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6463861
story
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.
Comments: 430 +- Science: On the Efficacy of Flu Vaccine on Saturday October 17, @03:39PM
Posted
by
kdawson
on Saturday October 17, @03:39PM
from the because-we-just-know-it-works-that's-why dept.
from the because-we-just-know-it-works-that's-why dept.
background: url(//a.fsdn.com/sd/topics/topicmedicine.gif); width:64px; height:80px;
medicine
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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Nationwide Shortage In Supply of Swine Flu Vaccine 579 comments
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All I have is an anecdote (Score:3, Interesting)
Re:All I have is an anecdote (Score:5, Insightful)
If its four or five days from two illnesses then its not Flu. Thats a cold.
Parent
Re:The one crucial point (Score:5, Informative)
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)
Parent
Re:The one crucial point (Score:5, Insightful)
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.
Huh?
The US Government backstops liability for all vaccines, except where it grants outright immunity from lawsuits.
1986: http://en.wikipedia.org/wiki/National_Childhood_Vaccine_Injury_Act [wikipedia.org]
The liability is otherwise so big that no private insurer will touch it.
(Same thing goes for nuclear power.)
Both the USA's dept of Health and Human Services (HHS) and the European Union's Parliment have granted pharmaceutical companies immunity from lawsuits relating to H1N1 vaccines. The USA's HHS Secretary went one step further and granted immunity for all future swine flu vaccines.
I'm not sure how Europe normally handles vaccine liability, but I'm sure a /.er can fill us in.
You're right though that the WHO and CDC are driving the H1N1 vaccines.
They're so desperate to get out ahead of the flu that they're accepting calculated risks.
Parent
Re:The one crucial point (Score:5, Insightful)
No, it shouldn't. Pandemic refers to the number of people infected and how quickly it spreads, not how deadly it is. People should fucking learn what this term means, rather than assuming it means "AMAZING DEADLY SUPER VIRUS". We should NOT redefine it to mean "SUPER DEADLY SUPER VIRUS".
Swine flue IS a pandemic. It's not super amazingly deadly, but it IS a pandemic. The paranoia is not the fault of the government. This paranoia is the fault of the dipshit idiot populous that elects idiots into the government and then ceases to think for themselves.
Parent
Re:The one crucial point (Score:5, Insightful)
Actually, if anyone bothered to look into it, rather than listening to the media outlets, 'the swine flu' is less than half as likely to kill you as the average seasonal flu. By 'average seasonal flu' I mean take the past 50 years worth of deaths related to seasonal flus and you'll find about 0.12% of the infected people die. By contrast, 0.05% of those infected with 'the swine flu' have died.
It is a pandemic, but the flu has been a pandemic forever, as is the common cold. The media just doesn't have anything else to get our attention so this is what they exaggerate into being scary.
Parent
Re:The one crucial point (Score:5, Informative)
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.
Parent
Re:The one crucial point (Score:5, Insightful)
You seem to be confusing the current seasonal flu with the pandemic of 1918.
They are by no stretch of the imagination comparable.
Parent
Re: (Score:3, Insightful)
Re:The one crucial point (Score:4, Insightful)
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.
Of course they can.
Between 1900-02, the life expectancy at birth was 49.24. In 1997, the life expectancy at birth was 76.5. Statistic [bc.edu]
Keeping your customers healthy now pays big dividends later.
Healthy people age into old age. Well, duh.
They have families. They have pets. They work longer and have more discretionary income.
That makes it worthwhile to invest in a broad spectrum of products that would have had little meaning to the industrial laborer of 1920 who was unlikely to see his fiftieth birthday.
Parent
Re:The one crucial point (Score:4, Insightful)
"Pharma doesn't make a dime from healthy people."
Well, that's a myth. Pharma makes big dollars *even* from healthy people. All you need to consider is that "cosmetics" is another name for "pharma".
"They want you in poor health, but not quite ready to die."
