People with Guillain-Barré syndrome develop the rapid onset of muscle weakness and then paralysis. They may also have numbness and a loss of reflexes.
Unlike some other conditions that cause weakness and paralysis, GBS is a symmetrical, ascending paralysis – it starts in your toes and fingers and moves up your legs and arms.
What Causes Guillain-Barré Syndrome?
GBS is an autoimmune disorder and often starts after a viral or bacterial infection, especially one that causes diarrhea or a respiratory illness.
One of the biggest risk factors is a previous Campylobacter jejuni infection, that is often linked to drinking raw milk, eating undercooked food, drinking untreated water, or from contact with the pet feces.
In less half of cases, no specific cause is found.
Fortunately, although progress can be slow, many people with GBS recover.
“On very rare occasions, they may develop GBS in the days or weeks after getting a vaccination.”
CDC on Guillain-Barré syndrome and Flu Vaccine
It is not common though.
For example, the increased risk of GBS after getting a flu vaccine is thought to be on the order of about one in a million – in adults.
Flu vaccines have not been shown to cause GBS in children.
“The risk of GBS is 4–7 times higher after influenza infection than after influenza vaccine. The risk of getting GBS after influenza vaccine is rare enough that it cannot be accurately measured, but a risk as high as one case of GBS per 1 million doses of flu vaccine cannot be reliably excluded.”
Poland et al on Influenza vaccine, Guillain–Barré syndrome, and chasing zero
It is also important to keep in mind that you are far more likely to get GBS after a natural flu infection than after the vaccine, plus the flu vaccine has many other benefits.
What about other vaccines?
“In this large retrospective study, we did not find evidence of an increased risk of GBS following vaccinations of any kind, including influenza vaccination.”
Baxter et al on Lack of association of Guillain-Barré syndrome with vaccinations
No other vaccines that are currently being used routinely have been associated with Guillain-Barré syndrome.
In fact, many studies do not even find an association between GBS and the flu vaccine.
What to Know About Guillain-Barré Syndrome and Vaccines
Guillain-Barré Syndrome may be associated with the flu vaccine in adults in about 1 in a million cases, but does not occur with any other vaccines, and occurs far more commonly after a natural flu infection.
Is this going to be the worst flu season in history?
That certainly seems to be how the media is playing it.
Have you read any of these articles?
California’s deadly flu season could be worst in a decade
Defending against this season’s deadly flu: 5 things to know
The CDC says this year’s flu may reach ‘epidemic’ proportions
Worst of deadly flu season may still be to come, Dallas County officials say
Texas Is Suffering Through its Worst Flu Outbreak in Decades
Hospital Overrun By Flu Cases Having To Turn Them Away
Get ready, some medical experts are predicting the worst flu season in history
Worst flu season in history? Really?
Flu Season Hazard
Flu season can be deadly.
That’s not hype.
That’s why every one should get a flu shot each year.
Early flu seasons can be bad.
Why? They overlap with RSV season. That means that everyone is sick at the same time with bronchiolitis, croup, colds, and the flu.
They are especially bad because many people haven’t taken the time to get their flu shot yet.
And an H3N2-predominant flu season can be especially bad. In addition to high levels of pediatric flu deaths, the CDC reports that the four flu seasons that were H3N2-predominant in recent years were “the four seasons with the highest flu-associated mortality levels in the past decade.” H3N2 virus strains drift easily, so that flu vaccines are less effective.
Flu Season Hype
Right off the bat, one big problem with most of these headlines, and the way that this year’s flu season is being hyped, is folks going out of their way to use the word “deadly” every chance they can.
Every flu season is deadly!
And guess what?
Flu season reaches “epidemic proportions” each and every year!
“The United States experiences epidemics of seasonal flu each year. This time of year is called flu season.”
CDC on Frequently Asked Flu Questions 2017-2018 Influenza Season
And we get to the point, in many cities, where a hospital fills up for a few days and has to turn away flu cases. It happens with RSV too. Its called a “code Yellow” in some hospitals.
The biggest problem with the current news coverage though, is that there is no evidence that this is going to be the worst or even among the deadliest flu seasons that we have seen.
“The Centers for Disease Control and Prevention says flu season runs from about September to May. Most years in Texas, a number called the ILI percentage — the number of patients doctors see with flu-like symptoms — checks in at about 2 percent or 3 percent during the offseason and crests to about 6 percent during the worst of the flu season. This year, according to a model developed by a Carnegie Mellon University team led by Roni Rosenfeld, Texas’ ILI percentage has already risen above 13 percent.”
“This is really record-breaking. In the last 20 years [the estimated number of people presenting flu symptoms] hasn’t reached that height,” Rosenfeld says. “It’s the highest it’s been this early in the season, and it’s the highest it’s been period.”
