Fear the flu not the flu shot. David Bronstein, M.D. Pediatric Infectious Disease

Transcription

1 Fear the flu not the flu shot. David Bronstein, M.D. Pediatric Infectious Disease

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3 PICTURE OF SNAKES & SPIDERS GOES HERE

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5 Beliefs It s just the flu. Only old people need a flu shot. I can t get the flu shot because I m sick. If I get the flu, I can just take oseltamivir. Cold weather causes the flu. I never get the flu, so I don t need the flu shot. FluMist is dangerous because it s a live virus vaccine. The flu shot always gives me the flu. I can t get the flu shot because I m pregnant. I don t need to get the flu shot every year. The swine flu vaccine was a lot more dangerous. I can t get the flu shot because I m allergic to eggs. The The government side effects is are experimenting worse than the on flu. us. I ll be stronger if I fight the flu naturally. The flu shot doesn t work. I can t get the flu shot because I m scared of needles. Even though I get the flu shot, I get sick anyways. I can t get the flu twice in 1 year. Our members have high rates of vaccine coverage. The flu shot prevents the stomach flu. The preservatives in the flu shot will make my kids autistic.

6 It s just the flu. Only old people need a flu shot. I can t get the flu shot because I m sick. If I get the flu, I can just take oseltamivir. Cold weather causes the flu. I never get the flu, so I don t need the flu shot. FluMist is dangerous because it s a live virus vaccine. The flu shot always gives me the flu. I can t get the flu shot because I m pregnant. I don t need to get the flu shot every year. The swine flu vaccine was a lot more dangerous. I can t get the flu shot because I m allergic to eggs. The The government side effects is are experimenting worse than the on flu. us. I ll be stronger if I fight the flu naturally. The flu shot doesn t work. I can t get the flu shot because I m scared of needles. Even though I get the flu shot, I get sick anyways. I can t get the flu twice in 1 year. Our members have high rates of vaccine coverage. The flu shot prevents the stomach flu. The preservatives in the flu shot will make my kids autistic. It s just the flu. Only old people need a flu shot. I can t get the flu shot because I m sick. If I get the flu, I can just take oseltamivir. Cold weather causes the flu. I never get the flu, so I don t need the flu shot. FluMist is dangerous because it s a live virus vaccine. The flu shot always gives me the flu. I can t get the flu shot because I m pregnant. I don t need to get the flu shot every year. The swine flu vaccine was a lot more dangerous. I can t get the flu shot because I m allergic to eggs. The The government side effects is are experimenting worse than the on flu. us. I ll be stronger if I fight the flu naturally. The flu shot doesn t work. I can t get the flu shot because I m scared of needles. Even though I get the flu shot, I get sick anyways. I can t get the flu twice in 1 year. Our members have high rates of vaccine coverage. The flu shot prevents the stomach flu. The preservatives in the flu shot will make my kids autistic. It s just the flu. Only old people need a flu shot. I can t get the flu shot because I m sick. If I get the flu, I can just take oseltamivir. Cold weather causes the flu. I never get the flu, so I don t need the flu shot. FluMist is dangerous because it s a live virus vaccine. The flu shot always gives me the flu. I can t get the flu shot because I m pregnant. I don t need to get the flu shot every year. The swine flu vaccine was a lot more dangerous. I can t get the flu shot because I m allergic to eggs. The The government side effects is are experimenting worse than the on flu. us. I ll be stronger if I fight the flu naturally. The flu shot doesn t work. I can t get the flu shot because I m scared of needles. Even though I get the flu shot, I get sick anyways. I can t get the flu twice in 1 year. Our members have high rates of vaccine coverage. The flu shot prevents the stomach flu. The preservatives in the flu shot will make my kids autistic.

