New guidelines by the American Academy of Allergy Asthma & Immunology say that individuals with egg allergies can safely receive the flu vaccine, without a skin test being performed first. Flu vaccines are grown in chicken eggs, which raised concerns about possible allergic reactions to residual egg protein. Up to now, precautionary steps were taken, which included vaccine skin testing, administration via a 2-step graded dose challenging (10%, followed by 90% of the age appropriate dose after a brief observation period), or stepwise desensitization.
This latest AAAAI paper “offers guidance in how to evaluate and treat the patient with egg allergy who desires influenza vaccination, and outlines the latest evidence based approaches to successfully administer the vaccine.” According to the position paper:
Conclusion There has been tremendous growth over the past year in demonstrating that TIV (and H1N1) are safe for egg allergic individuals to receive. While a few concepts bear further study, such as the safety of these vaccines in individuals with severe allergy to egg, it appears that most egg allergic patients can safely receive influenza vaccination if desired. While no particular approach to administering the vaccine has been shown to be the safest and most effective, several methods for providing this service exist. Providers should no longer withhold the vaccine on account of a patient’s egg allergy, and should feel comfortable selecting one of two strategies we outline for administering the influenza
The bad news keep on coming; the 10th baby, yet another 6-week-old, has succumbed to the whooping cough outbreak in California. All the babies who have died this year were too young to be fully immunized, so health officials are urging parents and caretakers to get booster shots to create a cocoon of immunity around vulnerable children. Our hearts and thoughts go to the families of these 10 innocent infants during these tragic times in their lives. We are very sorry for your loss.
Well, not exactly everything, but a lot.
Influenza, or “the flu” is an extremely contagious respiratory illness caused by influenza A or B viruses. Flu appears most frequently in winter and early spring. The flu virus attacks the body by spreading through the upper and/or lower respiratory tract. There are 3 types of flu viruses, A, B and C which can cause the flu, and new strains (especially the A type) evolve every few years.
Type A viruses are responsible for major flu epidemics every few years. Type B is less common and generally results in milder cases of flu. However, major flu epidemics can occur with type B every three to five years. There is a third type of virus, C, which also can infect but does not produce flu symptoms.
What are the symptoms/effects of the flu?
Besides generally making one feel miserable, here is a list of some of the most typical flu symptoms/effects.
- Severe aches and pains in the joints and muscles and around the eyes
- Respiratory congestion
- Fatigue & exhaustion
- Severe flu can lead to pneumonia
- Sore throat and watery discharge from your nose
Are there any complications that can arise from the flu?
The most common flu complications include viral or bacterial pneumonia, muscle inflammation, and infections of the central nervous system or the sac around the heart. Other flu complications may include ear infections, sinus infections, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes.
Those at highest risk for flu complications include adults over 50, children ages 6 months to 4 years, nursing home residents, adults and children with heart or lung disease, people with compromised immune systems (including people with HIV/AIDS), and pregnant women.
How does flu spread?
The flu is spread from person to person through respiratory secretions and typically sweeps through large groups of people who spend time in close contact, such as in daycare facilities, school classrooms, college dormitories, military barracks, offices, and nursing homes.
Flu is spread when a person inhales droplets in the air that contain the flu virus, make direct contact with respiratory secretions through sharing drinks or utensils, or handle items contaminated by an infected person. In the latter case, the flu virus on your skin infects you when you touch or rub your eyes, nose, or mouth. That’s why frequent and thorough hand washing is a key way to limit the spread of influenza. Flu symptoms start to develop from one to four days after infection with the virus.
Will one catch the flu if one goes out in the cold or gets wet by cold rain?
No. The flu is a viral infection; you need to come in contact with the flu virus to get infected. Feeling cold or being wet does not give you the flu. It might give you a runny nose though and other symptoms that may be reminiscent of the flu, but it does not cause a flu infection.
What are the symptoms/effects of the flu vaccine?
