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.

"Scare Tactics"

Recently, a mother who immunizes her children tried to post on a blog called "Modern Alternative Mama" in response to a worried mother of a newborn. The new mother had chosen not to vaccinate her baby out of fear, but was living in a community in the midst of a pertussis outbreak. Her pediatrician had called to ask if she might reconsider immunizing her baby at this point. The mother seemed worried--she didn't want to vaccinate, but clearly she didn't want her infant to contract pertussis. After reading responses from other non-vaccinating mothers--telling her to hold strong, to rest assured that breast milk would somehow make her baby immune from pertussis, one of the most devastatingly contagious diseases on the planet--this mother-who-vaccinates felt moved to post a response. 

She asked the mother of the newborn to reconsider getting her child the Dtap, and linked to Everlee's pertussis story here on this blog as an example of how an infant handles pertussis. Not only was the comment not approved by the woman who runs Modern Alternative Mama, but the mother also received an e-mail saying that the blog didn't allow commenters to use "scare tactics" and so the comment would be censored. After reading the e-mail myself, I was somewhat surprised--until I went to the blog's Facebook page and saw the anti-vax posts from the blog author. Typical stuff I encounter on a daily basis from the underbelly of the mercifully sparsely populated anti-vax world, more banal than the truly bizarre "Moms Who Vax Make Up Their Stories" conspiracy theories floating around. 

Still, I found myself stewing over this one.

In many ways, I am not surprised that we live in a world where the true story of a vaccine-preventable disease can be considered a "scare tactic." After all, we are still burdened by climate science skeptics and Creationists who believe the earth is 6,000 years old and that we hung out with our dino friends. But coming as it did in the midst of preparing a story from another mother whose life was changed by a vaccine preventable disease, I found this appellation--"scare tactic"--used to describe Everlee's story particularly distasteful, even for the anti-vax crowd. While serious side effects from vaccines are exceptionally rare, I would never look a parent, whose child had had a bad reaction to a shot, in the eye and say: your story, and your child, are a scare tactic, and therefore you do not deserve to be heard. I'm not certain how you can respond to any parent who is suffering in such a dismissive way and remain human. It doesn't necessarily mean you agree with their theories as to why their child became ill, or that you acknowledge that such reactions are common, but it means you have a basic level of compassion. 

Illness and death from vaccine-preventable disease, which are far, far more common and, unfortunately, on the rise, are not scare tactics. They are the true stories of fellow human beings who want to be heard and, even more important, who want to save other families the heartache they've suffered. More, the science is on their side. The facts are on their side. And I, as a parent, am deeply grateful for the work they do by keeping their wounds wide open in order that they might save lives, something those who criticize them have no interest in doing. 

Moms Who Vax: Dr. Kate O'Brien's Story

Editor's Note: To mark World Pneumonia Day, Moms Who Vax, along with a number of other blogs, will run this commentary by pediatrician Kate O'Brien from Johns Hopkins on her experience with her own child's bout of pneumonia. 

By Dr. Kate O'Brien

I’m a pediatrician, an infectious disease pediatrician at that.  We’re supposed to know what to do when a baby has pneumonia---apparently that’s not always true.  I’ve treated hundreds of such cases --- but this time was different.   When it’s your own infant none of that experience matters.  Jack looked at me with what seemed like panic in his eyes.  Coughing, crying, breathing fast, sleeping in fits and spurts.  Babies aren’t supposed to breath that fast.  He lay beside me in bed. It was the day before Christmas and I just kept telling myself that we’d be better soon---apparently that’s not true either.    We both had influenza, I’m sure of that.  If you’ve had it you’ll know what I mean---I felt like hell, exhausted, muscle aches, every time I coughed it felt like sandpaper scraping over my trachea.  But since I’m an infectious disease doc, of course we were vaccinated!---well, apparently that wasn’t true this year.  I had every intention of getting that done weeks earlier, but life got in the way.

The middle of the night always makes things worse, or at least things seem worse.  So, we became ‘that family’, calling our neighbors in the middle of the night to care for our two-year old while we drove to the hospital with Jack.  So many times I was that doctor we were about to meet in the emergency room, scratching my head wondering, “Why did they wait the whole day at home and decide to finally come in at 2 in the morning?”  Well, now I knew.  Sometimes it doesn’t get better.  He had pneumonia on the chest x-ray and needed antibiotics.  

