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Why Healthy Young Adults Should Fear The Swine Flu

Boy sneezingI’ve heard a lot of reasons why people don’t want to get influenza vaccinations.

“I always get the flu after I get the shot” – injections are killed viruses containing only surface antigens and subvirons, so flu shots can’t cause infection. The intranasal sprays are weakened (“attenuated”) viruses which do have the potential to cause mild symptoms. Maaaybe you can say you got the flu from the spray – not from the shot.
“Jenny McCarthy says that I’ll get autism from them” – don’t get me started. She also recommends doing routine “poop analysis” to check for “yeast, bacteria, or infections.”
“The swine flu is a conspiracy by the government (see comment section) to increase pharmaceutical profits” – um … right … let me introduce you to Ms. McCarthy over here.
“I never get the flu” – with up to 20% of the US population getting influenza each year, odds are against you.
“I’m healthy. My body can handle the flu.”

I heard someone use the last excuse recently and had to remind that person about a unique feature of the novel H1N1 virus (aka the “swine flu”). A disproportionate number of patients who died from H1N1 were young and relatively healthy. According to this Reuters article, 90 percent of the seriously ill victims in Mexico were less than 50 years old and most of those patients were previously healthy. In addition, 87% of those who died were aged 5 to 59 — compared to a usual average of 32% for seasonal flu. All of the patients who died had “multiple organ failure.” Here is another article from the Washington Post about increased H1N1 influenza deaths in young healthy victims.

Why are young healthy patients the ones dying from H1N1?

One theory is that the patients’ own immune systems are killing them. In younger children, the immune system hasn’t fully developed. In older patients, the immune system loses some of its effectiveness. The theory is that immune systems in young healthy people are “too good” and go out of control. Scientists call the theory “cytokine storm.”

I”ll attempt a simple explanation of a cytokine storm, but realize that the process is more complicated than what I am trying to explain. When a virus infects the body, the body produces extra immune cells to combat the infection. Some immune cells attempt to kill the virus, others analyze the virus and produce antibodies. Some immune cells produce inflammatory chemicals called cytokines that serve several functions. Included in the function of cytokines is an inflammatory response – an increase in inflammation throughout the body. Normally, the body holds the inflammatory response in check – similar to the way that the thermostat in your home regulates the temperature. When the temperature in your house hits a certain set-point, the furnace shuts off. In a cytokine storm, the immune response is so intense that the feedback systems become overwhelmed. Cytokine production continues out of control and a generalized inflammatory response occurs in the body. Similar responses occur in anaphylactic shock and sepsis. Think of the difference between controlling a few bees buzzing around a picnic looking for food and a swarm of bees defending a hive.

More information about cytokine storm can be found here and here.

One study noted that gemfibrozil (Lopid) – a cholesterol medication – doubled survival rates in mice that had severe influenza infections. Apparently gemfibrozil has an inhibitory effect on inflammatory cytokine production.

Not saying that every young healthy adult who gets swine flu is an automatic ICU admission. Death rates for H1N1 are low, but are still about 3 times the rate of that for seasonal influenza. Just noting how strange it is that a healthy immune system may cause an increased risk of death from H1N1 virus.

Still want to skip that flu shot?

Oh yeah, and cover your mouth when you sneeze. While looking for a picture for this post, I found a video showing how many goobers are sprayed from the mouth during one sneeze. Blecch.

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  1. Apparently, the young people who have died from swine flu are also more likely to have had some other respiratory problem, such as asthma, perhaps putting them at greater risk of succumbing to the virus.

  2. Effect Measure has done a great job covering the details of H1N1:


    I really wish the CDC and vaccine manufacturers would put a little bit more effort into describing the scientific details of the vaccine rather than loading up websites with conclusory remarks about how it’s safe.

    For example, there are all kinds of e-mails going around raising a hysteria about the potential for using adjuvants in the vaccine. Just a little bit of scientific explanation about what an adjuvant is and how they are safe and have been used for years would go a long way in rebutting these fears, yet all you can find on the official websites are vague remarks about how adjuvants likely won’t be used. Similarly, some concrete numbers on the dangers of vaccines — most of which have serious adverse event rates well below 0.01% — would do more to dispel these myths than a government website patting people on the head and saying it’s safe.

    • There are many questions that I would like to see answered. “Why is it that we only have 5 companies left in the US that can make the vaccine?” What happened to all the others? Also, we have had this strain isolated for 15 months, yet there was a huge delay in vaccine development. Also, why was it necessary for the HHS Secretary to get the vaccine companies immunity from lawsuits before the vaccine companies would produce the product?

  3. For what it’s worth, our ICU is full of relatively young people with influenza related pneumonia.

  4. So..what about people with autoimmune disorders..even if mild? Are such people more at risk… even if they don’t fall withing the age criteria for highest risk?

    Thanks for the post. None of us have ever gotten the flu shot, but I will forward this to our sons.

  5. Last year we had formerly healthy 13 year old girl die from flu. She had no other risk factors, was an honor roll student, and had never received the flu shot because “the flu doesn’t kill people.” She was admitted to the hospital, and eventually transferred to the PICU after a superinfection pneumonia developed (Hib). Several days after that, she was put on a ventilator, then eventually ECMO for two days before she finally died. It was horrible.

    While you can’t promise that the shot would have prevented everything, the vaccine at least would have made such an outcome less likely. I use that story to remind myself and my patients that flu can and does kill people.

  6. @ Max: As it happens, the recently licensed H1N1 vaccine does NOT contain any adjuvants, so that argument is moot.

    I just wrote two posts to my kid’s Ultimate Frisbee team, Everything you need to know about the flu, and Everything else you need to know about the flu. More straightforward flu talk aimed at college-age kids.

  7. As a lab tech who specialized in Mycobacteriology, I still get really ticked when I see people spit big ones on the ground as I am sure they have no idea that their junk can still spread disease, even if they are healthy. Same with the coughers and sneezers. Blech is right.

  8. I’ll wait to see numbers that are based on more than 18 deaths.

    From the WHO:
    85% of the deaths from malaria occurred in children under 5 years of age in 2006. This equates to 748,850 children.

    Malaria was present in 109 countries and territories in 2006.

    Why aren’t we talking about this like we’re talking about H1N1?


  9. What the heck is Jenny McCarthy smoking?
    Also, there are studies saying that statins help with infections, bacteraemia, sepsis etc. Always interesting to see which drug companies sponsor those studies as well. (Hint: they make lipid lowering drugs).

  10. Wow…. if you want facts please go to the cdc website.

  11. Love your blog, I’m going backwards through your posts.

    I just wanted to mention something that really irritated me at the time, but now I understand.

    I knew full well that you don’t get the flu when you get a flu shot, just to preface. Several months ago I was with a mixed group of people, one of whom was a nurse, and we were talking about the flu and flu shots and she mentioned she always gets flu shots. Out of curiosity I asked her if she’d ever actually had the flu and she immediately replied with “flu shots don’t give you the flu.” I was really pissed off at the time because nothing I said implied that I thought so and she didn’t answer my question. NOW I get it, she probably runs into this belief constantly and was just shooting back her standard answer without really thinking about what I actually asked.

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