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Swine flu
Posted: 12 July 2009 08:14 AM   [ Ignore ]   [ # 61 ]
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Thanks Mac, I just have to vent once in a while to remain sane!!  confused

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Posted: 12 July 2009 01:46 PM   [ Ignore ]   [ # 62 ]
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A critical unknown is if there will be genetic rearrangement while the virus is circulating along with the southern hemisphere’s seasonal influenza.  The history of the 1918-19 pandemic was a smaller outbreak in spring, then the second (and worse) wave beginning in October, see here.

Thus far, there have not been large numbers of deaths among otherwise healthy young individuals, as was the initial fear with reports from Mexico.

Per the most recent CDC information:

During the 2008-09 season, influenza A (H1), A (H3), and B viruses have co-circulated in the United States. On April 15 and 17, 2009, CDC confirmed the first two cases of novel influenza A (H1N1) virus in the United States. As of July 10, 2009, 37,246 confirmed and probable infections with novel influenza A (H1N1) virus and 211 deaths (6 deaths in individuals 0-4 years, 34 deaths in individuals 5-24 years, 87 deaths in adults 25-49 years, 50 deaths in adults 50-64 years, 19 deaths in adults age 65 and older and 15 deaths with unknown age) have been identified by CDC and state and local public health departments.

These data are for all comers and do not distinguish between individuals with no underlying illness and those with significant chronic illness.

It appears, thus far, that the panic this spring was not warranted.  However, those of us in health care cannot be complacent.  As has already been noted, the simple measures(i.e. hand washing) along with immunization will be our most effective tools.

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Posted: 12 July 2009 02:25 PM   [ Ignore ]   [ # 63 ]
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Two interesting questions: 

If the virus does undergo a genetic rearrangement is, will those who were infected then recovered during this season be immune to the new version?

If they develop a vaccine for this season, will it protect against the possible second generation?

Occam

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Posted: 12 July 2009 02:36 PM   [ Ignore ]   [ # 64 ]
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Occam - 12 July 2009 02:25 PM

Two interesting questions: 

If the virus does undergo a genetic rearrangement is, will those who were infected then recovered during this season be immune to the new version?

If they develop a vaccine for this season, will it protect against the possible second generation?

Occam

It depends on how much it mutates.

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Posted: 12 July 2009 03:01 PM   [ Ignore ]   [ # 65 ]
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Occam - 12 July 2009 02:25 PM

If the virus does undergo a genetic rearrangement is, will those who were infected then recovered during this season be immune to the new version?

I imagine they would have some immunity. Recently I heard the government of Australia announcing that the swine flu is especially dangerous to the aboriginals. This probably means that the Europeans have at least some immunity which must be (I imagine) derived from a regular flu.

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Posted: 22 July 2009 06:35 PM   [ Ignore ]   [ # 66 ]
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I just read the following on CNN.com:

Older adults might have some immunity to the new H1N1 virus as a result of being exposed to similar flu viruses in the past.

And it made me think that perhaps all these years I have been getting flu shots could now work against me. I mean, if I have been exposed to fewer cases of flu as a result of the vaccines, my immunity against H1N1 may be weaker. No? (I hope I am wrong.  confused )

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Posted: 22 July 2009 07:02 PM   [ Ignore ]   [ # 67 ]
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Also, WHO announced 98,000 documented cases worldwide and 700 deaths. (BTW, they now stopped counting.) So that gives a mortality rate of almost 0.7%. In comparison, the mortality of a regular flu is 0.1%, the Spanish flu had mortality between 2 and 20%.

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Posted: 22 July 2009 07:24 PM   [ Ignore ]   [ # 68 ]
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George - 22 July 2009 06:35 PM

I just read the following on CNN.com:

Older adults might have some immunity to the new H1N1 virus as a result of being exposed to similar flu viruses in the past.

And it made me think that perhaps all these years I have been getting flu shots could now work against me. I mean, if I have been exposed to fewer cases of flu as a result of the vaccines, my immunity against H1N1 may be weaker. No? (I hope I am wrong.  confused )

Immunity through vaccination may wear off somewhat after a number of years which is why you get ‘boosters’. The advantage of the vaccination is that you don’t get some of the nasty problems you may get with the flu, such as death or an autoimmune hyperinflamatory response, which is what killed people in 1918, if they didn’t die from secondary infection or other flu complications. Every year when I was working in the PICU, we would admit children who were recovering from a ‘flu’ virus which attacked their hearts and they would require transplants. If a vaccination could prevent all of these problems, I will happily endure ‘jabs’ every year.

