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Online Discussion: Tracking new emerging diseases and the next pandemic; Now tracking the Aussie Flu.

Flu Jab Mandatory For Some Medical Staff in NSW

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Technophobe View Drop Down
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    Posted: March 13 2018 at 3:19pm
I am delighted to see common sense/good science being demonstrated in Australia.  For those who object on "personal freedom" grounds, the alternative is permanent mask wearing whilst on duty.  (Quite appart from the freedom of the very seriously sick not to have their lives put at risk!)

Source and full article:  https://www.smh.com.au/national/nsw/flu-shots-nsw-medical-high-risk-wards-20180313-p4z447.html
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Post Options Post Options   Thanks (0) Thanks(0)   Quote DeepThinker Quote  Post ReplyReply Direct Link To This Post Posted: March 15 2018 at 10:56am
Just currious... do we have any actual scientific evidence that vaccinating healthcare workers reduces flu illness in those they care for.   It is very difficult to prove that vaccinating reduces illness just in those vaccinated.   I would love to see a study.(not holding my breath because I know it won't happen)
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: March 15 2018 at 12:08pm
VERY basic eppidemiology.  Healthcare workers are nexuses (nexii?  I have no idea what the plural of nexus is).  To contain or limit the spread of anything, they are the first step.  Unvaccinated, they make most superspreaders look tame.  Worse, those they spread to have a higher death rate from the damn bug.

Refrences:  Just a few - I lost count of how many there are.

https:///www.ncbi.nlm.nih.gov/pmc/articles/PMC5383605/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4945728/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775324/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021207/

'And most importantly:  https://www.coursera.org/learn/epidemics    where I learnt the basics.  (Thanks again Rickster)

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Post Options Post Options   Thanks (0) Thanks(0)   Quote DeepThinker Quote  Post ReplyReply Direct Link To This Post Posted: March 16 2018 at 12:35am
Yes I understand basic epidemiology at least to the degree you would expect from a well informed curious lay person.   My question seemed so simple and basic and the answer seems so straightforward that it seems absurd that I would even ask it.  However flu is a superbug with strange qualities that we really don't understand.

The flu Vaccine's efficacy has never been proven through a longitudinal study.   If you doubt me find ONE study that shows the vaccine reduces sick days, reduces hospitalizations, or mortality.

For the sake of argument lets say the vaccine does work to some degree.   Even if you could prove that you wouldn't know for sure if it would reduce healthcare acquired infections.   If I am truly sick with the flu I am staying home.   I am probably not even capable of work.    But if I got the vaccine and now I have a sub clinical flu infection  I might feel a little under the weather but I am going into work.   So if the vaccine does cause more sub clinical cases, it might make hospital acquired infections worse.

Superspreaders....  do you have any evidence that flu vaccines effect the occurrence rate of superspreaders within a population?   I find the whole subject of superspreaders to be fascinating and would love to read info on the flu.

Except as in the cases of novel flu viruses I really don't think healthcareworkers are the nexus.   Flu is primarily a community disease.    If in an imaginary world you closed down all the hospitals, many diseases would just go away.   They only thrive in the hospitals.   However I doubt you would see any meaningful change in flu rates in a community.

Forcing healthcareworkers to get flu shots is a very controversial subject.    It seems as though officials would want to do the kind of research that I asked for just to back u p their policy decisions.   It is hard to argue with science.... I want to see it.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote hachiban08 Quote  Post ReplyReply Direct Link To This Post Posted: March 16 2018 at 1:39am
Kaiser Permanente in Orange County, California doesn't force the flu shot on health care workers from my understanding, but if you choose to not get it, you are required to wear a mask for the whole flu season, per my physical therapist.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: March 16 2018 at 3:54am
I took the coursera course listed in my post. (Two+ years ago, but I am still boasting about my 100% score!)  A detailed epidemiological study of several diseases was included in one week's course module.  Among these was a study of measles

Opinions on the Ro of measles vary but the average figure is about 16 (By comparison, flu has an Ro of 1-3 depending on strain.)  Measles vaccine has an effectiveness of around 80%.  Those measles figures, along with anti-vaccine campaigns, make it a wonderful study (scientifically wonderful only, it still kills occasionally and often maims.)   With vaccination the Ro effectively drops to around 3 (flu's worst figure) and as the number of infected in a community either die or recover (neither of whom can spread the disease anymore) The effective Ro drops slowly below the magic Ro1 number and the outbreak ends.  (Any disease with an Ro below 1 is self-limiting.)

