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BONUS - Flu

David Newman, MD and Greg Moran, MD FAAEM
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EM:RAP 2013 December - Summary 1 MB - PDF

It's flu season y'all!! It's also people-who-should-get-the-flu-vaccine-but-don't season. Mel and Greg talk about what to expect this year. Then, Dave tells us that it works. Also, why Tamiflu is like an expensive placebo.

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Sean G., M.D. -

nnt 1/33 on a matched year 1/100 on non matched year to prevent one flu in nl healthy adults. Not sure what the accuracy rate is for matching, the lecture suggests its "pretty good" but obviously not 100%, so even if that match the virus 70% of the time the nnt is probably an average of around 50 healthy adults to prevent one case of the flu. Not sure why we are all excited about this flu shot biz. Also the studies show that vaccinating health care workers really has little proven upside, but we all have "get your flu shot" screen savers on our hospital computers. One of the guys(I forget which) says he's gotten the flu shot for like 20 years or something and never gotten the flu....kinda reminds me of the neuro interventionalist in may who said he's seen pts recover before his eyes when he removed the clot in surgery so he doesn't need research. I haven't gotten the flue shot in 17 years of hospital Ed work and Ive never had the flu either, don't think that means much. This whole "get the flu shot! Everyone on the planet get it now!" sounds like typical pharm industry bullshit, like the life saving Varicella vaccine for kids. All in all we are far too in love with pharmaceuticals in this country.

Erik D. -

What about oseltamivir for hospitalized and critically ill patients? My intensivists and hospitalists want to start it on every hospitalized patient, regardless of time since onset of symptoms. Is there any data in those unpublished studies from Roche to guide us? I haven't seen any randomized controlled trials on those types of patients, only observational studies from CDC, etc.

Christian M. -

A NNT of 33-100 is not great, but I think it is misleading to use NNT to describe efficacy of a vaccine. Unlike NNT, the number needed to prevent (vaccine) is affected by prevalence if I am not mistaken. Imagine a disease that is rare 1/100,000 say, and imagine a vaccine that is 100% effective in preventing the disease. In this case the NNP is 100,000. I would suggest that Dr Newman clarify this point because for a treatment, a NNT of 100,000 is horrible, but for a vaccination a NNP of 100,000 may not be that bad.

EW King, DO -

i am under the impression that oseltamivir is very effective- 85 %- for prophylactic use. should the provider not inquire about household contacts that are at high risk? and then use the medication as a bridge to the coverage provided by vaccination.

Chris S -

Are the references posted for this somewhere? It was mentioned in the segment that they would be.

Mel H. -

References, influenza vaccine efficacy:

JeffersonT,Di Pietrantonj C,RivettiA,Bawazeer GA,Al-Ansary LA,Ferroni E.Vaccines for preventing influenza in healthy adults. Cochrane Database Syst Rev. 2010 Jul 7; (7):CD001269. doi: 10.1002/14651858.CD001269.pub4.PMID: 20614424.

Jefferson T, Rivetti A, Di Pietrantonj C, Demicheli V, Ferroni E.Vaccines for preventing influenza in healthy children. Cochrane Database Syst Rev. 2012 Aug 15;8:CD004879. doi: 10.1002/14651858.CD004879.pub4. PMID:22895945.

Cates CJ, Rowe BH.Vaccines for preventing influenza in people with asthma. Cochrane Database Syst Rev. 2013 Feb 28;2:CD000364. doi: 10.1002/14651858.CD000364.pub4.PMID: 23450529.

JeffersonT,Di Pietrantonj C,Al-Ansary LA,Ferroni E,Thorning S,Thomas RE.Vaccines for preventing influenza in the elderly. Cochrane Database Syst Rev. 2010 Feb 17; (2):CD004876. doi: 10.1002/14651858.CD004876.pub3. PMID: 20166072.

Poole PJ, Chacko E,Wood-Baker RW, Cates CJ. Influenza vaccine for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006 Jan 25; (1):CD002733. PMID: 16437444.

Cheuk DK, Chiang AK, Lee TL, Chan GC, Ha SY.Vaccines for prophylaxis of viral infections in patients with hematological malignancies. Cochrane Database Syst Rev. 2011 Mar 16;(3):CD006505. doi: 10.1002/14651858.CD006505.pub2. Review.
PubMed PMID: 21412895.

Oseltamivir efficacy:

Ebell MH, Call M, Shinholser J. Effectiveness of oseltamivir in adults: a meta-analysis of published and unpublished clinical trials. Fam Pract. 2013 Apr;30(2):125-33. doi: 10.1093/ fampra/cms059. Epub 2012 Sep 20. PMID: 22997224.

Jefferson T, Jones MA, Doshi P, Del Mar CB, Heneghan CJ, Hama R,Thompson MJ. Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children. Cochrane Database Syst Rev. 2012 Jan 18;1:CD008965. doi: 10.1002/14651858.CD008965.pub3. PMID: 22258996.

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Episode 147 Full episode audio for MD edition 275:31 min - 130 MB - M4AResumen del EM:RAP Diciembre 2013 Español 83:52 min - 115 MB - MP3EM:RAP 2013 December Bonus MP3 47 MB - ZIPEM:RAP 2013 December MP3 272 MB - ZIPEM:RAP 2013 December - Summary 1 MB - PDFEM:RAP December 2013 Board Review Questions 594 KB - PDFEM:RAP December 2013 Board Review Answers 456 KB - PDF

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