Influenza

I've never had a flu shot, and I've never had the flu. I don't like the idea of injecting bad stuff into your body, which is basically what they do.
Donald Trump
09-11-2017 02:15
Translated from Russian by: Tatiana Jochimsen
  1. It is believed that flu kills more people than all the other diseases (for which vaccines exist today), combined. Therefore, theoretically, if there is any point at all to get vaccinated, it should be against flu.

  2. CDC Pinkbook Influenza

    There are three types of flu viruses: A, B and C.
    Type A influenza has subtypes that are determined by the surface antigens hemagglutinin (H) and neuraminidase (N). There are in total 18 hemagglutinin antigens, and 9 neuraminidase antigens, but what matters to the humans are three types of hemagglutinin (H1, H2, and H3), which have a role in virus attachment to cells. Two types of neuraminidase (N1 and N2) have a role in virus penetration into cells.
    Influenza C is rarely reported as a cause of human illness, probably because most cases are subclinical. It has not been associated with epidemic disease; it is not contained in the flu vaccine.
    Influenza B generally causes milder disease than type A.
    A flu vaccine usually contains one strain of each of the virus types: A(H1N1), A(H3N2) and B. Quadrivalent flu vaccines, containing an additional strain of type B virus, became available in 2013.
    Live intranasal flu vaccines became available in 2003.
    Seasonal vaccines 2017/18 contain following strains: A/Hong Kong/4801/2014(H3N2), A/Michigan/45/2015(H1N1)pdm09, and B/Brisbane/60/2008. Quadrivalent vaccine also contains the strain B/Phuket/3073/2013.
    A/Hong Kong/4801/2014(H3N2) means 4801-st type A flu strain, identified in Hong Kong in 2014. Virus strains in vaccines are not changed every year, and three out of these four strains remained the same from the previous season.

  3. The virus for a vaccine is grown in fertilized chicken eggs. Some vaccines are grown on kidney cells of dogs. Thiomersal (mercury preservative in vaccines) is no longer used in childrens’ vaccines, however it remains in the flu vaccine (in the multidose ampoules). The vaccine also usually contains polysorbate 80.
    Twice a year WHO decides which strains should be included into a vaccine. Strains that multiply well in eggs are usually chosen. In the process of growing the viruses mutate, that’s why the strain chosen by WHO does not always correspond to the strain in the vaccine. Each egg produces approximately one dose of vaccine, thus the vaccine manufacturer uses a million of fertilized eggs per day.

  4. Effectiveness

  5. Low 2016/17 season vaccine efficacy against hospitalized influenza A(H3N2) among elderly: awareness warranted for 2017/18 season. 2017, Rondy, Euro Surveill

    Vaccine effectiveness against virus strain A(H3N2) for 2016/17 season among hospitalized elderly people was 17%. Among those who also received vaccination the previous season, the vaccine effectiveness was -2% (negative).
    Authors expect that next season it will not be particularly effective either, due to the fact that the virus strain used in the vaccine 2017/18 - A(H3N2) – remained unchanged.

  6. Contemporary H3N2 influenza viruses have a glycosylation site that is antibodies to antibodies elicited by egg-adapted vaccine strains. 2017, Zost, Proc Natl Acad Sci

    The article explains why the vaccine for 2016/17 season was not effective (virus growing in eggs and mutating).

  7. How to calculate the effectiveness of a vaccine? All means are used. In observatory research (which are the majority), all hospitalized patients presenting symptoms of acute respiratory infection (ARI) were tested for being contaminated with flu viruses. However, these tests took into considerations only the strains contained in the vaccine. Vaccine effectiveness is calculated according to the formula VE = 1-OR = 1 - Oi/Oni, where Oi is a ratio of vaccinated to unvaccinated among the flu patients, and Oni – ratio of vaccinated to unvaccinated among patients with other respiratory symptoms, but not flu. In other words, vaccine effectiveness is usually measured only among hospitalized patients, or among already ill, which obviously does not give an adequate evaluation of its effectiveness. In the previous research, for example, the median age of the hospitalized patients was 80 years old, and 94% of them were suffering from another disease which predisposed them to ARI. As the virus strains change each year – just like the flu vaccines – its effectiveness is impossible to access before the flu season begins, therefore it’s accessed at the end of the season.

  8. A Perfect Storm: Impact of Genomic Variation and Serial Vaccination on Low Influenza Vaccine Effectiveness During the 2014-2015 Season. 2016, Skowronski, Clin Infect Dis

    During the season 2014/15 the effectiveness of vaccine against flu type A(H3N2) in Canada was estimated at 53% for those who got vaccinated that year. Among those who had been vaccinated the previous year, the effectiveness was negative -32%. Among those who were vaccinated third year in a row, the vaccine effectiveness was negative -54%. Therefore, the average flu vaccine effectiveness was -17% (negative).

  9. Impact of the repeated vaccination on vaccine effectiveness against influenza A(H3N2) and B during 8 seasons. 2014, McLean, Clin Infect Dis

    Flu type A(H3N2) vaccine effectiveness during 2004-2013 was 65% for those who got vaccinated that season. In those who are vaccinated frequently, the effectiveness was 24%. The effectiveness of type B flu virus was 75% for those vaccinated that season, and 48% for those who are vaccinated frequently.

  10. Influenza vaccine effectiveness in the community and the household. 2013, Ohmit, Clin Infect Dis

    Flu vaccine effectiveness during 2010/11 season among those who were vaccinated two years in a row was negative: -45%. Among those who got vaccinated only that same season, the effectiveness was 62%; among those, who got infected at home: -51%. Among adults, who got infected at home, the effectiveness was -283%.

  11. Influenza vaccine effectiveness in households with children during the 2012-2013 season: assessments of prior vaccination and serologic susceptibility. 2015, Ohmit, J Infect Dis

    Flu vaccine effectiveness during the 2012/13 season was 48% for adults and -4% for children younger than 9 years old.

  12. Effectiveness of influenza vaccine during pregnancy and outpatient visits for respiratory illness in pregnant women and their infants. 2004, Black, Am J Perinatol

    Analysis of the flu vaccine effectiveness for pregnant women in 1997-2002. The vaccine did not have any impact on flu prevention.

  13. Impact of influenza vaccination on seasonal mortality in the US elderly population. 2005, Simonsen, Arch Intern Med

    According to observational studies, flu vaccination in elderly reduces mortality among elderly people by 50%.
    Flu vaccination coverage among elderly increased from 15-20% in 1970-s to 65% в 2001. Unexpectedly, estimates of influenza-related mortality in this age group also increased during this period. Because fewer than 10% of all winter deaths were attributable to influenza in any season, the conclusion is that observational studies substantially overestimate vaccination benefit.