That's not exactly true. An overall ill society is not a society that will pay for expensive treatments. Pharma needs a healthy mixture (pun intended) of long-term ill people and healthy people to pay for the treatment; that's why you see a lot of investment on first world-low impact illnesses (when treated) like obesity, hypertension or diabetes or, the best of all, cosmetics (where the "illness" is only in the mind of the buyer) but so little on, say, malaria.
Parent
Re:All I have is an anecdote (Score:4, Informative)
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.
Parent
Re: (Score:3, Insightful)
What else changed when you started getting the flu shot? If you now have a mind to protect your health by getting the shot, then you're probably also doing more things like washing your hands, eating better, etc
I had the same result from simply drinking water (Score:4, Interesting)
During a typical winter I would be sick at least twice on average, usually missing about four or five days of work in total. Since I've started having seasonal flu shots I have not had any winter illness and missed no time from work.
Since we're going into anecdotes I can say I used to get a bit more sick than that, about three times a winter with usually one incredibly bad illness lasting about a week.
I stopped drinking soda, and drink water instead, and now I might get one mild cold a winter but sometimes not. I get about the same level of exercise and eat about the same (i.e. whatever the hell I want) with perhaps a touch more vegetables.
That's also all without ever having a flu vaccine shot. You have to wonder if just a few simple lifestyle changes across the U.S. would not totally eclipse any benefit from flu shots. And since I am not getting sick as often, I'm also not getting other people sick as often - the exact same benefit some claim for the vaccine approach. Only my overall health in all other matters is better too, unlike a flu vaccine which prevents only one thing, and temporarily at that (I have nothing against things like polio vaccines which make a ton of sense because they last forever).
Parent
Re:All I have is an anecdote (Score:4, Informative)
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.
Parent
this article has many problems and is bad science (Score:5, Informative)
Parent
Re:this article has many problems and is bad scien (Score:4, Insightful)
"H1N1 flu is demonstrably lethal to children, healthy young adults, and people under 65 with common preexisting health conditions like asthma or HIV."
What you seem to forget is that seasonal flu -*any* year's seasonal flu, is demonstrably lethal to children, healthy young adults, and people under 65 with common preexisting health conditions like asthma or HIV.
Certainly all this issue seems to be poisoned by sensationalist press beyond repair, one way or another but, to-date, all objective measures seems to point that while H1N1 *could* have been a tragic deathly pandemia it will be no significantly worse than any other seasonal flu (and even its very highly contagious rates owes a significant percentage to the fact that it is actively seeked and diagnosed), but Pandora's box is already opened and it's in no one interest (press, pharma, government) to try to close it now.
"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"
That's the way the go with everything, so no surprise there.
Parent
Re: (Score:3, Informative)
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 peop
Re: (Score:3, Insightful)
I mainly agree with you. Just a few quick points.
1. Funding issues will, for evolutionary reasons (i.e. whether a scientific career 'lives' or 'dies') have a profound effect on prevailing attitudes in the mainstream of various areas of the sciences (i.e. if your research group generally turns out pro-drug papers in journals, you are more likely to get pharmaceutical sponsorship than if you don't.)
2. The 'no scientific evidence' argument appears many times in an attempt to discredit an unpopular idea. The
It's not you, it's who you'd infect (Score:5, Insightful)
The flu shot is not about preventing you from dying. It's to avoid you from getting sick and infecting other people who may have weaker immune systems and have higher risk of dying if they get sick.
question for you: (Score:3, Interesting)
>The flu shot is not about preventing you from dying. It's to avoid you from
>getting sick and infecting other people who may have weaker immune
>systems and have higher risk of dying if they get sick.
It's been a long time since biology classes in high school.
Even if I'm immunized, can't I be a carrier?
Editorializing (Score:4, Insightful)
Re:Editorializing (Score:4, Insightful)
All you have to do is look up Vaccine on Wikipedia to see some people don't like vaccines for whatever reason ("it's god's will that we die" or whatever). Not worth giving those freaks any more attention, really, unless these claims are different in some way.