This model is universally applicable and has been repeatedly tested and proven in the field.  I have lost count of the number of studies there are which apply the calculations - there are computer programmes which use it and even a couple of games. 

True, flu is not completely understood*, also true that the vaccine varies in effectiveness, but neither of those facts alter the epidemiological effects to any great degree.  Vaccination is scientifically proven.  People merely confuse a few unique results (6 sigma and above if you study probability, or mathematical modelling) with the statistical certanties. 

It is also true that vaccination has its down side.  Mercury preservatives (rarer now thankfully) alergic reactions (which are a variation on what the vaccine is designed to do) and the mild symptoms (which make some ill-educated twits think they have been given the flu) all put people off.  Although the  very worst of these are colossally milder than the mildest case of the disease itself.

Frankly, members of the public are entitled to any opinion they wish.  It would be universally good if vaccine uptake rates rose, but free will is precious too.  However, when it comes to health care workers, they should know better.  They should have a basic understanding of the science at least and their patients are often utterly dependant upon them.  This is a moral obligation.  If they do not care about the health, suffering or very lives of their patients they should get anoter job.



* That applies to everything in the universe.  Chemically, epidemiologically and biologically we have the nasty s*d's full profile.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote DeepThinker Quote  Post ReplyReply Direct Link To This Post Posted: March 16 2018 at 10:21am
As far as I understand the measles shot can be up to 97% effective but because it is so contagious ou can still have outbreaks.   If it was only 80% it wouldn't even be that useful.  The best that the flu vaccine is 40-50%.

Doesn't it bother you that the flu vaccine has NEVER been shown to be effective with a longitudinal study?   It does me.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: March 16 2018 at 11:37am
No.  Longitudinal studies are controversial and most often applied to sociological science or psychology.  They are probably not the best method in this case, at least not for effectiveness.  What would be the point?  The flu is gone in a week or two.

As regards safety, that is aother matter.  I suspect a longitudinal study would have some merit here.  I have nothing to go on except the pharmaceutical companies' own studies - and they have a vested interest.  However, should really nasty stuff emerge over time, it would eventually come to light, wether they wanted it to or not, via the drug reaction reporting system, which takes the place of/functions as a longitudinal study.  The only exception to that would be if the really nasty stuff was incredibly rare.  Then it might not be linked to its actual cause.  In that case, it is still a far better set of odds and my conclusion remains the same.  I believe there was a fatality from the flu jab this year; yet THOUSANDS die of the flu every year, even when the circulating strain is a mild one.

It is possible that the measles jab has improved.  I have not necessarily spotted all medicine's updates.  It was 80% when the studies I quoted were done; that is where the statistical science springs from and therefore remains the relevant figure to this discussion and the epidemiological conclusions/models.
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children here are not allowed to go to school if they not been Vaccinated,

antivaxers are DUMB..............................


12 Monkeys...............
1995 ‧ Science fiction film/Thriller ‧ 2h 11m a must for AFT
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: March 16 2018 at 5:38pm
I am not sure I would put it quite so strongly, Carbon, but we are definitely on the same page.  How about misinformed?

Upon which subject,  I posted this just now http://www.avianflutalk.com/topic37116_post269301.html#269301  and may I draw attention tp the following part of the article:  "

Soriano said five people, aged between 4 and 23, had died.

None of the fatalities, however, was a recipient of the controversial vaccine Dengvaxia, which was used in the national government dengue immunization program starting 2016."

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Post Options Post Options   Thanks (0) Thanks(0)   Quote carbon20 Quote  Post ReplyReply Direct Link To This Post Posted: March 16 2018 at 11:57pm
Sorry, Aussie plain language......
12 Monkeys...............
1995 ‧ Science fiction film/Thriller ‧ 2h 11m a must for AFT
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Penham Quote  Post ReplyReply Direct Link To This Post Posted: March 17 2018 at 6:01am
I am one of those that are very happy they require health care workers to get the flu vaccine. I have asthma and if there is ANY chance of it reducing the opportunity of a health care worker spreading whatever it is they are exposed to while treating patient after patient after patient that has "who knows what" then I am all for it.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: March 17 2018 at 8:53am
Toddler dies of diphtheria after parents refused to vaccinate her against disease
Saturday, 17 Mar 2018

“The only reason we are seeing diphtheria cases is not because vaccine has failed, but because parents do not want their children to take the vaccine,” he said.


