Flu Season – Vaccine or Vitamin D?
With flu season getting closer we are starting to hear the
advertisements advising everyone to get a flu shot. Medical journals are calling for mandatory
flu shots for all health care workers. I
have two questions, 1) are flu shots effective? 2) Is there any better way to
protect against influenza?
Most people assume that flu vaccines are effective but a
2010 Cochrane Collaboration
review suggests otherwise.
This description of the Cochrane
Collaboration is taken from their website.
“The Cochrane Collaboration
is an international network of more than 28,000 dedicated people from over 100
countries. We work together to help health care providers, policy-makers,
patients, their advocates and carers, make well-informed decisions about health
care, by preparing, updating, and promoting the accessibility of
Cochrane Reviews”
The objective of the 2010 review was to “Identify, retrieve
and assess all studies evaluating the effects of vaccines against influenza in
healthy adults” The summary explains
some of the limitations of flu Vaccines.
“Over 200 viruses cause influenza and influenza-like illness
which produce the same symptoms.....At best, vaccines might be effective
against only influenza A and B, which represent about 10% of all circulating
viruses. Each year, the World Health
Organisation recommends which viral strains should be included in vaccinations
for the forthcoming season”
It is impossible to predict which viral strains we are going
to be exposed to in the upcoming season. Of the possible 200 viruses most flu shots will only offer some protection from 3 virus strains.
It is relatively uncommon for the strains in the vaccine to match the
strains we are exposed to. When they do
not match, 2% of unvaccinated people develop influenza symptoms compared to 1%
of vaccinated people. When they do match,
the numbers are 4% for unvaccinated people versus 1% for vaccinated. There is a small decrease in the number of
people developing influenza symptoms when vaccinated but the summary noted:
“Vaccine use did not affect the number of people hospitalised
or working days lost but caused one case of Guillian-Barre syndrome (a major
neurological condition leading to paralysis) for every one million
vaccinations” In their conclusion they
stated “There is no evidence that they (influenza vaccines) affect
complications, such as pneumonia, or transmission”.
Another
review done at the University of
Calgary that looked at vaccinations in health care workers who worked with the
elderly and found “there is no evidence that vaccinating HCWs (health care workers)
prevents influenza in elderly residents in LTCFs (long term care facilities).”
Almost half the trials studied were funded by the vaccine
industry. “ Studies funded from the
public sources were significantly less likely to report conclusions favourable
to the vaccines. The review showed that
reliable evidence on influenza vaccines is thin but there is evidence of
widespread manipulation of conclusions and spurious notoriety of the studies.” Industry studies were not only more likely to
be positive but they were “published in more prestigious journals and cited
more than other studies independently from methodological quality and size”
Proponents of flu vaccines will point to the hundreds of
Observational studies that have reported an approximate 50% reduction in all
cause deaths in vaccinated seniors compared to unvaccinated seniors.
This topic was reviewed in this
paper.
“ a 50% vaccine effectiveness (VE) against
death from any cause sounds too good to be true, if only because influenza is
related to an average of only about 5% of all senior deaths during winter and
the observed impact occurring prior to the season”
A 50% reduction in deaths when only 5% of deaths are related
to influenza indicates possible selection bias in the studies. When the researches went through the cohort
studies showing a 50% VE, they found that “the greatest difference in mortality
rates among vaccinated and unvaccinated seniors in the HMO database studies
turned out to occur in the months before the influenza epidemic period, and
strategies commonly used for adjustment of bias in cohort studies were
counter-productive” The fact that the
studies show that the vaccine prevented more deaths prior to flu season than it
did in flu season demonstrates vaccination selection bias. When they dug
further they found the probable cause of the confounding. There is a subset of frail and terminally ill
seniors who are less likely to become vaccinated because of their deteriorating
health. These unvaccinated seniors have
a much higher mortality rate which confounds the results.
They also noted a 2003 CDC
study that found that while
vaccination coverage in the 80’s and 90’s quadrupled, influenza-related
mortality rates increased at the same time.
This is an observational study, so it can find correlations, not cause
and effect, but it is still interesting to note that mortality rates increased
along with vaccination rates.
After searching through all the scientific data these
researchers could only find one Randomised Controlled trial that showed a small
improvement in influenza symptoms but no significant effect on hospital days, working days,
complications or transmission. They were
not able to draw and conclusions from the other cohort studies due to the
general low quality of the studies or presence of biases. Randomised Controlled Trials need to be done
to demonstrate improvements in outcomes like hospitalisation's, work days
missed, complications and transmission.
With the science available today it is hard to make a recommendation on
voluntary vaccinations and is even more difficult to reconcile mandatory
vaccinations.
