Military medical staff gives vaccination as patient hams it up.
Russian hackers have been maddeningly successful with websites hawking the fib that a major debate is raging about the safety of flu shots.
The campaign has no basis in fact. But that’s okay with the trolls.
They aim to spread the deception widely, sowing mistrust among Westerners to help destabilize democracies.
It’s disappointing (OK, infuriating) that Russian meme mongers are having some measure of success.
It’s m not due to the quality of their content.
Tweets from the hackers have included such clickbait as, “Did you know there was a secret government database of #vaccine-damaged children?” and “Only the elite get clean vaccines.”
Some Westerners fall for the bogus sites and help the claims go viral.
The result? I’m not an epidemiologist, but I can tell you that cause-of-death figures for 2017 show an uptick in deaths from influenza and pneumonia.
And guess what? Four out of five children who succumbed to the flu during the 2017-2018 season were unvaccinated.
Barriers to vaccination around the world have played into the trolls’ efforts, too.
A study published in International Health found that vaccination rates among the poor were already lower than necessary, due to:
- Parents needing more information on shots, including how to get them,
- Clinics that are too far away,
- Poor attitude, knowledge or performance of staffers,
- Lack of logistical skills among staff to maintain vaccine supply,
- Myths about what disqualifies a child from immunization,
- Parents’ uncertainty about side effects and how to handle them, and
- Conflicting demands on parents’ time.
The trollers might’ve had trouble gaining traction were it not for the mistrust that already existed among lay people.
As far back as the 19th century, anti-vaxxers have decried the “unchristian” animal origins of vaccines, as well as the unknown risks and effectiveness.
Skepticism is often a good thing. But current fears about flu vaccination are not so good.
Public health experts confirm that vaccinations are civilization’s best defense against the annual onslaught of the contageous, mutating virus.
Unfounded fears about vaccines are even more harmful when they speed the spread of diseases that are more contagious than the flu.
For example, 2019 marked the worst American outbreak in two decades of the measles, according to the U.S. Centers for Disease Control and Prevention.
The previous year, a measles outbreak across Europe linked to the propaganda of Russian trollers killed 72 and infected more than 82,000, according to Radio Free Europe.
The threat to public health from falling vaccination rates is so serious, school districts across the U.S. have adopted mandatory vaccination rules for influenza and other contagious diseases.
Everyone 6 months of age and older is urged to get a seasonal flu vaccine each year. (Image: U.S. Centers for Disease Control)
Even more shrewdly, Russian trolls play on the common fear of needles among people, including me.
The aversion is the main reason I often put off till January the inevitable shot to the shoulder. Not a smart strategy, I know.
Once I hear that the toll of flu season has hit panic levels, I speed to the nearest chain pharmacy, and take whatever formulation they’ll give me with a needle of any size.
Is the flu vaccine safe?
The consensus among scientists is a deafening “Yes.” I tried but couldn’t find one credible, peer-reviewed study saying it’s dangerous.
Does the flu shot work? Yes, as well as ever.
Should you get a flu shot?
Need you ask?
With sites like theirs, who needs funny pages?
You wouldn’t know that the shot is a virtual no-brainer from reading the headlines at some clickbait farms.
One such dubious report involved a 14-year-old girl who claimed the vaccine made her pregnant. At least the trolls have a sense of humor: They said her mother believed her.
Another told of a mom who is suing vaccine makers because the shot made her son gay.
With sites like theirs, who needs funny pages? Maybe it’s best to take such tall tales as the comic relief you might need after learning the sobering facts about the dangers of the flu.
The seriousness of the flu’s threat to human life helped motivate the painstaking, multi-national process overseen by the World Health Organization.
Experts from US and other countries gather during each flu season to predict which mutations of the virus will spread in the Northern and Southern hemispheres.
Vaccine makers use the results to decide which formulations they will develop for the following season.
The effort is driven by the fact that the flu kills up to 646,000 people each year, including an estimated 20,000 Americans.
The influenza vaccine works by preventing flu-virus particles from taking up residence in a healthy person.
The flu vaccine does this by signaling the body to create antibodies to block the virus’s surface protein from attaching to the cell-surface receptors in the well person’s body.
The WHO immunization group meets early in the year to recommend changes in the standard vaccine. The new formulation is based on the strains we are likely to face during the next flu season.
Key to the predictions are the identities of flu strains making the rounds in the Southern Hemisphere during their winter, the North’s summer.
As you may have guessed, protecting the public from the flu is among the biggest, most complicated challenges facing public-health officials.
Government health agencies use a variety many different approaches to persuade the public to get vaccinated. (Image: CDC)
Of constant concern are strains of illnesses that could make the unusual leap from animals to humans.
