Now is the time for your 2013 – 2014 flu vaccine

The 2013- 2014 flu season is here for the Northern Hemisphere. Los Angeles has reported it’s first flu case early September (Click here). New York city residents are surprised that flu season has already arrived and reaching people before their scheduled flu vaccination date. The first Los Angeles case is an H1N1 which is in this year’s flu vaccine combination to protect those vaccinated this season. The New York city strain has yet to be reported.  Fortunately, the flu vaccine of 2013 – 2014 has either three flu strains (trivalent) or the newly introduced four flu strains (quadrivalent) described more in detail below.  If you live in the Northern Hemisphere, you might want to begin flu vaccination plans much earlier this flu season, since the flu has already arrived atleast in two major USA cities and it is only early September. However, in Australia and countries of the Southern Hemisphere, the peak of the 2012 – 2013 flu season is expected to have just ended in August 2013, since the seasons are opposite.

This is what the flu virus looks like

Why should you take the flu vaccine?
The reason one has to take the vaccine every year is because the vaccine only provides immunity for about a year. Unlike the natural infection which gives you lifetime immunity, a flu vaccine does not. Even if in certain years the vaccine flu strain composition is exactly the same as in the previous year. The individual is  advised to take the flu vaccine annually. The answer is explained in detail in this previous article.

However, do take your doctor’s advice before vaccination. Certain flu vaccines are not recommended for all ages. For example, CDC recommends that one brand of inactivated flu vaccine called Affluria, should not be given to children 8 years of age or younger. A related vaccine was related with fever and fever – related seizures in young children in Australia. More about side effects below.  Young children who get inactivated flu vaccine and pneumococcal vaccine (PCV13) at the same time may be at increased risk for seizures caused by fever. Ask your doctor for more information. Tell your doctor if a child who is getting flu vaccine has ever had a seizure.addition,

Egg and/or latex allergy?
What if you have an egg and/or latex allergy? Consult your doctor. The answer is in this previous article.  However, there is a major update for individuals with egg allergy waiting to be vaccinated – Flublok.  In 2013, FDA has approved Flublok, for 18-49 year old, which is not developed in eggs but in insects. Hence, Flublok may be suitable for adults (but not children, teens and seniors) with egg and/or latex allergy.  Traditionally, the flu vaccine has been developed in eggs.  To learn more you may read a previous article, “Tracking the history of the development of the flu vaccine”, by clicking here.  The ability to develop the flu vaccine in insects instead of eggs is heralded as a boon to egg allergic individuals.  However, since it has been newly introduced in 2013, it remains to be clinically tested in individuals other than adults and hence, is not yet FDA approved in children, teens and seniors, since their immune system is different than a typical healthy adult.

Please, discuss with your doctor.  It is highly recommended to take the flu vaccine to avoid hospitalization and other secondary complications from a flu infection.  It is highly contagious.  Certain age groups are more susceptible than others.  The Centers of Disease Control of USA reports a total of 12,343 hospitalizations that occurred from October 1, 2012 through April 30, 2013, which translates to a cumulative rate of 44.3 influenza-associated hospitalizations per 100,000 people in the United States. The total number of influenza-associated pediatric deaths reported to CDC for 2012-2013 was 146 in USA. While the vast majority of the tested virus samples (>99%) showed susceptibility to the antiviral drugs oseltamivir and zanamivir, some varieties showed resistance. Watch an animated video of how the flu virus enters, and multiplies inside the human body.

Why do I feel fatigued after my flu vaccine?
The vaccine composition is changed every year. The WHO meets twice a year to discuss the varieties of flu strains causing flu infections and hopes to include the most “popular” strains in the flu vaccine composition (see below for for the 2013-2014 composition). However, the vaccine can accomodate a maximum of three to four flu strains. There might be a new flu strain that emerges later in the year. There might be a fifth or sixth flu strain also causing infections. The flu vaccine assists an individual in easing the “suffering from symptom” period. Therefore, a person who has the vaccine can still get the flu from a flu strain not included in the vaccine but the symptoms will be weaker. This is because the flu strains differ from each other very slightly and most of their characteristic proteins are included in the vaccine, hence “teaching” the body’s immune system to be ready to fight the flu infection.

There can be a slight fever and other side effects (see below) after the flu vaccine.  The symptoms would start right away and last 2 to 3 days. This might happen if the flu vaccine composition includes one or more flu strains that were not included in the previous year’s vaccine composition. If the individual has never been exposed to 1 or more of the flu strains in the vaccine, the immune system might react with symptoms like the flu. It is the immune system getting ready. The individual does not get flu from the inactivated flu vaccine and the live flu vaccine is too weakened to cause the flu. You may also read “Why am I feeling fatigued after taking the flu vaccine?”

