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On the Efficacy of Flu Vaccine 430

Posted by kdawson
from the because-we-just-know-it-works-that's-why dept.
The Atlantic is running a major article questioning the received wisdom about flu vaccines and antivirals, for both seasonal flu and H1-N1. "When Lisa Jackson, a physician and senior investigator with the Group Health Research Center, in Seattle, began wondering aloud to colleagues if maybe something was amiss with the estimate of 50 percent mortality reduction for people who get flu vaccine, the response she got sounded more like doctrine than science. 'People told me, "No good can come of [asking] this,"' she says... Nonetheless, in 2004, Jackson and three colleagues set out to determine whether the mortality difference between the vaccinated and the unvaccinated might be caused by a phenomenon known as the 'healthy user effect.' Jackson's findings showed that outside of flu season, the baseline risk of death among people who did not get vaccinated was approximately 60 percent higher than among those who did, lending support to the hypothesis that on average, healthy people chose to get the vaccine, while the 'frail elderly' didn't or couldn't. In fact, the healthy-user effect explained the entire benefit that other researchers were attributing to flu vaccine, suggesting that the vaccine itself might not reduce mortality at all." Read below for more excerpts from the article.

The annals of medicine are littered with treatments and tests that became medical doctrine on the slimmest of evidence, and were then declared sacrosanct and beyond scientific investigation. ...

This is the curious state of debate about the government's two main weapons in the fight against pandemic flu. At first, government officials declare that both vaccines and drugs are effective. When faced with contrary evidence, the adherents acknowledge that the science is not as crisp as they might wish. Then, in response to calls for placebo-controlled trials, which would provide clear results one way or the other, the proponents say such studies would deprive patients of vaccines and drugs that have already been deemed effective. ...

In the absence of better evidence, vaccines and antivirals must be viewed as only partial and uncertain defenses against the flu. And they may be mere talismans. By being afraid to do the proper studies now, we may be condemning ourselves to using treatments based on illusion and faith rather than sound science.
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On the Efficacy of Flu Vaccine

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  • by 93 Escort Wagon (326346) on Saturday October 17, 2009 @03:58PM (#29779835)

    ... I became biased against any conclusion. Up here in the Pacific Northwest, the common nickname of this HMO is "Group Death". They're not exactly known for high quality care or cutting edge research - they're mainly known for denying treatments as "experimental" for years after those treatments have become the norm in most medical circles.

    I remember an acquaintance (husband of a co-worker) who kept getting denied treatment for (IIRC) a persistent and very painful hydrocele. The Group Health doc told him nothing could be done - surgical correction of this was "experimental and dangerous". Finally out of desperation they consulted with an outside doc, who told them this was a very simple routine procedure! They paid out-of-pocket for the surgery, and the problem was quickly rectified.

    I know nothing about the particular doctor who did this flu vaccine study - but, given her employer, I have very little confidence that she is particularly knowledgeable. I'm sure Group Health would love to save the 15 or 20 bucks per patient they're currently having to spend on this vaccine.

  • FluMist (Score:5, Informative)

    by TheMeuge (645043) on Saturday October 17, 2009 @04:00PM (#29779857)

    The live attenuated flu vaccine, FluMist is substantially more effective than the inactivated injected vaccine (something that's blindingly obvious to those of us who've studied basic immunology). It provides a potent T-cell response, and a large pool of memory cells. Furthermore, it has been shown to be effective against viruses that have undergone some genetic drift.

    For anyone who is old enough, has no respiratory problems, and who isn't immunosuppressed, the live nasal spray vaccine is a much more sensible choice.

    For additional data refer here: http://www.cdc.gov/flu/professionals/acip/efficacycomparison.htm [cdc.gov]

  • by Anonymous Coward on Saturday October 17, 2009 @04:02PM (#29779873)

    Randomized, controlled trials have shown the effectiveness of flu vaccines, contrary to the claims of the article. (Example: Wilde et al., "Effectiveness of Influenza Vaccine in Health Care Professionals." [ama-assn.org])

    In addition, research into mortality reduction already takes into account comorbid conditions and age. (Example: Nordin et al., "Influenza Vaccine Effectiveness in Preventing Hospitalizations and Deaths in Persons 65 Years or Older in Minnesota, New York, and Oregon: Data from 3 Health Plans." [uchicago.edu])

    The article is at best poorly researched and at worst intentional FUD.

