Past, Present, and Future of “Biological Aging” with Dr. Fitzgerald
I’ve been writing about flu vaccines since I experienced the flu myself in 2013. During that rather unfortunate and painful couple of weeks, I was prompted to review the state-of-the-state research with regard to influenza vaccination to answer the question for myself: should I get a flu vaccine?
“The perception that current vaccines are already highly effective in preventing influenza is a major barrier to game-changing alternatives. Indeed, hundreds of influenza vaccine efficacy and effectiveness studies have been conducted since the 1940s, and vaccine efficacy in healthy adults of 70% to 90% is frequently cited. However, the preponderance of the available influenza vaccine efficacy and effectiveness data is from studies with suboptimal methodology, poorly defined end points, or end points not proven to be associated with influenza infection.” [Osterholm, M.T.,The Compelling Need for Game Changing Influenza Vaccines. 2012 ]
Osterholm went on to be quoted in the New York Times,
“We have over-promoted and overhyped this vaccine. It does not protect as promoted. It’s all a sales job: it’s all public relations.”
And now research recently published in the journal Clinical Infectious Diseases demonstrates that the more years one receives the influenza vaccine, the less efficacious it becomes.
Looking at 5 years of historical vaccination data, vaccine effectiveness for influenza A in individuals with NO prior vaccine history was 65% (95% CI 36%-80%) as compared to individuals with a frequent vaccination history, where effectiveness was reduced to 24%. Results were similar in Influenza B: 75% and 48% vaccine effectiveness, respectively. Results were similar for both children and adults.
If you regularly receive the flu vaccine, efficacy is reduced to about 24%.
Why?
It’s not well-understood, but one idea is “original antigenic sin” that is, pre-existing memory responses to previous vaccinations can preferentially expand at the expense of new (de novo) responses to the current vaccine. This appears to be greatest when viruses have some antigenic relatedness and are antigenically complex, which generally fits the annual influenza picture.
In the quest for a universal flu vaccine (that is, a one-time long lasting flu vaccine), research published this month in Science Translational Medicine by Andrews, et al. looked specifically at B cell response to 2009 H1N1 vaccine over time. They found that those with lower titer levels of preexisting antibodies were more likely to generate a good response to the more conserved hemagglutinin stalk region of the virus (see image below). People with higher levels of preexisting antibodies were more likely to generate antibodies to the variable hemagglutinin head region (the head region mutates, the stalk is conserved).
The higher amount of preexisting head antibodies prevented or blocked production of stalk antibodies, thereby reducing or eliminating the universal vaccine effect.
Further, the study also showed that production of the hemagglutinin stalk antibodies can cross-react with insulin and DNA. This is particularly concerning if the goal of the universal vaccine is to generate high numbers of stalk antibodies- promoting autoimmunity would be a very real concern, and has been suggested with previous influenza vaccines. [As an aside, check out this retracted study on cross reactivity between H1N1 Influenza A epitope and hypocretein/orexin in narcolepsy…]
Osterholm, a scientist not afraid to speak the plain truth, and director of the Center for Infectious Disease Research and Policy, isn’t convinced, apparently, that a universal vaccine is coming anytime soon.
[But all is not lost. FxMed can help, and once again, for the 2015-2016 flu season, I am reprinting below our clinic’s TOP TIPS for preventing and treating influenza.]
Image from: Viruses 2014, 6(8), 3159-3180
http://cid.oxfordjournals.org/content/early/2014/09/29/cid.ciu680.full
16 Comments
Related posts
Hello Kara, I appreciate all of your articles! My comment is not on the flu vaccine specifically but about the Measles or (MMR?) vaccine. I recently watched a video where a former government researcher named Judy Mikovits PhD claims mice infected the materials used accidentally leaving particles (mouse cells) in the vaccine (rotovirus or retrovirus??) I was wondering what you or Functional Medicine knew about this, if it can be tested for or is tested for, and if there is a treatment for it. Thank you!
