I don’t think it can be repeated too many times during flu season: People can die of the flu.

The flu vaccine is one of the two vaccines most easily demonized by the antivaccine movement. The first, of course, is Gardasil (or Cervarix), the vaccine against HPV. The reason why Gardasil is so easily demonized is because it protects against an infection whose end result of cancer is many years in the future. Alt-med fans frequently castigate “conventional medicine” for not emphasizing prevention enough, but HPV vaccines put the lie to that. HPV vaccines protect against an infection that is usually fairly harmless in and of itself but has the long term effect of vastly increasing the risk of at least one potentially deadly cancer, and likely several others. Also, HPV infections are commonly sexually transmitted, allowing the moralistic wing of the antivaccine movement and misguided religious people in essence to “slut shame” the vaccine by arguing that it will encourage promiscuity by removing one of the consequences of sexual intercourse, one of the stupidest arguments against the HPV in existence. (Seriously, does anyone think teens and young adults, when their hormones are raging, worry about maybe the possibility of maybe getting cancer 20 years down the road when on the verge of a night of passion now? I don’t.)

The flu vaccine, of course, is the victim of the difficulty in targeting the vaccine to the strains of flu that circulate yearly, rendering the flu vaccine of variable effectiveness from year to year. When health officials guess right and target a year’s flu vaccine correctly against the strains of flu that circulate that year, the vaccine is quite effective. When they don’t guess right, not so much. Unfortunately, the design of a universal flu vaccine is very difficult and introducing one into the market is likely still at least a few years off. There’s also the widespread mistaken conflation of flu-like illnesses and colds with the actual flu. The actual flu is a bad actor. The last time I had it, which was, not so surprisingly, the last time I was too lazy to get the yearly flu vaccine, it knocked me on my posterior for over a week. I thought I was in danger of dying: high fever, generalized malaise and musculoskeletal aches, a bad cough, and in general just feeling awful. That is the flu. It can cause so much inflammation in your lungs that you can get a secondary pneumonia or your lungs can fail from the inflammation caused by the infection. If all you have is a few sniffles and a cough plus or minus a low grade fever, you probably do not have the flu, but people commonly think that it is. Based on this misconception, they downplay the seriousness of the flu, thinking they can deal with it if they get it. Most probably can, although they’ll be laid up for several days. Some, however, cannot, even if they’re young and healthy:

Alice Jones and her husband, Darrell, both in college and raising three children, got sick with the flu on a Thursday. By Monday, Alice, 29, an aspiring Dallas nurse, was dead.

Darrell Jones, a criminal justice student who served in the U.S. Army in Afghanistan for nearly a year, said he and his children are so devastated they can’t stay in their house and are temporarily living with relatives.

“I made it through Afghanistan and thought we would move on with our lives,” said Jones, who turned 27 the day his wife died. “I was thinking that was the most dangerous part of our marriage.”

Neither Jones nor his wife had gotten flu shots this year. At the time of her death at University General Hospital on Jan. 6, doctors insisted that the three children, ages 10, 7 and 3, be checked out and vaccinated.

One of the boys tested positive for flu.

It happened fast, too. Three days after she started showing symptoms, Alice started to experience shortness of breath. The next morning, she went to a clinic to seek care and this is what happened:

Monday morning, Jones said he took his wife to their local medical clinic, and when they found that her blood pressure was low, the clinic called 911 and she was rushed to University General Hospital, where she began to experience seizures.

“They were going to do a CT scan and got her into the ICU,” said Jones. “She started coding, and they couldn’t get her stable. I made it out there on time before her last breath. … It was a big shock. I still can’t really believe it.”

Here was a woman who was young and healthy, and in a mere four days or so after getting sick she was dead. She had her whole life to look forward to, to quote the common cliché used whenever anyone young dies unexpectedly, and there are now three children without a mother and a husband without a wife. Antivaccinationists frequently try to discount people who die from the flu, either by claiming that it wasn’t the flu that killed them or trying to argue that the flu only kills the very old and sick or the very young (as in babies). Of course, that latter observation is, at the very least, an excellent argument for vaccinating babies and children, but antivaccinationists do their best to spread fear, uncertainty, and doubt (FUD) about flu vaccines (all vaccines, actually) among the parents who have to consent to allow their babies and children to be vaccinated. In the case of Alice Jones, none of these arguments apply. In the fantasy world of antivaccinationists who downplay the seriousness of the flu as a disease, Alice Jones should still be alive.

But she isn’t.