  • by irtza (893217) on Saturday October 17, 2009 @04:02PM (#29779875) Homepage

    Due to a long history of unethical behavior in the medical field, there are stringent requirements that require one to show a need for research and to demonstrate safety concerns before one can begin an investigation.

    This often means that simple experiments that could show benefit and harm of an intervention will not be done because of a large body of circumstantial evidence.

    There has to be a fairly even view of outcomes on both sides of a trial before it will be approved - or other studies showing possible efficacy of the side that is under question will need to be done first.

    When these situations arise, one can often perform the experiment in a subset of the population in which vaccine efficacy is questioned and benefits are unknown.

    The population of HIV infected individuals is one such population and there are double-blind placebo controlled trials done in this group.
    The annals of internal medicine (an American College of Phyicians publication) http://www.annals.org/cgi/content/full/131/6/430 [annals.org] published an investigation showing the efficacy of the influenza vaccine in a population that was least likely to benefit from it. While mortality data is not available here, its results stand on their own as a testament to the clinical efficacy of the vaccine.

  • by Anonymous Coward on Saturday October 17, 2009 @04:03PM (#29779879)
    Anytime there's a controversy over vaccines or prescription drugs, there is only one thing that needs to be widely understood by everyone: pharmaceutical companies cannot make money from healthy people.

    That fact tends to get lost in the fear-mongering. It's probably the main reason why we're making such a big deal out of the swine flu when the regular flu still kills thousands more people per year than the swine flu. The explanation for that is pretty simple: popular panic about a virus sells vaccines for that virus. The more I see the media and others telling us how afraid we should be of the swine flu, the more convinced I am that they are using this angle because there is no rational reason for most people to buy this vaccine. This is like the security theater that Schneier warns us about, except this time it isn't about airports, it's about medicine.
  • Re:article is BS (Score:3, Informative)

    by wizardforce (1005805) on Saturday October 17, 2009 @04:16PM (#29779957) Journal

    nonsense. These kind of studies are done all the time, there is absolutely nothing unethical about them! Now it would be a different story if you were to force people into studies but that is a separate issue entirely.

  • by maxume (22995) on Saturday October 17, 2009 @04:17PM (#29779961)

    The WHO and CDC are driving the H1N1 vaccines, not the vaccine companies. No matter how good the lobbyists for the vaccine companies are, they aren't good enough to get the government to step in and bear the liability without some government agency agreeing that there is actually something there to address.

    (The issue with H1N1 is not its lethality once it has infected a person, but how good a job it does of infecting those who are exposed)

  • by herpchick (1489679) on Saturday October 17, 2009 @04:33PM (#29780079)
    I'm feeding the troll, but the one plague911 cites is researched because it has stood up to peer review. This is how science works. You can't just watch three cars go by, note that all are red, and write a paper saying all cars are red. I saw it. In science, we subject papers to peer review, where we look at the methods of a study, and if the study is not done well, if the methods do not hold up to a rigorous standard, then the paper is rejected and it is not published. This woman tried to publish her paper and it was rejected. It's hard to give much cred to her paper if she can't even get it published in a journal like PLoS, which evaluates strictly on the methods, not at all on the significance. PLoS does no value judgements. So if her argument is that her methods are sound and JAMA doesn't like it because it is too "against the grain" then send it to one of these type journals. I note however, that it is still not published. In addition, only some of the flu vaccines have thimerosol in them; if you are concerned about trace chemicals entering your body, do you eat all organic, too?
  • by dmoore (2449) <david.moore@gm a i l .com> on Saturday October 17, 2009 @04:40PM (#29780119)
    The article acknowledges this:

    Only four studies were properly designed to pin down the effectiveness of flu vaccine, he says, and two of those showed that it might be effective in certain groups of patients

    The article seems to be primarily advocating double-blind, controlled clinical trials among the elderly, since that is the group where death is the primary concern rather than just getting sick.

  • Re:FluMist (Score:3, Informative)

    by ThousandStars (556222) on Saturday October 17, 2009 @04:53PM (#29780229) Homepage
    Did you read the site you linked to? It says: "However, data directly comparing the efficacy or effectiveness of these two types of influenza vaccines are limited and insufficient to identify whether one vaccine might offer a clear advantage over the other in certain settings or populations."

    You say, "Furthermore, it has been shown to be effective against viruses that have undergone some genetic drift." But there's nothing about that in the CDC site.

  • by benjfowler (239527) on Saturday October 17, 2009 @04:54PM (#29780233)

    LOL.

