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New Push To Mandate Flu Vaccine For Health Workers — But Some Push Back

As Massachusetts prepares for flu season, there’s a growing push to make flu vaccinations mandatory for health care workers, WBUR’s Martha Bebinger reports:

Numbers released by the state Department of Public Health show that 84% of hospital staff were vaccinated last year. But there is a range, with some hospitals at 47% and others at 99%. The consumer advocacy group Health Care for All’s director, Amy Whitcomb Slemmer, says various vaccination options should address most people’s objections.

vaccinearm“We’re trying to make sure folks are healthy,” Whitcomb Slemmer said. “We want hospital workers to continue to do their job. The time has come to require hospital employees and health care personnel to be vaccinated against the flu.”

The Massachusetts Hospital Association has filed legislation that would mandate flu vaccination for hospitals workers. But some health care workers — like the nurses union — object to forced preventive care. Continue reading

The Checkup On Shots: Vaccine Updates, Facts And Fictions

Somehow, over the last few years, one of modern medicine’s greatest achievements has turned into one of modern American parents’ most fraught subjects.

In this episode of The Checkup, our podcast on Slate, we offer Shots: Vaccine Facts And Fictions, in which we attempt to have a rational, fact-based discussion about some of the vaccines you may encounter in the immediate future: the flu vaccine and, if you have pre-adolescent children, the HPV vaccine.

(To listen to The Checkup now, click on the arrow above; to download and listen later, press Download; and to get it through iTunes click here.)

This year’s flu vaccines offer consumers more choices than ever: there’s a nasal version, a quadrivalent (four-strain) option, a “short-needle” option and an egg-free vaccine for people with allergies, among others. And even though it still feels like summer in some parts of the country, doctors are urging people to get their flu shots early.

The HPV vaccine was introduced seven years ago but, according to the CDC, only about half of girls are getting one or more doses, and only about one-third are getting the full three-dose course. This despite word from public health officials that it’s highly effective for preventing HPV — the most common sexually transmitted infection in the U.S. and a principal cause of cervical cancer — and so far, pretty safe. (It’s recommended for boys as well as girls, both because boys can spread HPV and because there’s a notable rise in HPV-related cancers in older men. See: Michael Douglas and oral sex. )

Doctors say a variety of obstacles stand in the way of more widespread use of the HPV vaccine. There remains the stigma of a vaccine for a sexually transmitted infection.  Also, when you’re talking about an 11-year-old,  preventing cervical cancer may seem less urgent than, say, preventing measles. Finally, there’s a general sense of “vaccine fatigue” among parents bombarded with so many official recommendations and competing agendas.

 

For more info, check out this HPV fact sheet created by our intern, Rachel Bloom:

gardasil-fact-sheet-image

Readers, please let us know how you’re handling vaccines for your family this year. Anything we can learn from your experience?

This Year’s Flu Vaccines: What To Know, And Why Not To Punt

An ad for vaccines outside a Brookline, Mass., pharmacy on Sept. 20, 2013. (Carey Goldberg/WBUR)

An ad for flu vaccines outside a Brookline, Mass., pharmacy on Sept. 20, 2013. (Carey Goldberg/WBUR)

It feels premature, off-seasonally odd, a bit like all the Halloween candy already on store shelves in August.

Flu is a cold-weather plague, yet the pharmacy signs advertising flu vaccines are already out on the sidewalks now, beneath the benevolent sun of perfect 70-degree days and leaves just beginning to tinge their edges with red and yellow.

But flu vaccine experts say that it’s really not too early to get vaccinated, and there’s a bit more to know this year as you roll up your sleeve. There are new and myriad options in flu vaccines, including:

• A “quadrivalent” vaccine that protects against four strains of flu virus rather than the usual three.

• New egg-free flu vaccines for people with egg allergies.

• High-dose “super” vaccines for older people.

• Short-needle vaccines (I’m not sure if I got one of these last year, but I was pleasantly shocked at how tiny the needle was and how little it hurt.) For shot-haters, nasal vaccines remain available for many as well.

