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Flu vaccine myths – an epic rant about dumb asses from Mark Crislip

We're coming upon the 2018-2019 flu season in the Northern Hemisphere. And every flu season, for the past seven years, I reprint Dr. Mark Crislip's epic

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Budget of Dumb Asses. 2014 Edition. Mark Crislip, MD, Infectious Diseases, 09:56PM Oct 6, 2014 I am off to ID Week, to sit in a cold room in Philadelphia while my betters read me PowerPoint slides. I can’t wait. Last time I was in Philadelphia I was disappointed with the cheese steaks. Perhaps this time I will be more fortunate. Since I will be preoccupied with learnin’ and not seeing patients, I will have no clinical material to write about, so instead I give you, slightly rewritten for 2014, a Budget of Dumb Asses. Some clarifications. This essay is directed at healthcare providers, not patients or the public. Healthcare providers have no excuse to avoid the flu vaccine: they have access to the world’s medical knowledge and should be able to rise above superstition and ignorance. Yes, I too am a Dumb Ass, but for different reasons. There are those in the past who have objected to the term Dumb Ass in a medical blog. Not professional, they say. Perhaps. But this is a opinion piece, my opinion of excuses for not getting the flu vaccine. Sure, an opinion supported by the medical literature and reality, but an opinion none-the-less. Dumb Ass is the milder form of the phase that goes through my mind and my honest reaction to HCW’s who do not get vaccinated for any of the following reasons. If the shoe fits… Finally, this essay is not meant to convience anyone. If you are not conivinced by the voluminous information at the CDC and on PubMed, 2000 words by me are not going to change your mind. And if it does you have some serious issues with critical thinking. So like It's the Great Pumpkin Charlie Brown, a fall tradition: I wonder, are you one of those Dumb Asses who do not get the flu shot each year? Yes. Dumb Ass. Big D, big A. You may be allergic to the vaccine (most are not when tested and there is an egg free vaccine), you may have had Guillain-Barre (most can be vaccinated safely and the risk of GBS is much higher from influenza than the vaccine), in which case I will cut you some slack. Not much. But some. But if you don’t have those conditions and you work in healthcare and you don’t get a vaccine for one of the following reasons, you are a Dumb Ass. 1. The flu shot gives me the flu. Dumb Ass. The shot is a killed vaccine. It cannot give you influenza. It is impossible to get flu from the influenza vaccine, either from the shot or the live attenuated vaccine. 2. I never get the flu, so I don’t need the vaccine. Irresponsible Dumb Ass. I have never had a head on collision, but I wear my seat belt. And you probably don’t use a condom either. So far you have been lucky, and you are a potential winner of a Darwin Award, although since you don’t use a condom, you are unfortunately still in the gene pool. As a HCW, when you do get influenza and come to work, you can pass it on to the most vulnerable hosts. Nice going. 3. Only old people get the flu. Selfish Dumb Ass. Influenza can infect anyone, and the groups who are more likely to die of influenza are the very young, the pregnant, and the elderly. Often those most at risk for dying from influenza are those least able, due to age or underlying diseases, to respond to the vaccine. Like your patients. You can help prevent your old, sickly Grandmother or your newborn daughter from getting influenza by getting the vaccine, so you do not get flu and pass it one to her. Influenza, by the way, is highly contagious, with 20% to 50% of contacts with an index case getting the flu. However, Granny may be sitting on a fortune that will come to you, and killing her off with influenza is a great way to get her out of the way and never be caught. That would make a good episode of CSI. 4. I can prevent influenza or treat it by taking echinacea, vitamin C, vitamin D, oscillococcinum or Airborne. Gullible Dumb Ass cubed then squared. None of these concoctions has any efficacy what so ever against influenza. And if you think oscillococcinum has any efficacy, I would like you to invest in a perpetual motion machine I have invented. None of the above either prevent or treat influenza. And you can’t “boost” your immune system either. Anyone who suggests otherwise wants you money, not to improve your health. 5. Flu isn’t all that bad of a disease. Underestimating Dumb Ass. Part of the problem with the term ‘flu’ is that it is used both as a generic term for damn near any viral illness with a fever and is also used for a severe viral pneumonia. Medical people are just as inaccurate about using the term as the general public. The influenza virus directly and indirectly kills 20,000 people (depending on the circulating strain and year) and leads to the hospitalization of 200,000 in the US each year. Influenza is a nasty lung illness. And what is stomach ‘flu’? No such thing. 6. I am not at risk for flu. Denying Dumb Ass. If you breathe, you are risk for influenza. Here are the groups of people who should not get the flu vaccine (outside of people with severe adverse reactions to the vaccine): Former President Clinton, who evidently doesn’t inhale. Michele Bachmann. Wait, that’s the HPV vaccine. And people who are safe from zombies. If you don’t get the vaccine you do not have to worry about the zombie apocalypse, because zombies eat brains. 7. The vaccine is worse than the disease. Dumb Ass AND a wimp. What a combination. Your mother must be proud. Unless you think a sore deltoid for a day is too high a price to pay to prevent two weeks of high fevers, severe muscles aches, and intractable cough to decrease the chance of passing the virus on to your vulnerable patients. 