The immunization group has suggested preparing a vaccine for the H5N6 avian flu that in 2017 infected a man in China. Although it was deemed unlikely to spread further, the panel advised being prepared.
A flu virus that starts out infecting only animals can mutate in a way that lets it spread to humans. It’s rare but it happens.
Anxious public-health officials are constantly on the lookout for any hint of such a mutation.
The thought of a dangerous virus making the leap from animals to humans and spreading quickly, unlikely as it might be, keeps experts awake at night.
They know that such a scenario could create a pandemic, since humans would lack natural immunity to the newly mutated virus.
Think of the Native American communities tragically decimated because they lacked immunity to diseases introduced to the New World by Europeans. Then you’ll get the picture.
Battling the viruses already known to spread among humans is challenging enough.
The techniques currently in use are far from perfect. They are, however, an improvement over the process that led in 1938 to the world’s first modern flu vaccine.
We now know the flu virus is constantly changing.
Developed using fertilized chicken eggs, the shot’s initial use was to protect American troops going abroad during World War II.
Some 80 years later later, the egg-based method of producing flu vaccine is surprisingly similar to the original.
The difference is in the quality and quantity of the information that goes into its development.
We now know that the flu virus is constantly changing, undergoing mutations that enable it to spread beyond the environment in which it previously lived and reproduced.
It also helps us to know there are different variations of flu, which experts have named A, B, C and D. We don’t have much to fear from C and D. The ones most likely to sicken humans are A and B, which are targeted by the vaccine.
In its infancy, the flu vaccine was formulated with far fewer facts than we have today about which strains are likely to circulate.
Modern flu shots protect us from the three or four strains of influenza A and B that are considered the most likely to spread in the coming months. Even if the strains are a little off, a flu shot can provide partial protection.
The end of October is more than jack o’ lantern time. It’s a recommended deadline for getting vaccinated against the flu in the northern hemisphere. (Image: Alex, Pexels)
The vaccine is reformulated each year, because the flu virus is very adaptable. That’s one reason the shot’s effectiveness can vary wildly. Since 2004, the vaccine has protected anywhere from 60 percent to 10 percent of the people who received it, depending on the year.
“What we do, is partly art and part science,” says infectious disease expert Stephen Morse of Columbia University.
“The flu remains one of the more complex viruses we deal with, and no one can tell you with certainty what this year’s strain will be until it appears,” he told Columbia’s Public Health Now. “It seems so prosaic, so mundane, and yet it defies all our attempts at prediction.”
The end of October is a good deadline for everyone to get a flu shot, according to the Centers for Disease Control. Immunity from a flu shot sets in after about two weeks.
Once the flu has begun to spreading, some protection can still be had from a shot later in the flu season, which in the Northern Hemisphere can extend into May.
Vaccine myths, such as the shot having the power to give you the flu, are still keeping people from getting vaccinated, said a frustrated Melissa Stockwell, who teaches population and family health at Columbia.
Concerns of a flareup for people with egg allergies are no longer valid. Only a small percentage of allergic people these days have suffered a severe allergic reaction that went beyond hives.
If you suffer from a severe egg allergy, health officials say you should still get a flu shot. If you are concerned about having a serious allergic reaction, don’t let that stop you. Instead, get your shot in a medical setting as a precaution.
Most flu shots and the nasal spray flu vaccine are manufactured with egg-based technology. Because of this, they contain a small amount of egg proteins.
Studies that have examined the use of both the nasal spray vaccine and flu shots in egg-allergic and non-egg-allergic patients confirm that severe allergic reactions in people with the allergies are unlikely. The likelihood of a severe reaction, according to a CDC study, is 1.3 out of a million vaccinations.
“You can’t avoid sitting on the train and having someone suddenly cough on you.” Melissa Stockwell, Columbia University.
The intradermal vaccination, using a needle 90 percent smaller than the regular one, is an option for people that 18 to 64.
Public health officials struggle each year to persuade as many people as possible to get flu shots. Stockwell suggests that social media be used for reinventing the image of the flu shot. Saying “I got my flu shot” should convey the same level of pride as saying “I voted.”
Many kinds of flu-dodging strategies have merit, but only vaccination offers protection in every situation. “You can’t avoid sitting on the train and having someone suddenly cough on you,” she told Public Health Now. “The vaccine is really the single best way to avoid getting sick.”
People who avoid flu shots because they hate the typical hypodermic needle now have no excuse. The intradermal vaccination, first approved in 2012, is an option for people between the ages of 18 to 64. It uses a needle 90 percent smaller than the regular one, injecting just below the skin.
