The Gap Between Stats and Understanding In Flu Cases

KentuckyFC writes "Bird flu gets all the headlines but ordinary flu kills several orders of magnitude more people each year and represents a significant threat to our society. The frightening thing about ordinary flu is how little we understand about how it spreads. According to a report at the physics arXiv blog, researchers trying to model this process say they still don't know some basic probabilities associated with infection (pdf, abstract). For instance, given that the disease has manifested itself clinically in an individual, what are the chances of that person dying? And if a virus can be caught from a number of different host species (as it might eventually be with bird flu) what is the probability of transmission?"

Comments

Is ordinary flu that dangerous?

[Eukariote]

but ordinary flu kills several orders of magnitude more people each year and represents a significant threat to our society.

That is a the popular perception. But it does not reflect reality: death risk from ordinary flu is actually statistically negligible. See for example this page http://thinktwice.com/cdc_2001.pdf taken from the CDC National Vital Statistics Report.

Yes, those are official statistics. Time to think twice. Yes, part of it is the good money made on all those flu shots. But that is only a small part of it. To learn more about the real reason, watch this talk by radiologist David Ayoub: http://video.google.com/videoplay?docid=6890106663412840646. Hard to believe? Verify the sources, they check out. Welcome to the real world.

Re:Is ordinary flu that dangerous?

[faragon]

Yes, it still kills people, but that its because it is massive, e.g., an inmunodepressed 90 year old can have 75% possibility of dying because of "normal flu". It's just a matter of exposition: you have more deaths by "normal flu" because of the massive exposition, in comparison to "avian flu". Let me guess that under the same grade of exposition, you could loss 1/4 of earth population, in the case of "avian flu". I think that Eukariote was trying to argue that way.

Re:Is ordinary flu that dangerous?

[Eukariote]

So investing time and money into understanding and combating both types of flu is understandable.

Indeed, infectious diseases should be carefully researched and closely monitored. But does that warrant the scare mongering enacted in the public media concerning flu and bird flu when the actual risk is very very low in comparison to other common risks? And does that low risk warrant the side effects and cost of all those yearly flu shots people are given?

Why not verify the data that is supposed to show that vaccines are even effective? Here is a book to help you out with that http://astore.amazon.com/medical-bookstore-20/detail/1881217302. Yes, you can interpret statistics in many ways, but the fact of the matter is that vaccines have been sold to the public and policy makers based on statistics of infectious disease reductions that occurred with improvements of hygiene, not with the later introduction of vaccination programs.

Re:Is ordinary flu that dangerous?

[puck01]

First, the flu shot is not universally recommended for everyone, but is certainly available to anyone in the US. It is recommended universally in young children and very old because of their high risk as well as those with co morbid conditions such as asthma or diabetes. Health care workers should get it to reduce the risk of spreading it to high risk patients.

Second, the data you referenced only used death as an end point. That is only one of several measures. For every death, the flu causes much more morbidity which is entirely ignored by you. It causes a huge numbers of hospitalizations and ICU stays which are incredibly expensive.

Third, very little money is made in vaccines. Primary care doctors are lucky if they don't loose money on vaccines. How do I know? I am a primary care doctor and its a wash between the cost of storing and purchasing them vs how much we get paid to give them. Manufactures almost have to be begged to make vaccines because there is little financial incentive to do so. Its not uncommon to have shortages occasionally because of this.

Forth, your referencing a radiologist to talk about an infectious disease / epidemiology problem. That's usually a red flag right there. For instance I know an orthopedic surgeon that argues quite well to the uneducated how evolution is genetically impossible. He's a doctor so the uneducated take his word and believe him. Problem is, he's a idiot outside orthopedics and anyone with half an education about genetics would butcher him. Another example would be this is like getting a plumbers opinion on what type of roof to put on your house. Would you do that?

