Influenza, or the “flu,” is the result of a viral infection that affects the respiratory system. It is caused by viruses in the family Orthomyxoviridae, which have single-stranded RNA genomes. Flu viruses can cause fever, aches, muscle fatigue, congestion, coughing, and sore throat. The flu is usually significantly worse than the common cold and often comes on very quickly. Most people can fight off the infection on their own with no residual side effects. However, there is no “cure,” and it can be fatal, especially for those who are more vulnerable: the immunocompromised, young children, the elderly, and people with chronic diseases, who are more susceptible to secondary illnesses like pneumonia. Despite the fact that most infected people do not die from the flu, the high number of cases alone results in a significant number of deaths. According to the CDC, influenza has caused 9,000,000 – 45,000,000 illnesses and 12,000 – 61,000 deaths annually in the U.S. since 2010 (these are not range estimates, but the highest and lowest estimates from individual years, the lowest being from the 2011-12 season, and the highest from 2017-18).

There is a vaccine for the flu, but it changes every year due to the antigenic drift that occurs in flu viruses. The RNA genomes of these viruses and their use of RNA-dependent RNA polymerases (RDRPs) to replicate their genomes leads to a high mutation rate. RDRPs are very error-prone and do not have the proofreading abilities of DNA polymerases. This regular antigenic drift means that we can’t just vaccinate a couple times against flu and be done with it, like we can with other viruses such as chickenpox.

Twice a year, influenza experts meet at the World Health Organization (WHO) to predict the dominant strains of the next year using all of the data collected in the past year by health care providers. Strain selection for the Northern Hemisphere occurs in late February, and strain selection for the Southern Hemisphere occurs in late September (the winter season in the Southern Hemisphere is during the Northern summer months). After selection, it then takes about six to nine months to develop and produce the vaccine for the upcoming flu season. The flu vaccine is designed to protect against the 3-4 most dominant strains of flu virus that were predicted earlier in the year.

The flu shot is not 100% effective. In years when the vaccine is well matched to the viruses present during flu season, it reduces flu illness by between 40% to 60% among the overall population. It can be even lower in years when the vaccine is not well matched, such as in 2014-2015, when the U.S. Flu Vaccine Effectiveness (VE) Network estimated the VE to be only 19%. However, getting the flu shot is still always a good idea. Studies have shown that even when vaccinated people get the flu, they are more likely to have less severe illness — which means mitigated symptoms, reduced hospitalization, and fewer deaths.

People should not avoid getting flu shots for reasons like: “Well I got the flu shot before and it gave me the flu.” Flu vaccines cannot give people the flu, because they only contain inactive (killed) viruses or a protein-coding gene that will stimulate an immune response without the infection. If someone gets flu-like symptoms after vaccination, it is likely because of a similar viral infection (read: common cold). It could also be due to a strain of the flu that the vaccine does not match well, an infection with the flu that occurred before the vaccination could take effect, or the vaccine did not work (for reasons other than a poor match). It would not be because the vaccine itself gave someone the flu.

In addition to getting the flu shot each year, people can also reduce the spread of the flu by washing their hands regularly, containing coughs and sneezes, avoiding sick people, not touching their eyes, mouth, and nose, and reducing time spent in crowded areas. There are also antiviral treatments for the flu, but they can only reduce symptoms and are most effective when given early in the infection.

The 2019-2020 Northern Hemisphere version of the flu vaccine includes (Influenza) A(H1N1) and A(H3N2) vaccine components, and (Influenza) B/Victoria and B/Yamagata vaccine components. The four strains used were predicted to be the most dominant in spring 2019. In September 2019, the strain selections were being made for the Southern Hemisphere’s 2020 flu season, and it was concluded that “the H3N2 and B/Victoria viruses needed to be updated because the ones used in the Northern Hemisphere vaccine didn’t match the strains of those viruses that are now dominant.”