Some of the reasons people may not want to take unnecessary
vaccines is because of the ingredients in the vaccines.
Multi dose influenza vaccines usually contain
thimerosol which is a mercury containing compound.
They may also contain aluminum oxide and
formaldehyde.
We are told that they are
in very small amounts that are safe. Macrophagic myofasciitis (MMF) has been
linked to aluminum oxide used as an adjuvant in some vaccines.
The question is, do we want any amount of a
neurotoxic metal injected into our bodies if it not going to result in
meaningful benefits?
These adjuvants are
used to stimulate the immune system to provoke a larger response to the
vaccine.
Could these repeated artificial
stimulation's impacting allergies and autoimmunity?
We don’t know the answers to these
questions.
A simple and maybe even more effective way of dealing with
flu season may be to make sure you have adequate levels of vitamin D.
This 2010 randomised controlled
study showed
that children taking vitamin D supplements were 42% less likely to get the flu.
Vitamin D’s
effects on the innate immune system appears to “both enhance the local capacity of the epithelium to
produce endogenous antibiotics and – at the same time – dampen certain arms of
the adaptive immune response, especially those responsible for the signs and
symptoms of acute inflammation, such as the cytokine storms operative when
influenza kills quickly.”
A 2006
paper appearing in the journal Epidemiology and
Infection made the following observations.
“1. Why the flu predictably occurs in the months following
the winter solstice, when vitamin D levels are at their lowest,
2. Why it disappears in the months following the summer solstice,
3. Why influenza is more common in the tropics during the rainy season,
4. Why the cold and rainy weather associated with El Nino Southern Oscillation
(ENSO), which drives people indoors and lowers vitamin D blood levels, is
associated with influenza,
5. Why the incidence of influenza is inversely correlated with outdoor
temperatures,
6. Why children exposed to sunlight are less likely to get colds,
7. Why cod liver oil (which contains vitamin D) reduces the incidence of viral
respiratory infections,
8. Why Russian scientists found that vitamin D-producing UVB lamps reduced
colds and flu in schoolchildren and factory workers,
9. Why Russian scientists found that volunteers, deliberately infected with a
weakened flu virus - first in the summer and then again in the winter - show
significantly different clinical courses in the different seasons,
10. Why the elderly who live in countries with high vitamin D consumption, like
Norway, are less likely to die in the winter,
11. Why children with vitamin D deficiency and rickets suffer from frequent
respiratory infections,
12. Why an observant physician (Rehman), who gave high doses of vitamin D to
children who were constantly sick from colds and the flu, found the treated
children were suddenly free from infection,
13. Why the elderly are so much more likely to die from heart attacks in the
winter rather than in the summer,
14. Why African Americans, with their low vitamin D blood levels, are more
likely to die from influenza and pneumonia than Whites are.”
These are observations so they cannot prove cause and effect
but they point to the need for Randomised Controlled Trials to be done on the
health benefits of Adequate vitamin D levels.
Serum Vitamin D levels can be tested but they are not
covered by BC Medical. It is my opinion
that millions of dollars would be saved in health care costs if BC Medical paid
for Vitamin D tests and everyone had adequate levels of vitamin D. If you want to get tested ask your doctor for
a 25-hydroxyvitamin D, or 25(OH)D. There is some debate about what the ideal
level of serum vitamin D is but a level of around 50 nmol/L seems to be a
common range with most experts.
Most people today need to supplement with Vitamin D3.
It is very hard to get from our diet,
historically we made our own Vitamin D with exposure to the sun. Most people
work indoors and do not get adequate sun exposure.
When we are in the sun we are told to cover
up and put on sunscreen, which blocks the production of vitamin D.
Sun burns are definitely dangerous, but
responsible sunbathing, 10-15 min/day without sunscreen, can be a very healthy
way to get your vitamin D.
Even if you
do get adequate sun exposure in the summer the sun is not high enough in the winter
to get adequate vitamin D if you live in Canada, so some supplementation is
recommended.
The
vitamin D Council
states that it is safe to supplement with up to 10 000 IU of vitamin D3/day and
recommends adults take 5 000 IU/day.
Reducing systematic inflammation and having adequate vitamin
D levels, along with its cofactors Vitamin A and K2, strengthens your immune
system. This not only reduces your risk from influenza, but may also have to
following benefits:
-protect the common cold
-increase bone health
-increase dental health
-protect against cardiovascular disease
With all the benefits of Vitamin D I see no reason not to
supplement during the winter months. A more prudent method of dealing with influenza in health care workers might be to test Vitamin D levels and supply supplementation.
This applies if you choose to get the flu shot or not. Eating a diet that does not cause
inflammation and getting enough sleep along with maintaining adequate vitamin D
levels will help you make it through flu season.