Needles for regular flu shots are larger because they must penetrate the skin and a layer of fat in order to enter the muscle.
Before you get too interested in the tiny needle, though, think about the downside. The intradermal vaccination has a greater chance of side effects. Among them are redness, swelling, toughness and itching at the injection site, plus headaches, muscle aches, and tiredness.
More severe reactions are rare, but anyone getting a intradermal flu shot should tell their provider if they have a history of allergy or serious reaction to flu vaccine or to of the ingredients in it, including eggs. Any history of Guillain-Barre Syndrome should also be given.
If you got a flu shot, you should probably thank a chicken. (Image: Alison Burrell, Pexels. )
The shortcomings and capabilities of all flu shots stem mostly from the method for making them. Private manufacturers create the vaccine each year using one of three processes approved by the US Food and Drug Administration:
The egg came first in creating flu vaccines. Invented more than 70 years ago, egg cultivation remains by far the most popular manufacturing method. It made the flu shot with killed vaccine and the nasal spray with weakened vaccine.
So, whenever you get a flu shot, you should probably thank a chicken.
The egg-based process starts when the WHO Global Influenza Surveillance and Response System distributes the chosen viruses to private labs that have signed up to make the vaccine.
the manufacturers inject the virus into fertilized eggs, allow several days for them to multiply, then harvest the virus-laden fluid from the egg.
Influenza viruses intended for the flu shot are killed. The maker then purifies and tests the resulting antigen, the substance that produces an immune response in us. To create the nasal spray, the lab starts with weakened viruses and puts them through a different process.
A cell-based process for making flu vaccine was approved by the FDA in 2012. It departs from the egg-based technique at the point when the lab takes the viruses recommended by WHO and inoculates them not into an egg but into the cultured cells of a mammal. After a few days of replicating, the fluid containing the virus is collected from the cells.
The cell-based technique shows promise as a swifter way of starting up the vaccine-making process, according to the CDC. If you’ve ever been told, as I have several times, that your doctor is out of flu vaccine and supplies are low all over, you’ll appreciate a faster process.
Recombinant technology, the third method for concocting flu vaccine, was approved in 2013 for the U.S. market. This method eschews chickens.
The recombinant process starts when the manufacturer isolates a specific protein from a naturally occurring vaccine virus recommended by WHO. The isolated protein, called HA, elicits an immune response in people.
Young children with influenza are susceptible to more serious conditions, such as pneumonia, the world’s leading infectious cause of childhood death.
The proteins are combined with parts of a virus that grows well in insect cells. The resulting recombinant vaccine virus is then mixed with insect cells and given time to replicate.
The manufacturer takes the protein from the cells, purifies it, and submits it to the FDA for testing and release.
If that’s not enough information for you about flu-shot safety, there are even more details, including adverse events, contraindications, precautions, screening, and safe vaccine administration, in the CDC’s “Seasonal Influenza Vaccine Safety: A Summary for Clinicians.”
Special Concern for Kids
Tests for purity have to be stringent enough for an infant. The recommend age to begin flu shots is 6 months.
Young children are a special focus of efforts to promote flu vaccination. The virus, contagious under any circumstances, can spread quickly when children are in groups, as in a daycare center, in-home family child care, preschool or elementary school.
Influenza is more dangerous than the common cold is for children. That’s because most youngsters haven’t had a chance to develop a natural immunity to it.
Young children with influenza are susceptible to more serious conditions, such as pneumonia, the world’s leading infectious cause of childhood death.
unvaccinated parents and other family members are often the cause when babies get the flu.
At high risk for complications from the flu are children suffering from chronic health conditions such as asthma, heart disease, diabetes, and disorders of the brain or nervous system. For them, getting a flu shot couldn’t be more crucial.
Consider Cocooning Infants
Babies under 6 months are too young to vaccinate, so it is vital that people who live with, care for, or just spend time around newborns and infants get flu shots. Vaccinating people who are around an infant to prevent illness is called “cocooning.”
People urged to get a flu vaccination to protect the infants in their lives include siblings, parents, grandparents, friends, health-care providers, and child-care providers such as nannies, babysitters and daycare staff.
Once they receive vaccinations, these key people can surround the infant with a cocoon of protection until the baby is old enough to get the vaccine.
Sadly, unvaccinated parents and other family members are often the cause when babies get the flu.
Starting at age 2, children who balk at getting a shot (I know I did) have the option of getting the nasal spray flu vaccine. The option extends to healthy, non-pregnant adults, too, up to 49 years of age.
Use of the nasal spray was approved in 2018 by a panel of immunization experts at the CDC after they declined to allow it during some flu seasons.
