Tag Archives: flu vaccine

To Flu Vaccine, or Not Flu Vaccine – 2018 Edition

Toronto Naturopathic Doctor

The flu vaccine is “released” annually in October, and with it, begins our season of answering the question: “Should I get the flu vaccine?”.

As naturopathic doctors, prescribing the flu vaccine, or advising against it lies outside out scope of practice.

We can however help you to make an informed decision by helping you understand what the most current research demonstrates with regards to flu vaccination decision factors.

We wrote a blog post on this a couple off years ago, but the research has been updated with the findings of more recent flu seasons, and here’s the what we know about the usefulness of the flu vaccine to date, and other relevant statistics, to date.

Statistically, your risk of contracting the flu is approximately 0.06% (but likely higher).

There are 23’000 laboratory confirmed cases of flu in Canada yearly1. The actual number of flu cases is likely higher, as many who contact the flu seek healthcare.

Assuming there are 36.95 million people in Canada, that’s simple math.

In the opinion of researchers, the flu vaccine isn’t particularly effective, but you be the judge.

These numbers are the most recent I could find, were from Cochrane’s 2018 February review of flu vaccine research.

Cochrane is a highly-respected organization that conducts research reviews (essentially gathering all the research available on a topic, removing biased or poor-quality studies, and using sophisticated mathematical tools to distil all the research findings into a “final word”).

According to the Cochrane review of research, to prevent one case of flu:

  • 71 healthy adults need to be vaccinated2
  • 7 healthy children need to be vaccinated with a live attenuated vaccine3
  • 5 healthy children need to be vaccinated with an inactivated vaccine3
  • 30 older adults need to be vaccinated4

Flu vaccination reduces rates of hospitalization and absenteeism modestly.

  • Healthy adults who have received the flu vaccine are hospitalized 0.6% less often than those who have not2
  • Having the vaccine reduced missed work days by 0.042 (assuming a work day is eight hours, this works out to your working an extra 19.2 minutes each winter)

The flu vaccine may have risks that are not well understood.

We can’t make this decision for you, but are fairly comfortable advising that if you are concerned about contracting the flu, you need to do more than only flu vaccination.

Jonah Lusis, ND

References

  1. Ministry of Health and Long-Term Care. 2018/2019 Universal Influenza Immunization Program: Health Care Provider Q & A: General information [Internet]. [Cited 2018 Nov 1]. Available at: http://www.health.gov.on.ca/en/pro/programs/publichealth/flu/uiip/docs/flu_uiip_HCP_QA_2018-19.pdf.

  2. Demicheli V, Jefferson T, Ferroni E, Rivetti A, Di Pietrantonj C.

    Vaccines for preventing influenza in healthy adults. Cochrane Database of Systematic Reviews [Internet]. 2018 Feb 1 [cited 2018 Nov 1]. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001269.pub6/abstract.

  3. Jefferson T, Rivetti A, Di Pietrantonj C, Demicheli V.

    Vaccines for preventing influenza in healthy children. Cochrane Database of Systematic Reviews [Internet]. 2018 Feb 1 [cited 2018 Nov 1]. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001269.pub6/abstract.

  4. Demicheli V, Jefferson T, Di Pietrantonj C, Ferroni E, Thorning S, Thomas RE, Rivetti A. Vaccines for preventing influenza in the elderly. Cochrane Database of Systematic Reviews [Internet]. 2018 Feb 1 [cited 2018 Nov 1]. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001269.pub6/abstract.
  5. Cunningham AS. Official doubletalk hides serious problems with flu shot safety and effectiveness [Internet]. BMJ. 2018 Jan 9 [cited 2018 Nov 1]. Available at: https://www.bmj.com/content/360/bmj.k15/rapid-responses.

 

Posted: 2018 November 1

Deciding On the Flu Vaccine

Toronto Naturopathic Doctor

Every year at the beginning of flu season, we are inundated with media extolling the value of the flu shot. Does the science support the marketing push? Jonah Lusis, ND reviews how well the flu vaccine has performed over the past 14 years.

 

 

Here’s a written summary of this “verbose” review!

For more great videos on health and wellness, visit our YouTube Channel!

 

Posted: 2017 May 24

 

To Flu Vaccine, Or Not Flu Vaccine: Natural Approaches to Flu Prevention

Toronto Naturopathic Clinic

This blog entry is in support of our Wellness Wednesday video of this week, and a continuation of last week’s topic of flu vaccine decision-making.

Flu vaccine prescription is outside the scope of practice of naturopathic doctors: we do not prescribe it, or dissuade people from it’s use. Our responsibility is, offering reliable information in service of making an informed decision

Last week we began to work through the four (often unconscious) factors people consider when making a health decision, in this case with respect to flu vaccination:

  1. What are the risks of not vaccinating?
  2. Is the vaccine effective?
  3. Is the vaccine safe?

Today we review:

What are my alternatives to vaccination for prevention of flu?