The CDC has not yet calculated the vaccine effectiveness (VE) for this year, because it is still too early to give an accurate number. However, the CDC has performed antigenic characterization (analysis of the viral antigens, which are the surface molecules needed for the immune system to recognize and respond to the infection) of 241 influenza viruses collected from health laboratories in the U.S. from September 29, 2019 to February 1, 2020. This is used to compare the most recent influenza strains to the reference strains used to develop the flu vaccines, and the results support the concerns stated back in September. The A(H1N1) and B/Yamagata reference viruses (vaccine components) were a match (antigenically similar) to 100% of the viruses that were characterized into their respective subtype/lineage. The A(H3N2) component only matched 43.5% of the collected A(H3N2) viruses, and the B/Victoria component only matched 60.2% of the collected B/Victoria viruses.

Despite the mismatch between some of the 2019-20 vaccine components and the flu virus population, the vaccine has been fairly effective, and there has not been an abnormal increase in illness, hospitalization, or death rates this year. The CDC estimates that from October 1, 2019 to February 1, 2019, there have been about 22,000,000 – 31,000,000 illnesses and 12,000 – 30,000 deaths in the U.S. due to the flu. So far, this is on par with the past 10 years (low of 9,000,000 illnesses and 12,000 deaths in 2011-2012, and high of 45,000,000 illnesses and 61,000 deaths in 2017-2018). The rate of influenza-associated hospitalizations is also similar to previous years with a current cumulative rate of 35.5 per 100,000.

What is interesting about the flu is that everyone generally knows what it is, yet the vaccination rate for the annual flu shot is not impressively high. According to the Census Bureau, there are approximately 330,000,000 people in the U.S. Yet only 173,000,000 flu vaccines have been administered this flu season. Even assuming that each vaccine correlates with one person, that is still only about half of the population. Maybe there is not as much awareness about the potential complications of contracting the flu. Or people know the risks, but take the “it won’t happen to me” approach — no different than those who drink and drive, smoke cigarettes, or allow themselves to gain an extra hundred pounds. Maybe people aren’t convinced by the personal cost-benefit analysis: “I could inconvenience myself (ugh) to do something I don’t like (see a doctor, get a needle stuck in my arm) to maybe get a 50% improvement in my odds of not getting sick. Eh, pass.” Still others don’t “believe” in vaccines. The flu vaccine is too widely available for inaccessibility or inconvenience to be a legitimate widespread excuse. Flu-related deaths are a part of the status quo, just like car accident fatalities. The media certainly doesn’t talk much about it. Unless there is a wild new viral strain (such as the H1N1 pandemic of 2009), few are bothered by the fact that tens of thousands of people die each year in the U.S. due to the flu (and far more worldwide). And much like fatalities due to car accidents, many of these deaths are preventable.

At first glance, many people would not know who Andrew Wakefield is, but they have probably heard of the scandal tied to his name. Andrew Wakefield is the former British physician who, with 12 other authors, published the infamous 1998 study in The Lancet that associated the MMR (measles, mumps, and rubella) vaccine with autism and gastrointestinal issues. This study, which has long been discredited, is partially responsible for the reduced vaccination rates and the increased prevalence of preventable diseases in the past two decades. Despite an overwhelming amount of scientific research that has shown no causation between vaccines and autism, Wakefield’s study did significant damage to the public’s trust in vaccines that still continues to this day. And although early critics quickly pointed out obvious shortcomings of the paper — such as the low sample number, lack of controls, and reliance on parental recall — it took much longer for the scientific community to discover the full depth of the fraud in Wakefield’s work.

