{"id":497,"date":"2014-12-11T11:00:01","date_gmt":"2014-12-11T11:00:01","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=497"},"modified":"2017-08-21T12:08:12","modified_gmt":"2017-08-21T12:08:12","slug":"primary-care-corner-with-geoffrey-modest-md-flu-vaccine-coverage-this-year","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2014\/12\/11\/primary-care-corner-with-geoffrey-modest-md-flu-vaccine-coverage-this-year\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Flu vaccine coverage this year"},"content":{"rendered":"

By: Dr. Geoffrey Modest\u00a0<\/strong><\/p>\n

The CDC sent out a health alert based on\u00a0initial evaluations of influenza types in the US, noting a significant mismatch with those\u00a0covered by the vaccine (see here<\/a>). \u00a0They note:<\/p>\n

\"091103-N-2562S-004\"–Influenza A (H3N2) is so far the most frequently reported influenza virus found (though influenza is\u00a0still pretty uncommon, they have found influenza A (H3N2)\u00a0in almost all states). So far, 91% of 1228 positive samples have been influenza A.<\/p>\n

–In the past,\u00a0influenza A (H3N2)\u00a0\u200bhas been\u00a0associated with higher overall and age-specific hospitalization rates and mortality (esp in the old, young and those with chronic medical conditions)<\/p>\n

–Only 48% of the\u00a0influenza A (H3N2)\u00a0analyzed so far are antigenically similar to the\u00a0influenza A (H3N2)\u00a0vaccine component, with 52% showing antigenic drift (only 85 samples tested). Of\u00a0note, the vaccine-types chosen each year are set the prior February, too late to change the vaccine now.<\/p>\n

–This type of antigenic drift is associated with decreased vaccine effectiveness. Though there may be some cross-protection. also, no evident antigenic drift for\u00a0influenza A (H1N1)\u00a0or influenza B<\/p>\n

–So, this finding still\u00a0reinforces the importance of the vaccine even in its reduced-effectiveness state, given the annual influenza mortality\u00a0of 3,000-49,000 people in the US\u00a0over the past 30 years,\u00a0but especially the importance of the neuraminidase inhibitors<\/strong> — oseltamivir (Tamiflu) and zanamivir (Relenza) — both for treating the flu (shorter duration of symptoms, reduced risk of complications, reduced risk of death in hospitalized patients), and for prevention in high risk situations. And these drugs should be given as soon as possible after symptoms begin, preferably within 48 hours. All viruses tested so far are susceptible to these drugs.<\/p>\n

–I would add, from previous years, that when influenzal illnesses first begin in a community, it is useful to do lab\u00a0test for flu (though don’t wait for results before treating with\u00a0neuraminidase inhibitors). But when influenza is established in a community, the likelihood of someone with typical symptoms\u00a0having influenza is so high that it is not useful or necessary to do lab tests (ie, the post-test probability doesn’t change much when the pre-test probability is high, based on symptoms and prevalence of of influenza in the community). just treat them.<\/p>\n

I would add to the above that this blog post<\/a>\u00a0of 2 Cochrane reviews of neuraminidase inhibitors finding that<\/p>\n

–There was significant drug company malfeasance in releasing the raw data<\/p>\n

–Osteltamivir has better evidence of efficacy\u00a0than zanamivir<\/p>\n

–The benefits are not very dramatic (decreased symptoms of 16.7 hours, with no difference in hospital admissions, pneumonia or any serious complications)<\/p>\n

\u200b–There were\u00a0significant adverse events (nausea, vomiting, increased QTc, psych effects, headaches)<\/p>\n

Reviewing the studies themselves\u00a0show a remarkable diversity of outcomes with neuraminidase inhibitors, with some showing significant reductions in pneumonia and mortality and others not. so, it is really hard for us mere mortals to be sure….\u00a0My practice has been to use only osteltamivir (not zanamivir), only when studies show minimal resistance (as appears to be the case so far this year), and\u00a0especially\u00a0in more symptomatic people (high fever) or significant medical comorbidities.\u200b<\/p>\n","protected":false},"excerpt":{"rendered":"

Flu vaccine coverage this year […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-497","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/497","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=497"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/497\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=497"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=497"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=497"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}