Influenza beginning to scare me... thoughts on the vax? - Page 2 - Mothering Forums
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#31 of 51 Old 03-29-2007, 04:30 AM
 
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Originally Posted by mamakay View Post
But that's actually true. It's # 7 of the "recipe" for creating demand for influenza vaccines.
They even discussed it at one of the ACIP meetings -- one of the justifcations they used for expanding seasonal influenza vaccine recommendations to cover more pediatric age groups was to "prepare" for the pandemic.

And let's not forget the CDC's recent drive to vaccinate more healthcare workers for seasonal influenza to prepare for a pandemic -- they feel that ensuring health care workers (from the doctors to the cafeteria workers) are seasonally vaccinated has "taken on greater importance with the spread of H5N1 avian influenza and its potential to create a pandemic."
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#32 of 51 Old 03-29-2007, 06:48 AM
 
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Anecdotally then (for what that's worth, which isn't much), my experience is that many "health care workers" aren't significantly more knowlegeable than anyone else. Next one you meet, ask them for their thoughts on why it is that the gene for neuraminidase is more highly conserved in the influenza genome than is the one for hemagglutinin..
I think, like everyone else, we'd be more inclined to tell you about our healthcare colleagues who got the flu shot and then walked around moaning about how crappy they felt (or else just staying home) for the next five days. And about then seeing those same people missing just as many days that season due to 'flu'. Or maybe about the three cases of patients hospitalized for confirmed influenza I saw this year, all of whom had received their flu shot. Oh, and that case of Guillain Barre...

The healthcare workers I know who opt out of the flu shot are doing it for the same reasons as everyone else: we see firsthand that it makes you sick to receive it, it doesn't protect you as promised, and just like all other sanctioned vaccinations, side effects and longterm outcomes are poorly characterized or not known.
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#33 of 51 Old 03-29-2007, 06:54 AM
 
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The healthcare workers I know who opt out of the flu shot are doing it for the same reasons as everyone else: we see firsthand that it makes you sick to receive it, it doesn't protect you as promised, and just like all other sanctioned vaccinations, side effects and longterm outcomes are poorly characterized or not known.
And that includes "scientists".

I'd really like to see some kind of statistic on what % of cell biologists actually get flushots each year.
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#34 of 51 Old 03-29-2007, 06:59 AM
 
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Originally Posted by mamakay View Post
But that's actually true. It's # 7 of the "recipe" for creating demand for influenza vaccines.

From Glen Nowak, CDC Director of Communications:

#7 - References to, and discussions, of pandemic influenza–along with continued reference to the importance of vaccination.
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#35 of 51 Old 03-29-2007, 07:03 AM
 
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Originally Posted by LongIsland View Post
#7

References to, and discussions, of pandemic influenza–along with continued reference to the importance of vaccination.
Yeah...it comes right after the discussion on how to scare the sh*t out of people with videos of sick kids.

Your tax dollars at work! Woo hoo!
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#36 of 51 Old 03-29-2007, 07:06 AM
 
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Just in case the reader hasn't seen the "recipe," here is a link: http://www.ama-assn.org/ama1/pub/upl..._flu_nowak.pdf

The actual "recipe" begins on page 27 (it should open up right to p 27).
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#37 of 51 Old 03-29-2007, 07:08 AM
 
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Yeah...it comes right after the discussion on how to scare the sh*t out of people with videos of sick kids.

Your tax dollars at work! Woo hoo!
After Thanksgiving, I gave an interview to a local paper about how well things were going. Best year yet for patients in flu death prevention.

The very day AFTER I gave the interview, the announcement from the CDC and the announcement from vaccine company came out stating that all the vaccine had been distributed. This combined with the reports of children dying from the virus, particularly in Colorado, started the phones ringing.

Our supply was used up in a matter of days.


From one of the other presentations given at the 2004 influenza summit:
http://www.ama-assn.org/ama1/pub/upl..._bangasser.pdf
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#38 of 51 Old 03-29-2007, 07:26 AM
 
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http://hcrc.missouri.edu/events/nowak_files/nowak.pdf


Quote:
Fostering demand, particularly among people who
don’t routinely receive an annual influenza
vaccination, requires creating concern, anxiety, and
worry (e.g., Dr. Poland’s pronouncement).

