I've been exceptionally bored since signing up for this flu program (kidding - I caught it naturally like everyone else). I'm almost back on my feet, so while I have time at home during the school day, I thought I'd do some reading on this whole flu thing and the controversy over vaccines and collate some tid-bits.
PLEASE: I AM NO EXPERT ON ANY OF WHAT FOLLOWS. I SIMPLY GATHERED INTERESTING (TO ME) PIECES OF INFORMATION I FOUND AROUND DIFFERENT PLACES ON THE NET, WHICH ARE HYPERLINKED SO YOU CAN READ THEM YOURSELF. DO NOT MAKE ANY DECISION BASED ON THIS TEXT. IF IT INVOKES YOUR CURIOSITY TO READ FURTHER AND MAKE A MORE EDUCATED DECISION FOR YOU AND YOUR FAMILY, EXCELLENT.My recent flu (which a doctor told me was a classic case of H1N1, but it'll be 9 days before I find out for sure) put me on my back 3 hours after my first feeling of "something isn't right" and kept me there for 90 hours straight. I awoke soaked and frozen several times each night, shivering as I towelled-off and sought dry clothes. My eyes were too sore to watch television much and I even squinted a bit playing Sudoku on my daughter's DSi (can you get a faster speed than "train" speed, by the way? I bet there's airplane speed but I can't get there and it's driving me crazy). Today, I'm 7 pounds lighter, I have a bit of a chill left, some cough and the annoyance of a bronchial infection (though easily treated). But it's been nothing like the minority of cases that turn quite serious indeed.
1918. The story begins in 1918 when the Spanish Flu killed a half million Americans at a time when the US population was 103 million. 1918 is the only year on record the US Census Bureau shows a decrease in population. One person in 200 died of the flu. To put that in perspective, 1.5 Canadians per 200 died in 2008 of all causes combined. In retrospect, the USA got off easy compared to the global population, where estimates put deaths at 3% to 6%, or 50 to 100 million people. Even more frightening, the disease targeted the strongest individuals via a mechanism now called a Cytokine Storm, where your immune system enters a dangerous, positive-feedback loop of self-destruction. The stronger your immune system, the more serious your illness. We still have the actual virus from 1918 somewhere. Samples were harvested from frozen cadavers some years later for research, they rebuilt it and killed a few monkeys to prove it worked. Turns out it was (is) an extremely virulent sub-type H1N1 of Influenza A strain.
1918 was the final throes of WWI and this concurrent flu pandemic was not a coincidence. The pandemic flu of that year actually started as a mild version that spread as a normal seasonal flu, with normal impact. In normal circumstances, disease self-selects to spread milder strains because only mildly sick people move throughout the population to spread the bug. In WWI, massive numbers of strong, healthy men were fighting in close contact (and probably not in the most sanitary of conditions) and the mobility-while-ill situation was upside-down. If a soldier was mildly ill, he might stay put for a day or two to recover. But if a soldier was really sick with a nasty bug, they put him on crowded trucks with other sick soldiers and he was sent to crowded field hospitals and/or put on crowded trains and boats. A lot of effort was put in moving that sick person, carrying a virulent bug, through a great amount of contact. It was this combination of strong immune systems that had found their match (a bug that figured out how to trigger a Cytokine Storm) and the massive mobility brought by the circumstances of war that triggered a global pandemic. This pandemic killed multiples more people than the entire war (15 million people died in the war; the flu pandemic is estimated to have killed between 50 and 100 million people), certainly more than the entire present-day population of Canada.
These Cytokine Storms (the linked wiki text says that this term was only coined in 1993) are the suspected cause of death in SARS (2003) and the known mechanism in human fatalities of H5N1 Avian Flu. Official sites I've found say it's too early to know if this is the mechanism causing deaths in the 2009 H1N1 pandemic.