    When you regurgitate silly right-wing talking points SCREAM AND YELL and STAMP YOUR FEET LIKE THIS, set up straw men and knock them down, it makes you look like the paragon of sensible, common sense, level headed conservatism.

    Really!

    By the way, all health authorities, public and private, have to ration. I've got no idea where people got the idea that one should pay for an average health plan (whether private or single payer), and then expect to have millions spent on cutting edge, experimental, and extremely expensive medicine when they get sick.

    Believing that paying for a bargain-basement health plan in the US and believing that you'll get Herceptin when you get breast cancer, is extremely naive.

    Oh, and by the way: even in the SOCIALIST COMMUNIST NAZI government run health systems, if you don't like the basic plan, you're free to go private. Of course, they'll ration too. I've never heard of a country with a single-payer or government run health system not let people go private and pay for gold-plated health cover.

    Of course, if were weren't listening to fat, drug-addled idiots on AM radio or FOX News, and actually spent time in the real world, you'd already know this, wouldn't you?

    You get nothing for nothing in this world, dumbarse.

  • by ColdWetDog (752185) on Saturday October 17, 2009 @05:15PM (#29780367) Homepage

    ... but it isn't difficult to apply a little logic to foresee the result. Given that information, it should be obvious that the vaccine will not stop the flu and will not protect you from getting the flu. It will only determine which strain you get.

    Logic doesn't help you if you don't understand the biology of influenza. It's not like there are several strains of influenza just waiting around, hiding in trash cans for the poor sap that gets immunized against it. During a given season, Influenza comes in waves of a particular strain, and in some cases, a couple of strains. It is a bit of a dance to figure out which strains are going to hit a given area six months in a year to advance. You can google for the particulars but epidemiologists have had a reasonable measure of success getting it right.

    Even with that knowledge, we've known that influenza vaccines aren't all that good. What you have is a treatment with few downsides (and there are complications from the vaccines, they just aren't all that common) and a few upsides basically a modest benefit. This sort of treatment, while depressingly common from an epidemiology standpoint, makes "soundbite medicine" rather difficult and makes it hard to argue for any given protocol.

    Something that seems to be missing from this whole affair is the built in experiment that this creates. If you can deliver the vaccine to a very broad spectrum of a population and let the individual decide if they want the vaccine, then you'll have large numbers of both cases - vaccinated and unvaccinated. IF you had a mechanism to track this (and that's where we fail here), then in six months and one year, you query those people, see if they're still alive. After all, we don't care if you died from influenza or the marthambles - if the vaccine keeps you out of the grave, then it's a win. That would answer the bottom line question of whether or not the vaccine actually helped you. You need big numbers to prevent a number of pre selection biases, but it's sort of doable.

  • by astar (203020) <max.stalnaker@gmail.com> on Saturday October 17, 2009 @05:32PM (#29780463) Homepage

    I was a group health member for many years. I would speak well of it,. But mainly I wanted to speak to the perjogative "group death". It happens group health started up about 1948. The local AMA hated it. They did things like kick the group health docs out of the chapter. And so on. This phrase "group death" was their invention. So consider the source.

    Oh group health is a coop, One thing you might approve of is that they do not pay inflated salaries to their executives.

    HMOs are a recent invention. Nixon I think. A government cost cutting technique. Like living wills and the current health reform plans. Now the typical HMO use the general prac docs as a gateway barrier to seeing a specialist. Group Health does not use that technique.

    But they are what is called an evidence based medicine approach. You will not get experimental procedures there. For instance, stomach stapling has been around for quite a while. Only in the past few years has it become an approved procedure at group health. Evidence based medicine virtues and defects could generate quite a little debate. For instance, Obahma likes it and presumedly the way he would implement it would discredit the concept for a generation. But I kind of think Group Health is honest about analyzing the evidence. But I do not really know. But I do know I do not want my doc trying out the latest fad on me or deciding on my drugs based on drug company marketing campaigns. Drug company marketing techniques to docs could be a subject in itself.

  • by mellon (7048) on Saturday October 17, 2009 @05:34PM (#29780479) Homepage

    You're oversimplifying. Generally speaking, the flu strains that are going around in any given year are related. Yes, there are different strains, but they usually have very similar surface proteins. So it's true that the vaccine you get in any given year is not guaranteed to exactly match the strains you are exposed to. Nobody even pretends that it will. Mass vaccination is all about statistics - reducing the number of people who get infected so that the spread of the disease is limited, and people who are vulnerable aren't exposed in the first place.