It’s a lot harder to create a motivating level of
concern and anxiety when
a) influenza isn’t yet
present and b) disease severity and impact are in
line with expectations
.
"But I got the flu, and it was....the flu."



I think this is my all time favorite:

http://www.iom.edu/Object.File/Master/21/674/Nowak.pdf

Quote:
Health literacy is a growing problem
When the risk communicators are considering health literacy a problem...something is very, very wrong with what thier "message" is.
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#39 of 51 Old 03-29-2007, 06:53 PM
 
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Originally Posted by LongIsland View Post
one of the justifcations they used for expanding seasonal influenza vaccine recommendations to cover more pediatric age groups was to "prepare" for the pandemic.
To me, that would suggest that they are genuinely concerned about the pandemic threat. But earlier, you implied that they fabricated the pandemic threat in order to increase demand for the seasonal vax. That you might have it both ways may make perfect sense to you, but it looks completely circular to me. Would you like to pick one or the other?

I find the simplest explanation to be that the CDC really believes (rightly or wrongly) that the effectiveness of flu vaccines is about what they say it is, and that recommending vaccination is therefore consistent with the agency's mission: to control disease. If you wanted to argue that the yearly promotion of the seasonal vax is inspired by a desire to keep at least a few pharmaceutical companies making the vax so as to provide at least some hope of defense against a pandemic, that would at least be consistent -- and while I'd agree that this is certainly an element, I'd continue to insist that they also do it because they believe that the seasonal vax actually works (and controlling seasonal flu is well within their mission as well, after all). There have also been thoughts about limiting the number of opportunities for reassortment through better control of seasonal influenza, but there is not enough certainty about whether the greatest risk is from "shift" or "drift" (or even "recombination") to make this a prime objective (let alone practical from the standpoint of implementation).

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Originally Posted by blessed
I think, like everyone else, we'd be more inclined to tell you about our healthcare colleagues who got the flu shot and then walked around moaning about how crappy they felt (or else just staying home) for the next five days.
If what you're getting at is that the flu shot can give you the flu, it needn't involve consultation with one of your esteemed colleagues; that little gem of wisdom is widely available on the street. Now try to find some clinical evidence to support it.

Quote:
Originally Posted by mamakay
Even "risk communication" isn't technically lying, although it's extremely deceptive in function.
Quote:
It’s a lot harder to create a motivating level of
concern and anxiety when a) influenza isn’t yet
present and b) disease severity and impact are in
line with expectations.
I wonder: have you had a chance to see Al Gore's documentary, "An Inconvenient Truth"? Until I saw it, I didn't really appreciate just how long and hard the "former next president" has been trying to convey the message about global warming. You might say that he has had a hard time "creating a motivating level of concern and anxiety" about the issue. Watching the documentary was deeply unsettling for me, and this even though I was by no means unfamiliar with the basic science. It was the images, I guess. Seeing the satellite maps animated to show huge areas of densely populated land that would be inundated by rising sea levels and thinking about the disruption and loss of life this would cause; the "before and after" pictures of rapidly receding glaciers; the melting permafrost, the dried-up lakes, the vanishing ice shelves -- it's downright scary. I can only imagine how it would affect someone just being introduced to the problem. Now you tell me: is Gore a "risk communicator", or a "fearmonger"?
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#40 of 51 Old 03-29-2007, 07:00 PM
 
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A few months ago I was approached by a medical worker who also happens to be my son-in-law. The hospital where he works was offering influenza vaccine to their employees and he wanted to know if he should go ahead and get one. He works with elderly and frail patients at the hospital and at a couple of nursing homes and he also works with children.

I put on my medical librarian hat, cast my mind back to library school and remembered, Jim Henderson, Life Sciences Librarian at McGill University, recommending the Cochrane Reviews as top quality information on the effectiveness of various treatments.

