Commentary

Is the Flu Vaccine Really ‘Working Well’ This Year?

Is the Flu Vaccine Really ‘Working Well’ This Year?

The following referenced information contains opinion and perspective on a health topic related to vaccine science, policy, law or ethics that is being discussed in public forums, including in medical, law and other professional journals; newspapers, magazines and other print; broadcast and online media outlets; state legislatures and the U.S. Congress.

Readers are encouraged to go to the websites of the U.S. Department of Health and Human Services (DHHS) for the perspective of federal agencies responsible for vaccine research, development, regulation and policymaking, including the U.S. Centers for Disease Control (CDC) for information on vaccine policymaking; to the U.S. Food and Drug Administration (FDA) for information on regulating vaccines for safety and effectiveness; and to National Institutes of Health’s National Institute of Allergy and Infectious Diseases (NIAID) for information on research and the development of new vaccines.

The World Health Organization has stated that “vaccine hesitancy” is one of the top 10 global public health threats.

According to interim estimates1 released by the U.S. Centers for Disease Control and Prevention (CDC) on February 15, 2019 — which uses data from 3,254 adults and children enrolled in the U.S. Influenza Vaccine Effectiveness Network between November 23, 2018, and February 2, 2019 — the overall adjusted effectiveness of the 2018-19 flu vaccine against all influenza virus infection associated with acute respiratory illness (ARI) needing medical attention was 47 percent.

While the media has played this up as “good news,”2 and the CDC calls the results “encouraging,”3 the fact of the matter is the vaccine failed to offer any protection more than half of the time, and for adults over 50, it’s more or less useless.

This Year’s Flu Vaccine Is an Abysmal Failure for Those Over 50

Among children aged 6 months to 17 years, the 2018–19 seasonal flu vaccine had an average effectiveness of 61 percent.4 However, among adults over 50, which is the most vulnerable group, the vaccine had a mere 24 percent effectiveness against all influenza types, and an abysmal 8 percent against influenza A(H1N1)pdm09 infection, which was by far the most common type.

According to the CDC, the A(H1N1)pdm09 virus was responsible for 74 percent of all influenza A infections for which subtype information was available. What’s more, the CDC notes that,5 “Among the 3,254 children and adults with ARI … a total of 465 (14 percent) tested positive for influenza virus by real time RT-PCR …”

In other words, of all the people who came down with acute respiratory illness, only 14 percent actually had confirmed influenza. In the vast majority of cases — 86 percent — their respiratory illness was associated with a viral or bacterial infection caused by something other than a type A or B influenza virus.

This is important to remember, as people have a tendency to jump to the conclusion that when they have influenza-like illness (ILI) symptoms they have influenza when, in fact, chances are the majority of the time they don’t.

The influenza vaccine contains only three or four type A or B vaccine strain influenza viruses. Even if those vaccine strain viruses are a perfect match for influenza viruses that are circulating in a given flu season, the vaccine does not prevent the majority of other respiratory infections that are experienced by people. As noted by the Cochrane Collaboration:6

“Over 200 viruses cause ILI (influenza-like illness), which produces the same symptoms (fever, headache, aches, pains, cough and runny nose) as influenza. Without laboratory tests, doctors cannot distinguish between ILI and influenza because both last for days and rarely cause serious illness or death.”

The 2017/2018 seasonal influenza vaccine’s adjusted overall effectiveness for the U.S. was just 36 percent against influenza A and influenza B virus infection,7,8 and between 2005 and 2015, the flu vaccine’s adjusted overall effectiveness was less than 50 percent more than half the time — with a low of only 10 percent in the 2004-05 season.9,10

It’s difficult to find another example of where a commercial product can fail to work more than half the time and still be recommended and even mandated for children and adults.

Obesity Is a Major Cause of Influenza Outbreaks and Vulnerability

In related news, research suggests widespread obesity may be a significant contributor to influenza outbreaks and general vulnerability, as obesity makes you shed and transmit virus for a longer period of time, thereby increasing the opportunity for spreading infections to others. According to this study,11 published in the September, 2018 issue of The Journal of Infectious Diseases:

“[O]besity increases the risk of severe complications and death from influenza virus infection, especially in elderly individuals … Symptomatic obese adults were shown to shed influenza A virus 42 percent longer than nonobese adults … no association was observed with influenza B virus shedding duration. Even among paucisymptomatic and asymptomatic adults, obesity increased the influenza A shedding duration by 104 percent.”

Aubree Gordon, Ph.D., senior author from the University of Michigan School of Public Health, told reporters,12 “This is the first real evidence that obesity might impact more than just disease severity. It might directly impact transmission as well.”

Additional research is underway to analyze whether influenza virus shed over longer periods is still equally infectious. The answer here, of course, would be to normalize your weight and strengthen your immune function. You can find more information about these strategies in the hyperlinked articles.

