Vaccine efficacy - Printable Version
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Vaccine efficacy - OutsiderFan - 09-05-2020
ICYMI, the CDC recently told states to be ready for a vaccine on Nov. 1.
Now, the top vaccine makers have said they won't even seek approval until they have done adequate testing and analysis to insure vaccine safety. I'm no vaccine expert, but this seems like an end-run being done by vaccine makers to stop vaccine development from turning into an election matter, which pretty much rules out any Nov. 1 vaccine approved for use. Why else would these companies - who usually are fierce competitors - put out something like this?
[tweet]https://twitter.com/lmorello_dc/status/1302009868535111681[/tweet]
RE: Vaccine efficacy - dabigv13 - 09-05-2020
My take- the companies know a vaccine will be put in arms before it normally would be, and they want to reassure the majority of Americans who don't trust the administration.
A public pledge? Seems thin gruel to me.
On a different but related topic, flu vaccine rates have been dissapointing since we received them a week or two ago. Was hoping with the increased attention to the importance of vaccines and health that more folks would accept them when offered, but that has not really been the case. Even hard sells being turned down, usually for no readily articulable reason. Disheartening.
RE: Vaccine efficacy - chrisk - 09-05-2020
Some doctors in the media have been saying wait until mid- to late- September.
Sutter is not providing info about flu shot clinics until 9/17.
lex24 - lex24 - 09-05-2020
They will be ready when they are ready. Getting everything in gear for being able to move quickly once it’s ready is crucial. So be ready by Nov 1, in a normal time with a normal admin makes sense. Cause if there is an approved vaccine and we are not ready to quickly move the blame will be on the Admin. Rightfully.
RE: Vaccine efficacy - dabigv13 - 09-05-2020
(09-05-2020, 10:32 AM)chrisk Wrote: Some doctors in the media have been saying wait until mid- to late- September.
Sutter is not providing info about flu shot clinics until 9/17.
I think the difference in a person's immunity from a month's difference of immunization date would be pretty low but I'm not up on any literature about it. When someone shows up to just a few doc appts a year, getting them the flu shot the earliest you can is best IMHO.
If you plan to get the flu shot, by all means waiting a month is fine. I haven't gotten mine yet.
RE: Vaccine efficacy - CompSci87 - 09-05-2020
(09-05-2020, 12:45 PM)dabigv13 Wrote:(09-05-2020, 10:32 AM)chrisk Wrote: Some doctors in the media have been saying wait until mid- to late- September.
Sutter is not providing info about flu shot clinics until 9/17.
I think the difference in a person's immunity from a month's difference of immunization date would be pretty low but I'm not up on any literature about it. When someone shows up to just a few doc appts a year, getting them the flu shot the earliest you can is best IMHO.
If you plan to get the flu shot, by all means waiting a month is fine. I haven't gotten mine yet.
I haven't heard anything from Kaiser Permanente about flu shots yet.
RE: Vaccine efficacy - Leftcoast - 09-06-2020
Yes, Kaiser in Northern California is still saying to check back for more info later - "This year we will be offering drive-up and walk-up flu clinics. Check back for flu shot locations, dates, and times."
https://mydoctor.kaiserpermanente.org/ncal/coldflu/#/prevention
(Edited to clear up formatting. Weird, cut and paste seems to be adding lots of http font characters even when it looked good in preview.)
RE: Vaccine efficacy - terry - 09-06-2020
Rite-Aid, Walgreen's, and CVS are offering the flu shot now.
RE: Vaccine efficacy - dabigv13 - 09-06-2020
(09-05-2020, 01:25 PM)CompSci87 Wrote:(09-05-2020, 12:45 PM)dabigv13 Wrote:(09-05-2020, 10:32 AM)chrisk Wrote: Some doctors in the media have been saying wait until mid- to late- September.
Sutter is not providing info about flu shot clinics until 9/17.
I think the difference in a person's immunity from a month's difference of immunization date would be pretty low but I'm not up on any literature about it. When someone shows up to just a few doc appts a year, getting them the flu shot the earliest you can is best IMHO.
If you plan to get the flu shot, by all means waiting a month is fine. I haven't gotten mine yet.
I haven't heard anything from Kaiser Permanente about flu shots yet.