The turning point was when a study published in the journal Pediatrics found that the spray was equally as effective as the shot at protecting children from a common strain of flu.
Three-Quarters of Flu Casualties Are Seniors
The other group that is a special focus of efforts to encourage flu shots is the 65-and-over crowd. Seniors are the age group most vulnerable to serious complications from influenza.
The immune system weakens with age. That’s why there is more severe flu disease among seniors than any other age group.
In recent years, public health officials estimate that 71 percent to 85 percent of seasonal flu-related deaths have been among people 65 and older. As for hospitalizations due to influenza, 54 percent to 70 percent have been among seniors.
Two super-charged types of flu vaccine are available to seniors, whose immune systems may not be what they once were. (Image: Geralt, Pixabay)
People 65 and older can get any flu shot approved for their age group. This includes shots made with cell-based, recombinant, and egg-based processes.
Two types of flu vaccines are designed specifically for people 65 and older:
The high-dose vaccine, with four times the amount of antigen as the regular flu shot, was approved for use in the United States starting in 2009. It offers a stronger immune response following vaccination, because more antibodies are produced.
A clinical trial of more than 30,000 participants showed that adults 65 years and older who received the high-dose vaccine had 24 percent fewer influenza infections than those who received the standard dose.
The adjuvanted flu vaccine, Fluad. An adjuvant is a substance that increases the body’s immune response to an antigen. A Canadian study of people 65 and up found that Fluad did just that, resulting in 63 percent greater effectiveness than the regular flu shot.
On the down side, both the high-dose and adjuvanted vaccines for seniors carry a greater chance of side effects than the regular flu shot.
Mild side effects from Fluad can include pain, redness or swelling at the site of injection, plus headache, muscle ache and malaise, or a general sense of feeling unwell.
Off limits to people 65 and older are the nasal-spray vaccine, flu shot and jet injector flu vaccine. The needle-free injector uses a narrow, high-pressure stream of vaccine to penetrate the top layer of skin,
Doctors encourage seniors to stay up to date on vaccinations for pneumococcal disease, such as pneumonia, meningitis, and bloodstream infections.
Pneumococcal pneumonia is a serious flu-related complication that can be fatal. Pneumococcal vaccine is generally available from providers who offer flu shots.
“I know less about influenza than I did 10 years ago.” Michael Osterholm, epidemiologist
In a really bad flu season, an estimated 50,000 people can die in the United States alone, giving public health officials plenty of motivation to find a vaccine that performs better.
“Ten percent to sixty percent protection is better than nothing,” epidemiologist Michael Osterholm of the University of Minnesota told Science magazine. “But it’s a terribly inadequate vaccine for a serious public health threat.”
Scientists are casting doubt on the assumption that, when the flu vaccine’s effectiveness is as low as 10 percent, the blame belongs to health officials for guessing poorly which strains would prevail.
But studies show that the vaccine may underperform even when the strains are predicted correctly. Theories about why include flaws in the manufacturing process and variations in people’s immune systems.
“It’s much more complicated than we thought,” Osterholm admitted. “I know less about influenza today than I did ten years ago.”
Some researchers are shaking up the standard question of how to improve the annual process of choosing a flu vaccine. Instead, they ask, how do we invent a permanent vaccine effective against a slew of strains?
A new approach for such a super-vaccine had some success in animal tests done by researchers at the University of California in Los Angeles. Another approach was being tested on people by a large pharmaceutical company and by the Bill and Melinda Gates Foundation.
A global effort to develop the vaccine was being led by James Crow, director of the Vanderbilt Vaccine Center. The project studied how a person’s first exposure to the flu affects their reactions to vaccines and viruses later on.
A vaccine developed by researchers led by Peter Palese, a microbiologist at the Icahn School of Medicine at Mount Sinai in New York, focused on the protein that helps the flu virus bind to cells.
The logic is that part of the protein remains unchanged from one year to the next, so why not direct the immune system to target that part?
As promising as the experimental approaches are, the development and testing process could go on for many years before an FDA-approved universal vaccine showed up at your doctor’s office.
“There are about a dozen candidates that range from preclinical animal studies up through and including phase-two clinical trials,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases told the Wall Street Journal. “But we’re still in the area of scientific discovery.”
One reason for pursuing a better flu shot is to persuade doubters to get one.
More than half of adults in the United States don’t get vaccinated. This despite the fact that, even if you get a shot and contract the flu, it will reduce the duration and severity of it.
A universal flu vaccine might make life simpler for health professionals who administer the shot. As it stands, new protocols must be learned and followed each flu season, including what types of shots may be received by which people and in what doses.
Recent advances aside, the most important thing about the flu shot can still be said in four words: Everyone should get one.