Flu-2013: get vaccinated or not?
Who will protect us from the flu?
Alexey Vodovozov, "Trinity variant", 05.11.2013
On social networks and in everyday life, more than once we see discussions about whether it is necessary to get vaccinated against the flu? Alexey Vodovozov, medical journalist, scientific editor of the magazines "ABC" and "Russian Pharmacies", tells about the pros and cons.
Whether you need to get a flu shot or not is one of the most controversial issues of vaccination. So far, no concrete evidence has been obtained, collected in large-scale and very randomized studies, indicating the unconditional effectiveness of this measure for the entire population. And the available data somewhat do not coincide with the current recommendations to vaccinate primarily children and the elderly with chronic diseases and those adults who work in organized collectives.
Thus, the largest meta-analysis on the first thesis was probably published in 2011 in The Lancet Infectious Diseases [1]. It included only 31 out of 5,707 studies conducted between 1967 and 2011; a mandatory inclusion criterion was, for example, confirmation of the diagnosis of "flu" using RT-PCR (i.e. polymerase chain reaction in real time). So, according to the results of this meta-analysis, it turns out that HIV-positive patients aged 18-55 years benefit the most from vaccination (effectiveness – 76%), followed by healthy people aged 18-46 years (70%), followed by healthy children aged 6-24 months (66%). For other categories, the efficiency is significantly lower.
The second thesis does not coincide with the results of the Cochrane review [2], in the long term, the morbidity of personnel in collectives where there are elderly employees (over 60 years old) cannot be regulated by vaccination. Another Cochrane review showed that vaccination in healthy people slightly reduces the number of days of labor loss and the severity of infection symptoms, but does not affect the risk of complications [3].
Plus, there are a lot of smaller studies on a wide variety of groups with very different, including contradictory conclusions. This is understandable, the flu is an incredibly labile infection, the virus causing it can be considered a champion of mutations. All this gives rise to speculation on the part of both supporters of vaccination and its opponents. The expediency of flu vaccinations is one of the most frequent topics of anti–vaccination holivars on the Internet.
Fig. V. BogoradaSo by and large, the whole burden of making a decision ultimately shifts to the person himself.
Vaccination against influenza is not mandatory, although some employers are trying to make it a condition for continued presence in the team, both in Russia and abroad. But no one has removed the possibility of refusing any medical manipulation from the laws so far; anyone, even a Russian court, will side with an employee dismissed for refusing vaccinations, although such precedents have not yet been heard of.
But here another problem arises: what if a person decided to get vaccinated? The fact is that Russian vaccines, how to put it mildly, do not stand up to competition with foreign analogues a little. At least, I have not had to meet correctly conducted comparative efficiency studies, and in local, Russian ones, of course, ours are winning, and by a large margin. After all, we have not just vaccines, but complex immunopreparations containing, for example, immunomodulators. And this supposedly increases their effectiveness to unthinkable figures. However, not confirmed by anything other than the assurances of the manufacturers themselves.
There is another pitfall: for example, the standards of good manufacturing practice (GMP) in our country are introduced only from January 1, 2014, while in the USA, for example, they were announced back in 1938 [4]. GMP control exists in Bangladesh, Pakistan and India, and in our country, about 30% of enterprises adhere to these standards, according to the Ministry of Health itself, and those are exclusively on a voluntary basis.
What does the non-compliance with international standards lead to? The case of an extremely hyped Russian antiviral drug is very indicative. During one of the online discussions, an idea arose: why not check what's in the tablet? They bought it at a pharmacy, loaded it into an NMR spectrometer and found 10% impurities. Even taking into account the error of the methodology for quantitative analysis, this is a lot, 20 times higher than it is acceptable from the point of view of the same GMP. And the tactics of supporting the domestic manufacturer gradually leads to the fact that there is only a choice between ours and ours, and not ours, you will not find it with fire during the day.
This is exactly the situation this year. Five years ago, it was possible to buy a choice of several foreign vaccines, in the past – two, but already with difficulty. Now, to find the coveted syringe with a dose, you need to run thoroughly. The official version sounds like this: "embryos have not grown at two large production facilities," and the unofficial one is voiced in a conspiratorial whisper, mentioning the notorious support of the domestic manufacturer with an unkind word.
So, apparently, this year you will have to protect yourself from the flu by washing your hands (by the way, a very effective measure, according to WHO and CDC) and believing in the best. And we hope that after the introduction of GMP, the injection site will not spread from domestic vaccines, the temperature will not rise so often, and their effectiveness will be proven in comparative international (and not only with the participation of India and China) studies.
References:
- Osterholm, MT; Kelley, NS; Sommer, A; Belongia, EA (2012). «Efficacy and effectiveness of influenza vaccines: A systematic review and meta-analysis». The Lancet Infectious Diseases 12 (1): 36-44. doi:10.1016/ S1473-3099(11)70295-X.
- Thomas RE, Jefferson T, Lasserson TJ (2010). «Influenza vaccination for healthcare workers who work with the elderly». Cochrane Database Syst Rev (2): CD005187. doi: 10.1002/14651858.CD005187.pub
- Jefferson T, Di Pietrantonj C, Rivetti A, Bawazeer GA, Al-Ansary LA, Ferroni E (2010). «Vaccines for preventing influenza in healthy adults». Cochrane Database Syst Rev (7): CD001269. doi: 10.1002/14651858. CD001269.pub
- Food, Drug, and Cosmetic Act (21 USCS § 351), 1938.
Portal "Eternal youth" http://vechnayamolodost.ru08.11.2013