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How Good Are Flu Shots?

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Health experts are warning that this year's influenza outbreak could be the worst in a decade. That's why public health officials are urging almost everyone to get a flu shot. Older people (those over 65) are cautioned that they may have weakened immune systems and are especially vulnerable to the consequences of influenza. They are told that a flu shot will reduce their chances of getting sick, and if they do catch influenza it will be less serious. It's hard to resist such a pitch. Millions of seniors are signing up for their shots. How good is the evidence to support this public health message?

The most objective organization for analyzing treatments is the Cochrane Collaboration. It is an international network of over 28,000 people from more than 100 countries who scrutinize scientific data from all over the world. The independence and objectivity of the Cochrane reviewers allows them to assess the effectiveness of a variety of treatment strategies in a way that few other groups can match. The Cochrane investigators have carefully analyzed flu vaccines and come up with some startling conclusions.

In 2010 (the most recent analysis) the Cochrane Database of Systematic Reviews published a study titled "Vaccines for preventing influenza in the elderly." The authors assessed 75 studies. The conclusions:

"The available evidence is of poor quality and provides no guidance regarding the safety, efficacy or effectiveness of influenza vaccines for people aged 65 years or older."

We don't know about you, but we find that conclusion shocking. Physicians are told that they are supposed to practice "evidence-based medicine." That means that they are supposed to rely on solid scientific data before recommending a particular treatment...such as a flu shot. And yet the best experts in the world state clearly that such evidence does not exist to support influenza immunization for those over 65.

What about everyone else? One of the reasons that public health officials also encourage younger people to get a flu shot is that it is supposed to provide "herd immunity." In other words, if children and healthy adults get a shot, they are theoretically less likely to spread the flu to the most vulnerable in the population, namely older people and infants. So, how good is the evidence that flu shots do something meaningful for healthy adults?

An analysis published in The Lancet Infectious Diseases (Jan. 2012) produced disappointing results. Researchers combed the medical literature for studies published between 1967 and 2011. After reviewing over 5,000 articles they narrowed their evaluation to 31 of the very best studies. These trials actually confirmed influenza infection through culture or a more sophisticated laboratory test. In the gold-standard randomized-controlled trials, the pooled efficacy was 59%. There was surprising variability in effectiveness from year to year. In some years, effectiveness was as low as 16%, while in other years it rose to 76%.

The Cochrane investigators also reviewed all the published studies of flu vaccine effectiveness in healthy adults (people between 16 and 65 years of age). They analyzed 50 studies carried out between 1966 and 2010 (Cochrane Database of Systematic Reviews, Jul 7, 2010). The authors concluded:

"Influenza vaccines have a modest effect in reducing influenza symptoms and working days lost. There is no evidence that they affect complications, such as pneumonia, or transmission."

Here is the "Plain Language Summary" of the results of their investigation:

"Authors of this review assessed all trials that compared vaccinated people with unvaccinated people. The combined results of these trials showed that under ideal conditions (vaccine completely matching circulating viral configuration) 33 healthy adults need to be vaccinated to avoid one set of influenza symptoms. In average conditions (partially matching vaccine) 100 people need to be vaccinated to avoid one set of influenza symptoms. Vaccine use did not affect the number of people hospitalised or working days lost but caused one case of Guillian-Barré syndrome (a major neurological condition leading to paralysis) for every one million vaccinations. Fifteen of the 36 trials were funded by vaccine companies and four had no funding declaration. Our results may be an optimistic estimate because company-sponsored influenza vaccines trials tend to produce results favorable to their products and some of the evidence comes from trials carried out in ideal viral circulation and matching conditions and because the harms evidence base is limited."

Yikes! If the primary purposes for getting a flu shot are to avoid getting influenza and reduce the likelihood of developing complications (such as pneumonia) or spreading the virus to other people (such as senior citizens), then there is little evidence that these goals are achieved. If you read the summary carefully, you will discover that even with a perfect vaccine, 33 people would have to be vaccinated for one to person to avoid the flu. In our humble opinion that is not very impressive.

