Swine Flu Vaccination + general swine flu chat thread

DrIndy

The single shot of flu vaccine is enough as it is just enough antigen with the effective adjuvants to activate an immune response which protects from the real flu.

If very severely immune suppressed, the first course may not work, but then instead you could consider a second shot, rather than giving two shots at once (double dose).

However, there is no antibody test to check if the appropriate immune response happened so people who were vaccinated may still get the flu, but in fairness, normal healthy people can also fail to mount a immune response.

Here is where herd immunity comes in - during an epidemic, so long as most of the population is immune - they provide a buffer which protects the non-immune as the virus cannot spread easily across a population. Thus immunosuppressed people rely on everyone ELSE being vaccinated for full protection - this is why high uptake of this vaccine is critical.

In general people are isolated in hospital if they are immunosuppressed - but there is a spectrum of immunosuppression (mild to very severe) and a finite number of isolation rooms. These are split between the most immunosuppressed and other people who have contagious bug like MRSA to keep them from spreading it elsewhere. In an ideal world all people with immunosuppression are automatically isolated. Remember though - it is really, really boring to be in a room on your own and some people prefer a ward for company so if you were automatically isolated, you could make a lot of people really unhappy!

davearthurs

One thing I've wondered about the Swine Flu pandemic and vaccination is the long term situation - is swine flu here forever, or does it dissipate after 2 years or so and then the winter flu stays as the main winter flu again or is swine flu pretty much here for good from now on. So if you haven't got it yet and you get the vaccination you'd need to do it every year forever pretty much. Does a flu like this one 'die out' after the majority have caught it or vaccinated themselves? or will it always change slightly leaving us with a winter flu and a swine flu that can be caught any time of the year.

sicguy

Thank you for the reply,

I try my hardest to explain to people how vaccination programs work but sometimes I feel I'd be better off explaining it to the dog, I'm even having difficulty getting people I am around for long periods with to go and get any vaccines, the usual responses are "but sure its only sick/old people who need it" or "ah your just being too cautious/its all hyped up, you'll be grand" (bangs head off wall)

In general people are isolated in hospital if they are immunosuppressed - but there is a spectrum of immunosuppression (mild to very severe) and a finite number of isolation rooms. These are split between the most immunosuppressed and other people who have contagious bug like MRSA to keep them from spreading it elsewhere. In an ideal world all people with immunosuppression are automatically isolated. Remember though - it is really, really boring to be in a room on your own and some people prefer a ward for company so if you were automatically isolated, you could make a lot of people really unhappy!

I tend to pick up a lot of infections both in the community and in hospitals, about 6-10 in the last few years from hospitals ranging from stomach bugs to MRSA and C-Diff.

I'm on 200mg of Azathioprine, and spend quite a bit of time in hospitals but as I've only a medical card I am always in a ward and although I see what you mean about some preferring wards, I absolutely hate them, in my experiance of them they tend to seem more like nursing homes, the sights sounds and smells and not forgetting the joy of the shared bathroom and increased risk of cross infection make me see them as outdated and obsolete in most medical and surgical environments, but of course others may feel different.
I'd be more in favour of having mostly individual units and having properly set up and equipped day rooms for patient interaction, whereas in my experience day rooms are a lot of time lacking and unpleasant rooms and in some cases non-existent as they've been changed in to staff rooms:rolleyes:

Wow I've gone way off topic and started dreaming of what should be, sorry about that.

Thanks again for replying and if anyone else can add more information for my questions it'd be most welcome.


Thanks

Bicycle

davearthurs wrote: »

One thing I've wondered about the Swine Flu pandemic and vaccination is the long term situation - is swine flu here forever, or does it dissipate after 2 years or so and then the winter flu stays as the main winter flu again or is swine flu pretty much here for good from now on. So if you haven't got it yet and you get the vaccination you'd need to do it every year forever pretty much. Does a flu like this one 'die out' after the majority have caught it or vaccinated themselves? or will it always change slightly leaving us with a winter flu and a swine flu that can be caught any time of the year.