  14. Influenza vaccination and benefits: new insights, new opportunities. 2009, Simonsen, Vaccine

    75% flu mortality falls on elderly above 70 years old. However, there is no randomized research proving that flu vaccination in elderly reduces their mortality. Some research show that flu vaccine prevents mortality before the flu season starts, which demonstrates data selection bias. The likes of these flawed researches, nevertheless, still get published in prestigious medical journals.

  15. What, in Fact, Is the Evidence That Vaccinating Healthcare Workers against Seasonal Influenza Protects Their Patients? A Critical Review. 2012, Abramson, Int J Family Med

    This paper presents the relevant literature and examines the evidence for patient benefit from healthcare worker vaccination. Published research shows that personal benefit from vaccinating healthy nonelderly adults is small and there is no evidence that it is any different for HCWs.
    The studies aiming to prove the widespread belief that healthcare worker vaccination decreases patient morbidity and mortality are heavily flawed and the recommendations for vaccination biased. No reliable published evidence shows that healthcare workers' vaccination has substantial benefit for their patients—not in reducing patient morbidity or mortality and not even in increasing patient vaccination rates.
    The arguments for uniform healthcare worker influenza vaccination are not supported by existing literature. The decision whether to get vaccinated should, except possibly in extreme situations, be that of the individual healthcare worker, without legal, institutional, or peer coercion.

  16. Influenza Vaccination of Healthcare Workers: Critical Analysis of the Evidence for Patient Benefit Underpinning Policies of Enforcement. 2017, De Serres, PLoS One

    Four randomized studies on the impact of vaccination of medical personnel on patients are analyzed here: according to these studies, the vaccination of eight health workers saves one patient from death, which means that vaccination of physicians saves 687,000 lives a year in the US, that is more people than died during the epidemic of 1918. It explains how the authors of the research are playing with statistics in order to get these completely insane results, and conclude that even according to the most optimistic estimates, we need 6,000-32,000 doctors to prevent one death from influenza.
    In addition, according to these studies, it turns out that 90% of people die from the flu without the presence of respiratory symptoms, and that vaccination saves more people from death than they get sick with the flu.
    The authors conclude that compulsory vaccination of physicians is not supported by empirical data, and that the resources spent for vaccination may be directed to something more scientifically proven.

  17. Influenza outbreak in a vaccinated population - USS Ardent, February 2014. 2014, Aquino, MMWR Morb Mortal Wkly Rep

    Influenza on the warship, where 99% were vaccinated (25 cases out of 102 soldiers). The isolated strain coincided with the strain in the vaccine. All the cases were given to Tamiflu. Another outbreak of influenza among fully vaccinated soldiers: [1], [2].

  18. Unprunited

  19. Effectiveness of trivalent inactivated influenza vaccine in influenza-related hospitalization in children: a case-control study. 2012, Joshi, Allergy Asthma Proc

    The study for 8 seasons (1999-2007).The risk of hospitalization due to influenza in vaccinated children was 3.67 times higher than in the unvaccinated.
    For these 8 years, strain A(H3N2) has not been guessed 5 times, and the strains A (H1N1) and B did not guess four times.

  20. Increased risk of noninfluenza, respiratory infection, infection with receipt of inactivated influenza vaccine. 2012, Cowling, Clin Infect Dis

    Randomized placebo-controlled trial. During 9 months after vaccination, the risk of non-influenza virus diseases in vaccinated people was 4.4 times higher than in the unvaccinated.
    Here reported that the risk of hospitalization in the case of influenza in vaccinated was 3 times higher than that of unvaccinated.

  21. Epidemiology of respiratory viral infections in children enrolled in a study of influenza vaccine effectiveness. 2014, Dierig, Influenza Other Respir Viruses

    The risk of ARVI in vaccinated people was 60% higher than in the unvaccinated within 13 weeks of vaccination, the risk of flu was the same in both groups.

  22. Effectiveness and cost-benefit of influenza vaccination of healthy working adults: A randomized controlled trial. 2000, Bridges, JAMA

    A randomized, double-blind, placebo-controlled trial of the economic benefits of influenza vaccination. In the first year of the study, the strain was not guessed, the vaccine was ineffective, vaccinated because of illness 45% more working days than unvaccinated, and doctors visited 378% more often.
    In the second year the strain was guessed, and the unvaccinated people missed 32% more working days than those vaccinated, and doctors attended 47% more often.
    In both seasons vaccination led to losses.In the season, when the strain was guessed, the loss was $11.17 per person, in the season when you do not have guessed, the loss was $31.4 per person.
    authors conclude that vaccination is not economically feasible for healthy working people.

  23. Effectiveness of school-based influenza vaccination. 2006, King, N Engl J Med

    In this study, we decided to test how influenza vaccination affects collective immunity. The pupils were immunized at school with a weakened vaccine. The families of vaccinated pupils were less sick with ARI than the families of the unvaccinated, but, paradoxically, in families vaccinated significantly more cases of hospitalization.
    There was no difference in the number of missed days in school between vaccinated and unvaccinated.

  24. Infectious virus in the exhaled breath of symptomatic seasonal influenza cases from a college community. 2018, Yan, Proc Natl Acad Sci U S A

    Vaccinated from the flu (2 consecutive seasons) exhale 6.3 times more viral particles than the unvaccinated.
    It is also reported that sneezing is not an essential factor in the isolation of the virus, unlike cough. But without any cough virus particles are released by breathing.

  25. Influenza vaccination and risk of hospitalization among adults with laboratory confirmed influenza illness. 2014, McLean, Vaccine

    In vaccinated people who contracted the flu, the risk of hospitalization was the same as in unvaccinated patients, the authors conclude that these data do not support the hypothesis that vaccination softens the symptoms of influenza.

  26. Assessment of temporally-related acute respiratory illness, the following influenza vaccination. 2018, Rikin, Vaccine

    Many people believe that influenza vaccination can cause flu, the authors conducted this study to prove that it is not so.They found that: 1) The incidence of influenza among vaccinated and unvaccinated did not differ. 2) The incidence of other respiratory diseases among vaccinated children was 71% higher than that of unvaccinated children.