Odd

[Asmodai]

Given the fact in the Netherlands and Belgium we have http://www.degrotegriepmeting.nl/ -- an effort by some medical institutions and related institutions to monitor the migratory patterns of the flu. This is the fourth year they're monitoring. The same kind of project happens in Portugal: http://www.gripenet.pt/ Moreover there's http://www.eiss.org/ -- the European Influenza Surveillance Scheme. So if you want to talk about current statistical data, it's right there and active.

Nothing like that even enters into their paper, so pardon me for finding it a bit one-sided approach.

how about doing what nature intended instead

[2ms]

I have an idea. How about letting the human species's immune system continue to adapt for the flu rather than short-circuiting continued adaptation the way we are in countless other areas by creating drugs that then eventually become ineffective as the diseases evolve while human immune systems devolve and put all that research time and money toward some of the infinite number of more pressing problems that need to be addressed now? We're the one species that's going to go down as not only having messed up the planet and ecosystems for all the other species, but also the one that actually largely put the most effort they possibly could into actually making themselves maladapted to the very planet they forced the most adaption of species for.

Re:how about doing what nature intended instead

[theshowmecanuck]

In one sense I totally agree with you. We need to exercise our "natural" immune system in order for it to become stronger. On the other hand, part of human evolutionary adaptation gave us the ability to modify our situation/environment.

With respect to the bird flu (being mentioned a lot in the replies), one of the best observations I have heard is that the real bird flu threat is the one you contract from KFC and McDonalds Chicken Nuggets, et al. Heart disease and obesity. That probably kills far more than all influenzas and pneumonias in the U.S. and Canada each year. :) A lot of people will need to become immune to all the advertising for that epidemic to die down.

Re:how about doing what nature intended instead

[YoungHack]

"How about letting the human species's immune system continue to adapt for the flu rather than short-circuiting continued adaptation the way we are in countless other areas by creating drugs that then eventually become ineffective as the diseases evolve while human immune systems devolve and put all that research time and money toward some of the infinite number of more pressing problems that need to be addressed now?"

That sounds great, but adaptation at the level of a species as we understand it happens through evolution. To clarify, you're basically saying, "Let the weak die (of pneumonia and complications) and the strong survive." If you believe that, perhaps by your logic we really should refrain from vaccinating kids. If they die young before reproducing, then evolution has been served. With luck, in about 20 generations we may see some difference, although we're talking about random processes (i.e. there's no guarantee).

But the old are past child-bearing age. They've passed on their genes or they haven't. How is the species to be served by their suffering? Personally, comments like the quote sound more like pseudo-science than reasonable argument. It seems like wisdom to say we meddle too much until it is your precious 3-year-old daughter in the intensive care unit.

Flu vaccine *does* let humans adapt to nature.

[KWTm]

I have an idea. How about letting the human species's immune system continue to adapt for the flu rather than short-circuiting continued adaptation the way we are in countless other areas by creating drugs that then eventually become ineffective as the diseases evolve while human immune systems devolve?

You seem to be lumping vaccination in with other anti-infectious measures that protect you from exposure, such as sterilizing potentially infectious objects or wearing disposable gloves, but in this case your concerns are not valid.

Vaccination stimulates the human species' [no need for "s" after the apostrophe] immune system by exposing it to a safe version of the pathogen. In this way the immune system continues to "adapt for the flu", exactly as you had hoped, and in no way short-circuits the continued adaptation. As the influenza virus mutates, so does the vaccination, and each year the scientists try to figure out which strain of flu to protect against. (One year they guessed wrong, and the flu vaccine ended up next to useless as it protected against a strain of flu that only appeared in a small minority of people.)

