Saturday, 1 December 2018

The Long Shadow of the 1976 Swine Flu Vaccine ‘Fiasco’ Some, but not all, of the hesitance to embrace vaccines can be traced back to this event more than 40 years ago dix.jpg This 1976 photograph shows a woman receiving a vaccination during the nationwide swine flu vaccination campaign. (CDC) By Kat Eschner February 6, 2017 In the spring of 1976, it looked like that year’s flu was the real thing. Spoiler alert: it wasn’t, and rushed response led to a medical debacle that hasn’t gone away. Related Content When Some 1920s Garbage Was Mistaken for an Ancient Artifact Trying Not to Get Sick? Science Says You're Probably Doing It Wrong No, I Don’t Need a Flu Shot: I’m an Alpha Female The Flu Has Been Making People Sick for At Least 500 Years What “The Legend of Sleepy Hollow” Tells Us About Contagion, Fear and Epidemics “Some of the American public’s hesitance to embrace vaccines — the flu vaccine in particular — can be attributed to the long-lasting effects of a failed 1976 campaign to mass-vaccinate the public against a strain of the swine flu virus,” writes Rebecca Kreston for Discover. “This government-led campaign was widely viewed as a debacle and put an irreparable dent in future public health initiative, as well as negatively influenced the public’s perception of both the flu and the flu shot in this country.” To begin with: you should get a flu shot. You should certainly get all of your other vaccines and make sure your children get them. They will protect you and others from getting deadly and debilitating things like mumps, whooping cough, polio and measles. But this is a story about one time over 40 years ago when poor decision-making on the part of the government led to the unnecessary vaccination of about 45 million citizens. We can't blame it for the modern anti-vaccine movement, which has more recent roots in a retracted paper that linked one vaccine to autism, but it certainly had an effect on the public's view of vaccines. On February 4 1976, a young soldier named David Lewis died of a new form of flu. In the middle of the month, F. David Matthews, the U.S. secretary of health, education and welfare, announced that an epidemic of the flu that killed Pvt. Lewis was due in the fall. “The indication is that we will see a return of the 1918 flu virus that is the most virulent form of flu,” he said, reports Patrick di Justo for Salon. He went on: the 1918 outbreak of “Spanish flu” killed half a million Americans, and the upcoming apocalypse was expected to kill a million. Spanish influenza was another form of swine flu, di Justo writes, and researchers at the Centers for Disease Control thought that what was happening could well be a new, even deadlier strain that was genetically close to the 1918 strain. To avoid an epidemic, the CDC believed, at least 80 percent of the United States population would need to be vaccinated. When they asked Congress for the money to do it, politicians jumped on the potential good press of saving their constituents from the plague, di Justo writes. The World Health Organization adopted more of a wait-and-see attitude to the virus, writes Kreston. They eventually found that the strain of flu that year was not a repeat or escalation of the 1918 flu, but “the U.S. government was unstoppable,” di Justo writes. They had promised a vaccine, so there needed to be a vaccine. This all happened in the spring, with emergency legislation for the “National Swine Flu Immunization Program,” being signed into effect in mid-April. By the time immunizations began on Oct. 1, though, the proposed epidemic had failed to emerge (although Legionnaires' Disease had, confusing matters further.) “With President Ford’s reelection campaign looming on the horizon, the campaign increasingly appeared politically motivated,” Kreston writes. In the end, one journalist at The New York Times went so far as to call the whole thing a “fiasco.” Epidemiology takes time, politics is often about looking like you’re doing something and logistics between branches of government are extremely complicated. These factors all contributed to the pandemic that never was. The real victims of this pandemic were likely the 450-odd people who came down with Guillain-Barre syndrome, a rare neurological disorder, after getting the 1976 flu shot. On its website, the CDC notes that people who got the vaccination did have an increased risk of “approximately one additional case of GBS for every 100,000 people who got the swine flu vaccine.” Several theories as to why this happened exist, they say, “but the exact reason for this link remains unknown.” As for the flu shot today, the CDC writes, if there is any increased risk it is “very small, about one in a million. Studies suggest that it is more likely that a person will get GBS after getting the flu than after vaccination.” Swine flu vaccine linked to increased risk of rare nerve disorder Sharon Kirkey, Postmedia News 07.10.2012 The 2009 human "swine flu" vaccine given to millions of Canadians was associated with twice the normal risk of developing Guillain-Barre syndrome — a rare but potentially paralyzing nerve disorder, Quebec researchers are reporting. With Guillain-Barre syndrome, or GBS, the immune system attacks the body's peripheral nerves, causing rapidly progressing muscle weakness and sometimes paralysis. In a new study led by Quebec City's Laval University, researchers looked at all suspected and confirmed cases of GBS as reported by doctors — mostly neurologists — and hospital discharge records starting in the fall of 2009, when more than half of Quebec's population was vaccinated against H1N1 as part of mass immunization campaigns that rolled out nationwide. Quebec's chief medical officer of health ordered the investigation. By the end of the year, 4.4 million Quebec residents had received the pandemic vaccine. Over a six-month followup period between October 2009 and March 2010, 83 confirmed GBS cases were identified; 42 occurred in people who had been recently immunized. Twenty-five developed symptoms within eight weeks of vaccination; of those, most — 19 — developed the syndrome within four weeks. Overall, the Laval group calculates that the number of cases that can be attributed to the human swine flu shot was approximately two per one million doses. The risk of contracting GBS from a normal seasonal flu shot has been estimated at about half that — an additional one case per million people vaccinated. Despite the small but statistically significant increased risk — which was seen only in people aged 50 or older (GBS is more common in older adults) — the researchers believe the benefits of immunization likely outweigh the risks. In Quebec, the risk of being hospitalized with H1N1 infection was one per 2,500; the risk of death was one per 73,000. "The H1N1 vaccine was very effective in preventing infections and complications," the team writes in this week's edition of the Journal of the American Medical Association. "The risk (of GBS) is of low magnitude — and it's probably much lower than the benefit of vaccination in case of a pandemic," said lead author Dr. Philippe De Wals, a professor in the department of social and preventive medicine at Laval. Most people recover from GBS, he added. In 1976, when swine flu was found in soldiers at Fort Dix, N.J., the U.S. government launched a mass vaccination of more than 40 million people against a pandemic that never happened. The shots were halted after 10 weeks, after an unusually higher cluster of GBS was discovered during active surveillance for reactions to the shots. According to World Health Organization experts, for no clear biological explanation, the shots increased the risk of GBS in adults within the first six weeks following vaccination. As Canada embarked on the largest vaccination program in the nation's history, doctors and health officials were urged to check for GBS and other potential adverse events. In a related paper, a nationwide study in Denmark involving more than 53,000 infants — nearly 7,000 of whom were exposed to H1N1 vaccine in the womb — found no significant increased risk of major birth defects, preterm birth or fetal growth restriction in babies born to women who were vaccinated against H1N1 during pregnancy. "Pregnant women were among the main target groups prioritized for vaccination (against the pandemic strain), and an estimated 2.4 million women were vaccinated during pregnancy in the United States alone," the team, from the Statens Serum Institut in Copenhagen, writes. In Canada, public health officials recommended pregnant women be among the first to be vaccinated when the H1N1 vaccine became available. But the rapid development of the vaccine, as well as the push to get it out ahead of a second wave of infection, raised concerns about safety, particularly among expectant mothers. In an accompanying editorial, Dr. Noni MacDonald, of Dalhousie University, and co-author Mark Steinhoff of the Cincinnati Children's Hospital Medical Center, said that the studies, taken together, should help somewhat alleviate concerns about the safety of pandemic flu shots in pregnancy.