I've spoken to our GP about it. He suggested that there will be only one vaccination against swine flu. Thats it. Done and dusted. A bit like some of the ones we used to get as kids.

But then, we were told that about the MMR as well!! And I recently had to bring my 17 year old for a booster. :rolleyes:

The_Conductor

Bicycle wrote: »

I've spoken to our GP about it. He suggested that there will be only one vaccination against swine flu. Thats it. Done and dusted. A bit like some of the ones we used to get as kids.

But then, we were told that about the MMR as well!! And I recently had to bring my 17 year old for a booster. :rolleyes:

Really- my GP said the Irish vaccine would only have 1/2 the antigen of that in other countries- and she would be routinely giving a booster after a 4-6 week period to her patients. Is there not a standard approach to this across the board?

Vorsprung

Lads what is the minimum percentage of the population do the health authorities need to vaccinate to see a benefit?

tallaght01

Vorsprung wrote: »

Lads what is the minimum percentage of the population do the health authorities need to vaccinate to see a benefit?

Depends on the reproductive rate. Theoretically it could be between 30 and 75%, which isn't much help at the moment.

Bicycle

smccarrick wrote: »

Really- my GP said the Irish vaccine would only have 1/2 the antigen of that in other countries- and she would be routinely giving a booster after a 4-6 week period to her patients. Is there not a standard approach to this across the board?

Data about the vaccine is just out on teletext at the moment.

YOU are right and I am wrong!!

Now whether I've been misinformed or whether I misinterpreted is a discussion for another time

El_Dangeroso

I really am surprised that normalising vitamin d blood levels aren't being acknowledged as an effective strategy for combating the severity of swine flu.

I'm currently writing a literature review on this and the scientific evidence is startling. Even the center for disease control have remarked that almost two-thirds of the children who died with swine flu had epilepsy, cerebral palsy or other neurodevelopmental conditions. Anti-convulsive medication lowers vitamin D status.

samson09

Temple_Grandin wrote: »

I really am surprised that normalising vitamin d blood levels aren't being acknowledged as an effective strategy for combating the severity of swine flu.

I'm currently writing a literature review on this and the scientific evidence is startling. Even the center for disease control have remarked that almost two-thirds of the children who died with swine flu had epilepsy, cerebral palsy or other neurodevelopmental conditions. Anti-convulsive medication lowers vitamin D status.

Have you seen this:

http://www.vitamindcouncil.org/newsletter/vitamin-d-and-h1n1-swine-flu.shtml

Lots of good information on that site. I'd be interested in seeing that lit. review when you're finished

Turtwig

Holy Crap:eek:
Youtube, actually *gasp* has some *deep breath* decent videos on vaccinations.
Somewhere, hidden in the midst of a dozen videos full of tripe, I found this little gem.

Note : For the Impatient among ye, you might be best to skip 2:55 as the video starts on a rather eccentric analogy to diss the general media's methods.


Mods, I'm not a doctor, so if it has some misleading information please feel free to delete my post. Near as I can tell it seems to be honest and frankly very much needed to quell some peoples fears. Honestly, some of the tripe being posted on youtube regarding vaccines is sickening :mad:

If I find more 'gems' I'll add them.:)

El_Dangeroso

samson09 wrote: »

Have you seen this:

http://www.vitamindcouncil.org/newsletter/vitamin-d-and-h1n1-swine-flu.shtml

Lots of good information on that site. I'd be interested in seeing that lit. review when you're finished

I have indeed, I'm stealing most of my references from the vitamin d council :pac: well it's a good starting point anyway..

They have done fantastic work trying to educate people on the massive body of research on vitamin d and cancer, heart disease and auto-immune diseases. I wonder why the mainstream isn't listening to them?

Vitamin d blood testing should be a compulsory aspect of any general health check. I have heard really gob-smacking ideas that certain types of cancer incidence could be reduced by 75%!