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Posted: 22 July 2009 07:31 PM   [ Ignore ]   [ # 69 ]
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So does a vaccination create similar amount of antibodies compared to the amount of antibodies an immune system would create if you actually get sick with the flu? (I hope the question makes sense…)

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Posted: 22 July 2009 08:49 PM   [ Ignore ]   [ # 70 ]
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George it really depends on the particular vaccine in question. In general live vaccines create higher antibody levels than killed vaccines but still not as high a level as you would get from a natural infection in most cases. In addition, natural infections sometimes generate more than one type of antibody

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Posted: 22 July 2009 10:08 PM   [ Ignore ]   [ # 71 ]
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macgyver - 22 July 2009 08:49 PM

George it really depends on the particular vaccine in question. In general live vaccines create higher antibody levels than killed vaccines but still not as high a level as you would get from a natural infection in most cases. In addition, natural infections sometimes generate more than one type of antibody

...but also, some infections will leave you open to some other infections that you would not otherwise get. I remember in the early 1980s we were getting cases of Hepatitis D (Delta Hepatitis) in IV drug users. We noticed that those who got the Hep D were only those who’d already had Hep B, and Hep D had an extremely high mortality rate. It arrived at the same time HIV infections were showing up in the IVDA (IV drug abusers) and gay populations. Previously, if you’d been exposed to Hep B, you would get a pooled gamma globulin from the blood of Hep B+ people, who were usually IVDA and this population was now coming down with AIDS in droves. No one wanted to get the treatment.

When I first started my nursing career, the doctors and nurses would exchange stories of how THEY had come down with Hep B, most of the nurses and doctors had been infected at some point and some died. The arrival of Delta Hepatitis put them at risk too.  In the late 1980s recombinant DNA Hep B vaccine came on the market. I received my vaccination that year. One of the nurses I worked with had previously tested negative to Hep B, when they tested her before her vaccination, her test came back positive, but not active. She did not recall being ill, but had obviously been infected recently, and did not know how. One hopes she did not infect anyone else (via sexual activity) during that time.

Often, it just isn’t worth getting the disease when there is the possibility of getting all of the other problems along with it. It is something I have seen far too often.
I’ll take my vaccines thank you!

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Posted: 22 July 2009 10:22 PM   [ Ignore ]   [ # 72 ]
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George,

Part of your question is really about whether the immunity you get from the vaccines is as likely to protect you as the immunity you would have gotten from getting the flu (assuming you survived it!). It’s hard to say for sure, but as Asanta points out, the vaccines provide sufficient immunity to protect a reasonable percentage of people exposed to the flu with FAR less risk than from natural infection. From a risk benefit perspective, then, you’re far better off getting vaccinated each year than not getting vaccinated so you can get the flu so that if a worse flu comes along later you might have some protection from that! grin

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Posted: 22 July 2009 10:49 PM   [ Ignore ]   [ # 73 ]
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The first time I got the flu vaccine was in October of 1999 against the influenza ‘A’ going around, it was a very nasty flu year and that winter our ICU stayed full of intubated and septic kids on drips, many nearly died. It was wiping out the staff and we were constantly working short (of MDs, RNs, RTs, you name it). On Dec 29th I caught it. I was soooo mad and soooo sick. I spent New Years Eve on the sofa drowsily watching all of the celebrations around the world of the ‘New Millennium’, feeling so lousy that if I’d had a gun, I would have been tempted to blow out my brains to get out of my misery. I had NEVER been that sick in my entire life! When I returned to work a week later, I was loudly complaining about the fact that I’d gotten the vaccination (I’m shot phobic -LOL) and STILL got the flu. The response was ” the vaccine worked, your flu was MILDER than everyone else, the people who DIDN’T get vaccinated were out for 6-8 WEEKS and some were hospitalized”. I received very little sympathy from my co-workers! I stopped complaining and became a firm believer. I’ve gotten the vaccine every year since. LOL
I caught the last swine flu that came around in the 1970s, but I will still get the vaccination—I’m not taking any chances!

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Posted: 23 July 2009 06:28 AM   [ Ignore ]   [ # 74 ]
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mckenzievmd - 22 July 2009 10:22 PM

From a risk benefit perspective, then, you’re far better off getting vaccinated each year than not getting vaccinated so you can get the flu so that if a worse flu comes along later you might have some protection from that! grin

In the tradition of Plato’s rules of dialogue ( grin ), I am going to repeat what you said here just to make sure that I understand it correctly:

I am better off getting a flu shot because that way I am guaranteed to get at least some antibody against a potentially more severe flu—even though the antibody may not be as strong as the one I would have gotten from a “natural” flu, according to macgyver—compared to not getting a flu shot and perhaps not getting infected with the flu resulting in getting no antibody at all. Is that correct?

[ Edited: 23 July 2009 06:35 AM by George ]
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Posted: 23 July 2009 11:43 AM   [ Ignore ]   [ # 75 ]
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George,

Very close. You’re better off getting the shot because you will get some antibodies that may protect you against future flu strains AND the risk from the shot is very low. If you didn’t get the shot and you actually did get the flu, you might get a stronger and broader immune response, but at the cost of much more risk of injury or death fro the infection than there would have been from the vaccine.

Because the flu strains out there change all the time, neither vaccination nor infection gurantees protection against the next strain to come along. The article you originally cited suggests that people with exposure to a few strains from a long time ago might have some protection because those strains had some similarities to the newest “swine flu” strain. But the same would be true if they had been vaccinated with a type of flu similar to the latest one, and the risk would have been lower, it’s juts that the vaccine wasnt around then so the only way to get antibodies was to get infected.

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