I dug up the following reviews:
http://www.mrw.interscience.wiley.co...269/frame.html

http://www.mrw.interscience.wiley.co...187/frame.html

Quote:
Plain language summary
There is no high quality evidence that vaccinating healthcare workers reduces the incidence of influenza or its complications in the elderly in institutions

There is evidence that vaccinating the elderly, particularly if the vaccine is well-matched to the circulating strains, has a modest impact on the complications from influenza. There is also high quality evidence that vaccinating healthy adults under 60 (which includes healthcare workers) reduces cases of influenza, especially if the vaccine is well matched to the circulating strains. Both the elderly in institutions and the healthcare workers who care for them could be vaccinated for their own protection, but an incremental benefit of vaccinating healthcare workers for the benefit of the elderly cannot be proven without better studies.
Based on the reviews, and on the fact that he takes very good precautions in terms of not coughing or sneezing on his patients, washes his hands constantly and does not work when ill, he decided to skip the vaccine. He hasn't gotten the influenza and it looks like he hasn't given the influenza to any of the folks he works with.

Dymanic, did I make the wrong choice in giving him Cochrane reviews? Why? What would have been a better source of information on the effectiveness of the influenza vaccine in a healthcare setting? Why?

Thanks for your input!
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#41 of 51 Old 03-29-2007, 07:06 PM
 
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Originally Posted by dymanic View Post
But earlier, you implied that they fabricated the pandemic threat in order to increase demand for the seasonal vax. That you might have it both ways may make perfect sense to you, but it looks completely circular to me. Would you like to pick one or the other?
No Dymanic, I very clearly implied that they're EXAGGERATING the threat of a H5N1 pandemic.

Definition of hype: Excessive publicity and the ensuing commotion; to publicize or promote using inflated claims

Nobody's telling you not to get the seasonal influenza vaccine. If it makes you feel safer . . . by all means.
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#42 of 51 Old 03-29-2007, 07:11 PM
 
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If what you're getting at is that the flu shot can give you the flu, it needn't involve consultation with one of your esteemed colleagues; that little gem of wisdom is widely available on the street. Now try to find some clinical evidence to support it...
No, I don't really think that or care whether the reason you feel like crap for days after the flu shot is because you have a clinical influenza infection. Doesn't matter much to me - I reject feeling like crap on general principle, regardless of which of the constituents of the shot leave us feeling that way.

The world is full - chock full - of truths which are not reflected in medical or scientific literature. And the world is full of truths which are facticiously discounted or misrepresented by medical or scientific literature. But since you favor medical literature, here is justification to which you may assign some degree of crediblity (or more likely not, I suspect) for my own decision not to have the flu vaccine.

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum
Cochrane Database Syst Rev. 2004;(3):CD001269.
Update of:
Cochrane Database Syst Rev. 2001;(4):CD001269.
Vaccines for preventing influenza in healthy adults.
///
REVIEWERS' CONCLUSIONS: Influenza vaccines are effective in reducing serologically confirmed cases of influenza. However, they are not as effective in reducing cases of clinical influenza and number of working days lost. Universal immunisation of healthy adults is not supported by the results of this review.
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#43 of 51 Old 03-29-2007, 07:55 PM
 
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Dymanic doesn't like the Cochrane folks. Err...at least not when they talk about flushots.

Whenever I hear about people supposedly catching the flu from their flushot, I always think of this...
http://www.fda.gov/cber/ltr/park092700.pdf

For every situation like that that the FDA catches, I wonder how many slip through the cracks...
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#44 of 51 Old 03-29-2007, 07:58 PM
 
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Originally Posted by dymanic
I wonder: have you had a chance to see Al Gore's documentary, "An Inconvenient Truth"? Until I saw it, I didn't really appreciate just how long and hard the "former next president" has been trying to convey the message about global warming. You might say that he has had a hard time "creating a motivating level of concern and anxiety" about the issue. Watching the documentary was deeply unsettling for me, and this even though I was by no means unfamiliar with the basic science. It was the images, I guess. Seeing the satellite maps animated to show huge areas of densely populated land that would be inundated by rising sea levels and thinking about the disruption and loss of life this would cause; the "before and after" pictures of rapidly receding glaciers; the melting permafrost, the dried-up lakes, the vanishing ice shelves -- it's downright scary. I can only imagine how it would affect someone just being introduced to the problem. Now you tell me: is Gore a "risk communicator", or a "fearmonger"?
You know they were talking about seasonal flu (the one we've all had several times) and not the pandemic that might be, right?