What are we to make of this confusion? The experts plea for better research to determine the true effectiveness of the influenza vaccine, especially in older people. How can public health officials encourage everyone to get a shot without excellent data to support their recommendations? Public health experts are hoping to get 80% of the American public vaccinated against influenza in coming years. People deserve convincing evidence that such an effort will be worthwhile.

This is not to suggest that vaccines in general should come under suspicion. The smallpox vaccine was responsible for the greatest public health achievement of the 20th century, the elimination of this deadly and disabling infection. Providing polio vaccine to all at risk of this virus should lead to a similar accomplishment early in the 21st century. Research evidence as well as experience demonstrates that the benefits of these vaccines greatly outweigh their risks. We'd love to see similar evidence on influenza immunization.

It may be that today's modern flu vaccines really do work, meaning that they protect 80 to 90 percent of those who get a shot from developing flu symptoms and complications. But we won't know that until objective research proves it. In the meantime, you are pretty much on your own. Ask your doctor to review the scientific literature to see whether she can find evidence of effectiveness and give you better guidance. We have provided links to the most complete data. We would welcome physician feedback.

We would also love your thoughts about the influenza vaccine. Do you always get a flu shot? Does it protect you? Have you ever gotten a shot only to come down with the flu anyway? Share your story below.

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I have never gotten a flu shot and have not had the flu for about 25 years.

I started receiving annual influenza vaccinations when I was in the US Air Force Reserve, 1979 - 1985. The vaccination was mandatory - you didn't get paid for the monthly drill until after you received the shot! I have no idea if it prevented any actual influenza infections. However, over several years I did notice a decrease in the number and severity of respiratory and other problems that formerly plagued me each winter. Since then I have voluntarily received the vaccination each year because of that effect.

I realize this is only anecdotal evidence but in this case I have neither the data or medical knowledge to present any other type.

Prior to my retirement I got flu shots because my employer encouraged it, offered it free and I felt that in close proximity to others, it would be best not to get sick. Now that I'm retired, I feel it is injecting bugs into me that may not be necessary.

With much less stress, less exposure to others who may be sick (stuck in a meeting with a sick person for hours), I have not gotten the shot. I had the flu while working and it was terrible. Knock on wood, I've been healthy now that I'm not working and not inoculated. Hoping I'm right...

I think we over medicate, over engineer our food and over do everything. I for one am trying to exercise, eat better, rest, love life and stay away from chemicals that make pharma companies wealthy. Let's make organic farms wealthy instead.

Thank you for sharing actual, factual information, while doctors, pharmacies and almost everyone is pushing all of us to get the flu shot. Based on what? Nearly nothing! Now THAT stresses me...

Turning 69 soon and wonder if I need to get the flu shot. Haven't had the flu in over 40 years, maybe 50. I took the shot last year and once when I turned 60, and felt bad for a few days. Did I understand the study? Was it checking the number of people you need to vaccinate to stop the flu from spreading? Does it keep a vaccinated person not getting the flu, whether young or old? Do you take the flu shot?

Every time I have gotten a flu shot I have gotten sick. The last time I took a flu shot was 2 or 3 years ago when the swine flu vaccine was mixed with the regular flu shot. That year I was sick for over a month and my doctor told me to never get a flu shot again. When I do not take a flu shot I do not get sick.

I am among those who have been getting flu shots for many years and assumed my good health was at least somewhat due to the shot. This year I had a flu shot in late September and right now I am just finishing a week of the worst case of flu in about 40 years. Difficult to believe that it would have been even more dreadful without the shot and I must say that next year I will probably think twice before bothering with the shot.

My husband and I are 60 years old. We have never gotten a flu shot. I had the flu once when I was a teen, my husband had the flu once as an adult. We don't believe in getting flu shots for ourselves.

We do not get flu shots. We have grade school age children & instead use 2,000-4,000 iu of vitamin D everyday during flu season. And during the swine flu just added a homeopathic supplement. While half the kids where out sick, my kids didn't even catch a cold. Now we use natural therapies for just about everything!