The New Quadrivalent Flu Vaccine: Until recently, the vaccine compositions have only had three different kinds (trivalent) of circulating flu varieties. This year, the vaccine choices include those with four different kinds (quadrivalent) of circulating flu varieties, approved by the WHO (see quote below). Do be aware of your vaccine choices in 2013 to 2014 – trivalent or quadrivalent and discuss with your care provider. The FDA approved companies in 2013 manufacturing the new quadrivalent flu vaccine are:

1) GlaxoSmithKline – Fluarix
2) AstraZeneca – MedImmune
3) Sanofi Aventis – Fluzone approved in June 2013 for children 6 months or older, adolescents and adults.

One method of delivery of Flu Vaccine

One method of delivery of flu vaccine

The 2013-2014 Influenza/Flu virus compostion
The compostion of the 2013 – 2014 trivalent and quadrivalent flu vaccine for the Northern Hemisphere:

The World Health Organization has met in Geneva Switzerland in February 2013 to decide upon the composition of the Influenza or flu vaccine composition of the upcoming 2013-2014 flu season. Read more.

Influenza/flu vaccine Adverse Effects

The CDC site has the following safety information. In addition to including three to four different flu varieties in the vaccine composition (trivalent or quadrivalent), the flu vaccine may be either inactivated or live. If inactivated, it can never cause the flu because it does not contain a live virus. However, inactivated flu vaccine could be associated with Guillain-Barré Syndrome (GBS), no more than 1 or 2 cases per million people. If the flu vaccine is live, it is made from a weakened virus and does not cause flu. Both may cause allergic reactions in less than one in million doses. Quote
Influenza (inactivated) vaccine side-effects
What are the risks from inactivated influenza vaccine?

With a vaccine, like any medicine, there is a chance of side effects. These are usually mild and go away on their own.

Serious side effects are also possible, but are very rare. Inactivated flu vaccine does not contain live flu virus, so getting flu from this vaccine is not possible.

Brief fainting spells and related symptoms (such as jerking movements) can happen after any medical procedure, including vaccination. Sitting or lying down for about 15 minutes after a vaccination can help prevent fainting and injuries caused by falls. Tell your doctor if you feel dizzy or light-headed, or have vision changes or ringing in the ears.

Mild Problems

soreness, redness, or swelling where the shot was given
hoarseness; sore, red or itchy eyes; cough
fever
aches
headache
itching
fatigue
If these problems occur, they usually begin soon after the shot and last 1 or 2 days.

Moderate Problems

Young children who get inactivated flu vaccine and pneumococcal vaccine (PCV13) at the same time may be at increased risk for seizures caused by fever. Ask your doctor for more information. Tell your doctor if a child who is getting flu vaccine has ever had a seizure.

Severe Problems

A severe allergic reaction could occur after any vaccine (estimated less than 1 in a million doses).
There is a small possibility that inactivated flu vaccine could be associated with Guillain-Barré Syndrome (GBS), no more than 1 or 2 cases per million people vaccinated. This is much lower than the risk of severe complications from flu, which can be prevented by flu vaccine.
The safety of vaccines is always being monitored. For more information, visit: Vaccine Safety Monitoring and Vaccine Safety Activities.

One brand of inactivated flu vaccine, called Afluria, should not be given to children 8 years of age or younger, except in special circumstances. A related vaccine was associated with fevers and fever-related seizures in young children in Australia. Your doctor can give you more information.

This information was taken directly from the Inactivated Influenza VIS
(This information taken from Inactivated Influenza VIS dated 7/26/2013. If the actual VIS is more recent than this date, the information on this page needs to be updated.)

Influenza (live) vaccine side-effects
What are the risks from LAIV?

With a vaccine, like any medicine, there is a chance of side effects. These are usually mild and go away on their own.

Serious side effects are also possible, but are very rare. LAIV is made from weakened virus and does not cause flu.

Mild Problems
Some children and adolescents 2-17 years of age have reported:

runny nose, nasal congestion or cough
fever
headache and muscle aches
wheezing
abdominal pain or occasional vomiting or diarrhea
Some adults 18-49 years of age have reported:

runny nose or nasal congestion
sore throat
cough, chills, tiredness/weakness
headache
Severe Problems

A severe allergic reaction could occur after any vaccine (estimated less than 1 in a million doses).