Dallas Observer on Texas Is Suffering Through its Worst Flu Outbreak in Decades
Do you know what is wrong with that report in the Dallas Observer?
It misses that the ILI percentage was above 14% in Texas during the 2014-15 flu season too! So no records are being broken, especially since the number already seems to have peaked…
The ILI percentage was actually between 10 to just over 14% for three out of four years recently.
Will hyping the flu to make it sound even more dangerous scare folks into getting a flu shot?
An important take away from the story? It actually reports on a lower hospitalization rate this year than the 2014-15 flu season, a hopeful sign that this year’s flu season won’t be worst than many others.
Why is the 2014-15 flu season important?
For one thing, looking at real data and not just trying to scare folks, we can say that this year’s flu season looks a lot like the 2014-15 flu season. That was also an H3N2-predominant flu season that got off to an early start, but tragically, ended up killing at least 148 children.
I’m sure that few people remember, but the 2014-15 flu season looked a lot like another H3N2-predominant flu season – the 2012-13 flu season. That year, we also got off to an early start and again, tragically, we ended up with 171 pediatric flu deaths.
So, is this going to be a bad flu season?
Is there ever a good flu season?
It’s hard to predict, but the odds are strongly against this being the worst flu season in history or even the worst flu season this decade.
“Indicators used to track influenza-like-activity (ILI) are similar to what was seen during the peak of the 2014-2015 season, a season of high severity. The overall hospitalization rate is high also, but still lower than the overall hospitalization rate reported during the same week of the 2014-2015 season.”
CDC Influenza Situation Update
For one thing, although it might be higher in some states, the overall hospitalization rate is lower this year.
And about the same or fewer pediatric deaths have been reported so far (30 pediatric deaths) than at the same point in either the 2012-13 (29 pediatric deaths) or 2014-15 (56 pediatric deaths) flu seasons.
“The majority of the influenza viruses collected from the United States during October 1, 2017 through January 13, 2018 were characterized antigenically and genetically as being similar to the cell-grown reference viruses representing the 2017–18 Northern Hemisphere influenza vaccine viruses.”
CDC Situation Update: Summary of Weekly FluView Report
And we don’t have a mismatched flu strain or a strain that has drifted to be concerned about.
That doesn’t mean that the flu vaccine is going to work perfectly, by any means, but it should be at least 30 to 40% effective against the circulating influenza A(H3N2) viruses. Vaccine coverage against influenza A(H1N1) and B strains should be even better.
The best news, besides a very good supply of flu vaccines and anti-viral medicines, like Tamiflu, this year?
We saw the same H3N2 strain in the United States last year. Although that might not guarantee immunity if you had the flu last year, it should offer some protection against severe disease.
Also, we have some new flu vaccines, including the cell-based vaccine, Flucelvax, and high dose flu shots and flu shots with adjuvants for adults 65 years of age and older.
Still, like most H3N2-predominant flu seasons, it will at best be a moderately severe flu season.
Worst ever? That’s doubtful.
Ignore the hype, but don’t ignore the advice to get vaccinated and protected against the flu. It’s never too late to get a flu shot. Even with an early start, flu season will continue into the spring.
What to Know About Flu Season Hype or Hazard
Like other H3N2-predominant flu seasons, this year’s flu season will be moderately-severe, but warnings that it could be the worst flu season ever are likely just hype.
reduce the risk of flu-associated death in children with underlying high-risk medical conditions by just over half (51%)
reduce the risk of flu-associated death in healthy children by just over two thirds (65%) – this is important, because despite what most people believe, many of the kids who die with the flu each year don’t have any underlying health problems
reduce how sick you get, even if you do get the flu, reducing “deaths, intensive care unit (ICU) admissions, ICU length of stay, and overall duration of hospitalization among hospitalized flu patients.”
reduce the risk of the babies getting hospitalized in their first 6 months when pregnant moms got a flu shot
reduce asthma attacks leading to emergency visits and/or hospitalizations in people with asthma
Getting vaccinated can also reduce the risk that you get sick with the flu and get someone else sick.
Considering all of these benefits, it is hard to imagine why anyone wouldn’t get a flu shot, even in year’s when it might just be 60% or even 40% effective.
I mean, it isn’t like the flu shot is actually going to give you the flu or anything…
Have you gotten your flu shot yet this flu season?
What to Know About the Benefits of the Flu Shot
In addition to helping you avoid getting sick with the flu, getting a yearly flu shot has many other indirect benefits, so that even if you get the flu, it can help you avoid getting really sick and ending up in the hospital, ICU, or getting so sick that you don’t survive.