7 It s just the flu. Only old people need a flu shot. I can t get the flu shot because I m sick. If I get the flu, I can just take oseltamivir. Cold weather causes the flu. I never get the flu, so I don t need the flu shot. Flumist is dangerous because it s a live virus vaccine. The flu shot always gives me the flu. I can t get the flu shot because I m pregnant. I don t need to get the flu shot every year. The swine flu vaccine was a lot more dangerous. I can t get the flu shot because I m allergic to eggs. The The government side effects is are experimenting worse than the on flu. us. I ll be stronger if I fight the flu naturally. The flu shot doesn t work. I can t get the flu shot because I m scared of needles. Even though I get the flu shot, I get sick anyways. I can t get the flu twice in 1 year. Our members have high rates of vaccine coverage. The flu shot prevents the stomach flu. The preservatives in the flu shot will make my kids autistic. Connection Curiosity Comfort Confidence Beliefs

8 Annual U.S. Deaths It s just the flu. It s just the flu. Each year in the United States: million cases of flu >200,000 hospitalizations Children < 2 years old are as likely as those > 65 to be hospitalized due to the flu It s just the flu. 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 AIDS Breast Cancer Influenza

9 Annual U.S. Deaths Annual U.S. Deaths Annual U.S. Deaths 0 It s just the flu. 45,000 40,000 35,000 36,000 30,000 25,000 20,000 15,000 10,000 5,000 AIDS Breast Cancer Influenza It s just the flu. 45,000 40,000 35,000 36,000 30,000 25,000 20,000 17,374 15,000 10,000 5,000 0 AIDS Breast Cancer Influenza It s just the flu. 45,000 40,000 35,000 39,520 36,000 30,000 25,000 20,000 17,374 15,000 10,000 5,000 0 AIDS Breast Cancer Influenza

10 Deaths (Laboratory-confirmed) It s just the flu It s just the flu. It s just the flu. National Economic Burden

11 It s just the flu. National Economic Burden Absenteeism It s just the flu. National Economic Burden Absenteeism Reduced Productivity The flu shot always gives me the flu.

12 The flu shot always gives me the flu. Flu vaccine only contains components of the flu virus Hemagglutinin (H) Neuraminidase (N) RNA Genome The flu shot always gives me the flu. Flu vaccine only contains components of the flu virus The parts of the virus that make people sick have been removed Hemagglutinin (H) Neuraminidase (N) RNA Genome The flu shot always gives me the flu. Side Effects Used to feel like a mild flu Now more mild Flu Shot in Flu Season Flu shot not fully effective for 2 weeks Other viruses cause flu-like illnesses Vaccine Mismatch Exposure to flu virus not in flu shot

13 The flu shot always gives me the flu. IMMUNIZATION RECORD DTaP Hib IPV MMR Pneumococcus PCV 13 Hep B Hep A VZV MCV Meningococcus Flu??? The side effects are worse than the flu. The side effects are worse than the flu.

14 The side effects are worse than the flu. Mild soreness & redness at site of injection More serious problems are RARE High fevers, chills, headache, muscle aches, fatigue, decreased appetite Cough, congestion, runny nose, sore throat The side effects are worse than the flu. Mild soreness & redness at site of injection More serious problems are RARE High fevers, chills, headache, muscle aches, fatigue, decreased Myocarditis appetite Encephalitis Reye Syndrome Pericarditis Cough, congestion, runny Flu Pneumonia nose, sore throat Bacterial Pneumonia Myositis Guillain-Barré The flu shot doesn t work.

15 Adjusted Overall VE (%) The flu shot doesn t work. The flu shot doesn t work. The most effective strategy for reducing the effect of influenza is annual vaccination. -- Advisory Committee on Immunization Practices The flu shot doesn t work

16 Number needed to vaccinate to prevent one hospitalization Hospitalizations averted 120, ,000 Hospitalizations Averted 119, moderate to severe season 80,000 59,835 60,000 40,000 20,000 13,238 2,383 10,879 21, mild season Vaccine Effectiveness (%) Fry AM, Kim IK, Reed C, et al. Modeling the effect of different vaccine effectiveness estimates on the number of vaccine prevented influenza associated hospitalizations in older adults. Clinical Infectious Diseases 2014;59(3): Number Needed to Vaccinate 12,000 11,214 10,000 8,000 6,000 4,000 2, ,151 2,457 1, Vaccine Effectiveness (%) Fry AM, Kim IK, Reed C, et al. Modeling the effect of different vaccine effectiveness estimates on the number of vaccine prevented influenza associated hospitalizations in older adults. Clinical Infectious Diseases 2014;59(3):406-9.

