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DEBUNKED: ABC News | Flu shot more likely to save your life than not getting it, says influenza researcher, 08 August 2019

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Original article: https://www.abc.net.au/news/2019-08-08/doctors-urge-people-get-flu-shot-after-toowoomba-mother-death/11394414

On 8 August 2019, journalist Melanie Vujkovic wrote an article quoting Professor Paul Van Buynder, who talked about the incidence and effectiveness of this year’s flu vaccine in Australia. Here’s our point-by-point rebuttal of the claims made in this article.

Myth #1:”Getting vaccinated against [flu] is more likely to save your life than without it”

Looking at this year’s reported flu infections and depending on which report is viewed, only around 50% of specimens sent for analysis around Australia have tested positive for influenza virus [1], [2], [3]. The chart below, produced by an Australian pathology lab tasked with analyzing specimens from patients suspected of developing influenza, shows many of the infecting viruses detected are not influenza viruses, so are not covered by the flu vaccine. It further illustrates the proportion of Influenza A and B strains that have increased over time, perhaps as flu vaccine antibodies have started to wear off, or as mutant flu strains emerge.

In short, perhaps our vaccines were relatively effective early on when most people were vaccinated but this protection is temporary and wanes over time. The CDC has reported “decreases in vaccine effectiveness (VE) within a single influenza season, with increasing time post-vaccination”. [4]

When analysed in a laboratory, many specimens taken from patients suspected of having influenza are found to be “Influenza Like Illness” (ILI). ILIs are not covered by the influenza virus strains targeted by the flu vaccine and can be caused by a lot of other very different viruses, as this ASPREN surveillance graph demonstrates.

A study recently published in Clinical Infectious Diseases found a potential mismatch between the vaccine virus in the 2019 Australian influenza vaccine and the dominant circulating strains of Influenza A virus in Australia [5] [6]. What this means is that our Australian flu vaccine may have been less effective than expected. This Influenza A virus mutation prompted the American FDA to delay its decision on the formulation of the 2019 flu vaccine for the Northern Hemisphere [7] [8].

Given the published data on virus mutation not covered by this year’s vaccine, decreasing vaccine effectiveness from time of vaccination and laboratory detection of ILI not covered by this year’s vaccine, we contest Professor Van Buynder’s assertion that this year’s flu vaccine is effective and that “this wouldn’t happen if the other 60 per cent went out and rolled up their sleeves”.

Myth #2: “A third to two-fifths of Australians got vaccinated…”

The current population of Australia is more than 25 million [9]. If all current influenza vaccines were used, Australia would have a national vaccination coverage of 50%. The total vaccine stock for Australia in 2019 is 12.5 million doses [10]. This is the highest number of vaccine doses ever provided for the population, higher even than in 2009 [11] during the A (H1N1) pandemic. In 2018, 11 million flu vaccines were stocked and in 2017, 8.3 million doses [12] were stocked. One fact is clear, Australian people are vaccinated more than ever against influenza in 2019.

Myth #3: “…and yet we’re seeing a record number of cases”

2019 is a record year for laboratory confirmed Influenza Like Illness, but the 2019 flu season peaked early in July and ILI notifications are now falling [13]. Notifications of laboratory detected ILI have been increasing dramatically year on year after the 2009/10 flu season (note the table below does not include figures for swine flu in 2009-10) [14]. Are unvaccinated people being made a scapegoat for a flu crisis or could the crises be related to the increasing numbers of those vaccinated for the flu? To our knowledge nobody is investigating this possibility.

Another big factor that influences increased lab counts of influenza is increased testing. NSW, being centrally located and with year-round consistent temperatures, is the State that analysts look to for average calculations relating to influenza. The weekly flu bulletin for NSW Health in August 2019 reports that the “total number of respiratory tests requested each week has fallen over the past month but testing levels remain higher than previous years. For the year up to week 34, there have been 458,681 respiratory virus tests, 132% more than for the same period in 2018 (197,500 tests) [15]. This fall may also be partly influenced by doctors getting tired of testing.

According to the Federal Department of Health Influenza Surveillance report 2019, despite an increase in ILI, “Clinical severity for the season to date, as measured through the proportion of patients admitted directly to ICU, and deaths attributed to influenza, is low” [16]. This indicates that the increase in notifications may be in part due to increased media coverage, putting fear into the public and sending them to a doctor or to hospital.

Published medical literature already tells us that people receiving flu vaccination exhale 6.3 times more viral particles of influenza A virus [17] and are at an increased risk of suffering from Influenza-like illness (ILI) [18]. A logical conclusion to this would be the increasing number of vaccinated in the population who are disseminating more viral shedding across the entire population.