1976. In February, an army recruit in New Jersey felt tired and weak and died the next day. It was a new strain of swine flu, not far removed from the strain of 1918. When news of this got out, it caused widespread anxiety and the government (under Ford at the time) was pressured to do something quickly. By this time in history - after more than 50 years studying the first strain and vaccinating against many other seasonal flu varieties - vaccines were not new. A huge program was launched to immunize everyone in the USA. The program had its staunch critics and, soon after the immunizations began, two or three deaths were reported after vaccination. By the time evidence showed these deaths were not related to the vaccine, it was too late, and a major public relations controversy raged, fuelled by panicked fears of the flu and panicked fears of the vaccine. An increase in the incidence of Guillain-Barré Syndrome (GBS) began to be reported. The debilitating and sometimes fatal autoimmune disease developed in about 500 people believed as a result of the vaccination and 25 of them died. There are some critical reviews of those figures I found, some citing that no increase in incidence of GBS was reported in the Netherlands where 1.5 million people were vaccinated in the only other country to launch such a program, but lots of reputable sources I've found say that there is still a 1 in a million chance of triggering GBS in a healthy person with a flu vaccine.
The program was cancelled after somewhat more than 48 million Americans (22%) were vaccinated (the figures vary; other sites say 33%, but I've only seen the number stated as somewhere north of 48 million). But that was pure overkill in the most incredulous way: only 230 people ever got sick with the virus. The flu never spread. It didn't become an epidemic, a pandemic or anything other than a big mistake. There was one death in 230 confirmed cases and 25 deaths after 48 million unnecessary vaccinations.
2009. Fast forward to today. Estimates of numbers infected are coarse because not all suspected cases are getting confirmed and not everyone is seeking medical attention as symptoms can be mild. As of October 25, the World Health Organization (WHO) reports over 440,000 laboratory-confirmed cases of 2009 H1N1, including over 5,700 deaths, or one death per 77 laboratory-confirmed infections (note that there are many more infections than those confirmed in a lab, so the mortality rate of 1:77 is definitely off, but we don't know how far off it is... maybe it's even 10x off or more, and is more like a 1:1000 mortality rate.
Again, official sites say it's too early to know if Cytokine Storm is the mechanism causing deaths in the 2009 H1N1 pandemic. Because the population in general is not resistant to this strain, up to 35% of Canadians (about 12 million) is expected to contract this flu. One death in a thousand would be a death toll of 12,000 Canadians of a young and healthy demographic. Normally about 2,000 to 8,000 fall victim to the flu, though usually the flu exacerbates an existing, serious condition. There is no mention anywhere that the regular flu strains will be any more or less common or dangerous this year than any other.
1918 was the final throes of WWI and this concurrent flu pandemic was not a coincidence. The pandemic flu of that year actually started as a mild version that spread as a normal seasonal flu, with normal impact. In normal circumstances, disease self-selects to spread milder strains because only mildly sick people move throughout the population to spread the bug. In WWI, massive numbers of strong, healthy men were fighting in close contact (and probably not in the most sanitary of conditions) and the mobility-while-ill situation was upside-down. If a soldier was mildly ill, he might stay put for a day or two to recover. But if a soldier was really sick with a nasty bug, they put him on crowded trucks with other sick soldiers and he was sent to crowded field hospitals and/or put on crowded trains and boats. A lot of effort was put in moving that sick person, carrying a virulent bug, through a great amount of contact. It was this combination of strong immune systems that had found their match (a bug that figured out how to trigger a Cytokine Storm) and the massive mobility brought by the circumstances of war that triggered a global pandemic. This pandemic killed multiples more people than the entire war (15 million people died in the war; the flu pandemic is estimated to have killed between 50 and 100 million people), certainly more than the entire present-day population of Canada.These Cytokine Storms (the linked wiki text says that this term was only coined in 1993) are the suspected cause of death in SARS (2003) and the known mechanism in human fatalities of H5N1 Avian Flu. Official sites I've found say it's too early to know if this is the mechanism causing deaths in the 2009 H1N1 pandemic.