To be clear: there are no “natural flu vaccines”.

A vaccine has a very specific mechanism of action – it “pre-raises” antibodies to a particular microbe in order that your body has a ready-made immune response to that specific microbe should you come into contact with it.

There are however other means of preventing infection – the most important example of a “natural alternative” to infection prevention, whether by the flu or any other infection, is hand-washing.

Natural Medicines for Flu Prevention

There are a range of natural medicines, primarily botanical medicines, that can be used to prevent flu infection.

Plants have over 124 confirmed pharmacological actions1, and approximately 40% of prescription medications have as their root a plant1, so it is reasonable that plant medicines can be used to protect against flu.

The primary actions to look for in an herbal medicine for prevention is plants that are:

  1. Immune- “boosting” (to increase your resistance to all infections, including the flu)
  2. Anti-viral (the flu is a virus)

A quick Google search will yield many results, here’s a more academic listing, but any product at the health store for “flu prevention” is likely to include some of the plants your Google search has turned up.

Botanical medicines however have nuance: for the initiated, they have “best ways” to be of use. To demonstrate this:

Echinacea spp. (Purple Coneflower)

Echinacea is an important “immune-modulating” plant. Immune modulating plants can be used daily through-out the season to support what-ever response your immune system is mounting (as opposed to “immune stimulating” plants that stimulate a specific action in the body determined by the plant/prescriber, rather than precisely what your body has “identified as it’s need”).

There are more than one species of Echinacea: the main one for infection prevention is one called Echinacea angustofolia. If buying a product in pill form, it should be “standardized” for chemicals called alkylamides.

Golden Seal (Hydrastis canadensis)

Golden seal is a plant that is most effective in treatment of infections at the mucous membranes – the pink skin in your nose and mouth (among other locations).

Practically, these types of infections are often experienced as runny nose, sore throat, etc. Sound familiar? Golden seal.

Garlic (Allium sativum)

Garlic is a plant that is useful in infections of the gastrointestinal tract, but has it’s strongest reputation as an herb for respiratory infection. The flu is a respiratory infection, therefore, garlic may be a better choice for flu prevention than some of the other plants that have demonstrated anti-viral activity.

Garlic, if purchased in pill form, should be standardized to a chemical called alliin, and be sold as enterically-coated capsules.

St. John’s Wort (Hypericum perforatum)

St. John’s Wort has an anti-viral action against enveloped viruses, a specific design category of virus that the flu falls into. Similarly to garlic, this may make St. John’s Wort a better choice for flu prevention than some other anti-viral plants.

Do we have specific product recommendations?

Yes we do.

We do not usually recommend products in this forum, but as the above demonstrates, purchasing herbal medicines (and natural medicines in general) is much more complex than purchasing conventional medicines (e.g., aspirin), from both a “knowledge-required” and quality control perspectives.

If you are able to find them, MediHerb™ makes very high-quality botanical medicines. They are intended to be available only by prescription by a health care practitioner, and are available via our Online Dispensary. MediHerb™ produces Echincea-, garlic- and St. John’s Wort-based botanical medicines.

Viriditas Herbal Products are only available through naturopathic doctors, but if you are a patient of a naturopathic doctor, ask them if they are able to organize purchase of a tincture called “Children and Adults Cold and Flu Elixer”, which we’ve found to be excellent for both prevention and treatment of flu.

Viriditas Herbal Products also makes a tincture called “Herbal First Defense” which is very reliable for when you sense a tickle in your throat, and may or may not wake ill tomorrow. Taken at this juncture, “Herbal First Defense” will ensure you wake hale and hearty.

Lastly, our office offers a “Flu Clinic” – a “one-off”, one-hour consultation in which we can review with you flu prevention strategies in your/your family’s lifestyle and a botanical medicine regimen to help you have a happy and healthy winter season.

References

  1. Fabricant DS, Farnsworth NR. The value of plants used in traditional medicine for drug discovery. Environ Health Perspect [Internet]. Mar 2001 [cited 2016 Dec 14];109(Suppl 1):69–75. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240543/pdf/ehp109s-000069.pdf.

Posted: 2016 December 14

 

To Flu Vaccine, or Not Flu Vaccine

Toronto Naturopathic Doctor

… that is the question: Whether ’tis Nobler in the mind to suffer. The Slings and Arrows of public pressure, Or to take Arms against flu infection, …

It’s flu season again, and with that our busiest season of answering the question: Should I get the flu vaccine?