    So yeah, the flu vaccine you get may not necessarily protect you. Indeed, in any given year there's a significant chance (something like 30%) that they'll guess wrong and put the wrong strain in the vaccine, and it won't protect anybody. But 70% of the time it does protect, and that's worth the 30% of the time when it doesn't.

  • Re:FluMist (Score:5, Informative)

    by Guppy (12314) on Saturday October 17, 2009 @05:55PM (#29780607)

    The live attenuated flu vaccine, FluMist is substantially more effective than the inactivated injected vaccine (something that's blindingly obvious to those of us who've studied basic immunology). It provides a potent T-cell response, and a large pool of memory cells. Furthermore, it has been shown to be effective against viruses that have undergone some genetic drift.

    I happen to have worked in the influenza vaccine business before. For children and younger recipients, what you've said has been clinically demonstrated to be true -- live attenuated influenza vaccine (LAIV, you may also see it referred to as CAIV in some literature) gives a more intense response, and better protection against mismatched strains.

    However, things get a little iffy when it gets to the adult population, where there doesn't seem to be any superiority for LAIV in that group (your link shows that).

    While it's not exactly known why, last I heard the theory was that, in contrast to the naive response in children, adults already have pre-existing responses to various wild influenza strains, that (although not matched to the target strains) cross-react with the LAIV and neutralize it too quickly, before it has a chance to replicate a little and provoke a stronger response (that matches the targeted strains).

    I haven't seen this last part in print anywhere (although I also haven't been looking), it was just an idea that was being passed around by some researchers who were working at MedImmune (company that makes FluMist).

  • Re:FluMist (Score:3, Informative)

    by Guppy (12314) on Saturday October 17, 2009 @06:01PM (#29780651)

    You say, "Furthermore, it has been shown to be effective against viruses that have undergone some genetic drift." But there's nothing about that in the CDC site.

    It's in there, in this part: "...An open-label, nonrandomized, community-based influenza vaccine trial conducted during an influenza season when circulating H3N2 strains were poorly matched with strains contained in the vaccine also indicated that LAIV, but not TIV, was effective against antigenically drifted H3N2 strains during that influenza season..."

    LAIV = Live Attenuated Influenza Vaccine
    TIV = Tri-valent Influenza Vaccine

  • by ekrock (736908) on Saturday October 17, 2009 @06:24PM (#29780769) Homepage
    Read the Atlantic article. The researchers' data set was specific to seasonal flu in people 65 and older!!! Yet did the article highlight this or confine the discussion to efficacy against seasonal flu among people 65 and older? No--it mentioned it once and then made general statements about the potential efficacy of vaccination for ALL PEOPLE for both seasonal flu and H1N1! Even if vaccination against seasonal flu doesn't reduce the death rate of people over 65 at all, H1N1 flu is demonstrably lethal to children, healthy young adults, and people under 65 with common preexisting health conditions like asthma or HIV. By getting vaccinated against H1N1, you not only reduce YOUR risk of death, but also the risk that you'll contract and pass on H1N1 to someone else who will then die of it. Get vaccinated!!! Also, look at how the article selectively hypes the credentials of the vaccine skeptics. They say Jefferson "knows the flu-vaccine literature better than anyone else on the planet." Really? There are 7 billion people on the planet; that's a bold statement. They say the Cochrane Collaboration is "a highly respected international network." That may be true, yet they fail to apply corresponding adjectives to Dr. Anthony Fauci, who was highly respected and the director of the NIAID the last time I checked. Selective, arbitrary hyping of the credentials of skeptical researchers on one side of the debate only is a classic pop science writing technique to sell magazines and create controversy. Where have I seen this before? Cecilia Farber's horrendous Harper's magazine article promoting HIV denialism (and nearly all other HIV denialist writing, incidentally). Selective credential hyping makes me doubt the authors' impartiality and trustworthiness on the whole topic. The article also states that young, healthy people "aren’t the people who die from seasonal flu." That's a wild overgeneralization. Young, healthy people have a lower risk of dying from seasonal flu but no guarantee it won't kill them. Many will read that statement and forget that (a) it excludes pregnant women, who are young and otherwise healthy but not defined as "young, healthy people" because they are immune suppressed during their pregnancy and highly vulnerable to death from the flu, and (b) the statement is about seasonal flu, not H1N1 which is already killing healthy young people today! The researchers are reasonable in calling for more studies on this question and pointing out the problem in rolling out treatments not tested in controlled trials, but Fauci is right in pointing out that giving people a placebo in a traditional prospective, double-blinded trial could be unethical. There is a potential perfect solution to this problem alluded to already by ColdWetDog. Since we have a shortage of the H1N1 vaccine at this time anyway, set up a study that looks at the death rate of people depending on what date they are vaccinated, before and after vaccination. The people waiting for vaccination (due to the shortage) become the controls for themselves (after vaccination) as well as for the people who get vaccinated earlier. Since we're UNABLE to vaccinate everyone right away due to insufficient availability of the vaccine, there's no ethical problem. This is called a "waiting list control." This would require a large study size and more statistical care than a traditional treatment/placebo protocol, but would be an ethical way to get the data we want for H1N1. I'd fully support doing such a study. Popular magazines should either stop covering science or should get scientists to review their articles written by lay journalists for scientific and statistical accuracy before they publish. The editors at magazines like The Atlantic and Harper's clearly do not have the scientific or statistical literacy to do the job themselves. I'm sick and tired of seeing popular magazines make selective and incorrect use of data and invalid logic to draw incorrect conclusions that mislead the public and cause people to doubt that HIV is the cause of AIDS, fear and doubt vaccines when they should welcome them, etc. Creating FUD and misconceptions is harmful to public health, leads to the deaths of innocent people who can't decipher misinformation, and drives up health care costs for us all.
  • by Posting=!Working (197779) on Saturday October 17, 2009 @07:04PM (#29780943)