17 Deaths averted Deaths Averted by Influenza Vaccination 10,000 8,000 6,000 flu-associated deaths were prevented between through ,000 2,000 0 Foppa IM, Cheng P, Reynolds SB, et al. Deaths averted by influenza vaccination in the U.S. during the seasons 2005/06 through 2013/14. Vaccine 2015;33: Even though I get the flu shot, I get sick anyways. Even though I get the flu shot, I get sick anyways. Influenza viruses Rhinoviruses Coccidioides immitis Respiratory syncytial virus Histoplasma capsulatum Human metapneumovirus Bordetella pertussis Parainfluenza viruses Bordetella parapertussis Adenoviruses Bordetella bronchiseptica Coronavirus Chlamydia psittaci Enteroviruses Coxiella burnetti Reoviruses Human bocavirus

18 Even though I get the flu shot, I get sick anyways. Adenovirus Astrovirus Noroviruses Parvovirus Coronavirus Pestivirus Breda virus Human bocavirus Yersinia enterocolitica Influenza viruses Rotavirus Aeromonas hydrophila Vibrio parahaemolyticus Vibrio cholerae O139 Bacillus cereus Campylobacter jejuni Clostridium difficile Clostridium perfringens Listeria monocytogenes Plesimomonas shigelloides Salmonella sp. Shigella sp. Staphylococcus aureus Vibrio cholerae O1 Even though I get the flu shot, I get sick anyways. Even though I get the flu shot, I get sick anyways.

19 Only old people need a flu shot. Only old people need a flu shot. Annual flu shot is recommended for: Only old people need a flu shot. Annual flu shot is recommended for:

20 Only old people need a flu shot. Age 6 months 4 years & >50 years Chronic disease Immunosuppressed Pregnant women Children on long-term aspirin therapy American Indians / Alaska Natives Morbidly obese Household contacts & caregivers of high risk persons Healthcare personnel Only old people need a flu shot. The flu shot is not optional. Only old people need a flu shot. The flu shot is not optional. The flu shot is recommended.

21 I never get the flu, so I don t need the flu shot. I never get the flu, so I don t need the flu shot. I never get the flu, so I don t Create need rapport the flu quickly shot. 1 in 3 flu-infected individuals is asymptomatic Elicit the full spectrum of concerns Asymptomatic individuals may shed flu virus Plan the visit

22 I never get the flu, so I don t Create need rapport the flu quickly shot. 1 in 3 flu-infected individuals is asymptomatic Elicit the full spectrum of concerns Asymptomatic individuals may shed flu virus Plan the visit I ll be stronger if I fight the flu naturally. I ll be stronger if I fight the flu naturally. The flu shot is natural.

23 I ll be stronger if I fight the flu naturally. Mild soreness & redness at site of injection More serious problems are RARE High fevers, chills, headache, muscle aches, fatigue, decreased Myocarditis appetite Encephalitis Reye Syndrome Pericarditis Cough, congestion, runny Flu Pneumonia nose, sore throat Bacterial Pneumonia Myositis Guillain-Barré I don t need to get the flu shot every year. I don t need to get the flu shot every year. EPIDEMIC PANDEMIC

24 I don t need to get the flu shot every year. Protection from the flu shot lasts for approximately I don t need to get the flu shot every year. INFLUENZA A (H3N2) INFLUENZA A (H1N1) INFLUENZA B A / Singapore / INFIMH / 2016 (H3N2) - like A / Michigan / 45 / 2015 (H1N1) - like B / Colorado / 06 / 2017 like (Victoria) I don t need to get the flu shot every year. INFLUENZA A (H3N2) INFLUENZA A (H1N1) INFLUENZA B INFLUENZA B B / Colorado / 06 / 2017 like (Victoria) B / Phuket / 3073 / 2013 like (Yamagata) A / Singapore / INFIMH / 2016 (H3N2) - like A / Michigan / 45 / 2015 (H1N1) - like

25 I can t get the flu twice in 1 year H3N2 predominance (more severe) Peak in mid-february B (YAMAGATA) A (H3N2) A (2009 H1N1) A (H1N1) B (VICTORIA) I can t get the flu shot because I m sick.