The natural reservoir for Influenza A (i.e. where viruses mutate) is among wild aquatic (migratory) birds and to a lesser extent pigs and horses as well as humans. Influenza A viruses co-circulate between species [19]. It is currently not possible to vaccinate every wild animal influenza host on our planet and we cannot control whether nature is contributing to more Influenza A virus. Herd immunity is therefore impossible to achieve with influenza vaccination.

Myth #4: “Such a small number of people were choosing to get protected, compared to diseases like meningococcal and whooping cough.”

Herd immunity for each disease cannot easily be compared with another unrelated disease. A population gains herd immunity to Influenza within one flu season and the number of people who contract and recover provides fast natural herd immunity to the disease. A study was conducted in 2017 to establish a basic herd immunity number for influenza vaccination coverage in the United States and concluded that “at least 44.4%” vaccination coverage of the population would be required to prevent the next influenza epidemic [20]. However the results of a successful campaign would depend on the vaccine matching the exact circulating strains, something our current flu vaccinations fall considerably short in doing. The conclusion from this 2017 study reads:

Childhood vaccination campaigns across the world have resulted in high community coverage for diseases like pertussis [21] but unfortunately this vaccine has caused a mutated pertactin-deficient (PRN) strain of microbe to become prevalent and this strain is not covered by the current DTaP and DTP vaccines [22]. There is a fundamental public misperception of the theory of herd immunity, fueled by media articles blaming unvaccinated populations, when compared with real-world scenarios of disease transmission complicated by waning vaccine immunity and an increasing number of immune compromised people [23] [24].

Myth #5: “Your chances of being hospitalised or dying are much less if you’ve had the vaccine.”

There are studies that conclude a positive benefit of receiving influenza vaccination, particularly if the recipient is immunosuppressed [25] but it is also true that the median age of deaths notified in the last Australian Influenza Surveillance report was 86 years [26]. Our national immunization schedule funds free flu vaccination for the over 65 age group and vaccination uptake for influenza vaccine has been calculated to be higher than for other adults, between 67-75% [27] [28]. It could therefore be assumed that many older-age Australians who suffer and perish from influenza are those who previously received a vaccination.

This is what the CDC has to say about whether a vaccine works effectively [29]:

Influenza Vaccine Effectiveness (VE) is calculated using a specific case control study called a Test Negative Design (TND) [30] and is subject to errors of interpretation and bias [31]. Nevertheless, Professor van Buyden’s quote that the vaccine is on average 60% effective (calculated via TND) is in line with the CDC, who rely on this method of calculating VE.

In relation to this year’s flu vaccine we have already shown that the vaccine has not been greatly effective on the actual circulating viruses, or at least re H3N2 viruses. Therefore we agree with Professor Van Buynder when he asserts “we know that all of our vaccines have some degree of failure”.

When weighing up whether to receive a flu vaccine we must also consider the risk of suffering from an adverse event post-vaccination. In 2018, according to the TGA, there were 1,173 adverse event reports recorded in the DAEN from recipients of flu vaccines, including 1 death and 8 recorded cases of Guillain-Barre syndrome, which involves serious paralysis [32]. Reports of adverse events, although not always found to be causally related to the vaccine are also underreported [33], [34]. On their website and media reporting on deaths from Influenza, the Australian Bureau of Statistics reports deaths from Influenza and deaths from Pneumonia as one combined statistic [35], therefore making it impossible to determine which deaths are causally related to influenza. It is also not possible to distinguish between deaths related to vaccine strain influenza or Influenza Like Illness (ILI).

A more detailed analysis of influenza deaths published by ABS, in their downloadable reports, shows an annually increasing number of influenza deaths from both known types of influenza virus and “influenza virus not identified” i.e influenza virus unsubtyped [36].

A similar trick is used by the CDC in the US who also report influenza and pneumonia as one statistic in their media releases [37].

There is however a CDC web page called FluView, where the differences in deaths between influenza and pneumonia are tabled [38].

 

Myth #6: “They don’t understand how severe influenza is and on top of that they don’t believe in the vaccine itself”

There are many reasons why people don’t have much faith in the influenza vaccine, apart from the doubts about its effectiveness already mentioned above. It could be due to becoming “coincidentally” ill following a previous dose of a vaccine [39] or personal experience of a family or friend suffering from an adverse reaction [40]. The media can often misrepresent somebody who has died from a “vaccine-preventable” illness as being unvaccinated for that particular illness, but fail to mention that the administration of other vaccines may have reduced that person’s immunocompetence.

It is worth reiterating that the CDC now reports 17% of the population of Sydney and 19% of the population of New York as being Immunocompromised [41], meaning their propensity to contract influenza and ability to recover from this disease will be severely impacted compared to someone who is healthy and not immune compromised [42]. Yet protection for the immunocompromised is also used to justify mass flu vaccination! Is it not feasible that our modern lifestyle incorporating cradle-to-grave vaccination has created a huge population of autoimmune and immune-compromised people? [43]

Myth #7: “There’s this belief out there that this vaccine is no good, or that the vaccine gives you the flu, or that the vaccine has bad side effects — and none of those things are correct”

We have contested Professor Van Buynder’s assertions in this rebuttal and challenge him to take the time to read this article and the included references. Perhaps then he can reflect on why people “believe” that the influenza vaccine is no good, or that it gives you the flu, or that the vaccine has bad side effects.