Health authorities emphasize that flu vaccine “shopping” shouldn’t get in the way of just getting it done. Flu is no joke, killing an average of 24,000 Americans a year, including dozens of children.  USA Today offers a nice rundown of the options here, and the CDC’s flu vaccine page is here. I also spoke with Dr. Michael Jhung, a flu vaccine expert at the CDC’s National Center for Immunizations and Respiratory Diseases. Our conversation, edited, is below, but first, my own personal favorite flu-vaccine tip: A 90-minute bout of exercise soon after a flu shot could help jump-start your antibody production, according to a recent study that suggests it might even double your antibodies

CG:  First of all, I’m seeing these ads for flu vaccines in pharmacies already now in September, and it seems ridiculously early; flu season doesn’t even peak until January, and also, doesn’t the vaccine wear off after a while? So I’m thinking, maybe I’ll get it, but not now . . . How would you respond to that?

MJ: That’s a great question. I think a lot of people entertain the idea of getting an influenza vaccine, but then they put it off and they say, ‘Well, the season hasn’t started, I have plenty of time.’ But the fact of the matter is, the best time to get an influenza vaccine is before the season starts, not during the season.

And influenza seasons are very unpredictable from year to year. Continue reading

On New Bird Flu, From A Doctor Who’s Been There: We Need Time

A worker at Sanofi Pasteur, the world’s larges influenza vaccine manufacturer. Some researchers in the United States have published letters in the journals Nature and Science arguing to create a more virulent strain of the H7N9 avian flu to prepare for its possible spread in humans.  (Sanofi Pasteur/Flickr)

A worker at Sanofi Pasteur, the world’s larges influenza vaccine manufacturer. Some researchers in the United States have published letters in the journals Nature and Science arguing to create a more virulent strain of the H7N9 avian flu to prepare for its possible spread in humans. (Sanofi Pasteur/Flickr)

We wrote earlier this week about the latest avian flu news, concerning a new strain called H7N9 that has killed at least 43 people in Asia. Summary: A probable case of human-to-human transmission has been reported in China, and some flu researchers say they’re going to alter the H7N9 virus in the lab in ways that will make it more dangerous, in order to understand and defend against it better.

I was left a little confused about those highly controversial plans to modify the virus. Very scary. What if it got out? On the other hand, bird flu is scary too. Shouldn’t we do all we can to fight it?

I spoke with Dr. Michael V. Callahan, a Massachusetts General Hospital infectious disease and disaster medicine physician who deploys to large-scale disease outbreaks. He’s the director of a Department of Defense-funded project to predict and defend against dangerous virus mutations. He is also an expert on flu outbreaks and one of the few Americans to have treated H7N9 patients last March in China.

How, I asked, does he see the letters in Science and Nature announcing the researchers’ plans to modify the H7N9 virus?

Dr. Michael V. Callahan outside Harvard Medical School (Photo: Joseph Ferraro, Massachusetts General Hospital)

Dr. Michael V. Callahan at Mass. General Hospital (Photo: Joseph Ferraro, MGH)

“In the right environment, with peer review, these gains of function studies are revealing and will help us home in on those conserved, critical elements of influenza that we might someday be able to use to block [all strains of flu] with one vaccine,” he said.

So how about the suggestion in the letter that the research should begin quickly in hopes of producing something of value by this winter?

“Both unwise and impossible,” he answered. “DARPA [The Defense Advanced Research Projects Agency] has developed the world’s fastest pathogen-to-vaccine capability, capable of 100 million doses in three months. This is the only process that could deliver vaccine by November, the start of flu season.”