  27. Systematic reviews

  28. Vaccines for preventing influenza in healthy children. 2012, Jefferson, Cochrane Database Syst Rev

    Systematic review of Cochrane effectiveness of influenza vaccines for children (75 studies, 17 of them Russian).
    For children older than two years, the effectiveness of live vaccine was 33%, and inactivated - 36%.
    For children under the age of 2 years, the effectiveness of the vaccine is practically zero. More: [1]. There is no evidence that the vaccine influenza reduces mortality, hospitalization, serious complications or infectiousness of influenza. The authors were surprised to find only one study of the safety of an inactivated vaccine, born in 1976, which included 35 children.They believe that it is rather strange that the vaccine is recommended to all children, despite the almost complete absence of safety studies, but they found 10 safety studies for the live vaccine, but they could not analyze the data, because manufacturers refused to provide all information about side effects.
    The authors note that all studies of vaccines were of poor quality.

  29. Vaccines for preventing influenza in healthy adults. 2014, Demicheli, Cochrane Database Syst Rev

    Systematic review of the Cochrane Effectiveness of Influenza vaccines for adults (90 studies.) Less than 10% of studies have been of high quality. Vaccination has a very modest effect. It is necessary to inject 40 people to prevent one case of ARVI, and 71 people to prevent one case of influenza, vaccination did not affect hospitalization for influenza, or for missing work days, 92 pregnant women should be vaccinated to prevent one case of ARVI in pregnant women and 27 women to prevent one case of flu in newborns.
    There is no evidence that vaccination reduces the risk of serious complications
    There are more than 200 viruses that can cause symptoms similar to the flu and that can not be distinguished without a laboratory check.The influenza A and B viruses represent approximately 10% all these viruses.

  30. Vaccines for prevention of infection in the elderly. 2010, Jefferson, Cochrane Database Syst Rev

    A systematic review of the Cochrane Effectiveness of influenza vaccines for the elderly (75 studies).
    All studies were so substandard that the authors could not conclude anything.
    Here it is reported that in the elderly after vaccination produced 41-76% less antibodies than the young.
    Here it is reported that in the elderly who take statins, 38-67% less antibodies are produced than those who do not take them.

  31. Influenza vaccination for healthcare workers who care for people aged 60 or older living in long-term care institutions. 2016, Thomas, Cochrane Database Syst Rev

    A systematic review of the Cochrane effectiveness of influenza vaccination against medical personnel who works with the elderly. There is no evidence that vaccination of health care providers reduces the number of influenza cases, the number of complications or mortality among the elderly.

  32. Relation of study quality, concordance, take home message, funding, and impact in studies of influenza vaccines: systematic review. 2009, Jefferson, BMJ

    Systematic review of Cochrane 259 influenza vaccine trials.
    70% of studies were substandard, and overly optimistic in their findings. Only in 18% of studies did the findings coincide with the results. Let that sink in. 82% of the findings did not coincide with the results.
    In quality studies, the results and conclusions were agreed 16 times more often.
    Qualitative studies 25 times less conclude that the vaccines are effective.
    Studies funded by the government are 2 times less likely to conclude that vaccines are effective.
    Research, Financing mye industry, more often published in prestigious journals (with a higher impact factor), regardless of the quality of research, or the number of participants.

  33. Heterosubptic immunity

  34. Vaccination against human influenza A/H3N2 virus inhibited the induction of heterosubtypic immunity against lethal infection with avian influenza A/H5N1 virus. 2009, Bodewes, PLoS One

    Infection with the influenza A virus increases immunity from more dangerous strains. This is called heterosubtypic immunity Vaccination has the opposite effect. Mice vaccinated from seasonal influenza, and then infected with pandemic avian influenza, grafted mice died, and ungrafted survived.
    The authors conclude that during the next influenza pandemic, the risk of serious complications and death in vaccinated children will be higher than that of unvaccinated. [1].

  35. Infection of mice with a human influenza A/H3N2 virus induces protective immunity against lethal infection with influenza A/H5N1 virus. 2009, Kreijtz, Vaccine

    A part of the mice were infected with the usual seasonal flu, and a month later all mice were infected with lethal avian influenza. The mice that had been ill with the usual flu almost all survived, and those who did not get sick all died. [1], [2].

  36. Potent protection against H5N1 and H7N9 influenza via childhood hemagglutinin imprinting. 2016, Gostic, Science

    Influenza in childhood protects against more dangerous strains of influenza in adulthood.

  37. Original antigenic sin

  38. Original antigenic sin responses to influenza viruses. 2009, Kim, J Immunol

    Since the influenza virus is constantly mutating, the immune system, reacting to it, is affected by the original antigenic sin.With a new strain of the virus, it produces antibodies to previous strains, due to antibodies to the new strain, which leads to an aggravation of the disease.

  39. Understanding Original Antigenic Sin in Influenza with a Dynamical System. 2011, Pan, PLoS One

    The effectiveness of the vaccine does not decrease monotonously with the increase in the antigenic distance between the vaccine and the circulating strain.The minimum effectiveness of the vaccine is at some intermediate distance between the strains.As the vaccine efficiency at this intermediate antigenic distance between the vaccine and circulating strains is below the efficiency at a greater antigenic distance, the original antigenic sin can lead to the fact that the vaccinated will become more susceptible to the virus than the unvaccinated.
    This phenomenon, it is possible, explains why in those years when the vaccine strain not guessed, the vaccine is not just useless, but on the contrary, only aggravates the course of the disease. strain guess less often than in 50% of cases.

  40. Vaccination and antigenic drift in influenza. 2008, Boni, Vaccine

    Vaccination can significantly affect the mutation of the virus, and accelerate its evolution if it provides partial or imperfect immunity. This was demonstrated on chickens. Vaccinated from influenza, there were twice as many virus mutations as in unvaccinated chickens. br> The authors conclude that in seasons with high vaccine coverage, mutant strains of the virus should be expected, and monitoring beyond them should be strengthened.

  41. Swine flu

  42. Seasonal influenza vaccine and increased risk of pandemic A/H1N1 related illness: first detection of the association in British Columbia, Canada. 2010, Janjua, Clin Infect Dis

    Seasonal influenza vaccination increased the risk of swine flu infection by 2.5 times among children in Canada in 2009. These results were confirmed in five other studies. More: [1].

  43. Randomized Controlled Ferret Study to Assess the Direct Impact of 2008-09 Trivalent Inactivated Influenza Vaccine on A (H1N1) pdm09 Disease Risk. 2014, Skowronski, PLoS One

    In this study we checked the previous results on ferrets, some of the ferrets were seasoned with the seasonal flu vaccine of 2008/9, and then they were infected with swine flu. Indeed, it turned out that grafted ferrets are heavier than ungrafted.

  44. Clinical and Epidemiologic Characteristics of an Outbreak of Novel H1N1 (Swine Origin) Influenza A Virus among United States Military Beneficiaries. 2009, Crum-Cianflone, Clin Infect Dis

    The grafted in the last season, soldiers fell ill with swine flu much more unvaccinated.