Source and full story:   https://www.thestar.com.my/news/nation/2018/03/17/fear-and-superstition-prove-deadly-toddler-dies-of-diphtheria-after-parents-refused-to-vaccinate-her/

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Post Options Post Options   Thanks (0) Thanks(0)   Quote DeepThinker Quote  Post ReplyReply Direct Link To This Post Posted: March 17 2018 at 11:39am
Technophobe I don't understand why you keep bringing up stories involving other diseases.   With most all  you need is a single shot or a short series of immunizations and you are done for life.   We have good evidence they work and a fair amount of safety data.   With flu you are asking me to  be vaccinated EVERY year and we have none of the research data we need to make an informed decision.

This is the research that I want to see.   Follow three groups of people for 5-10 years.   One group will be people that never receive the flu shot, one group infrequently receives and a group that always receives.    Simply compare their respiratory illness rates, and look at any other health related patterns that might emerge.   Hell I would be ecstatic if they even did this for ONE season.  Why would this type of research be considered controversial?
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I'm sorry, Deep thinker; I did not realise the connection was not obvious.  I might understand it, but I will never make a teacher.  The first class would lynch me for being too cryptic.

Epidemiologically, the flu is just another disease.  It follows the same biological rules. 

The only difference between flu and most of the rest, is that flu is a master of disguise.  The "working parts" of the flu virus stay pretty much the same, but it has a "coat" of haemagglutinin molecular protrusions which cover its surface. That "coat" is the bit our immune system learns to recognise. 

The flu keeps evolving a new coat.  A bit like an enemy agent changing his coat and hat in the train station so our spies lose track of him.  Each time a new strain of flu emerges from the evolutionary remix, we have to re-learn the colour of his coat*

As vaccination is designed to teach our immune sysytems to recognise this coat, the vaccine has to change each year.  Like the Radio broadcast:  "Attention all personnel:  Agent X is wearing a tweed hat and blue fedora now."

This is expected to change in a short few years as several scientific teams are working on ways of recognising the "spy" by his "shoes".  For now, we still have to run to keep up.



REFRENCES

*http://www.virology.ws/2009/04/30/structure-of-influenza-virus/
and PDF  https://ecdc.europa.eu/sites/portal/files/media/en/press/Press Releases/071012_PR_SI_Prof_Fact_Sheet.pdf
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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: March 17 2018 at 12:44pm
An AFT thread stay completely on topic? I would say that I eagerly await the day, but in truth I like the way we cover more ground than a topic title might suggest. It's what often separates us from the more heavily moderated sites. 

Hachi - we have to either get the shot or wear a mask for the duration of the flu season, and we require our patients to do the same. 


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"Any community that fails to prepare, with the expectation that the federal government will come to the rescue, will be tragically wrong." Michael Leavitt, HHS Secretary.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote DeepThinker Quote  Post ReplyReply Direct Link To This Post Posted: March 18 2018 at 12:48am
Originally posted by Technophobe Technophobe wrote:


The only difference between flu and most of the rest...

You act as though that is a trivial difference.     This is entire crux of my argument.  We vaccinate for an accidental quality of the virus and not its fundamental quality.    If there was a universal flu vaccine I would seriously consider it.  However I have very serious doubts if it is even possible.   We keep hearing that it is only a few years away.   I have been hearing that my entire adult life.    IMO if it was possible for our immune system to gain immunity from all flu viruses I think it would have already happened through evolution.
Originally posted by Technophobe Technophobe wrote:


What would be the point?  The flu is gone in a week or two.

So do you think that the vaccine and effects of the vaccine are also gone from your system "in a week or two" like the virus is?   If the vaccine did prevent some flu infections but also caused long term effects would it be worth it for a virus that will be gone soon anyways?   Virtually every medical procedure/medicine/equipment has to be tested over a very long period of time before use, why not the same for flu vaccines?  While I know you can't do all this testing before releasing the vaccine you can still do it after the vaccine was given.