Even for other vaccinations such as TdaP (tetanus, diphtheria, acellular pertussis) which is given only every ten years, vaccinations don't interfere with adaptation. The special case you may be thinking of is with smallpox, which was completely eradicated to the point that there is no further need for vaccination. That is not interference with adaptation, since:

• any reintroduction of smallpox is by artificial means, so in any case adaptation has nothing to do with it
• it's not worthwhile continuing to administer smallpox vaccine to let the immune system "adapt" to a potential smallpox outbreak, since the smallpox vaccine itself has a number of significant side effects. I myself was offered the smallpox vaccine shortly after the Sept11 incidents, and there was a non-negligible chance of serious illness including hospitalization and, by extension, death. (I did accept, but the threat level then decreased and it was no longer considered necessary.)
• if smallpox were to return due to natural circumstances rather than some human reintroducing the locked-up version, it would evolve from an existing virus in the wild, and vaccinations would play no part in whether the human immune system adapted
• Letting the human immune system adapt doesn't work all that well. SARS is an example of a virus for which we don't have a vaccine, and it had a mortality rate approaching 10%. That sucks. No antibiotics or other antimicrobial drugs, either, so you can't blame it on that.

I don't know if you're actually referring to the use of antibiotics, where pathogens do evolve against a fixed, unchanging drug molecule, but there are certainly advantages to having antibiotics, too, just as there are appropriate circumstances for sterilizing medical instruments or wearing disposable gloves. Nowadays we can treat skin cancer by a simple office procedure, for which the risk is negligible. Can you imagine if we didn't use sterile instruments, or if the doctor didn't wear sterile gloves, or we couldn't treat a surgical wound infection with antibiotics?

Be careful not to confuse excessive anti-exposure measures with vaccination, which takes leverages rather than suppresses the immune system.

American Newsspeak in Action

[Anonymous Coward]

...ordinary flu kills several orders of magnitude more people each year and represents a significant threat to our society.

Are you scared yet?

Vaccines are not snake oil

[brunes69]

You don't need statistics to show that vaccines work. it is scientifically provable.

You give someone a vaccine, they get the antibodies for the virus they didn't have before. You can see them in your blood. How do you think this stuff works?

This isn't saying anything as to whether or not the flu shot should be a required vaccine or not, IMO NO vaccine should be required by law, but up to the parent. And I have never gotten a flu shot in my life and I likely never will until I am 70 and at risk, because other wise it is just fear-mongering nonsense (the flu is not going to kill me, a healthy 28 year old. At worst I will get a 2 week paid vacation).

As for the video and the claims of vaccine causing autism in some? May or may not be true. IMO it is not the issue. Think of how many times a child cuts themselves on metal each year. The likelihood of them getting a SERIOUS case of tennis from these injuries far exceeds the likelihood of them acquiring autism.

There is a degree of risk in almost every treatment in modern science. You go into routine surgery to get your appendix removed, you might die from the anesthetic. But the risk of dying is MUCH HIGHER without treatment. No different than many vaccines - the risk of death from the disease is much higher than any risk of autism. Nearly ever kid in the US gets a huge vaccine regiment, hardly any have autism. To me, that makes the probability pretty small. Much smaller than the odds of dying from any of these eliminated diseases used to be.

fears seem well placed

[khallow]

Let's take a look at the last century. As I see it, roughly half of the people who died of flu, did so in the 1918 pandemic. In other words, one single variant of the flu killed as much as a century's worth of regular flu. It makes no sense to ignore a flu variant which to all appearances is more lethal than the 1918 flu (all we know is that more than half of the people who we figure out had it die which is much worse in general than the 1918 flu was), even if it is barely contagious. Obviously, there might be a big drop in lethality, if it adapts to humans. But if there isn't, and as in the 1918 flu epidemic, it infects about 20% of humanity (as I dimly recall), then that means 10% of humanity dies (as opposed to about 2% for the 1918 flu).

In fact, things are much worse now

[Kupfernigk]

In 1917-18 human mobility was much less than it is now, and a much lower percentage of humanity lived in large cities. Cheap air, bus and train travel mean that viruses can spread much faster than they could in 1918. Also, the fear of disease is much less and people will less willingly take precautions against exposure. Given the short exposure needed and the rapid incubation of the influenza virus, the spread could be so rapid as to overwhelm government agencies and hospitals. The Black Death reduced the population of medieval Europe by more than a third.