The most common side effects of the flu vaccine (both inactivated and LAIV) include mild:
- Swelling at the site of the injection (inactivated only)
- Body ache
When should one get the flu vaccine?
As soon as it is available.
How many types of flu vaccines are there?
There are two types of flu vaccine. Inactivated and LAIV. The inactivated vaccine is given as a shot, generally in the arm, while the LAIV version is a nasal spray. The main difference between the two is that the inactivated, or the shot, contains dead viruses, whereas the LAIV version contains alive, but extremely weakened, viruses. Because of that, the spray is expected to be more effective in inducing an immune reaction than the shot.
Why is the flu vaccine different every year?
Two of the three flu viruses are responsible for causing flu, type A and type B. Type A has 16 subtypes, while Type B is not categorized by subtypes. They both can mutate, especially type A which results in new strains every few years. Every given year, any combination of various strains of the various subtypes of A and of Type B can be in circulation and causing flu.
Every given year, both the LAIV and Inactivated vaccine contain three strains of influenza virus that are chosen each year based on what scientists predict will be the circulating viruses for the flu season. Given the long production times, it is impossible to know for sure which strains will be prevalent in the upcoming season, so every year scientists have to do their best to predict what they think will be the prevalent strains. Usually this process is done months ahead of the actual flu season. This is why the flu vaccine is different each year, and why we have to get re-vaccinated each year.
Which strains does the 2010 vaccine protect against?
Every year, the flu vaccine, protects against 3 specific strains of viruses that cause flu. The 2010 vaccine protects against two A viruses and one B virus. This year the vaccine protects against these 3 strains:
- an A/California/7/2009 (H1N1)–like virus (Swine Flu)
- an A/Perth/16/2009 (H3N2)–like virus
- and a B/Brisbane/60/2008–like virus
Can you get the flu from the flu vaccine?
No! You cannot get the flu from the flu vaccine. You may, however, experience some flu-like symptoms, which can be experienced from any vaccine in some cases and doesn’t have anything to do with the actual disease you’re being inoculated against.
How effective is the flu vaccine?
The effectiveness of the flu vaccine depends on the strains in circulation and the strains the vaccine prevents from. When the vaccine viruses and circulating viruses are well-matched, the vaccine can reduce the chances of getting the flu by 70% to 90% in healthy adults.
Can you get the flu, even if you get vaccinated?
Yes. Firstly, as we already saw, the 3 strains in the flu vaccine have to be guessed in advance of the flu season. If there is a good match between the predicted strains and the actual strains in circulation, the vaccine will provide good protection. On the other hand, even if there is a perfect match, no vaccine is 100% effective, so even then a person who got vaccinated may still develop the flu. However, in general, people who are vaccinated experience milder symptoms than the non-vaccinated ones.
Who should get the flu vaccine?
Except for high risk groups that are advised to skip the vaccine, it is recommended that everyone over 6 months of age should get the flu vaccine.
Who should not get the flu vaccine?
Anyone with a severe allergy to eggs or egg products should not get a flu shot. Other people who should not get a flu shot include:
- Infants under 6 months old.
- Anyone who has had a severe reaction to a past flu shot or nasal spray.
- Someone with Guillain-Barre syndrome.
- People with moderate to severe illness with a fever; they should be vaccinated after they have recovered.
How Long Am I Contagious After I Get the Flu?
You are contagious for up to seven days after the onset of the flu, although the flu virus can be detected in secretions up to 24 hours before the onset of symptoms. This means you might transmit the flu virus a full day before your flu symptoms begin.
In young children, the flu virus can still be spread in the secretions even into the second week of illness.
How Can I Prevent the Flu?
To prevent the flu, be sure to keep your hands clean — making sure to wash them frequently to remove germs — and get a flu shot. The CDC develops a flu vaccine based on the type A strain that they believe will be most prevalent in the coming flu season. This is the vaccine you get with the annual flu shot or FluMist nasal spray.
Give me some statistics please?