Flu Vaccine Still Allows Transmission of Disease

Obesity isn’t the only thing that might contribute to influenza outbreaks. A study13 published in the journal PNAS January 18, 2018, found infectious influenza viruses in the exhaled breath of people who had gotten seasonal flu shots and contracted influenza. Those vaccinated two seasons in a row had an even greater viral load of shedding influenza A viruses. According to the authors:

“Self-reported vaccination for the current season was associated with a trend toward higher viral shedding in fine-aerosol samples; vaccination with both the current and previous year’s seasonal vaccines, however, was significantly associated with greater fine-aerosol shedding in unadjusted and adjusted models.

In adjusted models, we observed 6.3 times more aerosol shedding among cases with vaccination in the current and previous season compared with having no vaccination in those two seasons … The association of vaccination and shedding was significant for influenza A but not for influenza B infections …

Finding infectious virus in 39 percent of fine-aerosol samples collected during 30 minutes of normal tidal breathing in a large community-based study of confirmed influenza infection clearly establishes that a significant fraction of influenza cases routinely shed infectious virus … into aerosol particles small enough to remain suspended in air and present a risk for airborne transmission …

The association of current and prior year vaccination with increased shedding of influenza A might lead one to speculate that certain types of prior immunity promote lung inflammation, airway closure and aerosol generation …

If confirmed, this observation, together with recent literature suggesting reduced protection with annual vaccination, would have implications for influenza vaccination recommendations and policies.”

Mounting Body of Research Questions Validity of Annual Flu Vaccination as a Public Health Measure

On the whole, there’s really very little evidence to suggest annual flu vaccinations are a good way to combat influenza and save lives. On the contrary, the medical literature is burgeoning with studies questioning the validity of this public health measure. For example, studies have shown that:

With each successive annual flu vaccination, the theoretical protection from the vaccine can diminish14  A 2012 Chinese study15 found a child’s chances of contracting a respiratory infection after getting the seasonal flu shot rose more than fourfold, and research published in 2014 concluded that resistance to influenza-related illness in persons over age 9 years in the U.S. was greatest among those who had NOT received a flu shot in the previous five years.16

More recent research suggests the reason seasonal flu shots become less protective with each dose has to do with “original antigenic sin.” Here, they found that influenza vaccine failed to elicit a strong immune response in most participants,17 which was explained as follows:18

“What’s at play seems to be a phenomenon known as ‘original antigenic sin.’ Flu vaccines are designed to get the immune system to produce antibodies that recognize the specific strains of the virus someone may encounter in a given year.

These antibodies target unique sites on the virus, and latch onto them to disable it. Once the immune system already has antibodies to target a given site on the virus, it preferentially reactivates the same immune cells the next time it encounters the virus. This is efficient for the immune system, but the problem is that the virus changes ever so slightly from year to year.

The site the antibodies recognize could still be there, but it may no longer be the crucial one to neutralize the virus. Antibodies produced from our first encounters with the flu, either from vaccines or infection, tend to take precedence over ones generated by later inoculations. So even when the vaccine is a good match for a given year, if someone has a history with the flu, the immune response to a new vaccine could be less protective.”

71 people have to be vaccinated for a single case of influenza to be avoided, and vaccination has “little or no appreciable effect on hospitalizations or number of working days lost” — In its 2014 meta-analysis19 of the available research on inactivated influenza vaccines, the Cochrane Collaboration reviewed evidence related to influenza and influenza-like illness (ILI) that people experience during flu seasons, concluding that:

“Injected influenza vaccines probably have a small protective effect against influenza … as 71 people would need to be vaccinated to avoid one influenza case … Vaccination may have little or no appreciable effect on hospitalizations … or number of working days lost.”

The flu vaccine can increase your risk of contracting other, more serious influenza infections — Canadian researchers found that people who had received the seasonal flu vaccine in 2008, on average, had twice the risk of getting sick with the pandemic H1N1 “swine flu” in 2009 compared to those who did not receive a flu shot the previous year.20

These findings were replicated in a 2014 ferret study.21 Similarly, a 2009 U.S. study compared health outcomes for children between age 6 months and 18 years who did and did not get annual flu shots and found that children who received influenza vaccinations had a three times’ higher risk of influenza-related hospitalization, with asthmatic children at greatest risk.22

The concept of heterologous immunity may account for these findings. Heterologous immunity refers to the concept that your immune system is directional, and that once you’ve encountered a pathogen, your body is better equipped to fight pathogens that are similar. However, in the case of influenza vaccines, this directionality appears to work against you.

By learning to fend off certain influenza virus strains contained in the vaccine, your immune system becomes less able to fend off other influenza strains and disease-causing pathogens. As noted in a 2014 paper on heterologous immunity:23

“Immunity to previously encountered viruses can alter responses to unrelated pathogens … Heterologous immunity … may be beneficial by boosting protective responses. However, heterologous reactivity can also result in severe immunopathology. The key features that define heterologous immune modulation include alterations in the CD4 and CD8 T cell compartments and changes in viral dynamics and disease progression.”

In other words, while influenza vaccine may offer some level of protection against the three or four viral influenza strains included in the vaccine, depending on whether the vaccine used is trivalent or quadrivalent, it may simultaneously diminish your ability to ward off infection by other influenza strains and types of viral or bacterial infections.

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