    In 1968 and 1997, the vaccine produced was the wrong one, it didn't match the prevalent strains for the following winter. People who got vaccinated were effectively receiving a placebo for the strain that they were most likely to come in contact with. There was not a corresponding spike in the number of deaths. It could be argued that those strains were less deadly than usual, but it would be an amazing coincidence if it just happened to correspond to the two years no one got an effective vaccine.

    If the flu vaccine reduces the number of deaths by 50% as is claimed, there should have been a 33% rise in deaths when no one was immunized. There wasn't.

    More of the people most at risk are getting vaccinated, 15% of people over 65 vaccinated in 1989, 65% today. That should have caused a significant reduction in mortality. But the number of deaths is rising. Again, an amazing correspondence is claimed, that the strains are more deadly every year.

    These are the two reasons that further study is needed, regardless of how strong your faith in vaccination is.

  • Re:Or....built up? (Score:1, Informative)

    by Anonymous Coward on Saturday October 17, 2009 @07:34PM (#29781071)

    What? They don't even work that way. The shot is different every year and could even vary by location. The shot would have to be the same from year to year for any kind of build up if it's even possible.
    One of the other reasons that it may be a total waste to get the seasonal flu shot is that they are only guessing at what "the flu" will be like each year.
    Here is a CDC update on this flu season's (09-10) shot.
    http://www.cdc.gov/flu/flu_vaccine_updates.htm It covers only three of dozens of strains/variations. The swine flu is a mix of two different strains making a whole new one problem but, version of the flu may be around for years and years before it even effects enough patients to become noticed.
    Here is a article on how the flu strains are named or defined.
    http://flu.emedtv.com/flu/types-of-flu.html

  • by AnotherUsername (966110) on Saturday October 17, 2009 @07:58PM (#29781169)
    According to Webster's New World Medical Dictionary:
    Pandemic: An epidemic (a sudden outbreak) that becomes very widespread and affects a whole region, a continent, or the world.

    Influenza A Virus Subtype H1N1(commonly called the swine flu) erupted suddenly, became widespread, eventually being found on all continents(save Antarctica).

    Therefore, yes, H1N1 is, by definition, a pandemic.
  • Re:life expectancy (Score:3, Informative)

    by AnotherUsername (966110) on Saturday October 17, 2009 @08:11PM (#29781215)
    You forget that people apparently lived to be over 900 years old [wikipedia.org] back in those days. I'm sure that their calendars were perfect, right? Why would they write 70 when they should have written 900 or 400(I know, I know, post Flood vs. pre Flood and all that).

    Basically, what I am saying is that you cannot trust the Bible(a religious, not scientific, book) to tell you the average age of people.
  • by ekrock (736908) on Saturday October 17, 2009 @08:52PM (#29781415) Homepage

    gr8_phk: Considering your personal experience with the individuals you happen to have known is not a scientifically valid way of determining the severity of the threat that seasonal flu or H1N1 pose to different demographic groups. Only scientific studies of large groups and retrospective studies of particular groups (e.g. reviewing the demographics of those who die of flu/H1N1 vs. demographics of the population as a whole) can accurately determine risk levels. See http://www.flu.gov/individualfamily/parents/pregnant5tips.html [flu.gov], which notes "Pregnant women, even ones who are healthy, can have medical complications from the seasonal and H1N1 (Swine) flu."

