{"id":7754,"date":"2015-10-17T11:36:37","date_gmt":"2015-10-17T15:36:37","guid":{"rendered":"http:\/\/blogs.nejm.org\/hiv-id-observations\/?p=7754"},"modified":"2015-10-18T17:27:42","modified_gmt":"2015-10-18T21:27:42","slug":"dear-flu-vaccine-please-improve","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/dear-flu-vaccine-please-improve\/2015\/10\/17\/","title":{"rendered":"Dear Flu Vaccine:  Please Improve!"},"content":{"rendered":"<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2015\/10\/dog-vaccine.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-medium wp-image-7802\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2015\/10\/dog-vaccine-300x200.jpg\" alt=\"dog vaccine\" width=\"300\" height=\"200\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2015\/10\/dog-vaccine-300x200.jpg 300w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2015\/10\/dog-vaccine.jpg 450w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a>Dear Flu Vaccine,<\/p>\n<p>As the supply of you and your brethren have arrived\u00a0in our clinics, on our hospital floors, and in pharmacies, I thought it would be a good time to reach out and tell you how to get\u00a0better.<\/p>\n<p>That&#8217;s right &#8212; here, free of charge, is\u00a0\u00a0a to-do list\u00a0for how you can improve.<\/p>\n<p>Understand, I&#8217;m\u00a0one of your top &#8220;boosters&#8221; (sorry for the pun), and of course I got mine this year &#8212; as I do <em>every<\/em> year. You&#8217;re better than nothing, after all.<\/p>\n<p>But as a\u00a0patient of mine refused his flu shot this past week &#8212; &#8220;it gives me the flu&#8221; he (wrongly) said &#8212; I became motivated to reach out and let you know\u00a0exactly what you should start working on:<\/p>\n<ul>\n<li><strong>Become more effective.<\/strong> I&#8217;m sure you think\u00a0that the less said about last year&#8217;s effectiveness the better, but really &#8212;\u00a0<strong><a href=\"http:\/\/www.cdc.gov\/flu\/news\/updated-vaccine-effectiveness-2014-15.htm\" target=\"_blank\">19% protection?<\/a><\/strong>\u00a0That&#8217;s pretty lame, my friend! Your usual 60% protection seems kind of awesome by comparison, doesn&#8217;t it, and even that&#8217;s no great shakes. OK, ok, I realize it&#8217;s because\u00a0the vaccine strains didn&#8217;t precisely match the circulating ones last year, but c&#8217;mon. <em>You can do better than that.\u00a0<\/em>I know you can.<\/li>\n<li><strong>How about some\u00a0durability?<\/strong>\u00a0Let me list the number of vaccines we recommend to our patients every year.<br \/>\n1) Flu.<br \/>\nThat&#8217;s it &#8212; you&#8217;re the only one. And you don&#8217;t want to be in this exclusive club. It&#8217;s no wonder that many people act like it&#8217;s tax day when you tell them that the flu vaccine is due. Again? Didn&#8217;t we do just do this, like, yesterday?<\/li>\n<li><strong>Give us fewer options.<\/strong> Must you come in <strong><a href=\"http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm6430a3.htm#Tab\" target=\"_blank\">so many different forms?<\/a><\/strong> It&#8217;s too complicated, like trying to choose a breakfast cereal in a big supermarket. Don&#8217;t you know that too much choice is paralyzing? Trivalent. Quadravalent. High dose. Regular dose. Attenuated\u00a0intranasal mist. Recombinant egg-free. Free range and gluten- free. (I made that up.)\u00a0Please, enough already. Even the vaccine experts at <a href=\"http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm6430a3.htm\" target=\"_blank\"><strong>ACIP can&#8217;t (or won&#8217;t) make a firm recommendation<\/strong>.<\/a> This is what they say: &#8220;For persons for whom more than one type of vaccine is appropriate and available, ACIP does not express a preference for use of any particular product over another.&#8221; Thanks, <em>really<\/em> helpful. Now what?<\/li>\n<li><strong>Be more reliably available.<\/strong>\u00a0Supply is notoriously erratic.