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June 6, 2018

14 Comments

Expert claims the protection of the flu vaccine is minimal, and may not be worth it.

Chris Del Mar and Peter Collignon, Australian National University

Winter has started, and with it, flu season. Inevitably, all of us (young, old and sick) have been implored to be immunised against influenza, with some eligible for a subsidised vaccine. And people are heeding the message, to the point that there is now a shortage of available vaccines.

At the same time, findings from three important Cochrane reviews on the effectiveness of the influenza vaccination aren’t consistent with the advice we’re been given.

Cochrane reviews are independent systematic reviews, which are comprehensive analyses of most of the literature relevant to a research topic. Cochrane reviews summarise the results in a multitude of studies, and are regularly updated to absorb new research.

These three Cochrane reviews have been recently updated, as well as stabilised, which is what happens when it looks as if it seems unlikely new research would be published that would change the conclusions.

What the reviews found

The first Cochrane review looked at the effects of the influenza vaccine in healthy adults from 25 studies conducted over single influenza seasons in North America, South America, and Europe between 1969 and 2009. It found the vaccine reduced the chance of getting laboratory confirmed influenza from 23 cases out of 1,000 to 9 cases out of 1,000.

While this seems to be a reduction of more than 50%, that seems less optimistic expressed in absolute terms.

The infection rate in adults drops from 2% per year to 1%. You could say that’s halved, but it effectively only drops by 1%. So this means that out of every 100 healthy adults vaccinated, 99 get no benefit against laboratory confirmed influenza.




Read more:
What you need to know to understand risk estimates


The second Cochrane review – which looked at trials in children over single influenza seasons in the US, Western Europe, Russia, and Bangladesh between 1984 and 2013 – found similar results.

The third Cochrane review looked at vaccines for the elderly in nursing homes. It found much less good evidence, with only one randomised trial – considered the gold standard in clinical trials as it establishes causation rather than correlation.

While observational studies (that draw inferences from a population to establish associations) have been done to show benefits of the vaccines, bias means we cannot rely on their results.

There are also potential harms from influenza vaccines noted in the reviews. They range from serious (a neurological disease called Guillain Barre) through to moderate (fevers, in children especially – some of which will cause febrile convulsions), and trivial (a sore arm for a couple of days).

Why are we so scared of the flu?

There is a special concern about influenza from a public health point of view. This comes about from its potential to cause pandemics. The first in modern history was the Spanish influenza pandemic of 1918-19, when tens of millions of people died worldwide.



There have also been been several, less severe pandemics. These include the most recent swine flu that, although while affecting some (unexpected) groups of people (including pregnant women, those who were obese, and had asthma), caused little more effect on the overall population than the usual seasonal influenza.



Read more:
Four of the most lethal infectious diseases of our time and how we’re overcoming them


Public health experts worry about another pandemic that can be more harmful and contagious, which could be devastating. But it’s important to note the vast majority of deaths from Spanish influenza were from secondary bacterial infections and predated the antibiotic era.

The reasons influenza virus has this ability to cause new pandemics comes from its instability – it changes genetically easily, making it more difficult for our immune systems to recognise newer strains. The effect is that new vaccines must be prepared every year for a best-guess at next year’s virus, and we need vaccination every year.

Influenza can also undergo a more radical change, such as when a new form of the virus emerges from an animal host (wild or domesticated birds or pigs, for example). This moving target makes it more difficult to vaccinate against – especially with the genetic shifts of pandemics. Just when we need protection most, vaccines can provide it least.

So what, if not the vaccine?

There are physical barriers that can prevent the spread of influenza.

These are the masks (to reduce the spread of aerosol-borne virus particles), hand washing (to reduce the spread if virus from hands onto shared surfaces), and quarantine measures (isolating infected people to reduce their infectivity).



Read more:
I’ve always wondered: why many people in Asian countries wear masks, and whether they work


The ConversationThere is now reasonable evidence such measures reduce infections considerably. It might take a bit of effort to change the psyche of Australians to make wearing a facemask acceptable if you have an acute respiratory infection. Even the heroic “soldiering on to work” (or school) with your virus needs to be reversed as a public health act.

Chris Del Mar, Professor of Public Health and Peter Collignon, Professor, infectious diseases and microbiology, Australian National University

This article was originally published on The Conversation. Read the original article.

  • It is more common to see people with masks now days and I think it’s great. still I get the flu vaccination and hope it works.

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  • With a very ill person in the house [lung cancer] it is a must for us to get this vaccine – the probable outcome doesn’t look pretty.

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  • I believe it worth having it to prevent getting ill

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  • I always think it’s useless

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  • Yep I will never get the flu bad, because it is indeed pointless.

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  • I wore a mask when I was quite ill once and people laughed! I laughed back, shrugged it off and knew I was doing the right thing by not infecting people with compromised health.

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  • I’ve only ever had the flu vax once and will never get it again. I also contracted type A during my last pregnancy and was sick as a dog for a week and tired as anything for further month. I agree, masks and physical barriers are better than a random best guess vaccination. I’m in no way an anti vaxxer, I just see no benefit from both the flu or chicken pox vaccines tbh

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  • I’m very ambivalent about the flu vaccine. Yet, my youngest has Down syndrome and so far I went for it every year.

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  • I’ve had a cold and I’ve been wearing a mask and washing my hands religiously and it hasn’t spread to my family members including Bub who I am breastfeeding

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  • I agree that masks are better. There is a stigma to wearing a mask in public, but that may change, especially if there is a severe outbreak of infection.

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  • Masks would cover alot of health issues from being shared. The flu shot doesn’t stop the common cold which can feel just as bad sometimes.

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  • The mask surely helps. In Asian countries (in particular Japan) they are quite widespread. But I wouldn’t substitute it to vaccinations though.

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  • It’s great we have these vaccines now.. even though they can’t fight off against every known virus, we are better armed to deal with it compared to the olden days.

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  • I would still vaccinate young children, the elderly and those prone to lung problems.

    Reply

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