The CDC reports mostly type A Flu nationwide and in New York, but in out office, the last 2 weeks or so, positive Flu tests have nearly all been TYpe B (unlike a month ago, when they were mostly Type A). MAkes us feel better about using Tamiflu (see earlier post) to which all Type B’s have so far been sensitive.

In other news, it seems as though people are becoming interested in what we have to say. In addition to the old NY Times, Daily News and NHK interviews, there are now articles incorporating our opinions to SIDS, obesity, “third-hand” smoke and (of all things) handling embarrassing baby situations. Our office is also mentioned by COLA (a clinical office lab accreditation organization) as a 2008 Laboratory Excellence Award Recipient, and we published a case report of an allergic reaction to a sewing needle. And, on one occassion, an interview in which I expressed an opinion was incorporated into an article that claimed the opposite. I think it is fair to say that we agreed to disagree.

We started doing more flu tests; today 5 tested positive for type A and 3 positive for type B flu.  A few comments:

(1) Flu vaccine efficacy: we had 2 positive tests so far in children who got injectable (Fluzone) flu shots; in both the disease was mild and went away quickly.  We have had NO flu at all so far in children who got the nasal Flumist vaccine.  Remember, injectable flu is shot still the only one recommended for ages under 2, over 49, and for high-risk individuals.
(2) CDC reports that most Flu A strains this season are resistant to treatment with Tamiflu, our usual drug of choice.  We tried to prescribe Relenza, to which the strains are sensitive, but ran up against the fact that none of the local insurers cover this medications.  I guess no one at the insurance companies reads  www.cdc.gov/flu/weekly…

(3) One of the children who tested positive for flu simultaneously tested positive for Group A Strep.  Both infections are running around schools and day care centers, so to have both at the same time would not be unusual; this is just a reminder not to stop looking for answers once you have one good answer: it may not be the only answer…

(4) Having Flu A does not make one immune to B, and vice versa.  It’s not too late to get you flu vaccine, even if you have been sick.

My near-classmate, Mark F. Bernstein ’83, wrote an article in the latest issue of Princeton Alumni Weekly, examining the impact of the great flu pandemic of 1918 on the Princeton campus.  The short version: the deadly epidemic that killed fifty-nine University of Michigan students and 32 Princeton town residents, killed no one on the Princeton campus.  Probable reason for this success: aggressive isolation of all persons with even mild respiratory symptoms for the duration of their illness, and restrictions on students attending public events with uncontrolled attendance.

This year’s flu is coming. We have had only 2 confirmed positive tests so far, but it is early in the season, with low (sporadic) flu activity reported by the CDC and the Google flu tracker.  This year’s decreased flu compared to previous years may be due to increasing use of Flumist, a more effective vaccine in stopping flu transmission (injectable flu still appears to be better at preventing complications in high-risk individuals), or perhaps less crowding in stores due to recession and online shopping, but this cannot be expected to remain so.  In addition to encouraging further vaccination, I would like to ask responsible education professionals to be less diligent in enforcing attendance requirements.  Staying home is still the best way to avoid transmitting the flu in schools, and people are just as contagious in the prodromal (sniffles only, no fever or aches) stage as when they are shaking with chills.

Sorry to disappoint some of the folks who will Google their way here:  It’s not about the connection, it’s about lack thereof.  Just wanted to let everyone know that, for the first time in my career, I saw an unvaccinated child with clear features of Autism Spectrum Disorder — between high-functioning Autism and significant Asperger’s syndrome.  Now, considering that I have far fewer than 150 unvaccinated children in my practice, and that 1 in 150 is the commonly accepted figure for ASD prevalence, this argues for at least as high a rate in unvaccinated as in vaccinated children.

Which brings me to, why do people think it’s the vaccines?

Sorry again; you ain’t gonna like the answer.

ASD is, for all practical purposes, a learning disability limited to interpersonal relationships.  Among other things, people with even mild  ASD cannot tell when someone is lying to them.  We responsible physicians tell them ASD is about genetics and parent age.  Translation: your children are growing up just like you but more so.

It’s as if we were saying: It’s all your fault.
From the other side, they are bombarded with another message.  Whether it’s MMR, mercury or microwaves, absence of evidence of connection is not interpreted as evidence of absence.  The more myths are debunked, the more fervently they are cherished, for at their core is this:

Someone did this to your child.

And what parent would not cling to that?

My own concerns with vaccines have nothing to do with either their safety or their efficacy.  I am concerned with the recent trend to require universal vaccination against diseases that are not significantly dangerous but rather unpleasant, which require school or work absence and medical care but are not likely to result in death or lasting damage.  I suspect that, as more children are crammed into day care for longer periods of time, other viruses will take their place — Norwalk and enteroviruses for Rotavirus,  Adenovirus for flu — negating the improvement from the vaccines.  Only if the current trend to place more and more children in day care is reversed will we see fewer sick children — and then the vaccines will really help.

We had our first clearly positive flu patient, a 2 year old who had one dose of injectable vaccine, with a 102 degree fever and no other signs. The rapid flu test was clearly positive for Flu type B.

Take home message:

(1) CDC recommends 2 doses of flu vaccine, 1 month apart, for certain patients, such as those under 9 years of age receiving the vaccine for the first time;

(2) Injectable vaccine is less effective than the nasal vaccine in preventing flu, but it is highly effective at preventing complications and hospitalizations;

(3) We have both, and will be happy to help you to select the right one for your needs.

(4) Two resources to find out about flu activity in our area:

http://www.google.org/flutrends/

http://cdc.gov/flu/weekly/

Stay healthy!