I'm taking 10,000IU vitamin d3 a day and have escaped two bouts of colds and flu going around at work, when I normally catch everything going. Good old antimicrobial peptides!

Will post my lit review next week when it's done..

Turtwig

Temple_Grandin wrote: »

I have indeed, I'm stealing most of my references from the vitamin d council :pac: well it's a good starting point anyway..

They have done fantastic work trying to educate people on the massive body of research on vitamin d and cancer, heart disease and auto-immune diseases. I wonder why the mainstream isn't listening to them?

Vitamin d blood testing should be a compulsory aspect of any general health check. I have heard really gob-smacking ideas that certain types of cancer incidence could be reduced by 75%!

I'm taking 10,000IU vitamin d3 a day and have escaped two bouts of colds and flu going around at work, when I normally catch everything going. Good old antimicrobial peptides!

Will post my lit review next week when it's done..

Emm,

I don't know how ye medecine folk do things, but, I thought, literature reviews usually include LOTS of relevant references to journals. That site, doesn't seem to have any....

*Suspicious*
If it sounds too good to be true....

sharky86

I for one will not it near my child or myself

El_Dangeroso

Malty_T wrote: »

Emm,

I don't know how ye medecine folk do things, but, I thought, literature reviews usually include LOTS of relevant references to journals. That site, doesn't seem to have any....

*Suspicious*
If it sounds too good to be true....

All the refs are under the research link in the menu, here's all the papers on influenza:

http://www.vitamindcouncil.org/science/research/vitamin-d-and-influenza.shtml

Bicycle

Temple_Grandin wrote: »

I really am surprised that normalising vitamin d blood levels aren't being acknowledged as an effective strategy for combating the severity of swine flu.

I'm currently writing a literature review on this and the scientific evidence is startling. Even the center for disease control have remarked that almost two-thirds of the children who died with swine flu had epilepsy, cerebral palsy or other neurodevelopmental conditions. Anti-convulsive medication lowers vitamin D status.

Just curious, in what area are you studying and is the lit review for a term essay, or an undergrad fyp or for a taught masters or a research masters or a PhD?

tallaght01

Temple_Grandin wrote: »

I wonder why the mainstream isn't listening to them?

.

The papers you lnked to were all done by "The mainstream". The reason that it's not being acted on is because it's a theory. NO one has actually done a proper trial to see if vitamin D prevents swine flu.

As an aside, I've been analysing the risk factors fr swine flu. I havent; seen any patients with Rickets. Nor are there big spikes in the communities where there are traditionally low vit D levels, like in the Indian subcontinent.

So, for every reason why Vit D might be part of the puzzle, there's a reason why it isn't.

Vit D is a theory. There's a million more out there. BUt people need to start actually testing this on people, if they want to be taken seriously. Intellectual masturbation only takes us so far.

So, let's not kid ourselves that there's this huge body of evidence for Vit D in influenza, and we're all just purposely ignoring it.

I'd love to see a literature review. BUt you'll need to critically appraise the papers , and not just look at abstracts that they've linked to.

El_Dangeroso

tallaght01 wrote: »

The papers you lnked to were all done by "The mainstream". The reason that it's not being acted on is because it's a theory. NO one has actually done a proper trial to see if vitamin D prevents swine flu.

As an aside, I've been analysing the risk factors fr swine flu. I havent; seen any patients with Rickets. Nor are there big spikes in the communities where there are traditionally low vit D levels, like in the Indian subcontinent.

So, for every reason why Vit D might be part of the puzzle, there's a reason why it isn't.

Vit D is a theory. There's a million more out there. BUt people need to start actually testing this on people, if they want to be taken seriously. Intellectual masturbation only takes us so far.

So, let's not kid ourselves that there's this huge body of evidence for Vit D in influenza, and we're all just purposely ignoring it.

I'd love to see a literature review. BUt you'll need to critically appraise the papers , and not just look at abstracts that they've linked to.