I bet if you have an office visit or urgent care visit now, they'd offer it to you. My hospital hasn't started flu shot clinics yet, but all the office staff are trained up on encouraging flu shots. There is a different version for older folks (65+, a good chunk of this board I imagine, so listen up) that my office doesn't have, that apparently provokes a stronger immune response in those patients. We refer those patients to their PCP. Not sure which of the two we have/will have. Previously we had the trivalent high dose, but I guess this adjuvant one is new for 2020 along with the quadrivalent high dose.
More info on Fluzone High Dose-
https://www.cdc.gov/flu/prevent/qa_fluzone.htm
More info on FLUAD- (adjuvant based for 65+)
https://www.cdc.gov/flu/prevent/adjuvant.htm
RE: Vaccine efficacy - M T - 09-06-2020
(09-06-2020, 12:08 PM)dabigv13 Wrote: I bet if you have an office visit or urgent care visit now, they'd offer it to you. My hospital hasn't started flu shot clinics yet, but all the office staff are trained up on encouraging flu shots. There is a different version for older folks (65+, a good chunk of this board I imagine, so listen up) that my office doesn't have, that apparently provokes a stronger immune response in those patients. We refer those patients to their PCP. Not sure which of the two we have/will have. Previously we had the trivalent high dose, but I guess this adjuvant one is new for 2020 along with the quadrivalent high dose.This was confusing to me, so let me try to clarify things.
More info on Fluzone High Dose-
https://www.cdc.gov/flu/prevent/qa_fluzone.htm
More info on FLUAD- (adjuvant based for 65+)
https://www.cdc.gov/flu/prevent/adjuvant.htm
Quadrivalent vaccines are designed against 4 strains of flu; trivalent vaccines are designed against 3 strains.
"Fluzone High-Dose Quadrivalent contains four times the antigen, the part of the vaccine that helps your body build up protection against flu viruses, then Fluzone Quadrivalent and other standard-dose inactivated flu vaccines. . . . In the United States, Fluzone High-Dose Quadrivalent is licensed only for persons aged 65 years and older." ("Four times the antigen" has nothing to do with "quad" in Quadrivalent. Apparently, Fluzone High-Dose Quadrivalent does not have the adjuvant.)
Apparently last year's high-dose shot was a trivalent vaccine; this year it is a quadrivalent.
"FLUAD and FLUAD Quadrivalent is a standard-dose, inactivated influenza (flu) vaccine, manufactured by Seqirus that contains an adjuvant. During the 2020-2021 influenza season, both trivalent FLUAD and FLUAD Quadrivalent will be available. Both of these vaccines are approved for people 65 years and older.....An adjuvant is an ingredient of a vaccine that helps promote a better immune response...... In the United States, FLUAD and FLUAD Quadrivalent are licensed only for persons aged 65 years and older."
So, [trivalent] FLUAD, FLUAD Quadrivalent, and Fluzone High-Dose Quadrivalent are 3 different vaccines, each licensed only for 65 years an older. The first two contain an adjuvant. The last contains 4x inactivated virus.
I didn't see a comparison on outcome or reactions to FLUAD or FLUAD Quadrivalent vs Fluzone High-Dose Quadrivalent. I didn't see any comparison of reactions of high-dose vs regular dose. (high-dose was more effective at reducing hospitalizations for seniors)
The CDC does not recommend any type of approved vaccine over another type (including types other than these mentioned here). [ie, they don't recommend ones associated with fewer hospitalizations over ones with more hospitalizations].
Although most experienced little reaction, there was slightly more reaction to quadrivalent vs trivalent (for either regular dose or high-dose).
My company had a flu-shot clinic last week (that I didn't get to), done on campus by Safeway. We were told that "high dose" was available, but that could have been confused (by me) with any vaccine appropriate for 65+. Safeway's web site mentions both Fluzone High-Dose and FLUAD Quadrivalent, so I think you're either going to have to check with a particular store to see whether they offer both or only one.
CVS only mentions the Fluzone High-Dose at their flu shot page but the page appears be a hold-over from last year as they portray the high-dose shot as a trivalent vaccine.