26 I can t get the flu shot because I m sick. Mild Illness Flu shot is effective Normal immune response On Antibiotics No increased side effects Severe Illness Fever from flu shot may complicate management I can t get the flu shot because I m sick. Retrospective KP study 42,777 hospitalized surgical patients (September 2010 March 2013) 6420 received flu vaccination in hospital, 36,357 did not No increased risk of (7 day follow-up period): ED visits Readmission Fever Clinical work-up for infections (culture / CBC) Marginal increase in risk for outpatient visits (RR 1.05) I can t get the flu shot because I m pregnant.

27 I can t get the flu shot because I m pregnant. 1 st Trimester 2 nd Trimester 3 rd Trimester I can t get the flu shot because I m pregnant. 1 st Trimester 2 nd Trimester 3 rd Trimester I can t get the flu shot because I m allergic to eggs.

28 I can t get the flu shot because I m allergic to eggs. I can t get the flu shot because I m allergic to eggs. A previous severe allergic reaction to influenza vaccine, regardless of the component suspected of being responsible for the reaction, is a contraindication to future receipt of the vaccine. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices United States, influenza season, MMWR, August 25, I can t get the flu shot because I m scared of needles.

29 I can t get the flu shot because I m scared of needles. INFLUENZA A (H3N2) INFLUENZA A (H1N1) INFLUENZA B INFLUENZA B I can t get the flu shot because I m scared of needles. INFLUENZA A (H3N2) INFLUENZA A (H1N1) INFLUENZA B INFLUENZA B

30 The preservatives in the flu shot will make my kids autistic. The preservatives in the flu shot will make my kids autistic. There is no scientific evidence that the mercury-containing preservative (thimerosal) in the flu shot (or any other vaccine) causes autism.

31 The preservatives in the flu shot will make my kids autistic. IIV3 IIV4 IIV3HD aiiv3 IIV4ID cciiv4 RIV4 Fluvirin multidose vial >4yrs Fluvirin prefilled syringe >4yrs Afluria multidose vial >9yrs Flulaval multidose vial >6mo Flulaval prefilled syringe >6mo Fluzone prefilled syringe 6-35mo Fluarix prefilled syringe >3yrs Fluzone High Dose prefilled syringe >65yrs Fluad prefilled syringe >65yrs Fluzone Intradermal prefilled injector >18yrs Flucelvax prefilled syringe >4yrs Flublok prefilled syringe >18yrs Preservative Free CHILDREN If I get the flu, I can just take oseltamivir. If I get the flu, I can just take oseltamivir.

32 If I get the flu, I can just take oseltamivir. Shortens duration of illness by: ½ to 1½ days Most common side effects: diarrhea, nausea, abdominal pain, vomiting When in doubt, use antivirals. When in doubt, use antivirals. American Indian

33 % Immunized % Immunized The government is experimenting on us. The government is experimenting on us. National Health Interview Survey African American Hispanic White African American Hispanic White The government is experimenting on us. National Health Interview Survey African American Hispanic White African American Hispanic White

34 % Immunized % Immunized % Immunized The government is experimenting on us. National Health Interview Survey African American Hispanic White African American Hispanic White The government is experimenting on us. National Health Interview Survey African American Hispanic White African American Hispanic White The government is experimenting on us. National Health Interview Survey African American Hispanic White African American Hispanic White

35 % Immunized % Immunized % Immunized The government is experimenting on us. National Health Interview Survey African American Hispanic White African American Hispanic White The government is experimenting on us. National Health Interview Survey African American Hispanic White African American Hispanic White The government is experimenting on us. National Health Interview Survey African American Hispanic White African American Hispanic White

36 % Immunized 98.0 The government is experimenting on us Physicians Employees Members

37 My Daddy convinced me to get my flu shot!