Wakefield’s study was not a controlled experiment, but a study of 12 children who were, according to Wakefield, “referred to a paediatric gastroenterology unit with a history of normal development followed by loss of acquired skills, including language, together with diarrhoea and abdominal pain” (637). There is no mention of how the 12 children were chosen beyond this description. According to investigative journalist Brian Deer, the children were recruited to Wakefield’s study directly or indirectly through anti-MMR groups such as JABS (Justice, Awareness, and Basic Support) (Fixed 78). In addition, a significant amount of the data was manipulated. For example, several children were reported to have symptoms within days of the MMR vaccine, but medical records contradicted these claims. Also, the paper claims that all 12 children were previously “normal,” but some had documented pre-existing conditions (Fixed 79). Clearly Wakefield cherry-picked or altered data. He ignored relevant medical histories, and likely depended on the (influenced?) testimonies of parents who are already biased by their anti-vaccine sentiments. As we will see, several parents were also litigants in law suits against vaccine-producing companies and have a vested interest in establishing a strong connection between the MMR vaccine and autism in this “scientific study.”

Deer also found significant conflicts of interest that Wakefield failed to make public. In 1996, a JABS lawyer named Richard Barr retained Wakefield to assist in a legal suit against MMR vaccine manufacturers, and therefore partially funded his research (Money 137). Many of the children in Wakefield’s study were litigants in this same suit (Money 138). In 1997, Wakefield filed for a patent on a “safer” single measles vaccine, also not disclosed (Money 140). After his paper is published in 1998, Wakefield urged the use of single vaccines instead of the 3-in-1 MMR vaccine at a press conference (Money 139). He also established a company intended to test patients for “autistic enterocolitis,” which would initially market to litigants in suits against MMR vaccine manufacturers (Money 140). So not only was Wakefield paid by the legal team of the plaintiffs against MMR vaccine manufacturers, but he had even more self-interest in the results of his study due to his own investments to sell “safer” alternatives to the traditional MMR vaccine. When combined with the extent of dishonesty found in his study, it is clear that Wakefield manipulated his study in his own self-interest, and there was never a legitimate basis for his claims about vaccines and autism.

It is disappointing that it took 12 years to completely redact this study, and almost worse that it was allowed to publish in the first place. Even when disregarding the severe conflicts of interest and fudged data, the study itself is rather weak. There is no control, and the very small sample prevents the data from being statistically significant. The data was also collected in a sloppy fashion, with such a strong dependence on parental recall. This strongly reminds me of witness testimony, which we know now to be one of the worst kinds of evidence in court due to the unreliability of human memory.

Measles, mumps, rubella, and varicella have all been drastically reduced by the introduction of vaccines, but are still common in many developing countries. Before the introduction and use of the measles vaccine, there were about 2.6 million deaths per year from measles alone. There were still 140,000 measles-related deaths in 2018, but that is significantly less than before. Measles is no longer endemic in the United States and many other countries. The U.S. was considered “measles-free” in 2000, and all of the Americas were declared free of endemic measles in 2016. However, there are still outbreaks in these countries, usually due to travel from out of the country, and where it then spreads to unvaccinated people in the population.

It is unlikely that there will never be “anti-vaxxers,” because it is difficult to “un-ring the bell,” so to speak. Once an idea has been put out and proliferated by the media, it has gained enough momentum to reach an audience that will be hard to dissuade. Even once told “Oh never mind, that was incorrect,” it may always be a “what if?” in the back of people’s minds. After all, how could something so wrong get so much traction? And still others will simply jump on the bandwagon of conspiracy out of distrust of “Big Government” and “Big Pharma,” regardless of the underlying science. Others claim religious reasons. This is very frustrating because unvaccinated people put others at risk, including young children and the immunocompromised. No one’s choices exist in a vacuum, and they can irreversibly affect other people. Hopefully, with the spread of vaccines to more developing areas and other countries, which generally do not have the same anti-vaccine population, we can continue to reduce the effects of these diseases worldwide.

https://www.buzzfeed.com/daves4/anti-vax-memes

My name is Evelyn Williams and I am writing this blog in class to make sure that I know how to hyperlink in Sakai. I was born in San Diego, California, but I am from Franklin, TN. I am a biology major at UNC. I am taking this class because I am interested in epidemiology and the importance of modern medicine in treating pathogen-related diseases. Hopefully this class will be fun.

In class practice.

Be yourself; Everyone else is already taken.

— Oscar Wilde.

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