Abstract
The use of influenza vaccine has both advantages and disadvantages. Its low efficacy rate has resulted to several questions being raised on whether it is necessary to have the vaccine. This paper aims to discuss whether it is beneficial to obtain influenza vaccine in terms of its safety and effectiveness. The topic will also go beyond science by focusing on the cost effectiveness of the influenza vaccine. The study was done by looking for other peer-reviewed sources and doing an assessment of the information presented. The studies have shown several benefits of using influenza vaccine such as efficacy, safety and cost effectiveness. There are, however, several disadvantages such as the reduced efficacy mainly due to uncertainty in the viruses that will be in circulation. Other than its low efficacy rate, there are no major reports on serious harm or side effects resulting from the use of the vaccine. This may be the major reason why it is still necessary to continue providing the vaccine just to enjoy the few advantages.
Introduction
Several people die every year from influenza with most of these deaths occurring among elderly people. Annual influenza attacks may range from 10 to 20% on average, although the rates may be higher when the epidemics are severe. Some symptoms that are associated with influenza are myalgia, fever, headache, sore throat, malaise and nonproductive cough. Incidents of influenza are associated with millions of days that are lost from work every year. It is urged that those people who are at a greater risk of suffering from influenza be immunized annually. This paper aims to discuss whether it is beneficial to obtain influenza vaccine in terms of its safety and effectiveness. The topic will also go beyond science by focusing on the cost effectiveness of the influenza vaccine.
The vaccination of influenza uses a vaccine that is specific for a specific year, and this is aimed to protect the body against influenza virus that is highly variable (Couch). Each vaccine is made up of antigens that represent three or four different influenza strains. These strains include the strain of the subtype H1N1 virus, strain, and the strain of the subtype H3N2 virus of the influenza type A, and one or two type B influenza virus strains.
The strains of the influenza virus strains are under a continuous mutation and necessitate the production of a new vaccine every year. The production of the vaccine involves the collection of influenza viruses from different sources including the pigs and people living in foreign other countries by the CDC. Once the strains have been collected, the CDC attempts to do a prediction on the strains that will possibly infect the population of a given country. Once the viruses are selected, they are distributed to the manufacturers of vaccine for the production of influenza vaccine to be used in the autumn of that year. The use of these vaccines has provided a credible protection against the viruses that cause influenza (Manzoli, Ioannidis and Flacco).
Argument for Vaccination
Efficacy
In a review on the benefits of the vaccine on those who are at a greater risk using the previously published work, Zieger who works in the department of allergy at the Kaiser Permanente Medical Center located in San Diego, recommended the vaccine to those people who are at a greater risk of suffering from influenza-related hospitalization. These groups include children aged between 6 months and 23 months and people who have an egg allergy. People with egg allergy are of great concern since the vaccines are a derived from the embryonic fluid extracts of the chicken embryos that are then inoculated with the influenza virus. This causes the vaccine to have measurable amount of egg protein that may trigger allergic reactions when administered to an individual who is allergic to egg protein (Zeiger).
In a study conducted by James et al, there have been adverse allergic reactions that have been reported in patients who have an egg allergy given a dose of inactivated influenza vaccines. The researchers who were from different institutions including the Kaiser Permanente Medical Center, Colorado Allergy and Asthma Centers, children’s hospital in Boston, Wake Forest University School of Medicine, and University of Wisconsin. Their study involved a multicenter clinical trial, where histories of the egg allergy were confirmed using skin testing with egg and where possible using the egg orally. The subjects who were confirmed to be allergic were administered with vaccine in 2 doses at an interval of 30 minutes. The first dose was a tenth of the recommended dose while the second dose was nine tenths of the recommended dose. Those who were not allergic were used as the control. However, vaccinating these groups has been shown to reduce significantly the risk of having the flu and at the same time reducing mortality from the disease. In their studies, it was shown that having influenza does given in a 2-dose protocol to be effective in protecting people who have an egg allergy after they took a dose of egg protein not exceeding 1.2 µg/mL of the egg protein (James, Zeiger and Lester).
Vaccination using influenza vaccine has also been shown to be effective in people with asthma. The rates of hospitalization due to influenza-like illnesses are reduced in children who are asthmatic after being vaccinated with influenza vaccine. Influenza vaccine also protects most children aged between 1 and 6 years against acute asthma aggravations and control severity of asthma (Zeiger).
Safety
In a review of several publications that have been published, Kelso reported that there is no evidence that trivalent influenza vaccine is toxic and thus safe for use by the patients with egg allergy. Influenza vaccines are also known to cause Guillain-Barré syndrome. Trivalent influenza vaccine can also be safely administered to patients who are asthmatic as the vaccine does not cause asthma exacerbations. However, some live attenuated influenza vaccines are known to cause asthma exacerbations. The trivalent influenza vaccine is also well tolerated by those patients who are immunocompromised. There are however some influenza vaccine brands that are not indicated to some groups due to the low effectiveness or side effects.