“The vaccine effectiveness of seasonal influenza vaccines is a measure of how well the seasonal influenza vaccine prevents influenza virus infection in the general population during a given influenza season.”
WHO on Vaccine effectiveness estimates for seasonal influenza vaccines
Is the flu virus that is going around the same strain that was picked to be in the flu vaccine?
Has the flu virus drifted, even if it is the same strain that is in the flu vaccine, becoming different enough that your protective flu antibodies won’t recognize it?
Is the H3N2 strain of flu virus the predominate strain during the flu season? H3N2 predominant flu seasons are thought to be worse than others.
In general, the flu vaccine is going to be less effective in a season where there is a poor match between the circulating strain of flu virus that is getting people sick and the strain that is in the flu vaccine, especially if it is an H3N2 strain that has drifted.
Unfortunately, we really won’t know the answer to that last question until this year’s flu season really gets going.
What about reports that the flu vaccine effectiveness will be as low as 10% this year?
It is important to note that those reports are not based on flu activity in the United States and it has been a long time since we have seen flu vaccine effectiveness that low – the 2004-05 flu season. That was the year that because of a drifted A(H3N2) virus, “only 5% of viruses from study participants were well matched to vaccine strains.”
The 10% number is instead based on reports of Australia’s flu season, in which early estimates found that the A(H3N2) component of the flu vaccine was only 10% effective. Importantly, the overall vaccine effectiveness was much higher. Including other strains, the flu vaccine in Australia was at least 33% effective this past year.
“In the temperate regions of the Southern Hemisphere, influenza activity typically occurs during April – September.”
CDC on Influenza Prevention: Information for Travelers
Couldn’t we see a drifted A(H3N2) virus this year?
Sure, especially since an A(H3N2) virus will likely be the dominant strain, but so far “data indicate that currently circulating viruses have not undergone significant antigenic drift.”
“It is difficult to predict which influenza viruses will predominate in the 2017–18 influenza season; however, in recent past seasons in which A(H3N2) viruses predominated, hospitalizations and deaths were more common, and the effectiveness of the vaccine was lower.”
CDC on Update: Influenza Activity — United States, October 1–November 25, 2017
Again, it is too early to predict how effective the flu vaccine will be, but based on an undrifted H3N2 virus that is matched to the vaccine, you might expect an effectiveness between 30 to 40%.
It might be less if theories about egg-adapted mutations are true and are a factor this year.
“…some currently circulating A(H3N2) viruses are less similar to egg-adapted viruses used for production of the majority of U.S. influenza vaccines.”
CDC on Update: Influenza Activity — United States, October 1–November 25, 2017
It is also important to keep in mind that vaccine effectiveness numbers from Australia and the United States don’t always match up.
For example, in 2009, Australia reported an interim flu vaccine effectiveness of just 9%, but in the United States, the flu vaccine ended up being 56% effective! On the other hand, in 2014, the flu vaccine worked fairly well in Australia, but vaccine effectiveness was found to be just 19% in the United States.
Vaccine Effectiveness by Year
What does all of this mean?
“This season’s flu vaccine includes the same H3N2 vaccine component as last season, and most circulating H3N2 viruses that have been tested in the United States this season are still similar to the H3N2 vaccine virus. Based on this data, CDC believes U.S. VE estimates from last season are likely to be a better predictor of the flu vaccine benefits to expect this season against circulating H3N2 viruses in the United States. This is assuming minimal change to circulating H3N2 viruses. However, because it is early in the season, CDC flu experts cannot predict which flu viruses will predominate. Estimates of the flu vaccine’s effectiveness against circulating flu viruses in the United States will be available later in the season.”
CDC on Frequently Asked Flu Questions 2017-2018 Influenza Season
The reports about what happened in Australia should not have made headlines beyond Australia.
As you should get your family vaccinated if you haven’t yet.
And while it isn’t perfect, getting a flu vaccine is certainly better than remaining unprotected and simply taking your chances that you won’t get the flu and complications from the flu.
What to Know About Flu Vaccine Effectiveness
Although the effectiveness of the flu vaccine varies from year to year, depending on how well matched the vaccine is to circulating flu virus strains, which strains are dominant, and whether they have drifted, it is always a good idea to get vaccinated and protected.
They might be used as an adjuvant, inactivating ingredient, preservative, stabilizer, or as a growth medium.
Does the flu shot contain a vaginal spermicide?
The latest scare story from anti-vaccine folks is that flu shots contain a vaginal spermicide.
Now why would a vaginal spermicide be needed in a vaccine?
Anti-vaccine folks who have exposed are spreading this misinformation have confused octoxynol-9, a vaginal spermicide, with octoxynol-10, an ingredient in vaccines.
Aren’t they the same thing?