Every day, of every year, millions of children get pneumonia and struggle to breath; more than a million of them don’t get the treatment they need and die.  

Every day of every year something unimaginable to the mothers we are, happens to mothers we don’t know, over 90% of them living in poor countries in Africa and Asia ---their child dies in front of their eyes from pneumonia.  It’s senseless.   It’s inhuman. Vaccines against the biggest pneumonia causing bacteria, Hib and pneumococcus, along with other simple strategies can prevent these deaths.   

So, this year on World Pneumonia Day, look at your kids and remember to get them vaccinated, remember to get yourself vaccinated and remember that not every mother is so lucky….yet.  The GAVI Alliance is helping give those mothers the same opportunity for their kids, faster than ever before for any vaccine.  At a time when the world seems to be more complicated than ever, this seems like a pretty sensible thing to do.

Dr. Kate O’Brien, pediatrician, epidemiologist, Deputy Director of the International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health, USA,

Winner of the 2011 US Presidential Early Career Award for Scientists and Engineers

The Google Conundrum

As a new parent, I did the same thing every single parent in my state, probably in the country, did before bringing in my kid for his vaccinations: I googled "vaccines." Big mistake. There were no obvious signs that I had fallen down the rabbit hole. In fact, I was directed to some very official looking websites, one of which was The National Vaccine Information Center.


National Vaccine Information Center. That sounds official. And I need information on vaccines. Great. It took me a while to realize that the site I was visiting belonged to an anti-vaccine organization. (As Dr. Ari Brown pointed out during this weekend's Got Your Shots immunization conference here in Minnesota, you always want to get your vaccine information from a website that has a scrolling ad for lawyers on the margin of the page, right!) Then there's the Vaccine Safety Council. Again, sounds official. And I want safe vaccines. Let's head on over there and see what gives. And so began some of the most stressful months of my life, becoming scared of harming my son with vaccines, coming to realize, through research, that I had been sold a bill of goods by the anti-vaccine community, and was in danger of putting my son's life at risk if I didn't vaccinate. Somehow I climbed out of that rabbit hole and got back on steady ground.  I know other parents face the same terror I felt after doing that first Google search, so I want to provide some basic information here in the hopes that it can be a kind of Cliff's Notes for you or new parents you know who are doing the vaccine thing. As new and expecting parents, the last thing we want and, frankly, have time for is examining verbiage, nuance of language, and point of view on websites we come across during a 2am Google search between nursing and changing a diaper. What I learned was that I could not take anything for granted--I could not assume that seemingly straightforward, unbiased names like "National Vaccine Safety Council" or "Vaccine Information Center" were providing factual information. Notice that none of these sites call themselves "The Anti-Vaccine Clearinghouse" or "Moms Who Don't Vax." They refer to themselves as people desiring "safe vaccines" (hint: we already have them) or "more research" (hint: the research is in, and it's conclusive).


I want to provide some shorthand for you sleepy parents out there who want to know about some of the sites you find during a Google search. Please note: I only list the first five notable anti-vaccine sites that appear in a Google search for "vaccines" here. I'm happy that the CDC's site, the Children's Hospital of Philadelphia (CHOP)'s site on vaccines, and other credible sources are appearing higher and higher in this particular Google search. But in the meantime, if you are a new parent, please know this about the following websites you will encounter on your Google adventure.


1.) National Vaccine Information Center: Anti-vax organziation run by an anti-vaccine activist named Barbara Loe Fisher. Unfortunately, this is currently the third or fourth link that shows up under a Google search for "vaccines." To get a sense of what these folks are about, check out this story from Discover Magazine online.


2.) SafeMinds: Anti-vax organization run by another anti-vaccine activist named Sallie Bernard, former marketing executive. Left Brain Right Brain, a science blog, says this about the organization:

"SafeMinds has shown themselves to be very resistant to the very research they called for. Studies which show a lack of association between thimerosal containing vaccines (TCV’s) and autism are always rejected by SafeMinds. They are not alone in this, groups such as Generation Rescue and the National Autism Association(NAA) have also refused to accept the science.