By mainstream I mean doctors on the ground and the media not researchers on vitamin d which is still very much a niche.

Vitamin D isn't even a theory, it's a hypothesis and I eagerly await intervention trials too. It's just that the incredibly strong correlative data out there screams that an intervention trial needs to happen and as far as I know there are none even planned. There are some Russian trials that were done by exposing factory workers to UV lights, they were quite successful but no way you'd get them past an ethics committee in any reputable institution now.

There is an intervention trial underway for cancer and vitamin D but that won't be complete for five years.

Vitamin D is definitely only part of the story, but if you read the studies that have been done, it's quite a big part. What other hypothesis have you come across? I'd be really interested to read up on them.

I think it wouldn't do any harm to normalise blood levels of vitamin D to >40ng/mL while we're waiting for the science to catch up.

Rickets is the result of extreme deficiency, 400IU is all that's necessary to prevent it, but at this latitude 5,000IU at least is needed to prevent all the consequences of moderate deficiency.

My whole masters is about critically appraising studies, so I'm sure if I didn't do that my professor would let me know.

sam34

Temple_Grandin wrote: »

By mainstream I mean doctors on the ground and the media not researchers on vitamin d which is still very much a niche.

the plural of "ancedote" is not "evidence".

El_Dangeroso

sam34 wrote: »

the plural of "ancedote" is not "evidence".

I never said it was. This is a carefully constructed hypothesis involving cholecalciferol upregulating the production of antimicrobial peptides which in turn works to internally combat viruses and bacteria. There are randomised clinical trials to support each aspect of the hypothesis, just not the whole hypothesis of yet.

tallaght01

Temple_Grandin wrote: »

I never said it was. This is a carefully constructed hypothesis involving cholecalciferol upregulating the production of antimicrobial peptides which in turn works to internally combat viruses and bacteria. There are randomised clinical trials to support each aspect of the hypothesis, just not the whole hypothesis of yet.

Yea the hypothesis is ell established, as is the theory. But What do you mean by "there are randomised clinical trials to support each aspect of the hypothesis"?

The very reason why "the mainstream", whatever they are, haven't take huge amounts of notice if vitamin D is because there are no RCTs.

El_Dangeroso

tallaght01 wrote: »

Yea the hypothesis is ell established, as is the theory. But What do you mean by "there are randomised clinical trials to support each aspect of the hypothesis"?

The very reason why "the mainstream", whatever they are, haven't take huge amounts of notice if vitamin D is because there are no RCTs.

I wish there were direct RCT's but there aren't yet, so I base my conclusions on what we do have, which is very strong correlative data that as the autism video mentions above has two of the three key aspects of a strong correlation:

1. We know the mechanism by which it occurs
2. We can use the data to predict future incidence
3. We can reproduce it (this hasn't been done yet but the potential is there)

If you break down the hypothesis into component parts:

1. Cholecalciferol supplementation increases levels of 25-hydroxyvitamin D
http://www.ncbi.nlm.nih.gov/pubmed/18541590?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
2. 25-hydroxyvitamin D in the blood strengthens the immune system (through the upregulation of AMP's)
http://www.fasebj.org/cgi/content/abstract/19/9/1067
3. AMP's have antiviral properties
http://abstracts.iovs.org/cgi/content/abstract/45/5/2256

There are no direct studies but there is some unexpected results from RCT's on osteoporosis, the researchers noticed that the people in the intervention group had drastically lower incidence of colds and flu.