The safety of vaccines is always being monitored. For more information, visit: Vaccine Safety Monitoring and Vaccine Safety Activities.

This information was taken directly from the LAIV VIS
(This information taken from Live Influenza VIS dated 7/2/12. If the actual VIS is more recent than this date, the information on this page needs to be updated.)

 

The WHO headquarters in Geneva, Switzerland

A meeting in action at the WHO headquarters in Geneva, Switzerland

World Health Organization (WHO) headquartered in Geneva, Switzerland recommends the flu vaccine composition each year for the Northern Hemisphere and the Southern Hemisphere.

Related Article:
Review by Anne Sealey: A Cruel Wind: Pandemic Flu in America, 1918-1920; Author Dorothy A. Pettit and Janice Bailie (Timberlane Books, 2008): The book has an excellent chapter on the biological detail of the flu virus, a historical narrative of the 1918 pandemic, and an intimate portrait of political life and social environment during the pandemic. It includes plenty of charts for statistical support.

The world’s top influenza (Flu) research laboratories decided to institute a self-imposed moratorium

Should research work that attempts to make the H5N1 virus more potent, virulent, dangerous and transmissible under laboratory conditions be allowed? A meeting will be held in New York in July that will discuss whether the voluntary ban should be lifted.

The controversy over influenza risky levels of research ban and non-publication issues began over research by Netherlands researchers. They took an influenza (flu) virus that previously could only infect birds. They selected mutations from Influenza (Flu) viruses that had caused human pandemics with millions of deaths in 1918, and other years. They combined these mutations with the bird (avian) flu virus and passed it through ferrets. The reason they passed it through ferrets was that these animals most closely resemble how a person behaves when they are sick with the flu – the ferrets sneeze. The flu virus changed a little bit with each passage helped by the scientist to pass it from one sick ferret to a healthy ferret. In the first passage the scientist had to help or assist the mutant bird virus to infect the ferret by actually introducing it into the ferret. It could not “fly” through the air when the infected ferret sneezed to infect a healthy ferret in the vicinity. However, by the fifth passage onwards, this bird flu virus had mutated or picked up the ability to infect a healthy ferret by “flying” through the air in a sneeze pellet released by a sick ferret. The Dutch scientists could show how a new dangerous flu virus could emerge to cause a pandemic in people by existing previously in birds only, but by picking up mutations in flu virus infecting other animals or people and becoming able to “fly” in the air and infect a population. The scientists feel that knowing this ability will help them arm in advance and better equip governments to prepare in advance for the next pandemic. None of the ferrets died from this infection, a result of genetic engineering and multiple ferret transmission.

This research, by Ron Fouchier, PhD, of Erasmus Medical Center in the Netherlands and colleagues, was announced in a meeting of scientists and along with other researchers announcing their research on similar topics. Click here to read the reaction of the other researchers and policy makers present. Derek Smith, of the University of Cambridge, coauthored the second science paper, on June 21, 2012 gave a press release saying that such a pandemic event was in the realm of reality. Yoshihiro Kawaoka at the University of Wisconsin–Madison, published online by Nature discovered how the flu virus recognizes and stabilizes on a host cell through a protein during an influenza attack process. (Every human being is made up of several cells, as are all living things like birds, ferrets and plants; just in case you did not have a biology class in school. Also, a virus is not a bacterium. Only bacterial diseases can be cured by antibiotics. Viral diseases cannot be fought or cured by antibiotics).

The Dutch people were pondering on not allowing publication of research that might be dangerous in the hands of the wrong scientist, who might want to hurt all people. This view was contested by other scientists, including Nobel prize winner and head of the National Institute of Health, USA, who believe that the Dutch scientists research and similar research by University of Wisconsin scientists should be published in full. Click here to read what proposals made the Dutch Government reconsider their decision on banning this pubication of a bird flu study.

So, the question here is:
Is it better to be knowleadgeable and thus prearmed and prepared for the pandemic war that could possibly arise in the near future given the three deadly pandemics since the first one in 1918 last century?
Or,
is it better to just wait and see what hits the public with a severe health blow to millions of people (about 50 million are estimated to have died in 1918) and then figure out what flu combination is causing the pandemic and look for scientists available to find a vaccine to prevent further spread?
You may contact via email: r.fouchier@erasmusmc.nl This group did show that …”The transmissible viruses were sensitive to the antiviral drug oseltamivir”….

