Madeleine and the Flu

Twelve little girls in two straight lines got the flu!

I was at a performance of Madeleine’s Christmas at a local theater the other day, my two children in tow. Madeleine’s Christmas is a charming book in the Madeleine series by Ludwig Bemelmans, written in 1956.  But as I watched the storyline unfold on stage, I found myself thinking like the MWV that I am, worrying about the eleven little girls suffering from influenza in an age when there was little to help them, besides the warm soup Madeleine (the only one unaffected) was able to serve them. I think my MWV radar was unusually sensitive that day, too, because my sixty-six-year-old father, who had received the flu vaccine this year, had just finished a bad bout with this year’s flu, and my children and I were struggling to kick a variety of different viruses as well.

Luckily, the eleven little girls—and Miss Clavel—all recovered in time to take a magic carpet ride around Paris, but the show did get me to thinking about how unusual this year’s flu season has been and why it’s so important that we see widespread vaccination, so that vulnerable people who might be more suspectible to the flu, even if they’ve been vaccinated (like my father), are better protected.

So I asked the folks at the CDC some of the questions that might be on your mind this flu season. The information below comes directly from CDC press releases, the CDC website, and communication with CDC representatives.

Why does the 2012-2013 flu season seem to be worse than previous flu seasons?

Flu seasons are unpredictable. The severity of influenza seasons can differ substantially from year to year. Over a period of 30 years, between 1976 and 2006, estimates of yearly flu-associated deaths in the United States range from a low of about 3,000 to a high of about 49,000 people during the most severe season. Each year in the United States on average more than 200,000 people may be hospitalized during a flu season. The 2009 H1N1 pandemic is an example of how unpredictable the flu can be. Click here for more information about the 2009 H1N1 pandemic.

The 2011-2012 season began late and was relatively mild compared with previous seasons (see “2011-2012 Flu Season Draws to a Close” for more information). Most of the viruses characterized so far this season have been H3N2 viruses; which are typically associated with more severe seasons.

Did the 2012-2013 flu season start “early”?

Significant increases in flu activity in the United States have occurred in the last two weeks (editor’s note: refers to late November, early December), indicating that an early flu season is upon us. Influenza-like-illness (ILI) activity levels in parts of the country are already higher than all of last season. 5 states are already reporting the highest level of activity possible. Click here for information from the CDC that discusses flu activity thus far. 

How effective is the flu vaccine?

The composition of the flu vaccine is reviewed each year. If needed, the vaccine is updated to protect against the three flu viruses that research indicates will be the most common during the upcoming season. New vaccine is manufactured every season. The 2012-2013 flu vaccine will protect against an influenza A (H1N1) virus, an influenza A (H3N2) virus and an influenza B virus.

Two factors play an important role in determining the likelihood that influenza vaccine will protect a person from influenza illness: 1) characteristics of the person being vaccinated (such as their age and health), and 2) the similarity or "match" between the influenza viruses in the vaccine and those spreading in the community.

In general, the flu vaccine works best among young healthy adults and older children. Lesser effects of flu vaccine are often found in studies of young children (e.g., those younger than 2 years of age) and older adults. Older people, who may have weaker immune systems, often have a lower protective immune response after influenza vaccination compared to younger, healthier persons. This can result in lower levels of vaccine effectiveness in these people. (This might explain why my father, who got the vaccine, still got the flu).

The good news is that most of the viruses characterized at CDC so far this season are well-matched to the vaccine viruses.

I want to make one note about the basic science of flu vaccines. Every once in a while, you might find an anti-vaccine website, like NaturalNews, make a comment about the flu vaccine. Last year, it was a story on its site that said that the reason a new flu vaccine had to be created every year is because the scientists “couldn’t get it right.” Most of you probably see scientific illiteracy in this statement, but in case it’s not clear, the flu virus changes each year, unlike most other vaccine-preventable diseases, and therefore a vaccine must “match” the predicted influenza viruses likely to spread in the community during the upcoming flu season in order to be effective.

