The Flu Vaccine: Love the One You're With--But Don't Stop Thinking About Tomorrow's Vaccine

So today I went through one of my favorite rituals and it wasn't a Buffy the Vampire Slayer marathon; it was my annual flu vaccination.

This year I got the quadrivalent version of the vaccine, at my place of appointment, and it was much easier to find than last year when I basically had to cold-call several pharmacies to find it. 

I want to make couple of points to make about the annual flu vaccination.

1. Getting the vaccine early is advisable. Though there is some decrement in the level of immunity as the season progresses, being immunized at the start of the season is the best way to avoid the flu. Remember it takes about 2 weeks for the vaccine to induce immunity so it's ideal to be vaccinated prior to the start of the season.

2. The quadrivalent vaccine should be the preferred vaccine for almost everyone with the exception of the elderly who should receive the high dose trivalent formulation (hopefully soon to be quadrivalent).

3. Children between 2 and 8 years of age should receive the nasal live-attenuated version given the high efficacy it shows in this population

4. I anticipate a rough flu season this year based on what is going on in the Southern Hemisphere's current season (which runs opposite to ours).

The ordinary vaccine is about 60% effective (assuming a good match with circulating strains) at preventing the acquisition of flu and, for the vaccinated who contract flu, it can decrease the chances of having a severe case.

Though we are still years away from the Holy Grail--a game-changing universal vaccine that does not require one to be revaccinated each year and provides near-sterilizing immunity (like other vaccines)--for now, we've got to love the one we're with.

In the Land of the Unvaccinated, The Immune is King

I've recently been drawn to the television dramedy Castle and have been making my way through prior seasons. Yesterday, I watched an interesting episode from season 5.

In this episode, entitled "Swan Song", Beckett and Castle investigate the murder of a man whose blood shows the absence of antibodies against polio and tetanus. Later on in the episode it is revealed that he had not been vaccinated because he belonged to a religious cult which forbade vaccinations.

The plot of this episode prompted me to think of how paradoxical it is to be part of a large community of individuals who are not vaccinated. Their isolation from society, rather than protecting them, strikes me as akin to bleeding in a tank full of great white sharks. In such a conglomeration of chum, all it takes is one individual exposed to, say, measles to set off an outbreak that could have deadly consequences.

If I were in an unvaccinated cult I would get vaccinated because, in the land of the unvaccinated, the immune is king.

A Back to School Victim-Finding Spree for Enterovirus 68

There are multiple reports today of a large outbreak of respiratory illness in the Midwest and, no, it's not Ebola or MERS.

It's Enterovirus D68. You might recall a few months earlier a big scare with this virus causing a polio-like paralytic disease in California, but this virus (which bears Jaromir Jagr's number, for Pittsburghers) is well known as a cause of respiratory illness.

A few points about this outbreak:

• Seems very large: 300 kids in Kansas City, MO (other states are reporting too) but this is likely not the full extent of infection as most cases are likely asymptomatic
• High degree of ICU admission: 15%
• Hospitals are limiting visitation of the hospitalized children

Enteroviruses, in general, are a ubiquitous group of viruses that number over 100 and cause a wide variety of illnesses from meningitis to upper respiratory tract infection. Each year over 10 million cases of infection with this group of viruses occur. However, the vast majority of these infections are without symptoms (but are still contagious). 

This new outbreak could reflect a number of things.

1. Better diagnostics: Many hospitals are moving to PCR-based testing of respiratory illness and what may have been an undifferentiated cluster of illness is now able to be named.

2. The start of school: It is widely known that schools function as viral exchange centers and this virus is likely benefiting from the school year (a sort of back to school victim finding spree for the virus).

The next steps will be to determine the true burden of this virus, understand it's full spectrum of illness, given its now proven ability to cause severe infection, and assess whether a vaccine against it (like is being developed against Enterovirus 71) is warranted. 

The Lair, The "Prey", and The Elixir

The woman entered the room with a tackle box of equipment. Upon opening, 2 cylindrical devices, each with sharp metal protrusions, were apparent as well as a canister of an unknown substance, its label long since replaced with an image of a popular culture icon. 

Another person in the room appeared apprehensive, unsure of what was to happen next. The woman seized both of his arms and applied a substance emanating from the two canisters and, almost seconds later, jabbed both arms with the cylindrical devices. 

This was not an assault, but a life-affirming rite of passage I hope every child has the opportunity to endure. 

Yesterday, I accompanied a child who was receiving routine vaccinations. I've given vaccinations myself and had them administered to me myself but yesterday, being an uninvolved observer, really concretized the value of these marvelous elixirs. 

The popular icon on the canister was Olaf from Frozen and each sharp protrusion delivered milliliters of polio and diphtheria/tetanus/pertussis vaccine.

The requisite Bugs Bunny band-aids were applied.

The "Laptop of Doom" & the Threat of Bioterrorism

Commenting on the ongoing Ebola outbreak, I often note that all the novel medications and vaccines being put in trials are the result of a recognition, post-anthrax, that Ebola could be a potential bioweapon. Almost 13 years have passed since Amerithrax and many have forgotten about the sense of alarm and calamity that gripped the nation in October of 2001. 

The specter of bioterrorism is in the headlines again with the revelation that a laptop found in Syria contained information about using plague as bioweapon. 

Unlike anthrax, plague--caused by the bacterium Yersinia pestis--can be transmissible from person-to-person.

Plague, like anthrax and Ebola, is also classified in the highest priority category (A) and has a long history of use as a bioweapon that stretches back to the times of The Black Death, when a Tartar commander catapulted plague-stricken corpses into the city of Caffa.

In the modern era, the bioweapons programs of the Soviets (and the US) also sought to weaponize plague. One fact that would delimit plague's effectiveness, however, is the fact that it is easily treatable with antibiotics and, upon exposure, prompt administration of antibiotics can abort infection. 

The lesson I draw from the discovery of this laptop is that, despite an absence from the headlines, the threat of bioterrorism is itself not absent.