  45. Vaccine-induced anti-HA2 antibodies promote virus fusion and enhance influenza virus respiratory disease. 2013, Khurana, Sci Transl Med

    Piglets vaccinated from one strain of influenza showed significantly more complications when they were infected with swine flu.. The antibodies from the vaccine helped the new flu strain penetrate the lungs.

  46. Security

  47. Annual Vaccination against Influenza Virus Hampers Development of Virus-Specific CD8 + T Cell Immunity in Children. 2011, Bodewes, J Virol

    Vaccination against influenza inhibits the production of cytotoxic T-lymphocytes in children, that is, makes them more susceptible to infections.

  48. Association of spontaneous abortion with receipt of inactivated influenza vaccine containing H1N1pdm09 in 2010-11 and 2011-12. 2017, Donahue, Vaccine

    Vaccination against influenza during pregnancy increases the risk of miscarriage in the next 28 days by 2 times. Among those who were also vaccinated against swine flu in the last season, the risk of miscarriage was 7.7 times higher.

  49. Comparison of VAERS fetal-loss reports during three consecutive influenza seasons. 2013, Goldman, Hum Exp Toxicol

    VAERS Analysis. In the 2009-10 season, when vaccinated with two flu vaccines (from conventional and from porcine), the risk of miscarriage was 11 times higher than in the 2008-9 season, and 6 times higher than in the 2010-11 season.
    As a proof of the safety of a flu vaccine for pregnant women, two studies usually lead, 56 in the first, and 180 women in the second, in a thiomersal-free vaccine.The third study involved 2,291 women, but miscarriages were not included in the analysis.
    It is believed that the vaccine leads to a miscarriage in 1.9 cases per million p However, these data do not take into account the fact that a negligible number of all side effects are registered in VAERS.

  50. Inflammatory responses to trivalent influenza virus vaccine among pregnant women. 2011, Christian, Vaccine

    The flu vaccine leads to an inflammatory reaction in pregnant women.The inflammatory response from vaccination is much weaker than from an infectious disease, but nevertheless, it can increase the risk of negative consequences. In the 2008-9 season were vaccinated 11.3% of pregnant women, in the 2009-10 season, thanks to a pandemic, 50.7% of pregnant women from seasonal influenza and 47.7% of swine flu were vaccinated.

  51. Association Between Influenza Infection and Vaccination During Pregnancy and Risk of Autism Spectrum Disorder. 2017, Zerbo, JAMA Pediatr

    A study of 197 thousand children born in 2000-2010 Autism was diagnosed in 1.6% (1 of 63)
    The vaccine against influenza during the first trimester of pregnancy increased the risk of autism by 20%.But after correction for multiple testing (Bonferroni amendment), the p-value becomes 0.1, and the authors conclude that with a probability of 10% this is only a random correlation.

  52. Guillain-Barré syndrome after vaccination in the United States: data from the Centers for Disease Control and Prevention/Food and Drug Administration Vaccine Adverse Event Reporting System (1990-2005). 2009, Souayah, J Clin Neuromuscul Dis

    In 1990-2005, VAERS recorded 1000 cases of Guillain-Barre syndrome after vaccination, 63% of them were after vaccination against the flu.

  53. Narcolepsy and hypersomnia in Norwegian children and young adults following the influenza A (H1N1) 2009 pandemic. 2017, Trogstad, Vaccine

    Risk of narcolepsy in vaccinated against swine flu in 2009 was increased 17 times. In another study the risk was increased 4-9 times. Third study showed 14-16 times narcolepsy risk increase.
    A similar Swedish study found increased psychiatric comorbidity in children and adolescents with narcolepsy.
    A possible explanation of this phenomenon may be that the human antibodies to nucleoprotein cross-react with human hypocretin receptor. [1]

  54. Inflammation-related effects of adjuvant influenza A vaccination on platelet activation and cardiac autonomic function. 2011, Lanza, J Intern Med

    Influenza vaccine causes platelet activation and may potentially cause cardiovascular events.

  55. Reversion of Cold-Adapted Live Attenuated Influenza Vaccine into a Pathogenic Virus. 2016, Zhou, J Virol

    Live influenza vaccine may in certain circumstances mutate into a pathogenic virus.

  56. ANCA-associated vasculitis, the following influenza vaccination: causal association or mere coincidence? 2009, Birck, J Clin Rheumatol

    Influenza vaccine may occasionally cause vasiculitis and neurological complications.
    Live influenza vaccine significantly increases colonization of pneumococcus and staphylococcus in mice.
    Live influenza vaccine also increases colonization of pneumococus within the middle ear in mice, which may increase the risk of otitis media.
    Inactivated intranasal influenza vaccine, used in Switzerland, increased the risk of facial palsy 84 times.

  57. Statistics

  58. Are US flu death figures more PR than science? 2005, Doshi, BMJ

    The CDC states that about 36 000 Americans die from flu. However they also include pneumonia-related deaths into this statistics, although pneumonia is not always caused by flu. For example, antacids increase the risk of pneumonia, but for some reason they are not included into this statistics.
    According to the National Center for Health Statistics (which is part of CDC), flu causes an average of 1348 deaths yearly.
    Prior to 2003 CDC stated that annual death toll due to flu is 20,000. Then article was published in JAMA which increased this number by 80% based on statistical model, although flu-related mortality in the 90's was 30% lower than in the 80's.
    “In 2003 the demand for flu vaccines was low, the vaccine-producing companies were not receiving orders even in December” said Dr. Nowak from CDC on NPR, - «therefore we decided to encourage people to get vaccinated».

  59. Here is an example of mortality data from CDC for 2014. 55,227 people died from influenza and pneumonia. But only 4,605 of them died from influenza, the rest died from pneumonia. Still, not all of these 4,605 really died of influenza, because the laboratory analysis of the virus is fairly uncommon. Nevertheless, CDC adds up cases of lab-confirmed influenza (J09-J10) and of suspected influenza (J11), despite the fact that only a fraction of acute respiratory illnesses are caused by influenza viruses.

  60. This presentation, prepared by Dr. Nowak, CDC PR director, explains precisely how the media and medical experts should scare the population to increase vaccine coverage. You also get to learn what CDC thinks of you. It believes that an atmosphere of anxiety and fear should be created, particularly among people who are not vaccinated yearly. It makes for an interesting read, indeed highly recommended, only 17 slides. Here’s a spoiler quote: “Health literacy is a growing problem".