Cost-Effectiveness
Other than the benefits in preventing influenza in normal people, as well as those with special conditions, influenza vaccine has been shown to save money. This was reported by Nichol, Lind and Margolis from the Hennepin County Medical Center, Veterans Affairs Medical Center, and the University of Minnesota Medical School respectively. In their study, adults aged from 18 to 64 years of age were recruited and assigned to either group 1 or 2. Group 1 received the influenza vaccine while group 2 received the placebo injections. They then monitored the presence of upper respiratory incidences, absenteeism due to upper respiratory illnesses, incidents of visiting a physician. Analysis of the economic benefits due to vaccination was done by doing an estimate on the direct, as well as indirect costs that may arise as a result of upper respiratory illness and immunization.
Doing analyses on the effect of the influenza vaccine in younger and healthy adults has indicated that having the influenza vaccine is a cost effective option and ultimately leading to saving money. Estimating the direct and indirect costs that are saved has shown that vaccinations has great economic benefits especially in the working adults. Cost effectiveness in vaccination results from a decrease in incidents of non-respiratory illnesses, a decrease in the incidents of hospitalization or death as a result of influenza illness or influenza complications. The actual economic benefit realized after vaccination usually depends on a particular population, the cost of illness in the population, severity and the type of influenza as well as the effectiveness of the vaccine selected during the time (Nichol, Lind and Margolis).
Argument against Vaccination
Although the influenza vaccine has been associated with a number of benefits especially to the young and elderly populations, there are several shortcomings that have been associated with the vaccination. One of these shortcomings is the fact that cases of poor mismatch between the viruses that are selected for use in vaccine development and viruses that actually infect people. For instance, in the 1994-1995 flu seasons, about 43% of viruses that were isolated for type A (H3N2) strains were not similar to the strain in the vaccine. Similarly, for the strains of type A virus (H1N1), in 87% of samples that were isolated, the strains were not similar to the ones in the vaccine. Due to this high rate of mismatch, it has been almost impossible to prove that having an influenza vaccine by elderly people may increase life expectancy. Some studies have also failed to demonstrate that influenza vaccine is effective in preventing mortality, hospitalization or reduction in hospital stay (Strikas, Cook and Kuller).
The influenza vaccine has been cited as one of the virus vaccines that are least efficient. This is as a result of the high level of mismatch. The ineffectiveness of the vaccine is highly noted in the elderly recipients who are at a high risk of infection. Due to these evident shortcomings of the influenza vaccine, it is being argued that the vaccine may be a useless and expensive procedure with poor efficiency records and thus not necessary. Since the production of the vaccine is mainly funded by the government, it is seen that the project benefits the companies making the vaccine, promoters of the vaccine and medical personnel rather than the individuals who are in need of the vaccine.
Conclusion
Despite the poor record, the shortcomings influenza vaccine has recorded some crucial achievements in reducing influenza incidents in elderly, young, asthmatic and egg allergic individuals. Other than its low efficacy rate, there are no major reports on serious harm or side effects resulting from the use of the vaccine. This may be the major reason why it is still necessary to continue providing the vaccine just to enjoy the few advantages.
Works Cited
Couch, R. B. "Seasonal inactivated influenza virus vaccines." Vaccine 26 (2008): D5-D9. Print.
Fireman, B., et al. "Influenza vaccination and mortality: differentiating vaccine effects from bias." American journal of epidemiology 170.5 (2009): 650-656. Print.
James, J. M., et al. "Safe administration of influenza vaccine to patients with egg allergy." The Journal of pediatrics 133.5 (1998): 624-628. Print.
Kelso, J. M. “Safety of influenza vaccines”. Current opinion in allergy and clinical immunology, 12(4) (2012): 383-388. Print
Manzoli, L., et al. "Effectiveness and harms of seasonal and pandemic influenza vaccines in children, adults and elderly." Human Vaccin Immunother 8 (2012): 851-862. Print.
Nichol, K. L., et al. "The effectiveness of vaccination against influenza in healthy, working adults." New England Journal of Medicine 333.14 (1995): 889-893. Print.
Strikas, R., et al. "Case control study in Ohio and Pennsylvania on prevention of hospitalization by influenza vaccination. Options for the control of influenza II." Elsevier (1993): 153-160. Print.
Zeiger, R. S. "Current issues with influenza vaccination in egg allergy." Journal of allergy and clinical immunology 110 (2002): 834-840. Print.