Comment to vitamin d in Epidemiology & Infection. 135(7):1095-1096, October 2007.
ALOIA, JOHN F.; LI-NG, MELISSA relating to:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1464166

Things like echincea are mainstream treatments of colds but have very little evidence backing them up, what there is isn't very strong. So that's why I find it strange that you have this massive body of evidence and yet most people in the street are unaware of how vitamin D can effect innate immunity.

tallaght01

Temple_Grandin wrote: »

I wish there were direct RCT's but there aren't yet, so I base my conclusions on what we do have, which is very strong correlative data that as the autism video mentions above has two of the three key aspects of a strong correlation:

1. We know the mechanism by which it occurs
2. We can use the data to predict future incidence
3. We can reproduce it (this hasn't been done yet but the potential is there)

If you break down the hypothesis into component parts:

1. Cholecalciferol supplementation increases levels of 25-hydroxyvitamin D
http://www.ncbi.nlm.nih.gov/pubmed/18541590?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
2. 25-hydroxyvitamin D in the blood strengthens the immune system (through the upregulation of AMP's)
http://www.fasebj.org/cgi/content/abstract/19/9/1067
3. AMP's have antiviral properties
http://abstracts.iovs.org/cgi/content/abstract/45/5/2256

There are no direct studies but there is some unexpected results from RCT's on osteoporosis, the researchers noticed that the people in the intervention group had drastically lower incidence of colds and flu.

Comment to vitamin d in Epidemiology & Infection. 135(7):1095-1096, October 2007.
ALOIA, JOHN F.; LI-NG, MELISSA relating to:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1464166

Things like echincea are mainstream treatments of colds but have very little evidence backing them up, what there is isn't very strong. So that's why I find it strange that you have this massive body of evidence and yet most people in the street are unaware of how vitamin D can effect innate immunity.

For starters, there is nothing in that paper you posted the link to which even mentions cols or flus. I may have missed it, but I've looked twice and can see nothing.

Your hypothesis breakdown is all very well in theory. BUt that's all it is. There have been a world of theories over the years. Many more than actual cured. All kinds of medications have worked in monkeys or in test tues etc. It means they warrant further consideration in trials, certainly. BUt the results mean nothing in themselves.

I would have pretty significant reservations about the lack of rigour in your analysis of the vitamin D situatin.

But if you want to actually discuss papers (and I stress you would have to actually read them, and critically appraise them) then I'd encourage you to post in the swine flu scientific discussion thread.

But scientific discussion means more than just accepting what's written in the conclusion of an abstract.

I woud also add that echinacea is not mainstream Tx for colds or flu. There is no good evidence that it works.

El_Dangeroso

tallaght01 wrote: »

For starters, there is nothing in that paper you posted the link to which even mentions cols or flus. I may have missed it, but I've looked twice and can see nothing.

Your hypothesis breakdown is all very well in theory. BUt that's all it is. There have been a world of theories over the years. Many more than actual cured. All kinds of medications have worked in monkeys or in test tues etc. It means they warrant further consideration in trials, certainly. BUt the results mean nothing in themselves.

I would have pretty significant reservations about the lack of rigour in your analysis of the vitamin D situatin.

But if you want to actually discuss papers (and I stress you would have to actually read them, and critically appraise them) then I'd encourage you to post in the swine flu scientific discussion thread.

But scientific discussion means more than just accepting what's written in the conclusion of an abstract.

I woud also add that echinacea is not mainstream Tx for colds or flu. There is no good evidence that it works.

The paper is the basis for a comment made by the authors of the paper in response to the Vitamin D and Epidemic influenza paper - the result of the reduction in colds and flu was outside of the scope of the original study so was not included. But the comment is there for anyone to see.

As I mentioned before, it's not a theory, it's a hypothesis. An hypothesis would have to undergo far more rigorous testing to come close to being called a theory. Gravity is a theory.

You seem to be assuming that I am presenting this as proven fact? When all I am doing is highlighting the significant amount of strong correlative data and decrying the lack of an RCT when there is significant reason to conduct one, especially in the current climate.

It's quite condescending that you would assume that I have not read the full papers and that I would have no ability other than to blindly accept the conclusion of the reseachers as fact. Where is my lack of rigour?

I was referring to echinecea as being accepted as beneficial to the immune system, with little evidence. I was using it to make the point that the general population and the doctors that I have met are unaware of the role of vitamin d in innate immunity.

tallaght01

The reason I said you're not being particularly rigorous, and aren't reading papers in full because you linked a paper to show some link between flu and vitamin D, where there's no mention of it anywhere in the paper, despite you saying that the comment s there for all to see.