    You are correct that infants do get a partial immune boost from antibodies they receive from the mother. However, you are not correct in concluding that infants therefore have "very good immunity" to seasonal flu, H1N1, or pathogens in general. In fact, infants younger than 6 are both more generally vulnerable to disease (because they have not yet been exposed to germs and developed the diverse immunity of an adult) and also particularly vulnerable to seasonal flu and H1N1. That is why cdc.gov notes that "people who live with or care for children younger than 6 months of age" are one of the priority groups for H1N1 vaccination: not to protect them, but to reduce the risk of transmission to their infants under 6 months who are especially vulnerable. See http://www.cdc.gov/media/pressrel/2009/r090729b.htm [cdc.gov]

    It's true that you could volunteer to participate in a study, and I'm glad you're willing to help advance science in that way. However, consent from the subjects is not (alone) sufficient to guarantee that conducting a study is ethical. Scientific ethics guidelines require that the study be deemed inherently ethical by a Human Subjects Research review board. Regardless of what level of risk the subjects are willing to accept, it's only ethical to conduct a study that exposes them to a level of risk that is commensurate with the scientific benefit to be achieved, and not in excess of some absolute limits as well. For example, even if there were human subjects willing with full informed consent to allow their syphilis to go untreated, it would not be ethical to conduct a study that studied the long-term effects of untreated syphilis by deliberately denying available treatment to participants with syphilis (a la the infamous Tuskegee study, which of course compounded the injustice further by using prison inmates as subjects, not getting their informed consent to boot, and selectively using subjects from a particular ethnic group rather than others, among other issues).

  • by irtza (893217) on Saturday October 17, 2009 @09:30PM (#29781545) Homepage

    H1N1 is a particular strain of influenza A that has made its way around the world and vaccination against this strain is being done separate from the seasonal flu shot. Concern over this strain is related to its virulence and early reports of death amongst young, immunocompetent individuals - people normally not adversely affected by influenza.

    The common cold and the flu are not the same thing - there is a believed to be a high mortality from influenza ( http://aje.oxfordjournals.org/cgi/content/full/163/2/181 [oxfordjournals.org] ) as compared to the cold (corona virus (with exception of SARSCoV, rhinovirus - deaths generally related to asthmatic patients). 40,000+ deaths per year is a significant mortality rate. Morbidity from influenza would be much more. It makes it difficult to believe that it should be overlooked.

  • by bjwest (14070) on Sunday October 18, 2009 @04:29AM (#29782873)
    pandemic (from Greek pan "all" + demos "people") - an epidemic of infectious disease that is spreading through human populations across a large region; for instance a continent, or even worldwide. A widespread endemic disease that is stable in terms of how many people are getting sick from it is not a pandemic. Further, flu pandemics exclude seasonal flu.

    It doesn't have to be serious. Hell, it doesn't even have to be deadly. H1N1 is nether infectiously stable nor seasonal, thus it qualifies as a pandemic.

    The word only raises fears among the ignorant who think they know what it means.
  • by Reziac (43301) * on Sunday October 18, 2009 @09:15AM (#29783997) Homepage Journal

    There was something that went around in 1979 of that sort -- you could watch it hopping from person to person as exposure occurred. Two or three days incubation, sick as hell for 24 hours (everything emptied out both ends), then it went away as suddenly as it came, with no aftersymptoms.

    However, most short-term stomach/intestinal upsets are not flu. Per some hospital studies, about 90% of presented cases are actually food poisoning.

  • by HiThere (15173) <`charleshixsn' `at' `earthlink.net'> on Sunday October 18, 2009 @12:27PM (#29785251)

    The problem is that H5N1 is rattling around out there, and it can cross-breed with H1N1 strains. So far H5N1 doesn't spread well in humans, but it *is* quite deadly. If someone gets two strains of flu at the same time, they're likely to hybridize. So it's important to keep flu infections to a minimum. Given time, H5N1 will become less deadly as it evolves to live with people, but it needs to have it's numbers kept down until it does. And that means don't give it the genes that H1N1 uses for spreading.
     

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