  61. Trends in Recorded Influenza Mortality: United States, 1900-2004. 2008, Doshi, Am J Public Health

    Homeland Security expects the next pandemic flu to kill 6-56 times more Americans than common seasonal flu. WHO is more conservative and expects that pandemic flu could claim 4-30 times more lives than common seasonal flu.
    However, except 1918, every following flu pandemic was less lethal than the preceding one. Moreover, mortality during the flu pandemics (1957/58, 1968/9) was not much different from that during season flu.
    NIH analyzed data from 30 flu seasons and could not correlate increasing vaccination coverage after 1980 with declining mortality rates in any age group. CDC states that flu-related mortality increased by 67% in the 90's, whereas in reality it decreased by 38%.

  62. Influenza vaccines: time for a rethink. 2013, Doshi, JAMA Intern Med

    For majority of population the influenza vaccine is quite useless, because the majority does not get sick with influenza. Only 7% of the acute respiratory illnesses are caused by flu viruses.
    Studies quoted by CDC are subject to ‘healthy user bias’, meaning that the healthy people are vaccinated more often than sick ones.
    In 2009 Australia stopped the country-wide vaccination program after it has been discovered that one out of 110 vaccinated children suffered from febrile convulsions. The assumption that safety of previously administered flu vaccines proves safety of future ones is unfounded.

  63. Influenza: marketing vaccine by marketing disease. 2013, Doshi, BMJ

    Promotion of influenza vaccines is one of the most visible and aggressive public health policies today. Twenty years ago, in 1990, 32 million doses of influenza vaccine were available in the United States. Today around 135 million doses of influenza vaccine annually enter the US market. This enormous growth has not been fueled by popular demand but instead by a public health campaign that delivers a straightforward message: influenza is a serious disease, we are all at risk of complications from influenza, the flu shot is virtually risk free, and vaccination saves lives. Through this lens, the lack of influenza vaccine availability for all 315 million US citizens seems to border on the unethical. Yet across the country, mandatory influenza vaccination policies have cropped up, particularly in healthcare facilities, precisely because not everyone wants the vaccination, and compulsion appears the only way to achieve high vaccination rates.
    In 1960-s CDC recommended vaccination only for elderly people (from 65 years old);
    1984 – the introduction of medical personnel vaccination;
    1987 – vaccination of those who share household with elderly people;
    1997 – vaccination of pregnant women in 2nd and 3rd trimester of pregnancy;
    2000 – vaccination of people older than 50 years old;
    2004 – vaccination of pregnant women during the 1st trimester of pregnancy, as well as children from 6 months to two years old and all who come in contact with them;
    2006 – vaccination of children up to 5 years old and all who come in contact with them;
    2008 – vaccination of all children up to 18 years old;
    2010 – total vaccination of all population with the exception of babies younger than 6 months old.
    Based on a single observation study (financed by CDC) CDC made the statement that flu vaccine reduces mortality by 48%. If this should be true than flu vaccines could save more lives than any medicine registered on our planet. If influenza is responsible for a mere 5% of winter mortality, the flu vaccine cannot prevent half of all life losses.
    If observational studies are not to be believed, what evidence is there that vaccines reduce mortality among elderly people? Practically none. Only one randomized study among elderly people was conducted 20 years ago, and it did not show that flu vaccines help to reduce mortality. In other words, the flu vaccine is being recommended regardless of total absence of clinical studies showing its effectiveness. This recommendations is based solely on the presence of antibodies, however there is no proof that these antibodies lead to reduced morbidity. And since to date the flu vaccine is recommended to everyone, it should seem unethical to conduct randomized studies at this point.

  64. WHO and the pandemic flu "conspiracies". 2010, Cohen, BMJ

    In 1999, after the avian flu outbreak in Hong Kong, WHO started preparations for influenza pandemic. 10 years later, on June 11, 2009, Margaret Chan, the director general of the World Health Organization, announced to the world’s media that world is now at the start of the 2009 influenza pandemic. Governments that took advice from WHO have spent billions of dollars’ worth of antivirus vaccines oseltamivir (Tamiflu) and zanamivir (Relenza). One year later — and these vaccines lay stockpiled unused in warehouses around the world, whilst governments were unwinding their vaccine contracts. Scientists who were helping WHO to put together vaccination recommendations were employed by pharmaceutical companies - a conflict of interest which was kept carefully under wraps. This is how the vaccine-producing pharmaceutical companies were using WHO to pass recommendations to governments to stock on vaccine supplies, as they would be in short supply once the flu pandemic sets in. WHO keeps secret the member list of its Committee for Emergency Situations. Dr. Margaret Chan refused to comment on the conflict of interest issue. A few months prior to announcing the pandemic WHO changed the criteria used to determine whether pandemic is indeed taking place, as it was no longer deemed necessary to assess morbidity and mortality.
    WHO did not have any scientific foundations to conclude that 2 billion people would be infected with swine flu. Moreover, WHO did not change this estimation even after the flu season was over in Australia and New Zealand, where only 1-2 people out of 1000 got ill. Vaccine safety and efficacy information was equally scarce.
    FDA was reluctant to license Relenza due to the fact that it did not show more efficacy than placebo. However, the license was finally given, ostensibly to put in the market at least something for the event of pandemic.
    There are more interesting facts in the article. BMJ, one of the leading medical journals, is conducting a journalist investigation and writes openly about total corruption within WHO. Should you have any more doubts that WHO is a deeply corrupt organization, this article will dispel them.

  65. Influenza vaccination: policy versus evidence. 2006, Jefferson, BMJ

    Systematic reviews show that flu vaccination is next to useless. Most of the studies are of low quality with safety almost never thoroughly analyzed. Vaccination programs need to be reviewed.
    These are the thoughts expressed by the head of vaccination department at Cochrane. The very same one who believes that despite the absence of proof of the safety of aluminum it is not worthwhile to continue the aluminum safety studies. Because of his views he was ostracized by his colleagues and he had to lunch alone during a pandemic preparation conference.

  66. In 2002 CDC started encouraging vaccination of children between 6 months and 2 years old; in 2004 encouragement turned into strong recommendation. From that point on a child receive two vaccines during the first year of his life. In 2009 children received additional vaccine against swine flu. Below is the graph of flu-related mortality of children aged 5 years old in 1994-2014.

  67. In 2010 the recommendation covered everyone older than 6 months old. Below is the graph of flu-related mortality of all age groups in 1996-2014.
    To put things into perspective, every year over 3000 people in the US die from malnutrition, 7000 - from C.difficile infection, 40,000 – from poisoning, 30,000 – from alcohol, 50,000 – from drugs, 40,000 – suicides, 80,000 – from diabetes, 90,000 – from Alzheimer and 200,000-400,000 from medical
    errors.