Dear Trina,
Unfortunately, I am not aware of the research of Dr. Mikovits, so I cannot comment on it specifically. DrKF
Excellent review and resources on this very controversial topic, Dr. Kara. Thank you for your courage to look into this and post on your results!
Dear Dr L-
Thank you, as always. I think it’s important that we take an honest look at the data around the influenza vaccine– we’re vulnerable to being hit really hard by a serious influenza epidemic, and the current vaccine doesn’t leave us well prepared, I think. Right now, our best action is improving overall wellness so we have good resilience. That said, the vaccine might shave a little bit of time off the duration of the flu, but I don’t think much else at this point. And as the data point out, the more flu vaccines we get, the less it works…. there are also many hurdles with the universal vaccine– its not close to being ready for clinical trials…. Clearly, functional medicine is REALLY needed to help prevent or mitigate the catastrophe of a serious influenza epidemic- DrKF
Dr Kara, thanks so much for the info. I agree that overall wellness is the best at fighting flu. I try to practice healthy habits on a daily basis and I have not had the flu shot or the flu in many many years. Coincidentally the year that I had the shot I actually got the flu. Do you think a healthy adult could actually reduce their health by getting the vaccine and make themselves more susceptible?
How someone might respond/react to the flu shot is a function of various factors. Regardless of whether we decide to get the flu shot or not, supporting overall health and strong immunity is an essential foundation for staying cold and flu-free this season.
Great detail and I’m sure this is covered somewhere inside one of your article links, but in 2014-15 overall effectiveness is said to be about 23%, estimate for 2015-16 is about 60%.
This is a link to an informational file from the World Health Organization discussing the effectiveness of 2014-15 flu vaccine.
http://www.who.int/influenza/vaccines/virus/recommendations/201502_qanda_vaccineeffectiveness.pdf
Thanks for the link and comments. I believe we do however need to develop a different game plan. The vaccine continues to be a crap shoot.
Hi Dr Fitzgerald,
Could you tell me the citation for the article in the Journal of Clinical Infectious Diseases? I can’t seem to find it.
Thank you,
Elizabeth Bird
Here you go, Dr. Bird. This link should bring you to the full text. https://academic.oup.com/cid/article/49/9/1405/301441
DrKF
Thanks! The link you sent was about salicylates and flu death, which was interesting, but I think I found the one about vaccine interference:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207422/
It is an interesting concept, vaccine interference and original antigentic sin. But I would just point out that this study’s results don’t negate that flu vaccine is more protective than no flu vaccine:
“vaccination provided protection against medically attended influenza infection, regardless of prior vaccination history. This is consistent with randomized clinical trials of influenza vaccine efficacy [38]”
I would certainly agree that this research is thought provoking, and I think most of my pediatric colleagues would agree that flu vaccines are not among our “highly effective” vaccines if the end point is freedom from infection, but there is definitive evidence that the vaccine does help both prevent and attenuate disease. I would not make the case for anyone to skip a flu vaccine based on this research.
All the best,
Elizabeth Bird
Dr. Bird: I don’t take a position on getting or not getting the current flu vaccine. I think that is up to the individual and their provider. And the findings in the above referenced study show some efficacy, even as it’s lowered over time. I am disappointed that the greater medical community puts so much emphasis on vaccination and doesn’t sufficiently mention vitamin D, for instance, or improving one’s overall resilience. Further, I think research investment towards “game changing” interventions (including a vaccine) is essential. I appreciate your comments and thoughts- jump in anytime. KF
*My apologies on providing the erroneous citation link- on the backend of the website, it’s not as clear which blog is being referenced. K
Totally agreed, given the flu’s potential to wreak havoc, we need better tools than a sort-of effective vaccine. I would be really interested in your thoughts as to how to optimize Vit D levels in kids. Insurance companies have recently started denying claims for routinely checking levels and I worry about overdoing supplementation without baseline levels, but perhaps I am being too cautious?
I haven’t gotten a vitamin D denied yet. That’s so unfortunate. We use Direct Labs for more affordable out of pocket testing. There are probably other labs that offer reasonably priced testing. Doctorsdata.com has a blood spot D test.
nice post