"Rite Aid said that this year it is offering a quadrivalent flu vaccine, FLUAD trivalent vaccine with an adjuvant for patients 65 years old and older, high-dose Fluzone HD for older patients, and egg-free Flublok." (source)
Walgreens has a web page for flu shot options for older people. Apparently they offer the FLUAD trivalent, FLUAD quadrivalent, Fluzone High-Dose quadrivalent.
RE: Vaccine efficacy - Mick - 09-06-2020
(09-06-2020, 11:59 AM)terry Wrote: Rite-Aid, Walgreen's, and CVS are offering the flu shot now.
I always get it at CVS. I had a terrible flu in 1992, was in bed for two weeks. Have had a flu shot every year since, never had a problem. I have anti-vaxxer acquaintances who tell me that's just 28 years' worth of coincidences...
RE: Vaccine efficacy - 2006alum - 09-07-2020
While we're on the subject of vaccine efficacy and we have a lot of experts in our midst, can anyone confirm or debunk the following:
I've been told/read that the flu shot loses its efficacy over time, and so if you are most worried about a peak flu season in Jan/Feb, you may want to wait and get the flu jab in November so that its peak efficacy overlaps with peak flu season. Is that total nonsense? For that reason, I've typically waited to get the flu shot until later in the fall, but if there's truly zero benefit to waiting, I'll take care of this now while COVID-19 case counts are lower in my community.
Thanks!
RE: Vaccine efficacy - Hurlburt88 - 09-07-2020
I read October is optimal, followed by September in terms of timing. WSJ, IIRC. For over 65, article definitely recommended October as the benefits would overlap the flu season best.
RE: Vaccine efficacy - BostonCard - 09-07-2020
(09-07-2020, 04:25 AM)2006alum Wrote: While we're on the subject of vaccine efficacy and we have a lot of experts in our midst, can anyone confirm or debunk the following:
I've been told/read that the flu shot loses its efficacy over time, and so if you are most worried about a peak flu season in Jan/Feb, you may want to wait and get the flu jab in November so that its peak efficacy overlaps with peak flu season. Is that total nonsense? For that reason, I've typically waited to get the flu shot until later in the fall, but if there's truly zero benefit to waiting, I'll take care of this now while COVID-19 case counts are lower in my community.
Thanks!
https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6207a1.htm#RecommendationsUseInfluenzaVaccines201314InfluenzaSeason
There may be something to that...
Quote:Antibody levels induced by vaccine decline over the months after vaccination (99,352–354). Although a 2008 literature review found no clear evidence of more rapid decline among the elderly (105), a 2010 study noted significant decline in titers 6 months postvaccination among persons aged ≥65 years (though titers still met European Medicines Agency levels considered adequate for protection) (354). More recently, some investigators have estimated vaccine effectiveness over the course of a season, as a function of time since vaccination. A case-control study conducted in Navarre, Spain, during the 2011–12 season revealed a decline in vaccine effectiveness from 61% (95% CI = 5–84) in the first 100 days postvaccination to 42% (95% CI = -39–75) for 100–119 days postvaccination and to -35% (95% CI = -211–41) thereafter. This decline primarily affected persons aged ≥65 years, among whom vaccine effectiveness declined from 85% (95% CI = -8–98) to 24% (95% CI = -224–82) to -208 (95% CI = -1,563–43) over these intervals.
That being said, the efficacy of the vaccine is 0 when you don’t get it. So they advise the following:
Quote: While delaying vaccination until later in the season might permit greater immunity later in the season, such deferral might result in missed opportunities to vaccinate, as well as difficulties in vaccinating a population within a more constrained time period. Community vaccination programs should balance maximizing likelihood of persistence of vaccine-induced protection through the season with avoiding missed opportunities to vaccinate or vaccinating after influenza circulation occurs.
BC
RE: Vaccine efficacy - akiddoc - 09-07-2020
(09-07-2020, 04:25 AM)2006alum Wrote: While we're on the subject of vaccine efficacy and we have a lot of experts in our midst, can anyone confirm or debunk the following:
I've been told/read that the flu shot loses its efficacy over time, and so if you are most worried about a peak flu season in Jan/Feb, you may want to wait and get the flu jab in November so that its peak efficacy overlaps with peak flu season. Is that total nonsense? For that reason, I've typically waited to get the flu shot until later in the fall, but if there's truly zero benefit to waiting, I'll take care of this now while COVID-19 case counts are lower in my community.
