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The Flu Vaccine & Alternate Treatments for the Flu
Dr. Kelly Han, ND Walnut Creek Naturopathic
February 2013
What Causes the Flu?
• Influenza virus • 3 types: A, B, and C • Each type has many subtypes and species • Responsible for over 306 different influenza viruses
• Different strain predominates every year • Peaks in January – February (season Oct-‐May) • Common symptoms: Fever, faYgue, headache, body ache, sore throat, stuffy nose, runny nose, vomiYng, diarrhea, cough
How is the Flu spread?
• Respiratory droplets-‐ coughing, sneezing, touching contaminated surfaces
• Contagious 1 day before symptom onset and 5-‐7 days a^er symptom onset
How serious is the Flu?
• Severity of the flu varies from year to year • Most cases are mild-‐moderate and resolve without complicaYon
• Severe complicaYons include dehydraYon, pneumonia, and inflammaYon and infecYon of heart, lungs, brain, or other organs
• Severe complicaYons can be fatal
Flu StaYsYcs (USA)* *staYsYcs vary according to source
• Millions of cases per year (very common) – EsYmated 5-‐20% of the US populaYon
• 100,000-‐200,000 hospitalizaYons per year • 1500-‐49,000 fataliYes per year (1976-‐2007) • > 90 % hospitalizaYons and fataliYes occur in age 65+
• Children < 2 yrs are the next largest group at risk of serious complicaYon
The Flu Vaccine
• The flu vaccine covers 3 influenza viruses: – Two influenza A viruses – One influenza B virus
• Each year the strains are updated based upon predicYons for this year’s circulaYng flu viruses
• Data is collected from around the world to determine the included strains
How effecYve is the Flu Vaccine?
• Varies from year to year • There have been limited controlled studies demonstraYng a decrease in influenza disease a^er vaccinaYon
• Research shows that it creates anYbodies to influenza, but there has been limited correlaYon with disease prevenYon
How safe is the Flu Vaccine? • Common Side Effects: Flu-‐like symptoms, injecYon site reacYons,
irritability, fever, drowsiness, loss of appeYte, vomiYng, diarrhea
• Severe S/E: Febrile seizures (esp < 2yo), GBS, severe allergic reacYons, especially egg allergy
• Pregnancy: Not enough human data; Category C or B
• Breasneeding: Not enough data, generally considered safe
• Generally best to give it away from other vaccines (1 mo apart) • Flu vaccine is not well studied when given simultaneously with
other vaccines
All Flu vaccines are not created equal
• Killed-‐virus injecYon – Several influenza strains grown in chicken eggs – AnYbioYcs added to egg – Viruses removed and inacYvated (non-‐infecYous) – Virus parYcles added into saline soluYon – Mercury may be added as preservaYve – Brands: Fluzone, Fluarix, Agriflu, Fluvirin, FluLaval
All Flu vaccines are not created equal
• Live-‐virus nasal spray – Several influenza strains put into egg to mulYply – Fluid removed, purified, and mixed with sucrose – Put into nasal spray – Live virus intended to mulYply within nose and throat to cause a low-‐grade infecYon and sYmulate immunity
– Mildly contagious for 3 weeks – Early data shows works berer than injecYon – Approved for ages 2-‐39 – Brands: FluMist
The Flu Vaccine
• CDC recommends annual vaccinaYon starYng at 6 months of age
• High risk-‐groups – Children < 5 yo, but especially < 2 yo – Adults age 65 and older – Pregnant women – Individuals with immune compromise – Healthcare workers – Family members or caretakers of above groups
ContraindicaYons for the Flu Vaccine
• InacYvated-‐virus: – CauYon with egg allergy – Moderate to severe acute febrile illness – History of negaYve reacYon to vaccine
• Live-‐virus: – Egg allergy – Children < 2 yo – Age 2-‐4 yrs with history of asthma or wheezing in previous 12
mo – Adults 50 years and older – Age 2-‐18 yrs receiving rouYne therapy with aspirin or salicylates – Pregnant women
Choosing a Brand of Flu Vaccine
• Choose proper brand and dose for age • Aim for mercury free
• Fluzone – Only flu vaccine approved for use < 3 yo; smaller risk of febrile seizure
• Mercury-‐free: Fluarix, Agriflu, FluMist (contains MSG), Fluvirin (single dose)
• AnYbioYc-‐free: Fluzone, FluLaval
To Vaccinate or Not To Vaccinate?
