5N1 influenza vaccine in persons 18-64 years of age (placebo and 7.5?, 15?, 45?, or 90??g doses), separated by 28 days. In this study, 337 participants received a third dose, 6 months thereafter. Microneutralization (MN) and hemagglutination?inhibition geometric mean titers (GMTs) of antibody declined before the third dose. Twenty?eight days after the third dose, 78%, 67%, 43%, and 31% of recipients in the 90?, 45?, 15?, and 7.5??g?dose groups had a MN GMT 1:40, respectively. Five months later, MN GMTs were significantly greater than those after the second dose.

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[ Parent ]
good protection after 4 months

url=[/url they claim that the vaccine is still well protective
after 6 months.

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[ Parent ]
Last time I was at the doctors I caught chicken pox
AND I washed my hands after I left the place :-(

[ Parent ]
This evening we received a recorded message
from our health care provider reminding us to have our 7 yr old DS vaccinated against the flu.  It also said the vaccination is covered under our policy and that a co-pay may be required if other services are received during the doctor's  visit.  I don't remember having received a reminder previously.

there's a real push this year
as you can see ;-0

[ Parent ]
Dem, I just saw a sign at my pediatrician's
that said that if your child received their first flu shot in 2006, that they'll need to have two flu shots in 2007.

I haven't seen this before. Any idea why this might be the case?  And, is this something people should be aware of?


Pixie, is the new recommendation for children under 5
One in the Spring and a second in the Fall.  I'll try to find it.

I am not like other birds of prey....

[ Parent ]
Here it is
2007-08 INFLUENZA PREVENTION & CONTROL RECOMMENDATIONS
Primary Changes and Updates in the 2007 Recommendations

ACIP reemphasizes the importance of administering 2 doses of vaccine to all children aged 6 months-8 years if they have not been vaccinated previously at any time with either LAIV (doses separated by >6 weeks) or TIV (doses separated by >4 weeks), on the basis of accumulating data indicating that 2 doses are required for protection in these children (see Vaccine Efficacy, Effectiveness, & Safety: Dosage, Administration, & Storage).

ACIP recommends that children aged 6 months-8 years who received only 1 dose in their first year of vaccination receive 2 doses the following year (see Vaccine Efficacy, Effectiveness, & Safety: Dosage, Administration, & Storage).

http://www.cdc.gov/f...



I am not like other birds of prey....


[ Parent ]
yep, that's it
under age 9 you need two shots your first year. If you got one last year, and it was your first year, you still need 2 shots this year.

[ Parent ]
Thanks CG & Dem!


[ Parent ]
Dem, I have a question.
My local t.v. station reported tonight that the flu shots will be delayed until next month(although they have recieved the first shipment), because the flu season for upstate ny isn't in full swing until Feb., and the shot is only good for 5-6 months. They said they are following the CDC's recomendations.

If the flu season has already started(viruses don't know it isn't flu season yet), isn't it sorta counter-productive to delay the flu shots? The flu is already going around here, although sporatic. Does it really make a difference if it's Oct, or Nov. when the shots are given?

United we stand: Divided we fall
www.flunewsnetwork.com


I got mine today, and they gave out a 5-page handout with the CDC imprint.
One explained flu and vaccines, reactions, and who shouldn't get a vax.  One was a sort of poster about handwashing and coughing in your sleeve.  The last piece was printed in January 2006 and explained influenza and vax again and that 2 antivirals (amantadine and rimandatine) shouldn't be used because they're ineffective against the strain of Influenza A circulating in 2005-2006.  That's out of date!

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

I had no trouble getting one
at Stop and Shop the other day (got the list from one of the many find-a-flu-shot websites).  Only problem now is my entire arm, not injection site itself is stiff and sore.  I could hardly straighten it out this morning when I woke up.  She must have nicked something.  It's a bit better now that I've been awake, but I've never had something like this happen before - anyone else?

THOUGHT YOU WOULD LIKE KNOW THIS
My employer is offering free flu shots for employees and their families.  I see it not as a way to prevent influenza now, but to begin good habits for later when it is very necessary.  Imagine, employees being more likely to report in when their families are innoculated.  Never mind that the shots won't be created when the pandemic begins.  But, I would wager, they will be promised, if you report to work!!

"The journey of a thousand miles begins with a single step. Never say can't. Never give up. Never surrender."

there's an idea...
...to begin good habits! ;-P

[ Parent ]
table
I want a table or graphic with the vaccination coverage
and pneumonia+influenza deaths for several countries.
Best I could find was here:
http://www.gbe-bund....

but some unexplained changes, e.g. Canada 2000,USA 1999,
France 1980,Italy,Japan,UK

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Get a flu shot, get a coupon book
From the weekly food advertising insert in today's paper:

"Get the Flu Shot at your local Safeway this season and receive a coupon book worth over $150 in value."


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