Thanks!
The older you are the shorter its effectiveness. I get mine in late October every year. I haven't had a symptomatic influenza infection in at least a decade, probably longer. After 30 years of flu vaccines and catching influenza a few times when I was younger, I seem to be pretty good at fending it off. I saw at least 200 kids with positive rapid flu tests last winter (late October through February). Somehow got through the winter with zero illnesses. I wasn't using PPE at the time. Did wash my hands within seconds of seeing every patient though. Was not wearing a mask prior to mid February.
RE: Vaccine efficacy - M T - 09-08-2020
I understand that if there were a significant outbreak of flu, it will muddy the water about people recognizing they have COVID-19 vs the flu. And, if people get both diseases simultaneously, the outcome would seem to have to be worse for them.
But, it seems to me that the flu season should be the smallest in decades, if not all time, in the US. Given the mask wearing & social distancing and to some extent, hand washing, only those that were lax enough that they could have gotten COVID-19 will be getting the flu.
THIS IS NOT TO SAY THAT YOU NEEDN'T GET THE FLU VACCINE.
But then, even "careful" SCC may be open for indoor dining (without masks when you eat) tomorrow. So maybe I'm wrong and we'll go right back to higher levels of infection by aerosols & droplets whether influenza or COVID-19.
I don't know of any evidence that says being unmasked indoors (to eat) with people of unknown infection status is safe. I think it is based on a false economy. I expect the state of California (or, rather, its governor) asserted the new guidelines as safe without giving any scientific evidence.
-----
By the way, speaking of "careful" SCC: Of the 45 counties in the US with population > 1M, SCC has the second fewest COVID-19 deaths per 10K population (1.31), at least up until 9/3/20. The top and bottom are
County State Pop. Deaths/10K
Bronx NY 1418207 34.66
Queens NY 2253858 32.08
Kings NY 2559903 28.48
New York NY 1628706 19.46
Wayne MI 1749343 16.54
Nassau NY 1356924 16.20
...
Alameda CA 1671329 1.77
Contra Costa CA 1153526 1.59
Santa Clara CA 1927852 1.31
Collin County TX 1034730 1.10
Maybe a more appropriate description of SCC is prudent, and omit any pejorative comments about SCC being careful.
Of the 140 counties with population > 500,000, SCC has the 8th fewest deaths/10K. San Francisco (pop 881K) is 5th fewest at 0.95 deaths/10K. Hawaii is fewest at 0.69 deaths/10K.
RE: Vaccine efficacy - oldalum - 09-08-2020
(09-07-2020, 10:13 PM)akiddoc Wrote: I get mine in late October every year.so do I
RE: Vaccine efficacy - BostonCard - 09-08-2020
(09-08-2020, 01:00 AM)M T Wrote: I understand that if there were a significant outbreak of flu, it will muddy the water about people recognizing they have COVID-19 vs the flu. And, if people get both diseases simultaneously, the outcome would seem to have to be worse for them.
But, it seems to me that the flu season should be the smallest in decades, if not all time, in the US. Given the mask wearing & social distancing and to some extent, hand washing, only those that were lax enough that they could have gotten COVID-19 will be getting the flu.
You are probably correct that the things we are doing to decrease "R" for COVID-19 will also decrease "R" for influenza, and consequently we will probably have a very mild influenza season, or, that is my hope. But we can't be sure until we look back, so I think we should all do our best to protect ourselves and others against the flu, which means getting vaccinated.
BC
RE: Vaccine efficacy - Goose - 09-08-2020
I haven't had the flu for over 25 years, and I hadn't taken a flu shot until 2019. I will get one this year. Do I really need one? Maybe not, but I am not going to do the experiment.
RE: Vaccine efficacy - dabigv13 - 09-08-2020
https://www.statnews.com/2020/09/08/astrazeneca-covid-19-vaccine-study-put-on-hold-due-to-suspected-adverse-reaction-in-participant-in-the-u-k/
AstraZeneca's phase 3 trial on hold for a severe adverse reaction. Not great. But not necessarily unusual. Good reminder that a successful vaccine is no sure thing.