No Flu -- Or FluMist -- For You: An Influenza Update

<a href="https://www.flickr.com/photos/niaid/16842615702/in/photolist-rEjNRU-4vttQX-rki4V2-6jk9td-7pu9Sz-8LVkQh-4B7ALH-rkcfU4
Transmission electron micrograph of H1N1 virus particles.

The influenza season typically gets in gear right about now.

True flu is characterized by the abrupt onset of a headache, high fever, severe muscle aches, sore throat and cough. The flu isn’t that raw and then heavily congested schnoz: that’s a cold virus. The flu isn’t the kind of nausea, vomiting and diarrhea that lays you out flat for 24 hours: that’s the dark Sith lord, Norovirus.

CDC surveillance hasn’t detected any new flu viruses this year. About 80 percent have been the familiar A(H3N2) strain and about 10 percent have been the A(H1N1) strain that caused the 2009 flu pandemic.

This year’s vaccine covers all the active strains, which should mean that rolling up your sleeve and getting vaccinated will lower your chance of contracting the flu by about 50-60 percent. If you have an explanation for why it isn’t closer to 100 percent effective, contact the CDC, and start filling out your online Nobel Prize application right now.

This year the CDC is not recommending the nasal spray form of the flu vaccine (FluMist), after new data showed that it wasn’t at all effective (~3%) during last year’s flu season. And that’s after it had underperformed in the two previous seasons.

This has a lot of smart people scratching their heads. FluMist contains live flu viruses that have been altered (“attenuated”) so that they are incapable of causing the flu, but plenty capable of stimulating our immune system. In fact, as the CDC media statement on the FluMist demotion admits, live virus vaccines have always been thought to stimulate a stronger immune response than the conventional shot-in-the-arm vaccines (which contain only killed virus).

The CDC statement also acknowledged that during the 2014-15 flu season it had actually recommended FluMist as the preferential vaccine option for young children. If you have a reasonably scientific explanation for FluMist’s fall from grace, call your stockbroker, and then call the vaccine’s manufacturer AstraZeneca. They sold $290 million of the product in 2015, but will take an “inventory write-down” of approximately $80 million in the second quarter of 2016.

If you do contact AstraZeneca, they’ll probably want to talk to you about recent data from the U.K. and Finland showing the nasal vaccine to be in the standard 50%+ effectiveness range.

Although the CDC data is at odds with the UK and Finland data, they were all drawn from observational studies, which are more vulnerable to bias. But a recently published randomized and blinded clinical trial (the strongest type of study) involving children from 52 Hutterite colonies in Alberta and Saskatchewan found FluMist to be as effective as a flu shot.

If you’d like join a Hutterite colony in rural Canada, maybe for a political or spiritual breather, contact www.hutterites.org and start brushing up on your Hutterisch, which I don’t have to remind you is a Carinthian-Tirolean dialect. Even so, it might be easier to learn than Finnish, as evidenced by one of the graph titles from the Finns’ flu vaccine report: “Influenssakausina kirjattujen rokoteannosten yhteismäärä.”

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