  68. According to VAERS, more than 960 people died after a flu vaccine since 2000, and almost 3000 became disabled. Considering, that VAERS registers only 1-2% of serious side effects, it is plausible that the flu vaccine took lives of more people than the flu inself.

  69. Influenza vaccination and benefits: new insights, new opportunities. 2009, Simonsen, Vaccine

    Despite claims made by observational studies that vaccination reduces all-cause winter mortality by approximately 50%, increased vaccination cover did not result in the reduction of either flu-related mortality or all-causes winter mortality.

  70. Treatment and prevention

  71. Role of medical history in the brain tumour development. Results from the international adult brain tumour study. 1999, Schlehofer, Int J Cancer

    Subjects who reported a history of infectious diseases (e.g., colds, flu) showed a 30% reduction in risk of glioma (brain tumor) development.

  72. Antiviral medications for influenza. 2015, Korownyk, Can Fam Physician

    Biased, poor-quality, mostly unpublished evidence suggests that oseltamivir and zanamivir shorten the duration of influenza symptoms by 0.6 to 0.7 of a day. Pneumonia and hospitalizations are not decreased.
    Oseltamivir sales are > $18 billion. Most have not been used. These products are not recommended if symptoms have lasted longer than 48 hours.

  73. Complications: tracking down the data on oseltamivir. 2009, Cohen, BMJ

    An interesting BMJ investigation, relating how Cochrane was trying to get access to Tamiflu clinical research.
    In 2009 a Japanese pediatrician asked Cochrane why their systematic review is based on unpublished manufacturer data and not on their own analysis. Cochrane were to answer within 6 months and were trying for a long time to get the baseline data from the manufacturer. They never got it.
    As a result, Cohrane decided to change their methodology of systematic reviews.

  74. The Tamiflu fiasco and lessons learnt. 2015, Gupta, Indian J Pharmacol

    Another interesting article on Tamiflu. How it happened that despite the absence of scientific proof of safety and efficacy of this drug WHO, FDA, CDC and EMA (European analogue of FDA) issued recommendations for its use in treatment and prophylaxis of influenza, and it's stockpiling as a measure to tide over the potential pandemic. More here [1], [2].
    Mortality risk 12 hours after taking Tamiflu is 1.9 times higher than after taking Relenza, and risk of complications is 5.9 times higher.

  75. The effect of the disease on antipyretics in the treatment of the infection: systematic review and meta-analysis. 2010, Eyers, J R Soc Med

    A systematic review and meta-analysis of the use of antipyretic drugs during influenza on mortality. Randomized and placebo-controlled studies in humans have not been conducted, eight animal studies (mice and chickens) have been found.
    Antipyretics (aspirin, paracetamol, diclofenac) taken during flu increased mortality by 34%.
    Paracetamol and Ibuprofen are recommended for adults and children as antipyretics during flu, despite the absence of scientific evidence of their effectiveness and safety. Furthermore, there is evidence showing that fever occurring during a disease increases survival chances and that using antipyretics may result in an unfavorable outcome. In non-human mammals, antipyretic treatment increases the risk of mortality due to different bacterial, viral and parasitic infections. There is also evidence from animal models that antipyretics may impair the response in bacterial pneumonia which may complicate influenza illness.
    Similar to influenza virus, many strains of pneumococcus are temperature-sensitive and die when the temperature is between 40–41°C. In mice, treatment with aspirin to treat pneumococcal infection increased mortality rates two to three-fold.

  76. Oral administration of Lactobacillus gasseri SBT2055 is effective for preventing influenza in mice. 2014, Nakayama, Sci Rep

    Probiotics show efficacy protecting mice infected with flu. More here: [1], [2], [3], [4], [5], [6].
    Probiotics are also effective in elevating seroconversion of influenza vaccines.

  77. Effects of probiotic Lactobacillus brevis KB290 on incidence of influenza infection among schoolchildren: an open-label pilot study. 2014, Waki, Lett Appl Microbiol

    Probiotics protect children from influenza as well.

  78. Probiotic effects on cold and influenza-like symptom incidence and duration in children. 2009, Leyer, Pediatrics

    Probiotics reduce cough incidence by 41-62%, rhinorrhea incidence by 28-58%, fever incidence by 53-72%. Children receiving probiotics had significant reductions in days absent from group child care, by 27-31%, and antibiotic use incidence was reduced, relative to placebo, by 68-84%.

  79. Physical interventions to interrupt or reduce the spread of respiratory viruses. 2011, Jefferson, Cochrane Database Syst Rev

    Cochrane systematic review. Respiratory virus spread can be prevented by hygienic measures, such as handwashing, especially around younger children. Surgical masks and gloves are also quite effective.

  80. Garlic for the common cold. 2014, Lissman, Cochrane Database Syst Rev

    Cochrane systematic review of the effect of garlic on common cold. Authors identified only one trial meeting the selection criteria. Taking garlic supplements daily reduced risk of common cold threefold.

  81. Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. 2004, Zakay-Rones, J Int Med Res

    A small, randomized, double-blind, placebo-controlled trial of treatment of influenza with elderberry extract.
    Elderberry extract shortened the duration of influenza by 4 days compared to placebo. [1], [2], [3], [4].
    For comparison, Tamiflu shortens influenza by 17 hours, at the same time increasing the risk of psychiatric complications and renal insufficiency. However, governments spend millions of dollars to stock up on Tamiflu, and nobody is stocking up on elderberry.

  82. The effectiveness of vitamin C in preventing and relieving the symptoms of virus-induced respiratory infections. 1999, Gorton, J Manipulative Physiol Ther

    Megadoses of vitamin C (1g every hour during 6 hours, then thrice a day) administered before or after the appearance of cold and flu symptoms relieved and prevented the symptoms by 85%.

  83. Zinc Lozenges May Shorten the Duration of Colds: A Systematic Review. 2011, Hemilä, Open Respir Med J

    Study showing a strong evidence that large doses of zinc (over 75 mg) contribute to reduction of the duration of common cold.
    Red ginseng, green tea, propolisiodine and honeysuckle also have anti-influenza properties.