So how is this analogy in any way appropriate?
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#45 of 51 Old 03-29-2007, 08:45 PM
 
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Originally Posted by mamakay View Post
Dymanic doesn't like the Cochrane folks. Err...at least not when they talk about flushots.
Well, if Cochrane screwed up in their analysis on the flushots, it ought to be possible to figure out why and point to their errors.
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#46 of 51 Old 03-29-2007, 11:11 PM
 
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Originally Posted by Deborah View Post
Based on the reviews, and on the fact that he takes very good precautions in terms of not coughing or sneezing on his patients, washes his hands constantly and does not work when ill, he decided to skip the vaccine. He hasn't gotten the influenza and it looks like he hasn't given the influenza to any of the folks he works with.

Dymanic, did I make the wrong choice in giving him Cochrane reviews? Why? What would have been a better source of information on the effectiveness of the influenza vaccine in a healthcare setting? Why?
I don't see how putting information in the hands of an intelligent person can ever be wrong, provided that it is not done in a way that might decieve, and with deliberate intent to do that. I strongly believe that the sort of precautions your SIL takes are at least as important in preventing the spread of flu as any vaccine, and I wish I could feel confident that such diligence was typical among healthcare workers.

We could go back and forth over Cochrane till the cows come home (and have done so before), but I'm not going to have time for that now. Briefly, I'd say that while the numbers quoted in the review you linked don't look that much different from the CDC's, the conclusions reached by the authors appear... a bit subjective. For instance:

"There is not enough evidence to recommend universal vaccination against influenza in healthy adults".

Yet:

"This review found that vaccinating healthy adults not at risk of complications reduced their chances of developing flu-like illness by only a quarter."

That appears to have been written by a person who does not believe that 25% would have much impact as far as herd immunity is concerned, but I find it hard to agree.

I'll also comment on this:

"There is also high quality evidence that vaccinating healthy adults under 60 (which includes healthcare workers) reduces cases of influenza, especially if the vaccine is well matched to the circulating strains. Both the elderly in institutions and the healthcare workers who care for them could be vaccinated for their own protection, but an incremental benefit of vaccinating healthcare workers for the benefit of the elderly cannot be proven without better studies."

So... for sure, vaccinating under 60's reduces cases of flu, but whether reducing cases of flu in HCW's (the bulk of whom are presumably in the under 60 group) reduces the likelihood of them passing it on to patients "cannot be proven without better studies". Sick people pass flu to well people; how much proof of that do we need? And, pending such proof, would it be reasonable to base vaccination policy among HCW's on the assumption that if infected with flu, they won't pass it on to patients?

And I can't resist the temptation to toss in one more quote from that review:

"Vaccination had no reported relevant adverse effects."


Quote:
Originally Posted by LongIsland
I very clearly implied that they're EXAGGERATING the threat of a H5N1 pandemic.
Now we're getting somewhere. Exaggerating the threat then. Do you feel that they are exaggerating the likelihood of the threat, or the projected consequences (or both)? And (if you don't mind me asking again): why is it that you think they would want to do that?


Quote:
Originally Posted by mamakay
You know they were talking about seasonal flu (the one we've all had several times) and not the pandemic that might be, right?
From the OP:

"Wondering what your thoughts are on preparing for an influenza pandemic, and about the flu vaccine."

Long Island's response:

"Part of the pandemic flu hype is designed to scare people into vaccinating for seasonal influenza."

further rendered the two inseparable as far as this thread is concerned.