Parent
Freaks are against science, yourself included (Score:4, Insightful)
All you have to do is look up Vaccine on Wikipedia to see some people don't like vaccines for whatever reason
It's stupid to inject yourself with something that does nothing. Especially when the thing that may not do anything for you, also has a non-zero chance of side effects that are much less pleasant than the original thing you were trying to prevent. That's a pretty good reason.
This article points out that we don't really know if the flu vaccine (any flu vaccine) does anything.
Since there is no good evidence either way, "better to be safe than sorry" can apply either way too. Which makes your heavy-handed dismissal of those questioning the flu vaccine every bit as faith based as the "freaks" you look down on with such contempt.
Meet the enemy, for he is you.
Parent
Re:Editorializing (Score:5, Insightful)
The problem with this article is that Ms. Jackson isn't even asking the right *question*. Of *course* healthy people don't get a significant personal benefit from being vaccinated. Nobody ever said they did. If all you care about is yourself, and you are healthy as an ox, then by all means don't get vaccinated. Not getting vaccinated is a great way to get your inheritance early. Just get H1N1, then visit your elderly uncle to cheer him up. You'll transmit the virus to him, he'll die, and you'll be rich. But if you want your elderly uncle to live, or, worse luck, he's already written you out of the will, then you might as well get vaccinated.
IOW, the point of the vaccine is to prevent the pandemic, not to protect you. So the *right* question to ask is, does the H1N1 vaccine confer any immunity to the recipient? This is a question that can readily be answered by an epidemiology study, and that can also be ethically studied in a double-blind study - just vaccinate half of a healthy population, don't vaccinate the other half, and see how many get H1N1 and how many don't. The problem is that if the vaccine works, you don't know until it's too late. So it's good for checking your work, but no good for making the decision as to whether to do mass vaccinations - mass vaccinations are pointless after the pandemic has run its course.
I suspect that epidemiology studies are just as good for evaluating the efficacy of the vaccine *after* the pandemic has passed anyway, so that's probably why they don't do double blind studies. But I'm not a virologist, so that's just a WAG.
What I really wish people would do would be to stop coming up with conspiracy theories about vaccines - these are really harmful. Information is what we need, not panicked hyperbole.
Parent
As soon as you mentioned "Group Health"... (Score:5, Informative)
... 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.
Re:As soon as you mentioned "Group Health"... (Score:4, Insightful)
But bear in mind that if she's wrong the company's costs, on balance, will be much higher when their insured start showing up in the hospital not having gotten the vaccine. The vaccine, if it works, should be a cost saving measure for them.
It seems to me that they'd want to get this right.
(This is all subject, of course, to speculation on my part regarding the cost of the vaccine, versus the cost and likelihood of hospitalization in its absence. Though I'd point out that, if the vaccine isn't cost effective for the insurer, they could elect not to cover it regardless of its effectiveness.)
Parent
Re: (Score:3, Informative)
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.
Or.... (Score:5, Insightful)
Also a second situation which would lead to the similar results. That people who got the shot...*gasp* likely got the shot the previous year and *shock* have some built up immunity due to the previous years shot.
This physician... not a biologist. Sounds like shes not very good at what shes supposed to be doing. The information she presented proves nothing. She randmly concludes just 1 or many possible scenarios based on her predisposition. Poor poor science.
There are randomized controlled trials (Score:4, Informative)
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.
Re:There are randomized controlled trials (Score:5, Informative)
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.
Parent
There are many obstacles to overcome (Score:4, Informative)
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.
article is BS (Score:5, Insightful)
36,000 die of complications from the flu annually in the US. That's very nearly as many as die from car accidents.