“Unfortunately, the vaccine capability is not fully approved by the FDA. The traditional cell and egg based vaccine systems require months to develop a ‘production strain,’ a hybrid of H7N9 and a ‘tame’ strain, which can be placed in cells and eggs. Continue reading

Déja-Vu On Avian Flu: Probable Human-Human Spread, Research Debate

A worker at Sanofi Pasteur, the world’s larges influenza vaccine manufacturer. Some researchers in the United States have published letters in the journals Nature and Science arguing to create a more virulent strain of the H7N9 avian flu to prepare for its possible spread in humans.  (Sanofi Pasteur/Flickr)

A worker at Sanofi Pasteur, the world’s larges influenza vaccine manufacturer. Some researchers in the United States have published letters in the journals Nature and Science arguing to create a more virulent strain of the H7N9 avian flu to prepare for its possible spread in humans. (Sanofi Pasteur/Flickr)

This is not my favorite topic, potential bird flu pandemics that could sweep humanity and kill hundreds of millions. But I also worry that a “cry wolf” phenomenon will set in, and then we won’t be prepared when the Big One hits. So let’s just consider, for a moment, the latest anxiety-producing avian flu news, about a strain called H7N9 that has killed at least 43 people in China.

Today brings two news items on this new strain: The BMJ medical journal reports the first case of probable human-to-human spread of H7N9, from a Chinese father who caught it from poultry to his daughter. And avian flu researchers publish a public letter in the prestigious journals Nature and Science saying they must produce “super-strains” of H7N9 — more easily transmitted, more resistant to attack — in order to understand the virus better and prepare to defend against it. (Science reports on some initial responses to the letter: Critics skeptical as flu scientists argue for controversial H7N9 studies.)

Science also offers this helpful round-up of the background, the reason why this all feels like flu déja vu. It’s that this is familiar ground from the last avian flu scare, with the virus H5N1: Continue reading

Flu Season Sorbet, Or The Frozen Hot Toddy

A dram of whiskey (Wikimedia Commons)

A dram of whiskey (Wikimedia Commons)

Old-timers know this remedy well: When you feel a bug coming on, you boil up some water and add honey, lemon and whisky — variations can include cayenne pepper — and voila, a germ-fighting Hot Toddy. You down it, you sweat through your clothes, you change them, you go to bed and wake up good as new. (That’s the theory, anyway. This isn’t exactly an evidence base, but it seems to work for my dad.)

Now, ABC news reports that the age-old Hot Toddy is being offered as a sorbet billed as soothing for flu sufferers:

Enter Jeni’s Splendid Ice Creams. The Ohio-based company’s Influenza Sorbet won’t cure the flu, but it will definitely make you feel better, said Jeni Britton Bauer, the company’s founder and president.

The Influenza Sorbet contains honey, ginger, orange juice and lemon juice. And if that weren’t enough, it also has Maker’s Mark bourbon and cayenne pepper. Continue reading

Why To Exercise Today: Perhaps Jumpstart Your Flu Shot

Flu shot

Darn. Wish I’d known this when I got mine. The New York Times reports today that exercise has long been known to improve immunity, but recently scientists have been looking at whether “a single, well-calibrated bout of exercise” could boost a flu shot’s effects:

Researchers at Iowa State University in Ames recently had young, healthy volunteers, most of them college students, head out for a moderately paced 90-minute jog or bike ride 15 minutes after receiving their flu shot. Other volunteers sat quietly for 90 minutes after their shot. Then the researchers checked for blood levels of influenza antibodies a month later.

Those volunteers who had exercised after being inoculated, it turned out, exhibited “nearly double the antibody response” of the sedentary group, said Marian Kohut, a professor of kinesiology at Iowa State who oversaw the study, which is being prepared for publication. They also had higher blood levels of certain immune system cells that help the body fight off infection.

Read the full piece for the ins and outs and caveats, of which there are many. At the very least, a researcher concludes, “spending 90 minutes on a stationary bike will make any small twinges in your arm from the shot itself seem pretty insignificant.”

Hat-tip to Tom Anthony.

Could Climate Change Affect Flu?

flu shot

For filing in the folder labeled “Hmmmm,” as in “Interesting theory. Let’s see.”

In a helpful Q&A on this year’s flu season and flu in general, Mother Jones writes that one reason flu tends to spread in winter is that the virus is known to thrive in low humidity, a condition common in the winter cold. Mother Jones senior editor Kiera Butler has an “Aha” moment: “So that’s why the flu is so bad this year — the drought! So climate change actually made the flu worse, right?” But nothing is so simple…

Wouldn’t it be nice if epidemiology were that easy? Unfortunately, it’s not. If that were the case, you’d never see the flu in hot, humid places. But there’s just as much flu in Florida right now as there is in some parts of Canada. Other variables make it impossible to predict flu seasons based on weather alone.