  84. Vitamin D

  85. Influenza, solar radiation and vitamin D. 2009, Moan, Dermatoendocrinol

    There are many hypotheses as to why seasonal colds are so widespread only during a certain season: low temperatures, dry air, crowding together indoor in the winter, travelling patterns, seasonality of ultraviolet (UV) radiation from the sun that might kill pathogens, circannual rhythms of hormones like the “dark hormone” melatonin, etc. Possibly, the seasonality of viruses and batteries is also partly responsible.
    In this study the authors have studied the annual death numbers of influenza and pneumonia in Norway for the time period 1980-2000 and compared with UVB level and vitamin D level produced by it.
    Influenza-related mortality is increased 2 months after reaching the minimum vitamin D level. This, however, may be caused by the fact that the disease usually starts weeks prior to the point of death, when the immune system is at the lowest.
    The vitamin D level is maximal close to midsummer; the lowest vitamin D is found in February, and average level as low as 25 nmol/l have been observed among women avoiding direct sun exposure.
    Norway is localized from 58 to 70 degrees north, vitamin D being synthesized in skin exclusively in the summer months. Generally, there is no distinct seasonal pattern in the tropics. At latitudes between 20 and 30 degrees north, clear winter seasons of influenza are found. This is at first sight surprising. However, at 25 degrees north the rate of vitamin D synthesis in human skin is about five times larger in late June than in late December.
    It is common knowledge that vitamin D strengthens immune protection. [1]

  86. Epidemic influenza and vitamin D. 2006, Cannell, Epidemiol Infect

    Solar radiation triggers robust seasonal vitamin D production in the skin; vitamin D deficiency is common in the winter. The elderly only make about 25% of the vitamin D compared to 20-year-olds after exposure to the same amount of sunlight.
    No vitamin D is made in the skin at latitude 52° N (the latitude of London) from about October to March because atmospheric ozone easily filters out UVB radiation. The average excess winter mortality in Great Britain alone is inversely related to hours of sunlight. Every additional hour of sunlight reduces mortality by 2·9%
    People who received a live influenza vaccine in February experienced high fever twice as often as those vaccinated in June; the lowest rate of antibody formation is registered in summer. 40% of people vaccinated in December shed the virus, compared to 16% of those vaccinated in June.
    There was no evidence of toxicity in young men taking 50 000 IU of vitamin D a day for 6 weeks (although such a dose would be toxic if taken over a longer period). A single dose of 600,000 МЕ taken via injection did not show any toxicity either.

  87. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. 2010, Urashima, Am J Clin Nutr

    A randomized, double-blind, placebo-controlled study of the effect of vitamin D on the incidence of influenza.
    Influenza occurred 42% less in schoolchildren who received 1200 МЕ of vitamin D3 supplements daily.

  88. Vitamin D for the prevention of respiratory tract infections: A systematic review and meta-analysis. 2012, Charan, J Pharmacol Pharmacother

    Systematic review and meta-analysis of the effect of vitamin D on the incidence of acute respiratory disease. 5 randomized placebo-controlled trials were included. Vitamin D reduces the risk of influenza by 42% in children and by 35% in adults.

  89. Vitamin D and Respiratory Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. 2013, Bergman, PLoS One

    A similar review and meta-analysis (11 studies). Vitamin D reduces the risk of respiratory tract infections (RTI) by 36%. Small daily doses reduce the risk of RTI by 49%, whereas infrequent large doses of vitamin D are less efficient and reduce the risk of RTI only by 14%.

  90. Vitamin D, innate immunity and outcomes in community acquired pneumonia. 2011, Leow, Respirology

    Among patients admitted to the hospital with pneumonia, mortality in those who had a vitamin D deficiency (less than 30 nmol/L) was 12.7 times higher than among those who had a vitamin level higher than 50 nmol/L.

  91. Association of subclinical vitamin D deficiency in newborns with lower respiratory infection and their mothers. 2009, Karatekin, Eur J Clin Nutr

    Vitamin D level in newborns, hospitalized with acute lower respiratory infection, was significantly lower than that in healthy newborns (9.12 ng/mL vs 16.33 ng/mL).
    Vitamin D level in mothers of the hospitalized newborns was also lower than that of the mothers of healthy newborns (13.38 ng/mL vs 22.79 ng/mL).
    Authors observed a strong positive correlation between newborns' and mothers' level of vitamin D.

  92. Cord-blood 25-hydroxyvitamin D levels and risk of respiratory infection, wheezing, and asthma. 2011, Camargo, Pediatrics

    Authors measured the vitamin D level in the umbilical cord of 922 newborn. During the 3 months following birth the risk of respiratory tract infections in newborns with vitamin D level < 25 nmol/L was twice as high as that in newborns with vitamin D level > 75 nmol/L. Risk of wheezing in children with low vitamin D at birth was twice as high till they were 5 years old than that of newborns with high vitamin D at birth.

  93. Cord blood vitamin D deficiency is associated with respiratory syncytial virus bronchiolitis. 2011, Belderbos, Pediatrics

    Newborns with vitamin D level in the umbilical cord below 50 nmol/L had severe lower respiratory tract infection during the first year of their lives 6.2 times more often than those whose vitamin D was above 75 nmol/L.
    In western countries 40% of pregnant women and 50% newborns have vitamin D deficiency. This deficiency during pregnancy is associated with type 1 diabetes, multiple sclerosis, schizophrenia and respiratory tract infections in children.

  94. Association of subclinical vitamin D deficiency with severe lower respiratory infection in Indian children under 5 y. 2004, Wayse, Eur J Clin Nutr

    Children with vitamin D >22.5 nmol/l contracted severe acute lower respiratory infection (ALRI) 91% less frequently. Exclusive breastfeeding in the first 4 months of life reduced the risk of ALRI by 58%.

  95. Serum 25-hydroxyvitamin D, mortality, and incident cardiovascular disease, respiratory disease, cancers, and fractures: a 13-y prospective population study. 2014, Khaw, Am J Clin Nutr

    A prospective study of 14 thousand men and women living in the UK, lasting 13 years.
    The level of vitamin D appears to be in inverse correlation with mortality. Among those whose vitamin D level was >90 nmol/L, mortality was 34% lower than among subjects with vitamin D <30 nmol/L.
    Risk of death from cardiovascular diseases in these subjects was 38% lower, from cancer – 15% lower and from lower respiratory infections – 78% lower.

  96. An association of serum vitamin D concentrations <40 nmol/L with acute respiratory tract infection in young Finnish men. 2007, Laaksi, Am J Clin Nutr

    Young men with low level of vitamin D (<40 nmol/L) had acute respiratory tract infections 63% more often than young men with level of vitamin D >40 nmol/L.
    Smokers had lower vitamin D than non-smokers. Young men who did physical exercise more than 5 hours per week had a higher vitamin D level.