I feel as though my objections are being addressed as if they come from a place of ignorance, when in fact the more I study the more questions  I have, not the other way around.    I also don't like being tossed in with all the other "antivax nuts" when I am objecting to a very specific vaccine not all of them.   In every case it is a risk vs reward equation.    IMO normal seasonal flu is not a huge risk.     When actually looked at and counted only a few thousand people a year die in this country, and the vaccines effectiveness is questionable at best.   While on the other hand the risks of the flu vaccine,particularly long term risks are mostly unknown. I am not disputing or disagreeing with science, I am just asking for more of it to be done.

Why does this all feel like "the emperor has no clothes".
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Post Options Post Options   Thanks (0) Thanks(0)   Quote DeepThinker Quote  Post ReplyReply Direct Link To This Post Posted: March 18 2018 at 1:17am
Originally posted by jacksdad jacksdad wrote:


Hachi - we have to either get the shot or wear a mask for the duration of the flu season, and we require our patients to do the same. 



What kind of work do you do?   I work in 177 bed long term care/post acute/rehab facility.    This flu season hasn't been that hard on our patients/residents, it seems the staff was more affected.   I keep hearing "but I got the shot why am I sick?".    It seemed this year those that got the shot tended to get more sick than those that didn't.

 Last year was  worse for respiratory illnesses for us.    We had at least 4 or 5 waves of illness that started in November and lasted till may some got sick every time.
 
'15-16  was MUCH MUCH worse.    I remember the week before Christmas we were placing 2-3 people a night on oxygen on just my hall of 24.  Probably 75 or 80 percent of the residents where affected many very severely.   It was also the last time I was sick enough to miss work.   I find it odd that I got sick almost 2 weeks after first caring for sick people, so either the incubation period for flu can very greatly or I was able to actually avoid being exposed for quite a while working all around it.

We keep hearing about the great number of people over 65 that die of the flu.... I think most are just pneumonia and not flu related.     Sad to say but those that the flu does take... most are ready to go.   We all have to die from something. 

So many people come and go through our facility ever day... at least 100 outside vendors and  likely just as many visitors.   Even if you could get 100% vaccine compliance among the staff I doubt it would make a big difference.

Also it was strange this  year was the first time we ever had a diagnosed flu patient.    We had to be in-serviced and made a big deal about it, while at the time  most of the staff and most of the patients had probably already been exposed.  But because it it is diagnosed you have to take it seriously.
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No no the difference is not trivial at all, but does not affect the effect on the eppidemiology.  It is the epidemiology which affects the patient-carer relationship.

I also know the difference between the effects of the vaccine ,which do hang around and the vaccine itself which is gone in a few days.  If the vaccine's effects did not hang around we would need to vaccinate every few days.

You are right that in a normal season flu is not a particularly big risk - for the healthy, but that is not the case for the medically vulnerable.  Hence the "moral duty" bit for healthcare workers.  They have a choice whether or not to get the jab and take or not take the risk.  But, the patient does not have a choice in whether or not they are sick and extra vulnerable to the flu.  I believe the hypocratic oath starts with "First do no harm" and giving a patient flu when they came for aid is an obvious harm.

Pneumonia is the big killer in many patient groups, but it most commonly follows the drop in effective immunity caused by a dose of the flu.  Pneumonia causing bacteria are around us all the time; waiting for a first wave attack from another agent, like flu, to make a foothold in the body for them.  Many death certificates mention pneumonia, but not the flu whick let it in.  That was how my father died.  Pneumonia also took my mum, but it was following surgery.  Both were in care homes at the time.

I do not know of California's drug reporting system.  Here in Britain Paper copies of the pharmacopia have yellow reporting cards in the back for reporting adverse effects.  When the majority of this went online, the online system included a virtual equivalent.  This serves the long term effects study, at least in part.  Most of the ingredients in the flu jab (other than the specific antigens) have undergone massive and extensive tests, although I can see a flaw in the system as the people doing the testing have vested interests. 

As for the antigens themselves, there is simply no time each year.  Each flu season, an educated guestimate is made about which strains are most likely to circulate.  Those guesses cover us against the most likely and the most nasty candidates, although not all.  It is still somewhat of a lottery, you are right there,  but the odds of catching (and for the purpose of this discussion spreading) the nastiest killers are dramatically shortened, resulting in fewer avoidable deaths.

Primum non nocere.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote DeepThinker Quote  Post ReplyReply Direct Link To This Post Posted: March 18 2018 at 3:18am
Very simple question...   why can't I hear something like this "In 2015 those that received the flu vaccine had this rate of illness and those that didn't that?"

The research wouldn't be hard.
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