It’s worth noting, though, that in a paper last year, [flu researcher Jeffrey] Shaman and his colleagues did document that each of the four flu pandemics of the 20th century were preceded by La Niña cycles, likely because birds mingled with each other differently during these unusual weather patterns. The flu strains that they were carrying probably hybridized and created a strain so new that humans had no immunity to it. Since, as we recently learned from this Climate Desk video, climate change does interact with El Niño/La Niña cycles, it’s not completely out of the question that global warming could affect flu transmission, at least indirectly.

Readers? Care to speculate?

Is ‘Google Flu Trends’ Prescient Or Wrong?

flu graph

Google in blue, CDC in red. Note the dramatic divergence toward 2013. (Keith Winstein, MIT)

Has Google’s much-celebrated flu estimator, Google Flu Trends, gotten a bit, shall we say, over-enthusiastic?

Last week, a friend commented to Keith Winstein, an MIT computer science graduate student and former health care reporter at The Wall Street Journal: “Whoa. This flu season seems to be the worst ever. Check out Google Flu Trends.”

Hmmm, Winstein responded. When he checked, he saw that the official CDC numbers showed the flu getting worse, but not nearly at Google’s level. (See the graph above.) The dramatic divergence between the Google data and the official CDC numbers struck him: Was Google, he wondered, prescient or wrong?

He began to explore — as much as a heavy grad-student schedule allows — and shares his thoughts here. Our conversation, lightly edited:

I accept the caveat that these predictive algorithms are not your speciality, but still, from highly informed, casual observation, what are you seeing, in a highly preliminary sort of way?

Well, I’m certainly not an expert on the flu. The issue that’s interesting from the computer science perspective is this: Google Flu Trends launched to much fanfare in 2008 — it was even on the front page of the New York Times — with this idea that, as the head of Google.org said at the time, they could out-perform the CDC’s very expensive surveillance system, just by looking at the words that people were Googling for and running them through some statistical tools.

It’s a provocative claim and if true, it bodes well for being able to track all kinds of things that might be relevant to public health. Google has since launched Flu Trends sites for countries around the world, and a dengue fever site.

So this is an interesting idea, that you could do public health surveillance and out-perform the public health authorities [which use lab tests and reports from ‘sentinel’ medical sites] just by looking at what people were searching for.

‘It is often a problem with computers that they only tell us things we already know.’

Google was very clear that it wouldn’t replace the CDC, but they have said they would out-perform the CDC. And because they’re about 10 days earlier than the CDC, they might be able to save lives by directing anti-viral drugs and vaccines to afflicted regions.

And their initial paper in the journal Nature said the Google Flu Trends predictions were 97% accurate…

That was astounding. However, it is often a problem with computers that they only tell us things we already know. When you give a computer something unexpected, it does not handle it as well as a person would.

Continue reading

CDC’s Latest Flu Update: Cases Widespread But Number Of Hardest Hit States Drop

(CDC)

(CDC)

The AP reports that according to the latest CDC data, nearly all states are reporting widespread flu, but the number of states with high activity has declined.

In Massachusetts, flu activity dipped slightly this past week, according to a state Department of Public Health update. Does this mean cases have peaked? Or is this just a lull? We’ll report back as more information emerges. For now, here’s the short wire dispatch via The Washington Post:

The Centers for Disease Control and Prevention on Friday said flu was widespread in 47 states last week, up from 41 the week before. But many cases may be mild. The only states without widespread flu are California, Mississippi and Hawaii.

The hardest hit states dropped to 24 from 29.

So far, 20 children have died from the flu. There is no running tally of adult deaths, but the CDC estimates that the flu kills about 24,000 people in an average year.

Experts say it’s too early to say if this is a bad year.

From the CDC’s weekly FluView: Continue reading