\u00a0Sometimes the hospitals get flu vaccines\u00a0first; sometimes the pharmacies; sometimes the community-based practices. Sometimes there are no vaccines for babies. There are shortages some years &#8212; then it&#8217;s like a new iPhone release, generating absurd lines &#8212; and too much supply the next, you can&#8217;t give the things away. This year it&#8217;s <strong><a href=\"http:\/\/www.abc2news.com\/marketplace\/flu\/nasal-spray-shortage-cancels-delays-flu-vaccine-clinics\" target=\"_blank\">the nose spray vaccine<\/a><\/strong>\u00a0&#8212; where is it?\u00a0Next year it will be &#8212; who knows? Figure it out already!<\/li>\n<li><strong>Develop an easy, universal tracking system.<\/strong>\u00a0People can get flu shots\u00a0in so many different locations we have no idea whether our patients have received them. Doctors&#8217; offices. Pharmacies. On the job.\u00a0Pop-up &#8220;flu clinics&#8221; at the\u00a0neighborhood mall, church-temple-mosque, community center. Toll booths and fast food drive-thrus (throughs?) will be next. While we like the widespread\u00a0availability, it makes quality assurance programs all but impossible. Here&#8217;s an idea &#8212; how about a web site, <strong><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2014\/02\/Louie-looking-at-you1.jpg\" target=\"_blank\">igotmyflushot.org<\/a><\/strong>, where people can enter their name and date of birth, and electronically release the information to their doctors? Yes, I know it&#8217;s a great idea. You&#8217;re welcome.<\/li>\n<li><strong>Make it\u00a0more understandable what you prevent.<\/strong>\u00a0Email from non-MD friend:<br \/>\nFriend: &#8220;Is there flu about? Wife has fever, nausea. Son too.&#8221;<br \/>\nMe: &#8220;Yes there&#8217;s flu. But flu is mostly a respiratory illness &#8212; cough, sore throat, that kind of thing. Sounds like they have a stomach bug.&#8221;<br \/>\nFriend: &#8220;Oh yeah. Both had questionable chicken tacos at State Fair yesterday.&#8221;<br \/>\nOk, maybe this misunderstanding isn&#8217;t really your fault. But somehow I believe that if you were more effective, the public would have a clearer understanding of what you prevent (on a good year) and what you don&#8217;t, and more confidence that they received something that works. Here&#8217;s what you prevent: \u00a0<em>Influenza<\/em>. Here&#8217;s what you don&#8217;t prevent: \u00a0<em>Colds.<\/em>\u00a0<em>Stomach bugs. Various other causes of fever.\u00a0<\/em>Is that so hard?<\/li>\n<\/ul>\n<p>Remember, I offer the above suggestions even though I&#8217;m a strong advocate of getting the flu vaccine. It does work <em>sometimes<\/em>, influenza is a miserable illness, and frankly one could justify it solely on altruism &#8212; who wants to be the disease vector that triggered a hospitalization in a baby, a frail elderly person, or someone with a weakened immune system?<\/p>\n<p>Still, there&#8217;s room for improvement. Ok, <em>lots<\/em> of room. And we can dream, can&#8217;t we? Just like the guy in the video below.<\/p>\n<p>Signed,<\/p>\n<p>An Infectious Diseases Doctor with a Slightly Sore Left Arm (but it&#8217;s not too bad)<\/p>\n<p>[youtube http:\/\/www.youtube.com\/watch?v=gasAm4DIVsg&amp;w=560&amp;h=315]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Dear Flu Vaccine, As the supply of you and your brethren have arrived\u00a0in our clinics, on our hospital floors, and in pharmacies, I thought it would be a good time to reach out and tell you how to get\u00a0better. That&#8217;s right &#8212; here, free of charge, is\u00a0\u00a0a to-do list\u00a0for how you can improve. Understand, I&#8217;m\u00a0one [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,5,8],"tags":[361,362,501],"class_list":["post-7754","post","type-post","status-publish","format-standard","hentry","category-health-care","category-infectious-diseases","category-patient-care","tag-flu","tag-flu-shot","tag-influenza-vaccine"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/7754","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=7754"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/7754\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=7754"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=7754"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=7754"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}