Naked Science Forum
Life Sciences => Cells, Microbes & Viruses => Topic started by: chris on 03/11/2009 10:35:59
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I broke the habit of a lifetime today. I had a flu vaccine. But not just any old flu shot, this was a big one - pandemic-bustingly big in fact - because I received a dose of Pandemrix, GSK's (GlaxoSmithKline) H1N1 swine-lineage influenza vaccine.
It comes as a white milky liquid drawn from a vial containing ten 0.5ml adult doses. I didn't even feel it go in actually, but immediately it did I found myself summoning all my powers of imagination to drum up the symptoms and side effects outlined on the accompanying patient information sheet.
Whilst I was waiting for the anaphylaxis to kick in, I asked the occupational health nurse - who told me she'd already notched up 2,500 vaccinations of seasonal flu already this year for staff at the hospital where I work - what the general uptake for vaccine had been like amongst the staff. "Amongst the admin staff, excellent," she told me. "But the doctors are a different matter!"
I found this quite surprising, particularly in the light of my own habit-busting rush for vaccination, but maybe that's because I'm a virologist?
So why don't I usually avail myself of the seasonal vaccine, for which there is actually very good evidence that it cuts death and complication rates by up to 50% in some people? Well, the answer is two-fold. One is laziness. But the other is based on a combination of experience, courage (read foolhardiness) and clinical evidence.
It's suggested that up to 50% of cases of seasonal flu infection are asymptomatic. This statistic is based on studies of volunteers who give a negative history of flu symptoms but, in many cases, nonetheless subsequently test positive for circulating blood antibodies to the present flu strain. This confirms that these people have caught, incubated and fought-off the virus but without becoming overtly symptomatic.
So how does that happen, and what makes them the lucky ones? We suspect that what's going on is that these people have pre-existing immunity to flu, having done battled with the virus in the past. Presumably this has endowed these people with white blood cells and antibodies that are capable of at least partially blocking the latest winter incarnation of the virus, albeit incompletely. Consequently they catch it, but develop only a limited infection.
But what this asymptomatic challenge probably achieves is an immune update, rather like clicking on the "get latest virus definitions" button on your McAfee antivirus software suite. In other words, the exposure to the virus leads the immune system to refine its response; and because it already had a head-start over someone with no pre-existing immunity that's why the ensuing infection is trivial or inapparent.
It's on this basis that I haven't bothered with the seasonal flu vaccine. I can recall having frank symptoms of the 'flu just once in my life, at the age of 8. I spent a week in bed with a raging temperature and unable to move, which, diagnostically-speaking, sounds pretty damning.
So, I figure that a combination of a busy social life, a wife who catches everything from every patient she sees and then exposes me, as well as two children who function as virus factories - is all the priming my immune system needs.
Thus far the strategy has served me well and I haven't been laid up with flu, knowingly, since that time when I was 8. But swine flu is a different matter. This virus "looks" different to the seasonally-circulating forms, so my pre-existing immunity to those won't help me at all if this new agent comes my way. I've also got to head off to Hong Kong in a couple of weeks and the prospect of Heathrow Terminal 5 followed by 13h couped-up in the company of a few hundred fellow passengers, a proportion of whom will likely have swine flu, fills my with horror.
For this reason I bit the bullet and headed off this morning to occupational health to show my immune system what killed S-LIV (swine-lineage H1N1) A/California/7/2009 looks like. To help the two get to know each other the maufacturers also include a substance called an adjuvant, in this case ASO3 (which contains the oily substance squalene). This is a bit like the warm-up act at a rock concert, designed to get the crowds attention focused on the main act.
Some people have expressed concerns about the safety of these immune-boosting adjuvants, but so far so good...they can certainly whip the immune system into a bit of a frenzy but probably much less of a frenzy that a genuine dose of flu would.
I'll let you know how I get on...
Chris
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How reliable are the government figures of 70,000-odd "swine-flu" cases last week?
I ask because, having suffered (I believe) a relatively mild flu-like illness last week, they are recommending people with flu-like symptoms go to the government website which will prescribe Tamiflu based on a simple questionnaire. They don't want people turning up at their GP. So surely there's no mechanism to actually test and provide a confirmed diagnosis...?
If the 'danger' of swine flu is calculated by the number of deaths relative to the number of infections (a statistic which I am querying may actually be a count of all flu-like illnesses including regular seasonal flu) then might the risks of swine-flu be grossly under-estimated...?
I had a sudden onset of sneezing and major runny nose last Tuesday afternoon, which continued through the whole of Wednesday. On Wednesday I also had a high temperature (I don't know how high), mild all-over acheyness, and tiredness - spent nearly all day in bed. My appetite was a bit less than normal, and the taste was distorted/subdued, but I wasn't off my food or nauseous or anything. The runny nose and sneezing stopped by Thursday, but the high temperature and tiredness continued - spent most of the day in bed. I had an interlude on Thursday in the early afternoon when my temperature must have come down a bit and I felt better for an hour or two. By the later afternoon/eve I was feeling rough again. I started the Tamiflu on Friday morning. Friday much like Thursday, but slightly less bad. A slight tickly cough developed on Friday, but didn't come to much. Saturday and Sunday I reckon my temperature was nearing normal, and I didn't spend the day in bed, although I still didn't have much energy to do anything. Monday, went back to work - basically ok, but felt totally exhausted by 4.30pm. Tuesday, went to work - fairly normal.
