What`s up with that Flu Vaccine?

ECHO Antibiotic Stewardship Program
Charles Krasner, M.D.
University of NV, Reno School of Medicine
Sierra NV Veterans Affairs Med Center
December 18, 2014
What’s up with that Flu Vaccine?
The Seven Deadly Lies
Flu starting to take off…
Almost all patient isolates this season and last are Influenza A,
but in 2013-4 most were the 2009H1N1 strain (swine flu) while
this season the large majority are A(H3N2)
What is in the 2014-5 flu vaccines
 All of the 2014–15 influenza vaccines contain antigens for the following three strains.
These are in the standard trivalent vaccines:
 •A/California/7/2009 (H1N1) pdm09-like virus- 2008-9 and 2013-4’s major flu cause
 •A(H3N2) virus antigenically like the cell–propagated prototype virus
A/Victoria/361/2011
 •B/Massachusetts/2/2012-like virus
 The quadrivalents—Fluarix Quadrivalent (GlaxoSmithKline), Fluzone Quadrivalent
(Sanofi Pasteur), and Flu-Mist Quadrivalent (MedImmune)—also contain an
additional Influenza B strain, the B/Brisbane/60/2008-likevirus antigen.
Changing A-H3N2 virus – trouble ahead? Antigenic Drift now occurring.
H3N2 influenza season usually much more severe than in a non-H3N2 season
 Antigenic shift- major change in viral structure- such occurred with Swine Flu
(H1N1) in 2009 lead to major epidemic. No immunity in the community existed
(except in the old ).
 Antigenic drift- minor change that may occur, may be some cross immunity to
the new virus from prior exposure or vaccination. So far half of the A-H3N2
isolated now are mutated- referred to as H3N2v (variant)
 First noted in 3/2014, not commonly isolated till this September- too late to
produce updated vaccine. H3N2
So – looks now like flu cases this season will be due to :
10% Influenza B- in vaccine ; rare H1N1- in vaccine; H3N2- 45% - in vaccine ;
H3N2v – 45% - not in vaccine,? Cross immunity .
Influenza Anti-viral medicationboth remain active verus Influenza A
Health Care workers- approx. one third don’t take
the flu vaccine
Lie#1. The vaccine does not work
Lie#2. The vaccine causes the flu
 The Live Vaccine: Flu-Mist Quadrivalent- attenuated live viral vaccine with
a room-temperature sensitive adaptation, it does not survive at core body
temperature(such as in the lungs). There has never been a documented
case of transmitted illness reported.
 Killed Virus Vaccines: All other Flu vaccines are killed virus and antigens
and cannot cause infection
 Systemic complaints after vaccination-caused by non-influenza infections
such as RSV, actual influenza that develops as vaccine not 100% effective,
but apparently no more systemic side-effects with the vaccine than
placebo
Lie#3. I have an allergy to eggs
 Only those with a history of anaphylaxis/angioedema/respiratory distress
should avoid vaccination
 Those who have hives after eating eggs should be watched for 30 minutes
after the vaccination – Advisory Committee on Immunization
 Most common food allergy after milk allergy ~ 2% prevalence
Lie#4. I never get the flu!
I am healthy and don’t need it!
 This excuse is commonly used by HCWs, but misses the whole point
of vaccination. This rationale ignores the potential risk to close
contacts, especially those patients so frail they are unlikely to
mount a strong immune response to the vaccine and rely on herd
immunity for protection. We have an ethical responsibility to
promote a safe workplace for our patients and coworkers
Lie#5. I cannot take the vaccine because I am
pregnant/live with an immunocompromised patient
 Remember all the pregnant women dying of the flu in 2009? Pregnancy
and immunocompromised patients are the ones that have been
recommended for the vaccine the longest, and the ones most likely to
benefit from not ill from the flu. It is completely safe in these patients- it is a
dead vaccine!
“In contrast to previous seasonal influenza strains, the novel 2009 H1N1 strain preferentially
affected young adults, with a clustering of severe and fatal cases in adults between the
ages of 30 and 50 years. Additionally, H1N1 displayed a heightened potential for severe
lung injury as well as gastrointestinal symptoms. Risk factors for severe disease included
obesity, morbid obesity, pregnancy, immunosuppression, asthma (in children), chronic
obstructive pulmonary disease, neurological disorders, other comorbidities, HIV-infection,
poverty, and lack of access to care. However, >25% of deaths were in previously healthy
individuals”
Semin Resp Crit Care Med. 2011, August, 393-9
Lie#6. The flu vaccine has mercury in it and that
causes autism. http://youtu.be/LapyKiMT2tc
Lie#7. Choose your conspiracy theory