-Every year during flu season, 1 in 20 Americans will contract the disease. Some years incidence can be as high as 1/5.
-Annually there are about 200,000 hospitalizations and an average of 23,600 annual deaths from the flu in the US alone.
Indiana state officials are reporting that Indiana is on track to see it’s highest whooping cough rates in 24 years. As of mid-September, the number of whooping cough cases reported to the Indiana State Department of Health for 2010 had surpassed 390, close to the total number for 2009, which had a total of 400 cases reported.
“Infants are the most vulnerable and they can die from the disease,” said Dr. John Christenson, director of Pediatric Infectious Disease at Riley Hospital for Children in Indianapolis. “But teenagers and adults serve as the vectors for the disease, transmitting it to infants who have no immunity.”
A new state law this year requires all students in grades six through twelve to get a booster shot. For details in Indiana’s school immunization requirements, you can refer to the Q&A posted at the Indiana State Department of Health website.
Anti-vaccination scares are as old as vaccination itself – but now they are putting lives at risk in the developing world
Vaccine scares are nothing new. When Edward Jenner first pioneered the use of the mild disease cow pox to innoculate against the deadly small pox in the 18th century, satirists drew cartoons of vaccinated patients sprouting cow’s heads. Now, it seems, every country in the developed world has their own type of scare. In France, protesters claim that the hepatitis B vaccines cause multiple sclerosis, in the US, that the vaccine’s mercury additives are responsible for the rise in autism. In the UK, there was a furore over whooping cough and then, famously, MMR. All have been exposed as groundless fears, yet anti-vaccine feeling continues to reverberate on the the internet. Now doctors warn that such rumours from the UK, Europe and the US are spilling over into the developing world, where they are threatening to derail global vaccination programmes. Terrifyingly, this means putting the lives of thousands of children at risk.
In South Africa, concerns about MMR, generated by coverage in the rest of the English-speaking world – including the UK – have led to an unwillingness to receive the vaccine, and there has been an outbreak of nearly 7,000 cases of measles. For children with poor health and limited access to medical services, this decision has been disastrous. There have already been hundreds of deaths.
Meanwhile, in India the government has recently overturned recommendations from its own scientific advisers to include the Hib (shorthand for a bug called Haemophilus influenzae) vaccine in its basic childhood programme, despite the fact that the World Health Organisation says that 20% of the 400,000 childhood deaths from pneumonias caused by Hib worldwide occur in India. In the UK, childhood Hib vaccination has seen Hib-caused meningitis (the more common Hib illness in the developed world) fall away to almost nothing. Yet Indian lobbying groups, led by opposition politicians, still claim that Hib vaccines are not only unnecessary, but have caused a number of deaths. The tactics of the Indian anti-Hib groups draw directly on the work of UK and US anti-vaccine websites.
Our anti-vaccine fears, and the groups set up to highlight them in the developed world, may not directly cause these problems, but are “fuelling and amplifying them”, according to Dr Heidi Larson of the vaccine programme and policy group at Imperial College London. Shockingly, just five minutes spent looking at websites critical of vaccines increases your perceptions of the risks, and reduces the perceptions of the risks of not being innoculated, according to a recent paper from a German group published in the Journal of Health Psychology. Rumours about vaccines quickly gain credence in the internet hothouse, with sites feeding off each other. Many sites will tell you that four girls in India died within 24 hours of receiving HPV vaccines. What they don’t say is that two died in road crashes, one from a snake bite, and one fell down a well. Add this rumour to the feeling that vaccination is something that is done to you by government, by global agencies or by big pharmaceutical companies, and conspiracy theories are virtually guaranteed.
So what can be done? So far, campaigners have insisted on more information, awareness and education. But this approach has failed. Instead, the idea of each country taking ownership is being explored, along with advocacy and immediate action to quell rumours.