Recent tests of symptomatic treatment of influenza have shown that this doesn't work, i.e. the lethality of the virus is based on its primary action. Given that governments will probably be too afraid or powerless to stop all air travel and movement from affected areas when it starts, this could realistically happen again.

The worst of it is that it will probably start in China , where a major population reduction would probably suit the Communist Party down to the ground. The survivors would be too busy reconstructing society to think about revolution, and the pressure on resources would suddenly drop dramatically. Provided they could protect themselves, the leaders of China would have little reason to try and stop a world wide influenza pandemic.

It's not the shot themeselves.

[DrYak]

It's the vaccine that may be the cause of the arthritis, it may be the adjuvants.

One doesn't develop systematically antibodies against everything that gots injected under the skin. How otherwise would you explain that no reaction happen (most of the time) following tatoos ? That people who develop antibodies against bioengineered drugs only develop them over time (and not right at the first exposure) ?

For the white cells to react, the intruder must be flagged as something worthy of a reaction, otherwise the intruding substance just gets cleaned up silently by macrophages.
For actual microbes (viruses and bacteria) that is mainly due to the destruction they cause. This damage triggers and inflamation which stimulates the immune response.
But a lot of vaccine are often only bioengineered inert proteins. They don't atract the lymphocyte's attention and may end up silently cleaned up. On of the technique consist to ad a special substance that will increase the probability of an immune response, that will boost the tendency of the body to react and produce antibodies.
The problem is that some adjuvant bring a small risk that the bodies over reacts and is stimulated to produce antibodies against other things too, like against it self and thus the dogs in the experiment you mention develop arthritis.
But that depends on the quantity of vaccines they got exposed too, and the composition of the vaccine regarding the response-boosting adjuvants.
Regularly old adjutants (either preservatives or boosters) get phased out and replaced by newer safer methodology.

But the process of vaccination (producing antibodies against foreign substance) isn't dangerous per se. And anyway is happening all the time continuously, whether or not someone gets shots by his doctor or not. If your not sick for long periods of time, that's not because you managed to somehow avoid all bacteria, it's just that your immune system is at work and manage to correctly handle continuously all pathogens present in your everyday environment.

Autoimmune diseases are also at increased risk after a disease, because the immune system got stimulated (and also because of the mimickery some bacteria use to try to hide - Antibodies that work against them may end up working against the body)

Lastly, autoimmune disease depends mainly on the genetic make-up of an individual. There are people at greater risk of autoimmune response and people at lower risk (also for various reason I won't detail here, being female doesn't help). And as I said before, if your at risk (have several family members with diseases like arthritis, lupus, psoriasis, etc.) running away from vaccine won't help, you could develop some as a consequence of a disease.

About Allergy : They are not caused by a depressed immune system. They are a (bad) reaction of the immune system and for that you need a working one. Once again it depends on the individual genetic markup.
But as you point out environmental exposition may play a role in the balance.
The cells involved in allergy (eosinophils) seem to normaly be usefull against parasites. In third world countries, those cells get someting to work on and thus remain busy. In our clean occidental settings, they stay useless. In some people, those cells just stay calm and don't do much. But in people with the wrong genes, the cells may try to work too much and do things they aren't supposed to : this bring you allergy (and the problem with allergy is, unlike a parasites which usually is 1 animal in 1 precies location, the allergenic substance can get in your blood and disseminate and trigger response in the whole body thus provoking anaphylaxis).

Note that, as mentioned before, some way to stimulate the immune response is needed in allergy too. Often this is linked to a family of proteins like lysozyme in the saliva of animals whose fur causes allergy (those proteins are used to kill bacteria but might be very slightly reactive in humans and thus trigger a response).

Probably (as pointed