Alice Jones is the human face of the toll influenza takes every year. I first noticed that it could be a bad flu season this year in my neck of the woods when this article appeared in a local newspaper shortly after New Years: “3 more die of H1N1 flu in Michigan, with a dozen others on life support”.

Potentially deadly H1N1 — the influenza virus strain behind the 2009 pandemic — continues its resurgence in Michigan, with three more deaths reported by hospital officials.

About a dozen adults and children — patients who previously were healthy — have been on life support at the University of Michigan Health System’s hospitals because of the virus, according to the hospital system.

Three adults have died, according to a health system spokeswoman. An infant from central Michigan also has died from H1N1, according to the Michigan Department of Community Health.

“These deaths are among previously healthy individuals. This is not the group that the public usually thinks about as being susceptible to serious illness with influenza,” said Dr. Matt Davis, chief medical executive for the state health department and a U-M professor of pediatrics and communicable diseases and of internal medicine.

Some of these patients were referred to the University of Michigan Health System because their flu was so severe. Some had to be placed on extracorporeal membrane oxygenation (ECMO), in essence a heart lung bypass machine for “long term” use (days instead of the usual hours when it’s used in the OR during cardiac surgery) to oxygenate the blood when the lungs shut down. U. of M. was a pioneer in this technique. This is consistent with a report I’ve heard from a certain blogging infectious disease colleague of mine known for his strong opinions on the flu vaccine right here on this very blog, who also has been consulted on patients with the flu who had to be placed on ECMO. It’s also consistent with news reports from elsewhere in the country, such as “Six more Bay Area flu deaths reported“:

Six more deaths in relatively young Bay Area residents have been attributed to influenza, likely the subtype known as “swine flu,” public health officials reported Thursday.

So far, that makes eight flu-related deaths in the region as the annual flu season kicks into high gear.

In Marin County, a 63-year-old man with serious chronic conditions in addition to the flu died on Dec. 27, and a 48-year-old woman with no underlying conditions died Jan. 6, according to public health officials. In Santa Clara County, public health officials reported the death of a 61-year-old man, the second flu fatality there.

A 23-year-old resident died of flu in Sonoma County and a woman in her 40s died in San Mateo County. Thursday evening, San Francisco public health officials reported one death from the flu.

This story, as others have, reports that most, if not all, of the adults who have died of the flu thus far this flu season had not been vaccinated.

Perhaps the most famous flu vaccine “skeptic” (actually, pseudoskeptic/denialist) is Bill Maher, who has been known for spreading misinformation claiming that the flu vaccine can contribute to Alzheimer’s disease, that it doesn’t work, that it’s full of toxins, and that getting vaccinated is the “worst thing you can do,” all mixed with germ theory denialism (his denials notwithstanding) and an unjustified faith in the ability of “healthy living” to protect him from the flu. It’s the vaccine that Maher criticizes the most, although, ironically, he’s totally down with Gardasil. Maher’s not alone, though. There are antivaccinationists, contrarians like Tom Jefferson (who has even appeared on Gary Null’s radio show, and many others spreading FUD about the flu vaccine.

When you read the latest screed by the latest antivaccinationist telling you that you shouldn’t get the flu vaccine, consider this. It is true that the flu vaccine could be better. It’s true that it doesn’t provide you anywhere near 100% protection against the flu (although in years when the vaccine matches the flu strains well it is quite good). It’s even true that flu vaccines (for adults, anyway) may contain mercury in the form of the thimerosal preservative that is still in some flu vaccines. You should get it anyway. The risk is minuscule, and the flu can still kill. You might think, as Bill Maher does, that just because you’re perfectly healthy you can prevent the flu with healthy living and, if you’re unlucky and get it anyway, weather its effects with little difficulty. You’d be wrong, even if you’re in seemingly perfect health.

We can’t know whether Alice Jones thought something like that or not. She’s dead now from the flu. But it wouldn’t surprise me if she did. I’m not saying that she was antivaccine. Again, we have no way of knowing that; most likely she was not. Far more probable is that she was more like most people who fail to get the flu vaccine. They tend to be just people who, perhaps under the sway of mistaken confidence that leads them to think that the flu isn’t so bad and that they can handle it if they catch it, place getting vaccinated low on their list of priorities, sometimes so low that some years they don’t bother to do it at all. It’s an easy omission to make, particularly if you’re a young mother with three children to take care of and are thus very busy doing other things. I’ve even made that mistake—once. Never again. I was fortunate enough that, although I was very sick, I didn’t need to be hospitalized, and I didn’t die. Far too many are not that fortunate. Like Alice Jones.

Oh, and if you haven’t already, get your flu vaccine, people. It’s late, but still not too late.



Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.