1976. In February, an army recruit in New Jersey felt tired and weak and died the next day. It was a new strain of swine flu, not far removed from the strain of 1918. When news of this got out, it caused widespread anxiety and the government (under Ford at the time) was pressured to do something quickly. By this time in history - after more than 50 years studying the first strain and vaccinating against many other seasonal flu varieties - vaccines were not new. A huge program was launched to immunize everyone in the USA. The program had its staunch critics and, soon after the immunizations began, two or three deaths were reported after vaccination. By the time evidence showed these deaths were not related to the vaccine, it was too late, and a major public relations controversy raged, fuelled by panicked fears of the flu and panicked fears of the vaccine. An increase in the incidence of Guillain-Barré Syndrome (GBS) began to be reported. The debilitating and sometimes fatal autoimmune disease developed in about 500 people believed as a result of the vaccination and 25 of them died. There are some critical reviews of those figures I found, some citing that no increase in incidence of GBS was reported in the Netherlands where 1.5 million people were vaccinated in the only other country to launch such a program, but lots of reputable sources I've found say that there is still a 1 in a million chance of triggering GBS in a healthy person with a flu vaccine.
The program was cancelled after somewhat more than 48 million Americans (22%) were vaccinated (the figures vary; other sites say 33%, but I've only seen the number stated as somewhere north of 48 million). But that was pure overkill in the most incredulous way: only 230 people ever got sick with the virus. The flu never spread. It didn't become an epidemic, a pandemic or anything other than a big mistake. There was one death in 230 confirmed cases and 25 deaths after 48 million unnecessary vaccinations.
2009. Fast forward to today. Estimates of numbers infected are coarse because not all suspected cases are getting confirmed and not everyone is seeking medical attention as symptoms can be mild. As of October 25, the World Health Organization (WHO) reports over 440,000 laboratory-confirmed cases of 2009 H1N1, including over 5,700 deaths, or one death per 77 laboratory-confirmed infections (note that there are many more infections than those confirmed in a lab, so the mortality rate of 1:77 is definitely off, but we don't know how far off it is... maybe it's even 10x off or more, and is more like a 1:1000 mortality rate.
Again, official sites say it's too early to know if Cytokine Storm is the mechanism causing deaths in the 2009 H1N1 pandemic. Because the population in general is not resistant to this strain, up to 35% of Canadians (about 12 million) is expected to contract this flu. One death in a thousand would be a death toll of 12,000 Canadians of a young and healthy demographic. Normally about 2,000 to 8,000 fall victim to the flu, though usually the flu exacerbates an existing, serious condition. There is no mention anywhere that the regular flu strains will be any more or less common or dangerous this year than any other.
Social Dilemma
Not everyone who gets vaccinated gets protection from the disease. Some people do not develop antibodies in response to some vaccines. Ethnicity is a factor, and there are others. Some people, for example those with a history of GBS, are at high risk from vaccination, and should not receive it. One of the most important effectiveness factors in protecting populations from pandemics is high immunization rates, even when the disease becomes rare. Diseases can quickly erupt as soon as vaccinations decline, as happened with Measles in the UK in 2000 and more recently in Nigeria (and its neighbouring countries) with Polio in recent years.
When we make a decision not to vaccinate ourselves or our children, we are making a decision to increase risk of the disease not just for ourselves, but for our community as a whole, regardless of the disease being vaccinated against. As the disease survives through unvaccinated hosts (instead of dying off in the face of a resistant population), it may change or strengthen enough to infect even vaccinated people.
Making vaccines mandatory is against our social code of free choice. Yet, it is a very interesting ethical dilemma because the decision you make directly impacts the risk profile of your community. Should this "second-hand" risk be treated like "second-hand" smoke? What about the decision to smoke in your vehicle with your newborn? Will someday our collective comfort with vaccines and their efficacy in our increasingly crowded world manifest into a "you're-too-undependable-to-have-that-choice" law like the "no-smoking-in-the-car-with-kids" law?
What Else...
In the WHO's monitoring programs there have been no reports of adverse affects from the vaccines developed yet.
There is no data to support claims in America that vaccinations caused autism in children. Due to public pressure there's been scrutiny, and nothing has been shown to link the two. The controversy was set-of by an author in Britain who was proven to be fraudulent. Wiki has the story.
Adjuvant vaccines have a component to increase the response of the body to the vaccine to increase effectiveness. There's controversy about them because of some legal and public relations screw-up in the USA (shocker!). There's lots of info on the web if you want to read that story.