To be clear, the flu vaccine is not within a naturopathic doctor’s scope of practice, and as such, it is not appropriate for us to either prescribe the flu vaccine, or advise a person not to have it.

We do endeavour to be helpful, and offer people the information they need to make an educated decision in matters of health they may be confused by, and in search of some manner of “expert” opinion.

This blog entry is actually in support of a Wellness Wednesday video we posted last week, but because it’s so “numbers heavy”, we decided to lay out the numbers (and our references here so readers can follow-up if they want to learn more).

Let’s get started!

Weighing whether or not to make any health decision based on research is not simple, and the flu vaccine is no exception.

In order to gather this information, I considered the four questions most people are considering (even if unconsciously) when making this (or any) decision:

  1. What are my risks if I don’t have the flu vaccine?
  2. How effective is the flu vaccine?
  3. What are the risks associated with having the flu vaccine?
  4. Do I have any alternatives?

What are the risks of not having the flu vaccine?

Getting the flu: an unpleasant, but usually short-lived infection that resolves on it’s own.

The worst case scenario is development of “flu-related complications”, which can result in death.

The number of Canadian deaths attributed to flu annually according to Health Canada is 3’5001, but this number is based on computer models, not confirmed cases of flu that resulted in deaths. An investigative report by the CBC in 2012 reported that in 2009 when confirmation of suspected flu cases was mandated in response to H1N1 flu- tracking, the number of confirmed flu-related deaths was 4282.

Considering this range of possibilities, and assuming the population of Canada is 35’000’000, your risk of death from flu is between:

  • 0.001% if 428 deaths yearly is an accurate estimate, or
  • 0.01% if Health Canada models are accurate

Will having the flu vaccine help me avoid flu infection?

Firstly, there are complexities inherent to reviewing medical research. In the case of the flu vaccine, among the complicating factors:

  1. The flu virus mutates. As such, a new vaccine has to be prepared annually before manufacturers know which strain of flu will be circulating. As such, some years the flu vaccine will be “well-matched” with the circulating virus, and therefore relatively more effective; and other years it will be poorly-matched, and not particularly effective.

As of 2014, the vaccine had been deemed well-matched in seven of the previous 14 years3.

  1. There is a technical difference between “efficacy” (how effective a vaccine is in a controlled, experimental setting) and “effectiveness” (how well it prevents infection in practice), and different research will focus on different “outcomes”.

Studies are not always “comparing apples to apples”.

  1. There is more than one version of the flu vaccine, but in broad terms, there is a vaccine made from “inactivated” (“dead”) virus and one made from “weakened live virus” (called “live attenuated vaccine”).

Again, not an “apples to apples” comparison.

  1. Much of the research on the flu vaccine is paid for by vaccine manufacturers. Research paid for by manufacturers has been demonstrated to be biased in favour of positive results, a fact known by reviewers of research, but not quantifiable.

To find research findings that are useful for answering this question, I considered three factors:

  1. Using “review articles”. Because new research is published daily, and studies on the same treatment may have differing and even opposite outcomes from study to study, “review articles” attempt to summarize “the bottom line” for readers.

Creation of a review article involves gathering all available research on a topic, removing studies of poor quality, assigning greater weight to more meaningful studies, and finally producing “a final answer”.

  1. Referring to review articles that present their final determinations in “number needed to treat” (NNT), which is the most meaningful way to present effectiveness of a treatment.

NNT considers not only the people who benefit from a treatment (which is usually how the media reports on medical research), but also other factors such as placebo effect.

For example, if 95% of patients in a group given a particular treatment recover, it would appear that the treatment is very effective. But, if 90% of patients given placebo also recover, the studied treatment is actually contributing very little to recovery (i.e., it’s only 5% better than doing nothing).

Statistically, NNT for this treatment is 20, meaning the first 19 people receiving this treatment would not benefit from it – 20 people have to receive this “very effective” treatment before anyone actually benefits from it.

In the case of the flu vaccine, the NNT represents the number of people who need to receive the flu vaccine to prevent one case of flu.

In order to prevent one case of flu infection, “this many people” need to be vaccinated:

  • Limited information indicates the inactivated flu vaccine is no more effective than placebo in children younger than two years (i.e., the vaccine has no effect)3
  • 6 – children younger than six years (using weakened live virus)4
  • 28 – children older than six years (using inactivated vaccine)4
  • 37 – adults (16 to 65 years), in years the vaccine is well-matched3
  • 77 – adults (16 to 65 years), in years the vaccine is poorly-matched3
  • 40 – adults older than 65 years3

Vaccination using the flu vaccine also:

  • Decreased sick days by 0.5 days (in years vaccine was well-matched)

What are the risks associated with having the flu vaccine?

Common side effects of having the flu vaccine are flu-like symptoms lasting one to two days5.