And then you talk about echinacea as a "mainstream" treatment, when it's not. Most doctors won't recommend echinacea as a treatment for flu, because it's not proven. Same with vitamin D.

There's no point in claiming that you're not advocating the use of vitamin D in this role, when you earlier decried the unwillingness of "the mainstream" to embrace it.

I'm asking you why we should embrace it.

El_Dangeroso

It is a comment to the Epidemic Influenza and flu paper that I quoted, the authors of the comment were referencing their own study that yes had nothing in the scope for flu. I have access (and have read) both of the full papers, if you read what I was referencing to it was the comment.

I think there is a sufficient weight of evidence for doctors to take this as a serious complementary strategy to traditional prevention methods of not only flu but several other chronic diseases.

Really I don't want to get into the minutae as I have a paper to write but Dr. Cannell and Hollis can say it better than I ever could:

http://findarticles.com/p/articles/mi_m0FDN/is_1_13/ai_n25332537/

Please appraise the above and tell me whether normalisation of vitamin D is worthy of consideration in clinical practice to address overall immunity, including immunity to colds and flu.

I think it is wise to supplement to normalise 25(OH)D levels as a matter of course, do you think it would be more prudent to leave a patient in a deficient state?

tallaght01

See, just linking articles doesn't help your cause. You never talk about the evidence...why it's good or bad....are the results statistically significant....are the authors members of the vitamin D council (yes) etc etc.

The points you made related to Vitamin D and swine flu. So, let;s not shift the goalpost, by posting articles about the general benefits of vitamin D.

If you're happy that there isn't good enough evidence for doctors to treat swine flu with Vit D then I'm happy to leave it at that.

To address your point about the deficiency state, yes I think there's an argument for replacing vit D in some circumstances.

To put it back to you another way.....you could probably reproduce the same results in a test tube using various interleukins and cytokines, which are essential for immune function. Do you think we should tell patients to ingest them to fight swine flu?

What course are you doing the lit review for, btw?

El_Dangeroso

There's no RCT's anyway so our discussion is going to bounce around in hypothetical land. I think there's sufficient evidence already out there to merit this as a strategy. You think otherwise, I guess time will tell.

The reference to interleukins and cytokines was rather specious I think. I think it's not beyond the realms of reality to make a reasonable extrapolation on the basis of the research that I've presented. I guess I'm a bit impatient waiting for the published science to catch up.

I am doing a masters in medical science, basically evidence based medicine.

Oh by the way I wans't for a second suggesting treat, I was suggesting prevent or reduce the severity by normalising levels to improve innate immunity prior to contracting the virus. It sounds like a sensible strategy to me, along with washing your hands.

tallaght01

That's why I think you're jumping the gun a bit.

I think there's all kinds of stuff out there that has in vivo activity. But most of it comes to nothing from a therapeutic point of view.

From a clinician's point of view, you have to be cautious. There are lots of false dawns i medicine, and you can't just medicate on the basis of what might be. Well, you sometimes do, if there's a compelling reason.

But you have to look at the data carefully. Like, the Vit D lobby always make a ig deal of the meta analyses which claims to show a small reduction in all cause mortality when vit D supps were used. But their confidence intervals for the relative risk went up to 0.99, which i guess is technically "statistically significant", but it's not very convincing.

BUt I would definitely be interested to see what an RCT would show. I guess a lit review of what's already out there is of limited use to clinicians because there's no good clinical trials. But you're doing lab science, so it would definitely be something useful for you.

El_Dangeroso

You say that in some cases you may make a decision on what might be, if there is a compelling reason. In this instance you have the opportunity to boost innate immunity with minimum to no side effects, for a cheap blood test and even cheaper medication. I personally think it's worth trying and examining results for oneself.

Not all clinical knowledge is based on papers, more of it should be but that's not to discount the merit of clinical experience.