This is a legitimate question to ask: if vaccines work in preventing diseases, why do we say that unvaccinated children are a danger to the vaccinated ones? There are many reasons why unvaccinated children pose a risk to vaccinated children. Here I will go over the main ones:
- There are many children that cannot be vaccinated, for various reasons such as an autoimmune disease, allergies, or simply being too young to have received the vaccine. These children have no protection against the disease. If they are exposed to it through an unvaccinated peer, they are at risk of suffering and/or even dying.
- Unvaccinated children are protected by the herd immunity created by the vaccinated children. Herd immunity basically means that if enough people are vaccinated it becomes really hard for the disease to find hosts it can survive in and spread. The more children are unvaccinated the greater the risk that herd immunity will fail. If herd immunity fails, all suffer for the reasons described below.
- Vaccines do not offer 100% immunity towards disease. The efficacy varies; some vaccines offer higher rates of efficacy, some lower. Having received a vaccine doesn’t guarantee that a child will not get sick when exposed to the disease. Vaccines reduce the risk of contracting the disease, if exposed, dramatically, but there will always be a number of children for whom the vaccine will not provide protection. Those children will be at risk, from other unvaccinated children who may contract and spread the disease.
However, the first and foremost children that are being put at risk by the unvaccinated children, are the unvaccinated children themselves. Before they can become a danger to others, they’d have to contract the disease themselves, and that disease could carry with it all kinds of pain and suffering, including in some cases death.
Age at death – 16 years
Cause of death – Meningococcus
Vaccination Status – Unvaccinated
What happened – MaryJo was a vibrant and intelligent girl who thoroughly loved life. Her mother, Rose, is a registered nurse. Early Saturday morning as Rose was getting ready for work, MaryJo complained of a sore throat. Rose examined her, but noted no unusual signs and recommended some Tylenol and lots of fluids. She checked on her later but MaryJo only mentioned feeling a little weak. In the afternoon, MaryJo telephoned her mother because she had developed brownish spots on her face. This was the first ominous sign that she was very ill. Rose was terrified as it hit her that she might have meningitis! This disease is frightening because it masquerades as the flu then suddenly bursts into a deadly conflagration.
She rushed home and found MaryJo seated on the sofa with blotchy purplish rash on her face. Brown rashes or purplish blotches indicate the infection has invaded the blood stream. Rose immediately called 911. She was taken to the emergency room where blood work and a spinal tap confirmed the diagnosis. Her body was overwhelmed by the infection that her condition deteriorated rapidly. Thirteen hours after her initial symptoms, MaryJo died from a bacterial blood infection that is vaccine-preventable. Writes Rose:
I felt devastated like the world just imploded in me! My heart was pierced right in the middle by this sharp awful arrow and weighted by a gigantic anvil. MaryJo’s face, with a tranquil smile, was still beautiful despite its purplish hue. I felt her presence hovering for a moment, before she ascended with the angels. Everybody was in a state of shock and disbelief due to the unexpected loss of this young and gifted person.
The sudden death of a healthy teenager is a shock to everyone. According to CDC (Centers for Disease Control and prevention), the Sacramento County Health Dept. and local practicing physicians, “the meningococcal vaccine is not recommended because it is expensive, the number of cases is rare, vaccinating teenagers is not cost effective and the number of deaths are negligible”. However, the devastating effect of losing a loved one to this disease is anything but “negligible”.MaryJo is remembered for her loving, spirited dedication to helping others. In her journal she wrote: “Others should be remembering us for our positive influence on the lives of those around us. We should be known because we changed someone’s life”.
The lives of our children will not be in vain. I want others to know that meningitis can happen to anyone, anywhere and at anytime even to accomplished healthy teens. Since MaryJo’s death, MAK – Meningitis Awareness Key to prevention, a nonprofit organization, was founded to campaign for increased meningitis awareness, to advocate for legislation & resolutions, and to collaborate with other agencies in support of meningitis vaccination programs.
My deepest condolences go out to MaryJo’s mother and the rest of her family. I am very sorry for your tragic loss.