Why Influenza Vaccine?

An upcoming issue of The Medical Letter (October 13, 2014) includes an article on the new influenza vaccine for the 2014-2015 season.

We live in a time when many of our patients are suspicious of vaccines. Failure to be vaccinated against flu threatens not only the well-being of the individual patient, but also, when viewed collectively, the health of the community. What can we say to our anti-vaccine patients, other than that the influenza vaccine is safe and effective? We could tell them that while influenza is usually a mild illness, it has a frightening side that they should be aware of.

First of all, influenza probably killed more people (25-50 million in various estimates; more than 500,000 in the US) in a short period of time (the winter of 1918-1919) than any disease in history. More than the black death. More than World War I. Most of the deaths were attributed to viral or secondary bacterial pneumonia. They did not occur primarily in elderly people, pregnant women, and young children, as they do now. They occurred in healthy young and middle-aged adults. Was the high mortality rate caused by starvation, loss of shelter, and the other difficult conditions of wartime? Possibly, but no one really knows. The large number of deaths in the US, which was relatively untouched by the war, suggests otherwise. Could it happen again? As far as we know, it could.

Even in the absence of a pandemic like the one in 1918, influenza can do a lot of damage. It has been estimated that it causes about 50,000 deaths annually in the US. The incidence of death is highest in nursing home residents and the immunocompromised, but perfectly healthy young and middle-aged adults can die from influenza. Complications of influenza virus infection include myositis and myoglobinuria, toxic shock syndrome, encephalitis (including Reye’s syndrome), transverse myelitis, and Guillain-Barré syndrome. And that’s not even mentioning the discomfort and time lost from school, work, or family responsibilities. Worried about Ebola? It makes a lot more sense to worry about influenza, partly because that is right here and partly because we can do something about it. Like get a flu shot.

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  1. Gordon W. Reiter says:

    Dr. Abramowicz:
    Your comments spelled out in “Why Influenza Vaccine” were spot on. I had always seen the upper number of deaths (50 million) when talking about the 1918-1919 pandemic; with many occurring on the Indian subcontinent. The Canadian author, Malcolm Gladwell had an excellent article about this event (and the then search to sequence the virus) in the September 29, 1997 New Yorker magazine; “The Dead Zone”. As to why younger persons were more prone to die from the virus, I’ve heard two scenarios (from non-peer reviewed sources): (1) The exaggerated response of the immune systems in younger persons led to more deaths, and (2) The older persons had been exposed to numerous assaults of flu viruses over their lifetimes and, although they would have been different hemagglutinin/neuraminidase numerical shuffles, it was enough to provide an modicum of protection. This would not explain the effect on children and pregnant women, which I had not heard of previously. From the annectodal desk: A number of internists have told me that persons receiving flu shots annually seem to have substantially attenuated symptoms if they contract the current influenza virus, no matter what type. Excellent blog, keep up the good work.

    Gordon W. Reiter
    Sedona, AZ

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