Swine flu, regular flu, or something else?
Will I be a Gov 'swine flu' statistic because the website prescribed Tamiflu when I (truthfully) clicked the options for my symptoms?
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Good question. Surely they are careful when calculating the death statistics, maybe they only use confirmed cases to find the ratio.
About 5 years ago is the last time I remember getting very sick, I took almost a week off work. But I think my immune system was weakened from playing a rather devastating drinking game at a 21st party. I've had colds since, but nothing severe enough to stop me from working.
But with my luck, if I chuck a sicky and take a few days off work, I actually will get sick soon afterwards and actually need the sick days I just used up :p
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Note there's a 2-3page article in the 31st October 2009 edition of NewScientist on truths and myths of swine-flu.
(I've heard that officially they now only call it H1N1 and never 'swine flu' in the USA after intense lobbying by the pig farmers early in the year!)
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DAY 2 Post-vaccine
After my swine-flu vaccination yesterday I quite quickly developed an impressively large bulge in my muscles - in fact, it looked like I'd been working out. The fact that it was unilateral might have had some people wondering about the state of my vision, but I can assure you it was the vaccine.
The muscle was quite painful during the day and kept me awake at night whenever I rolled onto my arm; I also developed a few mild flu-like symptoms - feeling feverish, slight headache, feeling very tired. However, these were trivial, went away with a couple of paracetamol and had subsided entirely today.
So, my experience is that I have survived the acute effect of swine flu vaccination and now I am hoping that my immune system is busy clonally expanding B cells with anti-H1N1 specificity.
Chris
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Chris, please can you tell us more about adjuvants and why they're controversial.
Thanks,
Andrew
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I went for a seasonal flu jab at my doctors practice recently and they said the swine flu vaccination is in two parts. Or maybe they meant that they only give the swine flue inoculation on a separate day to the seasonal flu jab?
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The swine flu swept through our household over a month ago. Fevers of 104F and 103F. Lots of aches. Fortunately, all was over in less than a week. Friends of our were sick ranging from 6 to 14 days. It seems swine flu makes people sicker, but for a shorter period of time.
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Since the swine flu came through here before the vaccines were widely available I've met few people that got the vaccine. What I did run into was a lot of silly commentary on what the vaccine would do to people. One of the more ridiculous claims was that it had no effect on swine flu at all, but would speed up your metabolism when the normal flu was encountered. The speed up would be so dramatic that you'd die. It was difficult to keep a straight face while listening to this claim.
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Mmm, well a vaccine will increase metabolic rate slightly because it will provoke an immune response, which is an energy-dependent process. But I've never come across anyone suffering a fatal augmentation of metabolism when encountering the pathogen later...
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I was having trouble with air ntake and had developed bronchitis with it so was on three new neds ,,Tamiflu, prednisone, and Azithromycin for bronchial infection in upper respiratory tract.
I felt terrible for about three and 1/2 to 4 days before it began to ease up...
Whatever the meds contained seemed to really
Make an impact around thursday.. my headache disppeared and I felt like there was light even though later Friday night I thought we may have started up again sympton wise but by morning I was ok.. at least back to feeling semi Human..
Yesterday 7 and I was good got tired out my first day back at the pool had to sit out a bit and use my inhaler a couple times as felt bit breathless still after exercise.. very light even..
I hated being sick and am glad it is moving on...and I am fine it seems which so far is very good!
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Since the swine flu came through here before the vaccines were widely available I've met few people that got the vaccine. What I did run into was a lot of silly commentary on what the vaccine would do to people. One of the more ridiculous claims was that it had no effect on swine flu at all, but would speed up your metabolism when the normal flu was encountered. The speed up would be so dramatic that you'd die. It was difficult to keep a straight face while listening to this claim.
That one is the best I have heard so far!
I heard one the other day, if you have general flu symptoms, and are prescribed Tamiflu, of you take one tablets and begin to feel better then it is H1N1.However if you take one and then have some of the side effects of Tamiflu, nausea etc then it isn't H1N1.
Yeah, because Tamiflu is a litmus test....!!!
Like Karen I have turned the corner now,but still have hacking cough and my voice is going. It was quite short spell in terms of flu though, just over a week so not as long as previous 'flu's I have encountered.
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I am glad you are feeling better Variola.
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I'm still not sure what I had. I started feeling ill on the thursday late afternoon, and it really did feel like flu - not actual cold symptoms. I felt hot and cold, my muscles ached, and all I wanted to do was lie down. In fact a man asked me if I wanted to sit down on the tube - I was holding on to the rails with my eyes closed and swaying slightly!! Went to bed and stayed there for nearly 24 hours. didn't feel like eating particularly. Could barely move, and you know it's bad when my phone bleeps and I can't summon up the energy to read the text!! I started getting more 'coldy' symptoms later on friday and saturday morning, but nothing much. Went back to work on monday but was a bit out of it, and my nose started to run later that morning! Cough developed a day or so later, and it still around a couple of weeks later!
It seemed too bad for a cold, and not bad enough for flu, but I had flu one summer (seasonal, but in July!) about 10 years ago, so I wonder if maybe I have a level of immunity from that?
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Well I hope you are getting better and that all of it disappears soon.. Hugs feel better soon.