Rare side effects include life-threatening allergies, and development of an autoimmune condition in which nerves are damaged called Guillain-Barre syndrome5.

Are there alternatives to the flu vaccine?

Well, this is where it gets dicey. Yes and no.

There is no “natural flu vaccine”. A vaccine has a very specific mechanism of action of “pre-raising” antibodies to a specific infection that cannot be replicated by any other known means.

There certainly are other means to prevent flu infection. Hand-washing is considered by public health professionals an uncontroversial “alternative” means of preventing infections, including flu infection.

There are natural medicines that will stimulate general immune system activity that can be similarly used to reduce (all, not specifically flu) infections.

I will discuss these next week (this video and blog entry are already waaay too long).

Anything else?

Yes. If you plan to have the flu vaccine:

  1. Get it at the beginning of flu season (November or early December) so your body has time to create antibodies before you might encounter the virus. Getting the vaccine at the end of the season in response to late-season advertising will confer limited or no protection during flu season itself.
  2. Get the “live attenuated” vaccine which is inhaled, not the “flu shot”. Research has demonstrated that the live vaccine is more effective.

Until next week.

References

  1. For health professionals: Flu (influenza) [Internet]. Government of Canada. [cited 2016 Dec 5]. Available at: http://healthycanadians.gc.ca/diseases-conditions-maladies-affections/disease-maladie/flu-grippe/professionals-professionnels-eng.php.
  2. Flu deaths reality check [Internet]. CBC. 2012 Nov 25 [cited 2016 Dec 5]. Available at: http://www.cbc.ca/news/health/flu-deaths-reality-check-1.1127442.
  3. Kolber MR, Lau D, Eurich D, Korownyk C. Effectiveness of the trivalent influenza vaccine. Canadian Family Physician. 2014;60(1):50. Available at: http://www.cfp.ca/content/60/1/50.full.pdf+html
  4. Jefferson T, Rivetti A, Di Pietrantonj C, Demicheli V, Ferroni E. Vaccines for preventing influenza in healthy children. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD004879. DOI: 10.1002/14651858.CD004879.pub4.
  5. Seasonal flu shot: questions and answers [Internet]. CDC. 2016 Aug 25 [cited 2016 Dec 7]. Available at: http://www.cdc.gov/flu/about/qa/flushot.htm.

Posted: 2016 December 8

 

Musings on the Flu Vaccine

Toronto Naturopathic Doctor

So, a propos of flu season, I thought I’d opine on the flu vaccine.

As a naturopathic doctor, the expectation is likely that I’m against it, but I’m neutral to it.

What had come to my attention, and what I was thinking of commenting on, was Shoppers Drug Marts’ aggressive promotion of the flu vaccine in the new year, in spite of the fact that the CDC had already determined this years’ vaccine is poorly matched (it’s estimated to be only 14% effective in persons over 50 years of age, the group most targeted in flu vaccine advertising), and that with a two week period required to develop antibodies, a person receiving the vaccine in mid-January will not have developed flu protection until little of the flu season remains.

In the course of looking up facts and numbers to round out my griping, I stumbled across this more interesting article on flu statistics.

The article questions whether or not the flu is actually the public health threat that results in much fear-based advertising and government pronouncing, moral judgment of those choosing not to use the vaccine and billions of dollars in annual government spending.

Essentially, the article brings to our attention that the claim that 2’000 to 8’000 deaths attributed to flu annually in Canada likely over-estimates, possibly greatly, the health impact of the flu.

Flu death figures are not arrived at by counting confirmed flu cases that ended in patient death (the testing required for this is not practical, and would cost a fortune).

Estimates are arrived at by using computer models. Assumptions are created (e.g., pneumonia deaths occurring in the winter months are caused by flu), and a computer will generate a number based on the assumptions. Different assumptions generate different numbers. Prior to 2003, Health Canada used different assumptions in their models, and the models predicted 500 to 1’500 flu-related deaths annually.

So, how dangerous is the flu really? The H1N1 flu pandemic of 2009 prompted close scrutiny of flu cases, widespread laboratory testing and the implementation of a national reporting program. In other words, implementation of the ideal flu-death counting system described above. That year, the final number of deaths attributed to the flu was 428.

If 428 is a more accurate prediction of how many Canadians will die of the flu, greater than 99.999% of Canadians will survive the flu each season. Is this worth the anxiety, hostility and dollar cost it results in each year?

Addendum: I happened upon this article written by a past chief medical officer for Ontario, an infectious disease specialist, questioning the value of the flu vaccine for different reasons (hint: the best case scenario for use of this years’ flu vaccine was vaccination of 50-100 persons to prevent a single case of flu).

Jonah Lusis, ND

 

Posted: 2015 February 26