Incidentally, one of the hallmarks of the anti-vax movement is an astonishing level of defensiveness. This is a trait you will rarely see (I've never seen it) in the pro-vax movement. Perhaps this is because we have nothing to be defensive about. You will also not see vindictive attacks on anti-vax activists from public health authorities and pro-vax parents, like this one Safeminds perpetrated on one of their pro-vax critics, a parent. Acts like this should go into your consideration of whether a source is trustworthy enough to earn your confidence.




3.) Association of American Physicians and Surgeons: a very official and "medical-sounding" organization that is anti-vaccine. For a detailed explanation of this organization's approach, please go to Science-Based Medicine's post on it. Shorthand: they had disgraced former doctor Andrew Wakefield speak at their conference.


4.) Natural News.com: Sadly, some parents look to this website as a source for medical information. It is notably anti-vaccine and has no problem providing "medical information" suggesting vaccines cause harm that is, frankly, nothing but lies. Even if you've never taken a science class in your life, you will quickly see through the stories posted on this very odd website. To give you an idea of how poor of a grasp the folks who run this website have on basic science, one of their recent headlines was: "CDC admits flu vaccines don't work (which is why you need a new one every year)" I nearly spit out my coffee when I read that one. It's astounding that these people don't understand that new flu viruses arrive every single year and that the vaccines are manufactured to guard against the new strains. They also claim "multiple studies" show mercury causes autism, something even most anti-vaxxers are now moving on from.


5.) Vaccines.net: this site has become very stripped down, but it still directs you to "vaccine adverse events," which is a somewhat unmonitored reporting system that collected all reports of perceived vaccine-related illness or injury. I hope to have a post from someone far more knowledgable than me on the VAERS (Vaccine Adverse Event Reporting System) set up by the U.S. government, and how it works, but long story short, someone can report (and apparently has) that their son got a vaccine and then turned into the Incredible Hulk, and that will be part of the VAERS reports; no causation is needed, just a report, even something overheard. I've read reports of a teenager receiving a vaccine, then thirty days later committing suicide, and it being part of VAERS because the reporting party wondered if the vaccine caused her suicide. Anyway, vaccines.net, despite the official-sounding name, is an anti-vaccine website.


6.) Vaccine Exchange: I honestly wouldn't have known about this site if the person running their Twitter account hadn't Tweeted us with some nonsense accusing us of not liking National Vaccine Information Center because we are cockroaches who scatter when light is shined on "the truth." (Because insults like this coming from  a site purporting to provide unbiased information about vaccines always inspires confidence in the site's usefulness.) Vaccine Exchange is just another site promoting an anti-vaccine agenda and using scary stories and misleading language to dupe new parents into buying into their stories. There's a lot of talk about "informed consent"--which has become shorthand for "antivax," because patients who choose to vaccinate their children are both informed (to the nth degree, actually) and have given their consent. You'll see stuff there about "Scientists Under Attack" and the fact that parents from West Virginia "have no right to decide what is injected into their children." If their overblown, meretricious prose doesn't tip you off, their poor web design might.


These are just a handful of the sites you might come across in a search on vaccines. Please take a look at the links on the right of this page for credible, science-based information on vaccines, as well as a few blogs from really smart people who do this infectious disease/immunology thing for a living. For a readable, accessible, but penetratingly intelligent--and accurate--account of the groups named above, please read "Yet Another Bad Day for the Anti-vax Movement in 2011" on the science blog Respectful Insolence.


I also want to point out one sad fact that I've had to come to grips with, and that is that the mothering.com board, for all its attachment parenting, breastfeeding, and "natural mama" support, is mostly an anti-vax board. You'll see a lot of links to books by anti-vaccine activists, and lots of justification for their reasons for not vaccinating. And once in a while you will see a valiant soul trying to coax them into using science. But I would warn any new parent away from this particular resource, as the rampant misinformation and scare tactics you see in the comments are not worth the trade-off for breastfeeding tips and lists of paraben-free baby products.