• Reasons to vaccinate: – Elderly – Chronic medical problems or immuno-‐compromised
– Infants < 2 yrs – Families of above groups – Financial consideraYons (from loss of work)
– History of severe flu
To Vaccinate or Not To Vaccinate?
• Reasons NOT to vaccinate: – Risk of febrile seizure – Flu-‐like illness as side effect – Breasneeding infants are less suscepYble to flu – Pregnancy-‐ lack of safety informaYon – SensiYvity to chemicals or mercury – Children > 2 yo are less likely to require hospitalizaYon – Research is unclear if flu vaccine is effecYve in children under 2 yo
– AnYviral medicaYon available in first 48 hours – AlternaYve opYons are available for prevenYon and treatment of flu
AlternaYve OpYons for Flu PrevenYon
• Set a strong foundaYon for health and immunity – Diet:
• Sugar and dairy-‐free. • Limited intake of refined carbohydrates and alcohol. • Increase intake of fruit, vegetables, garlic, & ginger
– Avoid smoking and recreaYonal drug use – Daily intake of 8-‐10 glasses of water – Stress reducYon and management
AlternaYve OpYons to Treat the Flu
• REST, REST, REST • Elderberry (no standard dosage) • Vitamin D (1000-‐4000 IU daily) • ProbioYcs (25 billion organisms daily) • Garlic (400 mg, 3x per day; standardized to contain 1.3% alliin or 0.6% allicin)
• Colostrum (no standard dosage) • Zinc (30-‐50 mg daily) • Mushrooms (reishi, maitake) (no standard dosage) • Homeopathy (see separate handout)
Elderberry
• Contains flavonoids • Cooling-‐ reduces swelling and inflammaYon
• Mild diaphoreYc-‐ helps opYmize fever and break a sweat
• Expectorant-‐ helps expel mucus
• AnY-‐viral and anY-‐bacterial properYes
Elderberry • An#-‐influenza virus effects of elderberry juice and its frac#ons. Kinoshita E, Hayashi
K, Katayama H, Hayashi T, Obata A. • Elderberry showed relaYvely strong defense against IFV infecYon. We conclude that CJ-‐E had
a beneficial effect by the sYmulaYng immune response and prevenYng viral infecYon.
• Inhibitory ac#vity of a standardized elderberry liquid extract against clinically-‐relevant human respiratory bacterial pathogens and influenza A and B viruses. Krawitz C, Mraheil MA, Stein M, Imirzalioglu C, Domann E, Pleschka S, Hain T.
• Rubini elderberry liquid extract is acYve against human pathogenic bacteria as well as influenza viruses. The acYviYes shown suggest that addiYonal and alternaYve approaches to combat infecYons might be provided by this natural product.
• Elderberry flavonoids bind to and prevent H1N1 infec#on in vitro. Roschek B Jr, Fink RC, McMichael MD, Li D, Alberte RS
• The H1N1 inhibiYon acYviYes of the elderberry flavonoids compare favorably to the known anY-‐influenza acYviYes of Oseltamivir (Tamiflu; 0.32 microM) and Amantadine (27 microM).
Vitamin D
• AcYvates the body’s T-‐cells to seek and destroy invading viruses and bacteria
• Calcitriol [1, 25[OH]2 D3] pre-‐ and post-‐treatment suppresses inflammatory response to influenza A (H1N1) infec#on in human lung A549 epithelial cells. Khare D, Godbole NM, Pawar SD, Mohan V, Pandey G, Gupta S, Kumar D, Dhole TN, Godbole MM.