  97. Serum 25-hydroxyvitamin d and the incidence of acute viral respiratory tract infections in healthy adults. 2010, Sabetta, PLoS One

    Adults with vitamin D <38 ng/mL suffered from acute viral respiratory tract infections 2.7 times less, and the duration of the disease was 4.9 times less. Influenza vaccine did not affect the incidence of acute viral respiratory tract infections.

  98. Some more studies on relation of vitamin D and influenza and other acute viral respiratory tract infections: [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18].

  99. On the epidemiology of influenza. 2008, Cannell, Virol J

    A very interesting review on epidemiology of influenza and vitamin D, well worth reading. It turns out that the numerous laboratory experiments failed to prove that a person with flu can infect a healthy person.

  100. Vitamin D: a new anti-infective agent? 2014, Borella, Ann N Y Acad Sci

    An association has been established between low levels of vitamin D and upper respiratory and enteric infections, pneumonia, otitis, Clostridium infections, vaginosis, urinary tract infections, sepsis, influenza, dengue, hepatitis B, hepatitis C, and HIV infections. Vitamin D is used in treatment of osteoporosis, rheumatoid arthritis and cancer.
    Till mid 20-th century, treatment of tuberculosis patients was restricted to sun exposure in sanatoria and fish oil. These two methods have one thing in common – vitamin D.

  101. Vitamin D for influenza. 2015, Schwalfenberg, Can Fam Physician

    Tamiflu and Relenza are useless drugs which do more harm than good. The author writes that in nursing homes he has seen some of the patients and staff develop vomiting; some with serious diarrhea (also a known side effect); some with acute confusion, hallucinations, or delirium; and a number with worsening cognitive function. These medications should no longer be stockpiled or used. This would result in tremendous savings in health care dollars.
    The Institute of Medicine recommendation for adults younger than 70 years of age is 600 IU of vitamin D daily, to achieve a level of 50 nmol/L in more than 97.5% of individuals. Regrettably, a statistical error has resulted in erroneous recommendations by the Institute of Medicine leading to this conclusion. In actual fact one needs to take 8800 IU of vitamin D to achieve this level in 97.5% of the population.
    The author and his colleague have introduced vitamin D at doses that have achieved greater than 100 nmol/L in most of their patients for the past number of years, and they now see very few patients with the flu or influenza like illness. In those patients who do have influenza, they have treated them with the vitamin D hammer: a 1-time 50 000 IU dose of vitamin D3 or 10 000 IU 3 times daily for 2 to 3 days. The results are dramatic, with complete resolution of symptoms in 48 to 72 hours. The cost of vitamin D is about a penny for 1000 IU, so this treatment costs less than a dollar.

  102. Pandemic preparedness for swine flu in the United States. 2009, Edlich, J Environ Pathol Toxicol Oncol

    Some health-care workers may be hesitant to take a vaccine because it contains a mercury preservative-thimerosal - which can be harmful to their health. These health-care workers and patients should be tested and treated for vitamin D deficiency to prevent exacerbation of a respiratory infection.
    Optimal vitamin D level is 50-75 ng/mL, and an optimal dose for grown-ups is 4000-5000 IU daily.

  103. What follows from these articles is that there is a correlation between vitamin D level and susceptibility to infectious diseases. What does not follow is that administration of vitamin D is safe and effective. What does follow is that exposure to sunlight has health benefits.
    - What is meant by vitamin D here is vitamin D3. You should choose the supplement carefully as not all of them equally harmless. Best solution is to supplement your vitamin D by being exposed to sunlight instead of taking supplements.
    - My personal opinion is that taking a vitamin D in supplements as a preventive measure is, probably, a good idea for grownups and elderly, but I am not sure that it is so for children, especially for newborns.

    Weston Price foundation articles about vitamin D: [1], [2].

  104. Miscellaneous

  105. Do we have enough evidence how can we prevent prolonged use? 2016, Thomas, Vaccine

    An influenza virus is most easily transmitted at close contact (less than 1m). The virus survives the longest on stainless steel surfaces (several hours), on uneven surfaces it survives less than 15 min. A flu virus is 99% inactivated by hydrogen peroxide vapor (10 ppm) in 2,5 minutes.

  106. Influenza virus A(H3N2) is accused in having caused deaths of hundreds of elderly Australians in 2017. This virus was contained in a vaccine, but managed to mutate in 4 months. [1].

  107. New clinical trial of a respiratory syncytial virus (RSV) vaccine has started. Volunteers needed. There already was an attempt in the 1960s to develop such a vaccine, but it was unsuccessful. The vaccine did not protect against subsequent infection and caused a much greater frequency of severe disease, particularly in the youngest age group <6 months. Of 31 infants immunized with the vaccine, 25 required hospitalization following natural infection and two died. The existing vaccine was enhanced with aluminum, which gives the scientists help that it will be more safe and efficace.

  108. It is believed that the 1918 pandemic was caused by an influenza virus. However, this is far from being an established fact. According to some studies, what resulted in a massive death toll in 1918 was caused by a bacterial agent, not a virus. Possibly, it was Streptococcus.

  109. Salicylates and pandemic influenza mortality, 1918-1919 pharmacology, pathology, and historic evidence. 2009, Starko, Clin Infect Dis

    The high-case mortality during the 1918 flu pandemic may have been caused by aspirin, because physicians of the day prescribed in extremely high doses (8-31 g per day).

  110. Review of the prescribing information for influenza vaccines for pregnant and lactating women. 2016, Proveaux, Vaccine

    WHO, CDC and many other national public health advisory groups issue strong recommendations in favor of flu vaccination for pregnant and lactating women.
    The majority of vaccines contain precautionary language which could discourage use in pregnant women and some include stronger language discouraging or contradicting use in pregnant or lactating women.
    Authors conclude that regulators and manufacturers should regularly assess the language of pregnancy and lactation sections in product information for vaccines and include information from national public health advisory groups regarding use by pregnant or lactating women.

  111. An interesting investigation into the swine flu vaccine of 1976. CDC knew that this flu vaccine may cause neurological complications but forgot to inform the population about this fact.

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By chapters:

1.
Anti-vaxxers
2.
Physicians
3.
Placebo
4.
Safety
5.
Unvaccinated
6.
Aluminum
7.
Papilloma
8.
Hepatitis B
9.
Whooping cough
10.
Tetanus
11.
Diphtheria
12.
Measles
13.
Mumps
14.
Rubella
15.
Polio
16.
Influenza
17.
Haemophilus influenzae
18.
Pneumococcal
19.
Chickenpox
20.
Rotavirus
21.
Hepatitis A
22.
Meningococcal
23.
Tuberculosis
24.
Vitamin K
25.
SIDS
26.
Mercury
27.
Autism
28.
Allergies and autoimmunity
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