There is a very simple way to test the effectiveness of a vaccine and that is to carry out a double blind study utilising placebos alongside the active vaccine. Any effect that is solely due to the "healthy user effect" would be virtually eliminated.
further problems: the article has no references, no real hard data from relevant studies and several studies contradict the article's assertions.
Re: (Score:3, Informative)
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.
Beware of antivaxxers (Score:5, Insightful)
I think it's commendable that folks still challenge received wisdom, and are actually attempting to answer difficult questions, as opposed to merely sweeping them under the carpet.
However at the same time, we need to be super, super careful that we don't encourage the fringe extremist nutters in the antivax movement, who are sure to seize upon doubts of the efficacy of the swine flu vaccine as PROOF that all vaccination is bad, and that we should protect our kids by going to flu and chickenpox parties because it's "natural".
And I would need convincing that this isn't some kind of stunt by Group Health or other elements of the private health industry to wriggle out of paying for flu shots. Gotta love profit-focused private "health" care, and its useful idiot defenders on the Right.
Re: (Score:3, Informative)
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 ext
The Scientific Method (Score:5, Insightful)
We killed smallpox outright, but every vaccine since then has been prevented from achieving its final goal through the effort of anti-vax forces of one kind or another. That's the reason I have to be against this sort of article - even the chance that it might be correct isn't worth the near-certainty that it will be another blow for vaccination in general. If they had any sort of actual firm proof, it would be different, but this sort of conjecture *is* dangerous - and not to the person doing the conjecturing.
Re:Good article (Score:5, Funny)
I don't whether to laugh or cry.
Parent
Re: (Score:3, Funny)
Sounds like you're having a devil of a time figuring it out.
Re:Good article (Score:5, Interesting)
"Let's pray that science wins out over irrationality."
That's what the article's point is! It's not saying "vaccines don't work" it's saying "they say vaccines reduce the death rate by 50% and the numbers don't bear that out. What's the real number?"
And that's a fair question. We know the virus isn't 100% effective, it damn near killed this girl: http://www.google.com/search?pg=q&fmt=.&q=dystonia+flu+vaccine [google.com]
Neither though is anybody saying the vaccine is zero percent effective or universally toxic, what happened above is a rare edge case (but as an aside it would be nice to be able to predict when this was going to happen, this is a fairly *catastrophic* edge case).
But the examples brought up in the article do suggest there is sustantive argument that the claimes reductin of 50% reduction in martaliry rate is indeed in question, that's all.
Nobody's actually measuring people who have anti-bodies of a specific type, the data gathered is fairly meaningless by lumping a lot of things (rhinovirus, coronovirus etc) as "flu", also the cohort factor and related effects do have a demonsterable non-zero effect on the mortality rate.
So, it's not a question of is the vaccine useful or nor, more like a plea for more accurate analysis and gathering of the data in question.
Parent
Re:Good article (Score:5, Funny)
Parent
Re:Good article (Score:5, Funny)
Parent
Re:Good article (Score:5, Interesting)
You joke, but there's mounting evidence that the placebo effect is indeed getting stronger [wired.com].
(Of course, conducting a double-blind test to confirm this would create numerous paradoxes)
Parent
Re: (Score:3, Funny)
I took a placebo and I didn't catch Flu.
Actually it sounds like you caught a nasty case of placebocitis, a nasty flu-like infection that has no perceivable symptoms including a lack of high fever, no stomach ache or GI irritation, soreless throat, non-inflamed tonsils, and pounding migraine headaches not being reported.
W
FluMist (Score:5, Informative)
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]
Parent
Re:FluMist (Score:5, Insightful)
T
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Re: (Score:3, Informative)
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.
Re: (Score:3, Informative)
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
Re:FluMist (Score:5, Informative)
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).
Parent
Re: (Score:3, Insightful)
I'd be pissed if the doctor didn't tell me there was a very slim chance that it might be a more serious form. The Doc did the right thing, as it emphasized that the patient should come back if things get worse, indicating that it might be a bacterial caused menegitis.