What is the downside of getting a flu shot? For seniors on Medicare it's free and you are probably in a pharmacy that gives them anyway. Understand if you have allergies or a bad reaction, but otherwise, what's to lose?

I get the flu shot every year and have not had the flu for over 50 years. I never have a cold either. I am 88 years old, but I do have a chronic respiratory problem. I take accolate 2 X a day, use flovent inhaler 2 X a day and nasonex one time a day. I have had this condition for over 20 years and I am thoroughly tired of it. It started with a chronic cough. My doctor says you do not have COPD. Well, what do I have?

I have gotten the flu shot for 35+ yrs. My husband used to joke about it until he came down with the flu about 30 yrs ago and was very sick (I didn't get it.) After that, he has had a flu shot every yr and has not had the flu again.

My wife and I have had a flu shot every year for years and have never had the flu. Age 75.

I have received a flu shot every year since 1990. The only time I have had the flu was in 1968. It was an unforgettable experience.

I have never had a flu shot. I am so drug sensitive that it took forever to even find a BP med I could tolerate so I avoid things that are not absolutely necessary. Everyone around me is shocked that I don't run and get the "free shot". They all can't understand why they still get coughs and colds in the winter because they've "had their shot". You can't explain to them that the shot is only for specific strains of influenza. The types of vaccines developed don't always match the types of flu that will exist in a given year is my understanding. It's a gamble and I'll gamble that I'm not going to get the flu even if I am old. I never have had it and strangely enough I don't get colds, sore throats etc anymore either.

I'm 73 years old. I have had the flu shot every year since it came out and I actively encourage my friends and children to do likewise. Before the flu shots were available I had flu twice and believe me I never want to have it again. If it takes 33 people having the shot to prevent one case of the flu, then I think it's worth it.

Of course, I'm somewhat of a recluse, especially during the winter so that may be helping but I worked around people until I was 58. It is my understanding that scientists guess at what strains of flu might be prevalent each year so maybe some years they guess wrong. I still think it's worthwhile to have the shot.

At 76 I have never had a flue shot and, since my mother developed Guillian-Baarre after having one in the mid-eighties, would not dream of it.

I have gotten flu shots consistently for more than 20 years and only had flu the one year I missed. However I opted not to get the higher potency shot for seniors this year. Information circulated recently increases my skepticism regarding the value of the shots.

I take a flu shot every year and haven't had the flu for twenty years. I started getting flu shots because I had two bad cases of flu back to back each lasting about ten days and I decided I would do anything to prevent that happening again. So far it has worked for me.

My husband and I rarely get the flu shot and lots of luck asking our gp doctor cause he doesn't even give flu shots anymore.
We have gotten them at our Kroger Pharmacy in the past. Older people are advised to get the extra strength flu shot and I kind of hate that. Flu shots still have mercury in them too. We never get the flu or colds for some reason. I'm 69 and he's 73, last time I had the flu I remember well my 42 yr old daughter was a teenager and we both had the flu together. It was bad!

Btw, nowadays my husband and I take 5000 IU Vitamin D each day and I know if I didn't I wouldn't have much 25OHD storage because I don't go outside in the sun much and when you are old as we are, you don't make as much d in your skin. I believe d is important.

Haven't had a flu shot since 1968. I got very sick from that shot and said I would never take another one. I missed almost a week of work. I'm 69 now and have never had the flu. I won't take one until my Ins. network makes me take one. I'm sure that will be coming.

For what it's worth, I tell you this: I have taken a flu shot every year since the 1950's and have yet to suffer from a case of the flu. I am now 85 years old.

SLN

I am 72 years old. Before getting flu shots I got flu almost every winter. Have been getting flu shots for at least 10 years each fall and have not had flu since.

Had flu shot ten yrs. ago, got flu 3x that yr. Have not had shots or flu since.

Never had a flu shot, never had the flu. I'm 61 years old and active in many fields.

When I was in the military I had to get the annual flu shot. Yup, I got the flu anyway and it was always bad. I never get flu shots now at all!