• The findings provide support for the iniYaYon of vitamin D supplementaYon program in reducing the severity of influenza.
• Randomized trial of vitamin D supplementa#on to prevent seasonal influenza A in schoolchildren. Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H.
• This study suggests that vitamin D(3) supplementaYon during the winter may reduce the incidence of influenza A, especially in specific subgroups of schoolchildren.
ProbioYcs
• 60-‐80% of your immune system is located in lining of your gut
• ProbioYcs are essenYal to maintaining the integrity of your gut lining
• ProbioYcs enhance acYvity of natural killer cells
• Enhance digesYon to opYmize nutrient absorpYon and uYlizaYon
ProbioYcs • A new chance of preven#ng winter diseases by the administra#on of synbio#c
formula#ons. Pregliasco F, Anselmi G, Fonte L, Giussani F, SchieppaP S, SoleQ L. • These results demonstrate that a regular, long-‐term intake of various synbioYcs may improve
health by reducing the incidence and severity of respiratory diseases during the cold season.
• Lactobacillus plantarum CECT7315 and CECT7316 s#mulate immunoglobulin produc#on aYer influenzavaccina#on in elderly. Bosch M, Méndez M, Pérez M, Farran A, Fuentes MC, Cuñé J.
• L. plantarum CECT7315/7316 has an immunosYmulaYng effect and could be used to improve the response to influenza vaccinaYon in elderly.
• Lactobacillus GG as an immune adjuvant for live-‐a[enuated influenza vaccine in healthy adults: a randomized double-‐blind placebo-‐controlled trial. Davidson LE, Fiorino AM, Snydman DR, Hibberd PL.
• Lactobacillus GG is potenYal as an important adjuvant to improve influenza vaccine immunogenicity
Garlic
• Warming-‐ moves the blood and lymph • Rich in selenium, criYcal to immune funcYon
• AnY-‐viral, anY-‐bacterial, anY-‐fungal properYes • May be contraindicated with blood-‐thinning medicaYons
Garlic
• Supplementa#on with aged garlic extract improves both NK and γδ-‐T cell func#on and reduces the severity of cold and flu symptoms: a randomized, double-‐blind, placebo-‐controlled nutri#on interven#on. Nantz MP, Rowe CA, Muller CE, Creasy RA, Stanilka JM, Percival SS.
• SupplementaYon of the diet with aged garlic extract may enhance immune cell funcYon and that this may be responsible, in part, for reduced severity of colds and flu.
Colostrum
• Augmenta#on of cellular immunity and protec#on against influenza virus infec#on by bovine late colostrum in mice. Uchida K, Hiruta N, Yamaguchi H, Yamashita K, Fujimura K, Yasui H
• These results indicate that oral administraYon of SCBLC acYvates not only systemic cellular immunity but also local cellular immunity, such as in the respiratory tract, and that acYvaYon of cellular immunity is one of the mechanisms of amelioraYon of Flu infecYon.
Homeopathy for the Flu
• Please see separate handout • Epidemic Updates by Paul Herscu, ND, MPH
How to opYmize a fever
• Please see separate handout
References
• Dr. Sears, The Vaccine Book • CDC website: – hrp://www.cdc.gov/flu/index.htm
• Epidemic updates from Paul Herscu, ND: – hrp://www.paulherscuepidemics.blogspot.com/2013/01/current-‐influenza-‐epidemic-‐january-‐2013.html#more
• Vaccine Preventable Diseases and Vaccine Counseling by CANDACE AASAN, ND at CASCADE NATURAL MEDICINE KIRKLAND, WA
• Pediatric VaccinaYons by Heather Zwickey
THANK YOU!
• Any quesYons, comments? • Interest in future topics?
Dr. Kelly Han, ND Walnut Creek Naturopathic
February 2013