You might also hear some people—even people in the world of public health—denigrating the current flu vaccines as ineffective. This shouldn’t be interpreted as a call to forgo the vaccine. Most of the time, when public health authorities, or leaders in the world of epidemiology, such as Michael Osterholm of the University of Minnesota, criticize the flu vaccine, they are advocating for a universal flu vaccine, or at least a better seasonal flu vaccine, both of which scientists are working on. 

I will take 60% protection over nothing any day, having lived through flu myself in years previous. And, without question, I would offer my children that same protection. I’m pretty sure that if that rug merchant in Madeleine’s Christmas had been peddling flu vaccines instead of magic carpets, the twelve little girls in two straight lines would have had a healthier Christmas, too.

The Subtle Way

Those of you have read this blog for some time probably know that I have contacted the local publication MN Parent before due to what I consider its lax fact-checking and tendency to promote anti-vaccine misinformation. I don't necessarily think this is a line of reasoning that the publishers or even the editor follow, but it appears in the pages of this big-circulation free publication from time to time. When I initially complained about MN Parent's profile of an anti-vaccine mother, in which none of her false assertions were fact-checked or even challenged, I initially received a very gracious response from the editor. However, when the next issue was published, the editorial response to my complaint (and the complaints of others) was to say that they don't fact-check parent quotes and shouldn't be expected to do so. They even went on to challenge CDC information about which state has the most cases of autism (the woman profiled claimed it was Minnesota).

While disappointing, I felt good about speaking up--and even better about the other parents who had apparently written in to complain.

Fast forward to last month. I picked up the November edition of Minnesota Parent and flipped to "20 Questions to Ask When You're Pregnant," written by "personality psychologist" Heidi Smith Luedtke. Number five was a straightforward question: "Should I get immunized?" Below is Luedtke's complete response in the article:

Your physician may recommend shots for the flu, hepatitis b, and tetanus (sic), especially if you're at risk. Live-virus vaccines and those for measles, mumps, and varicella (chicken pox) may be harmful during pregnancy. Speak up to make sure you're safe.

This is all sorts of wrong. First, it doesn't answer the question. Second, I think by "tetanus" the writer means the Tdap, which the ACIP (Advisory Committee on Immunization Practices) just recommended for all pregnant women, due to the increasing outbreaks of pertussis, a disease that is particularly devastating to infants.

But what is most interesting--and wrong--here is perhaps a bit subtle to those not involved in trying to increase immunization rates. Luedtke utilizes a scare tactic not uncommon among anti-vaccine activists: Trying to scare you off vaccines by bringing up totally irrelevant information.

Example: She brings up what I assume is the MMR vaccine (she says "measles, mumps" but leaves off the rubella component of the MMR vaccine, which is ironically the most devastating disease for a pregnant woman and her fetus) and the varicella vaccine. These are two vaccines that are NEVER offered to a pregnant woman. Never.

Here's what would happen. If you didn't know if you had been immunized for MMR, you would have a titers drawn to see if you were immune to rubella (I did this when pregnant). This would reveal your level of immunity. If you were not protected for rubella, your doctor would wait until you had given birth before immunization. As far as varicella goes, a pregnant woman would never be offered this vaccine either.

I'm not sure where the author is going with her comment about the Hep B vaccines--if you were a prostitute or drug user, your doctor might encourage you to get vaccinated, but the average pregnant woman would not need to worry about this.

It's pretty easy to locate the CDC's recommendations for vaccines during pregnancy. It would have been nice if the author of this piece--or better yet, her editor--had simply consulted this document instead of writing an error-ridden collection of nonsense designed to confuse a pregnant woman, at best, or scare her off vaccines, at worst.

As lagniappe, Luedtke directs pregnant women to "speak up to make sure you're safe." I don't know if Luedtke is actually opposed to vaccination, but the image she creates is of a vaccine-mad doctor coming at her with a syringe full of MMR vaccine. If it were me in that doctor's office, though, I'd speak up to make sure both of us--my baby and me--were safe by asking for my flu vaccine and Tdap.

Please speak up when you see members of the media mispeaking on vaccines. Most of the time, these are innocent mistakes (with potentially dangerous consequences) and the editors are glad to have them pointed out. The more often parents hold members of the media to a basic standard of accuracy, the better reporting we will get.