I have not had a cold or flu since March of '85. That is when I got tested for allergies. It was the under-the-skin testing in those days and not fun to go through. Now there is a blood test that makes it much easier.

For those of you who do get colds or flu, you might want to get tested for allergies. Also get your vitamin D level checked as well.

WJR, what's to lose?

Your mental functioning maybe. There is a lot of nasty stuff in the shots including aluminum. This is particularly important for seniors too unless you get chelation done from time to time.

Everybody would like research study findings to be 100% valid, reliable, and just want they want them to be. In the real world this is simply not the case, no matter how well controlled the studies are. There is no way to control for every variable. At best, we hope that the study finding result in a high (generally 5% or more) level of significance. There will almost always be people who took the vaccine and came down with the flu and others who did NOT take the vaccine and did NOT come down with the flu. What is a poor soul to do?

All of this boils down to a single, simply question: Would you be better off WITH the flu vaccine or without it? To me, the answer is overwhelmingly simple: You will PROBABLY be better off with the vaccine than without it. I'm 80 years old, take the vaccine every year, and have not had the flu. But that might NOT have been due to the vaccine!

Good luck!

I think mostly it's in my head. I've gotten sick when I needed a break because I was so run down, you may say my immune system was weak. I've had the flu when I had the shot and didn't get the flu when I didn't get the shot. Do you think some of us get it because we were exposed and didn't wash hands fast and thoroughly enough and because we were a little weak? Other times, do you think we escape it because we are strong, we wash hands, we step away from sneezers? I don't know the answer, but hope I don't get it, because it's terrible to be sick like that.

I asked my children's doctor. He said it was up to me and that there were pros and cons. I've had the flu shot some years and not others. Has it helped me? Who knows! What to do? Who knows? My mother (80) has been ill each time she's had a flu shot and her doctor told her to stop; this makes me wonder about having it since I, like her, am sensitive to meds. I do not know what to do, so I do nothing!

In the fall of 1952 all the students at an Air Force training base were lined up to get a flu shot. The guys that got the shot said it felt like a ball of fire in their arms. As I approached the "shot station" they went to lunch and told us to come back in an hour. Several of us just wrote our names down on the list as having the shot and left.

I did not get the shot and did not get the flu. At 81 I've had one shot, about 6 years ago, and have never had the flu. I'll probably get it this year.---jm

Have been getting a flu vaccine yearly since the 70's and only had the flu once in the late 70's. I find getting enough sleep gives me a lot of immunity to diseases. Plus, I wash my hands a lot. I am a 68 y.o. RN.

I had the flu shot once as an adult. Got very sick within a few days, and spent a good portion of that winter sick. Have not taken the flu shot since then, and have not had the flu. If I start getting an Upper Respiratory Infection during flu season, I use a homeopathic remedy and keep on moving. For years, I've been the "last man standing" in an office passing the flu around.

My husband got the flu several years ago the same week as he got the flu shot. A couple of years ago, my friend's mother suddenly went permanently blind a few hours after getting the flu shot.

Took the flu vaccine while working, mandatory. Got sick only one time after taking. after retiring, My husband was coming down with the flu and I felt sick with fever, raced to the dr. for Tamiflu on two different occassions. Tamaflu stopped it both times. (must be taken in the first 48 hours of onset.) Now that I'm retired, I guess i'll take my chances.

Worked with patients in the 70's with Guillen-Barrea syndrome. Some died.

I have never, nor will I ever get a flu shot.

As a nurse I was forced to get a flu shot every year and in spite of this, I did have the flu a few times. Since retirement 6 years ago, I have not had a flu shot and refuse to get one and have not contacted the flu. I worked in a nursing home where every resident was given a flu shot and in bad flu years, they got sick anyway.

Clearly from the figures the benefits for individuals are modest, with those seasonal effectiveness studies showing 16-76% effectiveness, but the overall effect of the flu shot campaigns for society is enormous. Even 16% effectiveness cuts into the transmission rate. And if we are hit by a deadly flu, like the 1918-1919 pandemic, cutting into the transmission rate may save hundreds of millions of lives.