While both are a type of Triton X-100 nonionic surfactant, as you likely suspect, they are different. And that’s where the confusion sets in.
“Nonionic surfactant mixtures varying in the number of repeating ethoxy (oxy-1,2-ethanediyl) groups. They are used as detergents, emulsifiers, wetting agents, defoaming agents, etc. Octoxynol-9, the compound with 9 repeating ethoxy groups, is a spermatocide.”
PubChem on Triton X-100
In contrast to octoxynol-9, the compound octoxynol-10 has 10 repeating ethoxy groups.
Octoxynol-10 in Flu Vaccines
Octoxynol-10, which is also known as octylphenol ethoxylate, is a surfactant that is used in some flu vaccines in a 1% concentration to help further inactivate and then “split” the inactivated influenza virus that will ultimately be used in the vaccines.
“The majority of marketed seasonal influenza vaccines are prepared using viruses that are chemically inactivated and treated with a surfactant. Treating with surfactants has important consequences: it produces ‘split viruses’ by solubilizing viral membranes, stabilizes free membrane proteins and ensures a low level of reactogenicity while retaining high vaccine potency.”
Lee et all on Quantitative determination of the surfactant-induced split ratio of influenza virus by fluorescence spectroscopy.
A “low level of reactogenicity” means less side effects. That’s good.
Octoxynol-10 also acts as a stabilizer.
Like many other non-active ingredients, it is mostly filtered out from the final vaccine product.
How much is left?
Only residual amounts.
In Fluzone, it is reported to be at a maximum amount of ≤250 mcg per dose.
Do you know the dose of octoxynol-9 that was used in vaginal spermicides? At least 50mg (one applicator full), inserted vaginally before sex. Keep in mind that since they don’t protect against STD’s, they are typically used in combination with other forms of birth control.
What to Know About Octoxynol-10 in Flu Vaccines
Octoxynol-10 is an important ingredient of flu vaccines and is mostly filtered out of the final vaccine.
And even after a vaccine is added to the immunization schedule and it is given together with other vaccines, our post-licensure vaccine safety monitoring systems, from VAERS to the Vaccine Safety Datalink, kick in to make sure that they are indeed safe and effective.
The Myth That Vaccines Aren’t Tested Together
If it is clear that vaccines are in fact tested together, then why do some folks still believe that they aren’t?
Hopefully everyone sees the irony in Dr. Bob saying something about vaccines being untested, as he is infamous for pushing his own made up and completely untested alternative vaccine schedule.
“Babies get as many as 6 or 7 vaccines altogether…and the CDC is admitting that they don’t always research them that way.”
Dr. Bob Sears on Fox & Friends Vaccines: A Bad Combination?
When did they admit that???
“We’ve researched the flu vaccine in great detail and it seems safe when it’s given alone, but the CDC has never researched the flu vaccine when you give it in conjunction with all the other infant shots…and that’s what we’re worried about. ”
Dr. Bob Sears on Fox & Friends Vaccines: A Bad Combination?
So, what about the flu vaccine?
While most kids get their flu vaccine by itself, just before the beginning of flu season, some might get it when they see their pediatrician for a regular checkup, at the same time they are due for other vaccines.
Not surprisingly, Dr. Bob was wrong, and several studies have shown that the flu vaccine can be safely given with other vaccines.
And don’t forget, any problems with co-administration of vaccines would show up in post-licensure vaccine safety testing.
That’s how a very small increased risk of febrile seizures was found during the 2010-11 flu season in toddlers who received either DTaP or Prevnar and a flu shot at the same time.
The very small extra risk doesn’t mean that you still can’t get the vaccines at the same time if your child needs them all though. Remember that febrile seizures “are temporary and do not cause any lasting damage.”
It will be even more reassuring to some parents that another study “examined risk of febrile seizures (FS) after trivalent inactivated influenza vaccine (TIV) and 13-valent pneumococcal conjugate vaccine (PCV13) during the 2010-2011 influenza season, adjusted for concomitant diphtheria tetanus acellular pertussis-containing vaccines (DTaP)” and found no extra risk for febrile seizures.
“Vaccines can generally be co-administered (i.e. more than one vaccine given at different sites during the same visit). Recommendations that explicitly endorse co-administration are indicated in the table, however, lack of an explicit co-administration recommendation does not imply that the vaccine cannot be co-administered; further, there are no recommendations against co-administration.”
Summary of WHO Position Papers – Recommendations for Routine Immunization
Also remember that “there are no recommendations against co-administration of vaccines,” unless of course, you are getting your advice from Bob Sears…
What To Know About Vaccines Being Tested Together
Vaccines are thoroughly tested for both safety and efficacy and they are also tested in many of the different combinations on the routine childhood immunization schedule.