Preservatives (from Wiki): "Many vaccines need preservatives to prevent serious adverse effects such as the Staphylococcus infection that, in one 1928 incident, killed 12 of 21 children inoculated with a diphtheria vaccine that lacked a preservative. Several preservatives are available, including thiomersal, phenoxyethanol, and formaldehyde. Thiomersal is more effective against bacteria, has better shelf life, and improves vaccine stability, potency, and safety, but in the U.S., the European Union, and a few other affluent countries, it is no longer used as a preservative in childhood vaccines, as a precautionary measure due to its mercury content. Although controversial claims have been made that thiomersal contributes to autism, no convincing scientific evidence supports these claims."
More interesting reading
There is no data to support claims in America that vaccinations caused autism in children. Due to public pressure there's been scrutiny, and nothing has been shown to link the two. The controversy was set-of by an author in Britain who was proven to be fraudulent. Wiki has the story.
Adjuvant vaccines have a component to increase the response of the body to the vaccine to increase effectiveness. There's controversy about them because of some legal and public relations screw-up in the USA (shocker!). There's lots of info on the web if you want to read that story.
Preservatives (from Wiki): "Many vaccines need preservatives to prevent serious adverse effects such as the Staphylococcus infection that, in one 1928 incident, killed 12 of 21 children inoculated with a diphtheria vaccine that lacked a preservative. Several preservatives are available, including thiomersal, phenoxyethanol, and formaldehyde. Thiomersal is more effective against bacteria, has better shelf life, and improves vaccine stability, potency, and safety, but in the U.S., the European Union, and a few other affluent countries, it is no longer used as a preservative in childhood vaccines, as a precautionary measure due to its mercury content. Although controversial claims have been made that thiomersal contributes to autism, no convincing scientific evidence supports these claims."
More interesting reading
There are many recent cases in the world where public sentiment tilted away from vaccination, only to have disease outbreaks, deaths, and a reuptake of vaccinations.
I found this map at the WHO surprising. Apparently we're in the middle of this thing.
http://gamapserver.who.int/h1n1/geographic-spread/h1n1_geographic-spread.html
Between 2,000 and 8,000 Canadians die of seasonal flu each year (from whatever the complications). The WHO (World Health Organization) asked countries to ensure they completed the manufacturing of the regular flu strain vaccines first, before starting to make the H1N1 vaccines. Canada followed that guidance.
I found this map at the WHO surprising. Apparently we're in the middle of this thing.
http://gamapserver.who.int/h1n1/geographic-spread/h1n1_geographic-spread.html
Between 2,000 and 8,000 Canadians die of seasonal flu each year (from whatever the complications). The WHO (World Health Organization) asked countries to ensure they completed the manufacturing of the regular flu strain vaccines first, before starting to make the H1N1 vaccines. Canada followed that guidance.
"How long does the virus live outside of the body?
The H1N1 Flu Virus can live outside the body on hard surfaces, such as stainless steel and plastic, for up to 48 hours and on soft surfaces, such as cloth, paper, and tissues for less than 8-12 hours; however, it can only infect a person for up to 2-8 hours after being deposited on hard surfaces, and for up to a few minutes after being deposited on soft surfaces." So, your local barista could hand you the virus right along with your tazo chai. Or more likely, any one of fifteen customers before you could have left it for you on the counter or that stack of lids.
Links
Canada Health Agency H1N1
Canada Health Agency "FluWatch"
Canada's Product Information Leaflet for our H1N1 Vaccine
World Health Organization (WHO) H1N1
Wikipedia on Vaccines
Wiki on Vaccine Controversy
Guillain-Barré Syndrome
Fact Sheet (US Nat'l Institute of Neurological Disorders and Stroke)
Interesting press article on Guillain-Barré syndrome and 1976 (written May 2009)
Canada Health Agency "FluWatch"
Canada's Product Information Leaflet for our H1N1 Vaccine
World Health Organization (WHO) H1N1
Wikipedia on Vaccines
Wiki on Vaccine Controversy
Guillain-Barré Syndrome
Fact Sheet (US Nat'l Institute of Neurological Disorders and Stroke)
Interesting press article on Guillain-Barré syndrome and 1976 (written May 2009)