8. I had the vaccine last year, so I do not need it this year. Uneducated Dumb Ass. Each year new strains of influenza circulate across the world. Last year’s vaccine at best provides only partial protection. Every year you need a new shot. 9. The vaccine costs too much. Cheap Dumb Ass. The vaccine costs less than a funeral, less than Tamiflu, and less than a week in the hospital. 10. I received the vaccine and I got the flu anyway. Inexact Dumb Ass. The vaccine is not perfect (60% effective in preventing the flu, depending on the population tested) and you may have indeed had the flu. More likely you called one of the many respiratory viruses (viri?) people get each year that they call ‘the flu’. Remember there are dozens of potential causes of a respiratory infection circulating, the vaccine only covers influenza, the virus most likely to kill you and yours. 11. I don’t believe in the flu vaccine. Superstitious, premodern, magical thinking Dumb Ass. What is there to believe in? That is like saying, I do not believe in reality. Belief is what you do when there is no data. Probably don’t believe in gravity or germ theory either. Everyone, I suppose, has to believe in something, and I believe I will have a beer. 12. I will wait until I have symptoms and stay home. Dangerous Dumb Ass. Despite often coming to work ill, especially second year residents. About 1 in 5 cases of influenza are subclinical and hospitalized patients are more susceptible to acquiring influenza from HCW’s than the general population with 27% of nosocomial acquired H1N1 dying. And you will never realize that you were the one responsible for killing that patient by passing on the flu. 13. The flu vaccine is not safe and has not been evaluated for safety. Computer illiterate Dumb Ass. There are 1812 references on the PubMeds on safety of the flu vaccine as I write this and the vaccine usually causes at most only short term, mild reactions. All health care requires weighing the risks of an intervention against the benefits. And if you are worried about toxins, good news. There are neither toxins nor gluten in the flu vaccine. For the flu vaccine all the data suggests huge benefit for negligible risk. And as a HCW, it could be argued that we have a moral responsibility to maximize the safety of our patients. 14. The government puts tracking nanobots in the vaccine as well as RFID chips as part of the mark of the beast, and the vaccine doesn’t work since it is part of a big government sponsored conspiracy to keep Americans ill, fill hospital beds, line the pockets of big pharma and inject the American sheeple with exotic new infections in an attempt to control population growth and help usher in a New World Order. Well, that excuse is at least reasonable. Paranoid Delusional Dumb Ass. So get the vaccine. And pass this essay on to someone else instead of the flu. The life you may save may be your own. Or be a Dumb Ass. One final thought. There is a tremendous amount of medical literature pointing to the safety and wide ranging benefits of the influenza vaccine as well as the morbidity and mortality that influenza inflicts on humans every year. Despite that information, when you are admitted to the hospital you have a greater than one in four chance that the HCW taking care of you is ignoring that information and going unvaccinated. So they are putting you and yours at risk for no legitimate reality-based reason. The preponderance of data is clear: when health care workers are vaccinated against the flu, patient mortality declines. I have long been of the opinion that you judge a person by the company they keep. If your health care worker is a big enough Dumb Ass to avoid the flu vaccine, in what other areas of medicine are they equally incompetent ? Do you want to drive in a car with no seat belts or air bag, whose brakes are of uncertain maintenance? Do you want you or your loved ones to be cared for by someone who is Dumb Ass enough to not get the flu vaccine, putting you and yours at risk when most vulnerable? Can you expect that person to do the rest of their job correctly when they cannot understand and implement a core competency of medicine? Not me. Here is my suggestion. When you and yours are in the clinic or the hospital, request care only from practitioners that have had the flu vaccine. Put a sign on your hospital room door: No entry unless you are influenza vaccinated or put a copy of this essay on the door. You do have the right to refuse care, especially from a Dumb Ass. I know this idea is a non-starter. Sick, vulnerable people are in no condition to potentially antagonize their providers, even though sick, vulnerable people should be able to trust that their HCW is maximally protecting them. No one wants to piss off their HCW, especially if that person holds the key to the morphine. I do not really expect anyone will actually ask to be cared for by influenza vaccinated providers only. But I can dream. References My co-bloggers and I over at Science-Based Medicine have written at length about vaccines in general, influenza, the influenza vaccine and the ani-vaccination movement. Here are links to some of my extensively referenced essays on influenza and vaccines, including essays on that pile of fetid dingoes kidneys that is the Cochrane Reviews on influenza vaccine and treatment: Scam Stud The Tamiflu Spin Yes, But. The Annotated Atlantic. Cochrane Reviews: The Food Babe of Medicine? One Flu Into the Cuckoo’s Nest* Uneasy Lies the Head That Wears the Flu What are words for? I refute it thus Uneasy Lies the Head That Wears the Flu Protect Yourself Drinking from the Fire Hose: Odds and Ends on the Gasping Oppression Random Flu Thoughts Ososillyococcinum and other Flu bits. Influenza Vaccine Mandates Nine Questions, Nine Answers. Flu Vaccine Efficacy More Flu Woo for You Boo Boo. Herd Immunity Flu Woo Hodge Podge

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The three most dangerous words in medicine are 'in my experience.' [1] Two cases is 'In my experience' where three becomes 'In case after case.'  So if it works, in my experience…[2]

Mark Crislip, MD, in the blogs [1] Science-Based Medicine and [2] Rubor, Dolor, Calor, Tumor