I reside in California and a member of an HMO group. Every year there is a drive for every member over 65 to get a flu shot. I am now aged 81 and for years I follow their advice. Every years I got a shot - I reacted (using my own terminology) in a semi-negative way. Meaning that I fell a bit "under-the-weather" after the shot for a a couple of months. For the last 4 years I decided to avoid the "flu-shot" and have been noticed that by taking simple to do safety precautions live avoiding being in very large crowds an washing my hands after several contact - shaking of hands -with people in public I had also avoided being a victim of the flue epidemic. I no longer believe in the promotions of "flu drives; considering that several - not just a few - of my geriatric-age acquaintances did suffered from the flu even after receiving the shots at the proper time - meaning not when the already have suffered from flu symptoms.

I am 70 and have never gotten a flu shot. I retired a year ago and where I works the ladies were sick all through winter, flu shot or not. But I never got the flu. I feel the difference between them and me is I took and still do, 3000 IU of Vita 3 daily. I also eat organic food and very little sugar. I also cook from scratch. And I get 8 hour of sleep per night.

I am 70, and I have never gotten a flu shot. I retired a year ago, and where I worked, the ladies were sick all through winter, flu shot or not. But I never got the flu. I feel the difference between them and me is I took (and still do) 3000 IU of Vita D3 daily. I also eat organic food and very little sugar. I also cook from scratch. And I get 8 hours of sleep per night.

I am 62 yrs old and have had a flu shot since 2007. I have not had flu since, nor have I had any bad colds. Prior to receiving the flu vaccine, I had throwing-up type flu once about every 2 or 3 years, and at least one bad cold every year. I always felt certain I was dying every time I had the flu.

If flu vaccines prevent only one in 33 to 100 incidents of flu a year, I think it is still well worth people getting the vaccine. In terms of side effects, I have never had more than a very slight fever a day after a flu shot. There are younger people who do not get the shot and call in sick frequently where I work. We are exposed to numerous germs from all over the world, as we see hundreds of people a day and handle items they touch, as well as breathe the air they cough into.

I am a hand-washer, citrus-eater, vitamin-taker, and committed to flu vaccine every year. I hope research continues and improves the predictability of which strains need to be included in the vaccine. I wonder what the excluded studies had to say....

I am a 70 year-old white male (will be 71 in three weeks) and have had the flu shot every year since it became available, and have never had the flu. Like any vaccine, it is not 100% efficacious, but IMHO, it certainly reduces the risk.

The flu shot is like virus protection for your computer; under average conditions it will work effectively, but if you are constantly exposed to the flu virus day in and day out, eventually some of those pathogens will get through your immune system and make you sick. Also, there may be an unknown strain of the virus floating around in the air for which the flu shot will not prevent. It is a gamble; you may or may not catch the flu. However, it is always wise to play it safe by getting a flu shot every year.

Agree! Moreover, you are receiving strains that are expected to become a serious epidemic (Bird Flu, Swine and NIHI again, etc and they are coming). This publication is simply scare tactics, and people should not be lied to, or have publications that have no replicated data to back it up.

Equally tragic, people can be carriers and those who do not have the flu vaccines are spreading it and may harm the most vulnerable. Frankly, that is nothing but self-serving idiocy. This website has some merits, but this article is simply way off! The couple who run this have obviously never seen someone die from Influenza; I have!

Had my last flu vaccine about 5 years ago. 1-2 hours later had a facial rash/flushing. Then 3 days later had an inflamed spleen. Staying away from the flu vaccs now. A nurse in the doctors office commented at the time that she used to work for a company that made the vaccines, and she would NOT take one. BG in NC

RJM, you have a right to your beliefs so go ahead and get your shot but don't force me and mine to do the same! We do have a few freedoms left in this country and I choose NOT to get a flu shot. Haven't had the flu shot or the flu in almost 30 years! nor colds!

People who are afraid of the flu need to do some homework and get themselves healthier. If you are unhealthy or have unhealthy habits even the flu shot won't help...which is probably why so many people who get the shots get the flu anyway.

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