[1] https://www1.health.gov.au/internet/main/publishing.nsf/Content/4AE7606CE2B9D9B3CA2584580014529B/$File/flu-08-2019.pdf
[2] https://aspren.dmac.adelaide.edu.au/documents/20714/292784/ASPREN+Update+16+2019/19db42ec-21c7-4772-bd39-38743190bfbc?version=1.0
[3] https://www.snp.com.au/media/Multisite8265/20190831-snpir-influenza-graph.pdf
[4] https://www.cdc.gov/mmwr/volumes/68/rr/rr6803a1.htm?s_cid=rr6803a1_w
[5] https://www.biorxiv.org/content/10.1101/681734v1.full#F1
[6] https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciz723/5546015?redirectedFrom=fulltext
[7] https://www.fda.gov/media/121426/download
[8] https://www.cdc.gov/flu/season/flu-season-2019-2020.htm
[9] https://www.worldometers.info/world-population/australia-population/
[10] https://www1.racgp.org.au/newsgp/clinical/flu-vaccine-supplies-increase-to-accommodate-recor
[11] https://www.sciencedirect.com/science/article/pii/S0264410X1000719X
[12] https://www.immunisationcoalition.org.au/news-media/higher-uptake-of-the-flu-vaccine-in-2018/
[13] https://www.immunisationcoalition.org.au/wp-content/uploads/2019/08/19Aug-AusFluStats02019.pdf
[14] https://onlinelibrary.wiley.com/doi/full/10.1111/irv.12642
[15] https://www.health.nsw.gov.au/Infectious/Influenza/Publications/2019/weekending-25082019.pdf
[16] https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm
[17] https://www.pnas.org/content/115/5/1081.full
[18] http://vaccinepapers.org/wp-content/uploads/Increased-risk-of-noninfluenza-respiratory-virus-infections-associated-with-receipt-of-inactivated-influenza-vaccine.pdf
[19] https://www1.health.gov.au/internet/main/publishing.nsf/Content/3D622AEAE44DDEB2CA257BF0001ED884/$File/influenza-infection-2019.pdf
[20] http://jrhs.umsha.ac.ir/index.php/JRHS/article/view/4239/pdf
[21] https://www.mja.com.au/system/files/issues/198_11_170613/kac10044_fm.pdf
[22] https://www.academia.edu/30127078/Investigations_into_the_emergence_of_pertactin-deficient_Bordetella_pertussis_isolates_in_six_European_countries_1996_to_2012
[23] https://wwwnc.cdc.gov/eid/article/24/4/17-1233_article
[24] https://jamanetwork.com/journals/jama/fullarticle/1456072
[25] https://www.sciencedirect.com/science/article/abs/pii/S0021915019300218
[26] https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm/$File/flu-08-2019.pdf
[27] https://www.ncbi.nlm.nih.gov/pubmed/31315167
[28] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037616/
[29] https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm
[30] https://www.eurosurveillance.org/content/10.2807/1560-7917.ES2013.18.37.20585
[31] https://reflectionsipc.com/2018/01/22/test-negative-design-the-best-study-design-ever/
[32] https://apps.tga.gov.au/PROD/DAEN/daen-report.aspx – report parameters Dec 2018-May 2019 for influenza vaccines Afluria Quad, Fluad, Fluarix, Fluarix Tetra, FluQuadri, FluQuadri Junior, Fluzone High Dose, Influvac Tetra all listed as 2019 flu vaccines.
[33] https://www.tga.gov.au/media-release/new-web-service-helps-consumer-reporting-side-effects
[34] https://imoparty.com/Adverse-Events-Under-Reported
[35] https://www.abs.gov.au/ausstats/[email protected]/0/88EFFE07A1559DD1CA258354000BABB4?Opendocument
[36] https://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/E75E4E2CD675034BCA25831300141C2F/$File/3303_1%20underlying%20causes%20of%20death%20(australia).xls
[37] https://www.cdc.gov/flu/weekly/
[38] https://gis.cdc.gov/grasp/fluview/mortality.html
[39] https://www.jeremyrhammond.com/2018/12/12/why-the-flu-death-of-a-vaccinated-girl-is-not-reason-to-get-a-flu-shot/
[40] https://www.news.com.au/lifestyle/health/man-suffers-flu-death-despite-being-vaccinated/news-story/0ea1ea3275d793793035de48ebcca4ae
[41] https://wwwnc.cdc.gov/eid/article/24/4/17-1233_article
[42] https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html
[43] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0008382

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