Influenza Update 2012

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Ned -

I assumed the association of the flu vaccine with guillain-barre syndrome was bogus. After Mel agree I decided to look at the data.
Seems there is an association.

JAMA. 2004 Nov 24;292(20):2478-81.
Guillain-Barré syndrome following influenza vaccination.

Risk of Guillain-Barré Syndrome Following H1N1 Influenza Vaccination in Quebec
JAMA. 2012;308(2):175-181. doi:10.1001/jama.2012.7342.

Any ideas?

Mel H. -

In 1976 a flu vaccine really did appear to increase GBS. Since them the literature is mixed but according to the CDC MAYBE you get one extra case of GBS over the baseline rate, in literally 1 per million vaccinations. So the benefit/harm ratio is still way in favor of the vaccine. Some local regions sometimes show higher rates of GBS and it is not clear if it is the local wild strain or something with the local manufacturing of the vaccine. This is now all above my pay grade.

Jeremy W. -

Hi Mel.
General question that came up from a colleague of mine, in the context of the influenza segment: he is a 'trust but verify' person like most of us. I am of the opinion that, having been a listener for 6 months now, the speakers you have are first rate and generally trustworthy. However, depending on the gravity of what they are saying, I may or may not go to the source from which they draw for their comments. In regard to influenza this month, my colleague was asking about data on admitted/ill patients with influenza--specifically, what data is there to justify giving oseltamivir to ill patients (being admitted), who indeed are influenza-positive, beyond the 'window' of 48 hours? Is this simply the reasoning and speculation of ID specialists on the basis of the H1N1 hub-bub? Or is the data there for us to review? If so where?

So, the more general question is, regardless of the topic, are the segments linked or connected in any way to any references that we can use to 'trust but verify'?

Mel H. -

Jeremy thanks for the note. Sarge is off for a vacation but a few things: First here is a link to the CDC recommendations:

There apparently is a recent meta-analysis on the topic that we will post soon. The more important comment is your "trust and verify" . A GREAT point. We have used this forum to do this in the past - but one of the new years resolutions is to provide the references more clearly in the written summaries.

Patricia M. -

Thank you for an excellent program as usual!
I just wanted to clarify a comment made in this segment and in the show notes regarding egg allergy and the influenza vaccine. It is my understanding that for the 2012-2013 seasonal influenza vaccine that an egg allergy is no longer an absolute contraindication and instead now depends on the severity of the allergy.

This algorithm gives one option for administration: Full dose and observe for 30 minutes. In Canada, the Public Health Agency of Canada presents us with two options: Full dose and two step graded dosing. Please find on this link about half way down the page under "IV.3.3.1 Vaccine delivery protocols for egg allergic persons"

Alexis K. -

I recently had a few discussions with my hospital's OBs about treating influenza in pregnant women. Their triage has in place a few protocols that were puzzling including using a higher 'loading' dose of tamiflu (150mg instead of 75) and treating regardless of time since symptom onset even in relatively well-appearing patients. I've done the requisite google search and looked through the recommendations on the CDC's website and couldn't find anything to back this up. Am I missing something?

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