Related Articles about the controversial flu virus current research
Bird flu study published after terrorism debate ….could start a deadly pandemic among humans. These initial findings were presented last September in Malta at the European Scientific Working group on Influenza meeting to an auditorium packed with fellow scientists and policy makers…
Fouchier anticipates resuming H5N1 studies soon….said the voluntary 60-day moratorium on lab-modified H5N1 viruses expired Mar 20 and added that researchers are waiting for national governments to release their lab biosecurity assessments. These assessments were a component of a plan stemming from a World Health Organization (WHO) meeting of technical experts in February.

Fouchier made his comments during a live episode of virologist Vincent Racaniello’s “This Week in Virology” (TWiV), which was broadcast via webcast from the Society for General Microbiology conference in Dublin, Ireland. Racaniello, a virologist at Columbia University, authors Virology Blog and hosts the weekly virology podcast series.

Fouchier’s group at Erasmus and a University of Wisconsin team led by Yoshihiro Kawaoka, DVM, PhD, conducted experiments that involved engineering an H5N1 virus and an H1N1-H5N1 hybrid, respectively, that were transmissible in ferrets via airborne droplets.

The studies have been accepted for publication in Science and Nature, but advisors to the US government in December recommended against publishing the full details of the studies, due to bioterrorism concerns….
Debate Persists Over Publishing Bird Flu Studies – you may click to hear a NPR discussion on this subject by biosecurity expert D.A. Henderson on the risks of publishing the research.
N.Y. Times: H5N1 ferret research should not have been done – by virology blog shows the New York Times editorial on 8 January 2012, entitled ‘An Engineered Doomsday’.
Mutant-flu paper published: Controversial study shows how dangerous forms of avian influenza could evolve in the wild. By Ed Yong on 02 May 2012 in Nature.com …Kawaoka found that the hybrid virus could spread between ferrets in separate cages after acquiring just four mutations. Three of these allow the HA protein to stick to receptor molecules on mammalian cells, and the fourth stabilizes the protein. “Before we initiated this experiment, we knew that receptor specificity is important,” says Kawaoka. “We didn’t know what else was needed.”…

Related Articles: The Controversial Flu virus papers being discussed above
1. Airborne Transmission of Influenza A/H5N1 Virus Between Ferrets in Science 22 June 2012: Vol. 336 no. 6088 pp. 1534-1541
by Sander Herfst and colleagues – A report. (…..The genetically modified A/H5N1 virus acquired mutations during passage in ferrets, ultimately becoming airborne transmissible in ferrets. None of the recipient ferrets died after airborne infection with the mutant A/H5N1 viruses. Four amino acid substitutions in the host receptor-binding protein hemagglutinin, and one in the polymerase complex protein basic polymerase 2, were consistently present in airborne-transmitted viruses. ……)
2. Pathogenesis and Transmission of Swine-Origin 2009 A(H1N1) Influenza Virus in Ferrets / http://www.sciencexpress.org / 2 July 2009 / Page 1 / 10.1126/science.1177127
3. Severity of Pneumonia Due to New H1N1 Influenza Virus in Ferrets Is Intermediate between That Due to Seasonal H1N1 Virus and Highly Pathogenic Avian Influenza H5N1 Virus. J Infect Dis. (2010) 201 (7): 993-999. doi: 10.1086/651132

Related Articles about the history of the Flu virus and vaccine development
History of the 1918 pandemic and the search for a vaccine
Should I get a flu vaccine this year?
Why am I feeling fatigued after getting the flu vaccine?

65th World Health Assembly in Geneva: Mental Health and Vaccinations Resolutions 2012

From May 21-26, 2012, the 65th World Health Assembly met in Geneva, Switzerland, to resolve how to improve world public health. They re-elected Dr. Margaret Chan for a second five year term as Director General of WHO, World Health Organization. Mental Health, vaccinations, maternal and child nutrition and financing for implementing resolutions and several other public health issues were discussed over plenary sessions. You may click here for details of sessions and resolutions. We shall update you here as the financing decisions of the resolutions are announced. Hopefully, we shall update you after the meeting in Rio coming up.

Re-election of Dr. Margaret Chan for second five year term as Director General of WHO

Professor Thérèse N’Dri-Yoman, President of the Sixty-fifth World Health Assembly, addresses the delegates at the plenary session.

Notes: Saturday, 26 May 2012

Financing research and development

The Health Assembly unanimously adopted the resolution on the Consultative Expert Working Group on Research and Development: Financing and Coordination in the form presented as draft by the drafting group and circulated yesterday.
To continue reading resolutions for each day from May 21-26, 2012, click here.

World Health Assembly forum 2012