Public perception of flu vaccine categories

Whatever we might be saying, this is what they are hearing (must be cartoon day today!).

Happy Halloween!

From the Columbus Dispatch

“Does the Vaccine Matter?”

Mike just blogged about this article in the Atlantic, which questions conventional wisdom about the effectiveness of influenza vaccination. I agree that the article is not to be dismissed as an anti-vaccine screed, as it balances discussions with both skeptics and high profile advocates of influenza vaccine (including Nancy Cox and Tony Fauci).

The title of the article (“Does the Vaccine Matter?”) grossly oversimplifies the question. I agree that estimates of vaccine effectiveness in the elderly are inaccurate, as they rely on imprecise outcome measures (death rates) and are confounded by variables associated both with receipt of vaccine and risk of death from all causes (see here and here for the references cited in the article).

But, as the article concedes, flu vaccine appears to effectively prevent symptomatic infection in the young and healthy. While these individuals are very unlikely to die from influenza, they are critical in sustaining influenza spread during epidemics. Blunting an epidemic by vaccinating as much of this population as possible will thereby reduce infections among the elderly and among other groups at higher risk for complications and death.

This begs the question—what is the best way to utilize a limited vaccine supply? Is it better to flood those population groups who are most likely to generate protective immunity and are most important in community transmission? Or should we concentrate on those most vulnerable to death from influenza complications, even if the effectiveness of the vaccine in that population is lower?

Flu vaccine: Too good to be true?

There's a well written, provocative article in the November issue of The Atlantic on influenza vaccination and how the evidence for its effectiveness is overstated. In the article Tom Jefferson, the head of the Vaccines Field at the Cochrane Collaboration, says "For a vaccine to reduce mortality by 50 percent and up to 90 percent in some studies means it has to prevent deaths not just from influenza, but also from falls, fires, heart disease, strokes, and car accidents. That's not a vaccine, that's a miracle." The writers describe how Jefferson has been shunned by the vaccine research community. The article has been branded by some as anti-science and anti-vaccine, but I didn't sense that. I still think the benefits of influenza vaccine outweigh the risks and continue to promote vaccination of healthcare workers, but I don't believe the evidence for effectiveness is strong enough to mandate vaccination.

More on H1N1 after seasonal flu vaccination

We’ve blogged before about the as-yet-unpublished Canadian data suggesting that prior receipt of seasonal influenza vaccination may increase risk for nH1N1 infection. Now a case-control study is out in the BMJ that suggests just the opposite—a protective effect of the 2008-09 seasonal vaccine during the early days of nH1N1 emergence in Mexico City. This study should be viewed as preliminary, given the small numbers and the case-control design. I’ve still heard no word on when (and where) the Canadian data will be published.

Anti-vaccine movement gaining strength

Click here to read a very interesting article in Wired.com about Dr. Paul Offit, the pediatric infectious diseases specialist and vaccine expert, who has been hounded by the anti-vaccine movement.

No MRSA here!

At the end of each quarter I prepare a report on HAIs in our ICUs and examine the trends. In doing so last week, I had a pleasant surprise--for the first time ever, we had no device related MRSA HAIs in any of our 8 ICUs (136 beds, >8,600 patient days for the 3-month period). Moreover, our infection rates from all pathogens was the lowest ever. Now I didn't fall out of my chair since we have been watching a progressive decrease in the rate of MRSA infections over the past several years. This decline in MRSA parallels the fall in our infection rates in general. To what do we attribute all of this? Our belief is that a strong horizontal platform of infection control with non-pathogen specific strategies has led to this success. Probably most important has been our focus on hand hygiene (median ICU rates consistently exceed 90%) and the use of chlorhexidine for patient bathing. Now one could correctly argue that our uncontrolled observations cannot establish causation. However, I think the most important and irrefutable fact is that this fall in infection rates, including those caused by MRSA, cannot be attributed to active surveillance for MRSA, since our NICU is the only ICU in which active surveillance is performed. Despite my happiness at MRSA's absence, I'll refrain from the use of words like elimination or eradication, and won't even say we got to zero, since I'm certain this crafty bug is not about to leave us alone.