Quote:
So how is this analogy in any way appropriate?
When a large body of evidence points to a looming threat, one about which there is some uncertainty, but which has the potential to cause massive suffering on a global scale, it would seem to me that those scientists who become aware of it incur a moral responsibility to bring the matter into public view. (Again in Gore's words: "Scientists have an independent obligation to respect and present the truth as they see it.") But if it isn't an imminent threat, getting anybody to pay attention is likely to be a difficult task. This is the challenge of risk communication. You've spoken numerous times of "risk communication" as though you viewed it as morally flawed in principle ("extremely deceptive in function"); but I don't think you really believe that, and offer the global warming analogy as a way of encouraging you to take a closer look at this inconsistency in your arguments.
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#47 of 51 Old 03-29-2007, 11:43 PM
 
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Originally Posted by the OP, LI, dymanic, and myself
Originally Posted by mamakay
You know they were talking about seasonal flu (the one we've all had several times) and not the pandemic that might be, right?

From the OP:

"Wondering what your thoughts are on preparing for an influenza pandemic, and about the flu vaccine."

Long Island's response:

"Part of the pandemic flu hype is designed to scare people into vaccinating for seasonal influenza."

further rendered the two inseparable as far as this thread is concerned.


Quote:
So how is this analogy in any way appropriate?

When a large body of evidence points to a looming threat, one about which there is some uncertainty, but which has the potential to cause massive suffering on a global scale, it would seem to me that those scientists who become aware of it incur a moral responsibility to bring the matter into public view. (Again in Gore's words: "Scientists have an independent obligation to respect and present the truth as they see it.") But if it isn't an imminent threat, getting anybody to pay attention is likely to be a difficult task. This is the challenge of risk communication. You've spoken numerous times of "risk communication" as though you viewed it as morally flawed in principle ("extremely deceptive in function"); but I don't think you really believe that, and offer the global warming analogy as a way of encouraging you to take a closer look at this inconsistency in your arguments.
Let's really break this down.

You admit that
1) the best evidence says that flu shots top out at 33% effective in the years that the strains match, which isn't always, or even usually.
2) the CDC uses fear to promote seasonal influenza vaccination

Now when I said this:

Quote:
Originally Posted by me
So how is this analogy in any way appropriate?
I was referring to the CDC's open use of creating fear and worry to promote seasonal influenza vaccination. But you're extrapolating that to fearmongering about a hypothetical pandemic with the global warming analogy.

I'm talking about fearmongering to get folks to get their probably-won't-even-work-seasonal-flu-vaxes each year.

You know this. That's what the "risk communication" quote was talking about. Fear of seasonal flu. The art of frightening people into going along with seasonal flu vaccines.

But then you say :

Quote:
When a large body of evidence points to a looming threat, one about which there is some uncertainty, but which has the potential to cause massive suffering on a global scale, it would seem to me that those scientists who become aware of it incur a moral responsibility to bring the matter into public view.
The "looming threat" of seasonal influenza???
The one we all have had several times????

So I don't know if you're just not following the thread, or if you're just being totally full of...illogicalness.

But unless we get on the same page, this discussion is pointless.
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#48 of 51 Old 03-29-2007, 11:45 PM
 
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Dymanic - are you stockpiling food and Tamiflu?
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#49 of 51 Old 03-30-2007, 10:28 AM
 
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Originally Posted by mamakay View Post
I was referring to the CDC's open use of creating fear and worry to promote seasonal influenza vaccination. But you're extrapolating that to fearmongering about a hypothetical pandemic with the global warming analogy.
We did get tangled up there then. Sorry about that. Maybe you could point to something you see as a good example of the CDC using fear to promote seasonal influenza vaccination, and we could consider how far over the top it should be regarded.

Quote:
Originally Posted by LongIsland
Dymanic - are you stockpiling food and Tamiflu?
I'm pretty much all stocked up on food and water. I could go eight weeks no prob, and being very conservative, maybe twelve. Quite some time back, I also started ordering my meds by mail, 3-month's supply at a time, and since the reorder date arrives well before the last order is exhausted, the surplus has built up, so I'm in great shape there. Private hoarding of Tamiflu isn't something I'd encourage, and I haven't made an effort to aquire any (and my understanding is that it currently isn't very easy to get). I wouldn't count too much on it being effective anyway. I do have a modest supply of Amantadine (which, btw, has an exceptionally long shelf life), but I'm even less optimistic about that being very effective. My strategy would be based mostly on isolation (which I'm pretty good at by nature). I'm currently looking at ways to improve my ability to handle power outages.

None of these need be viewed as exclusively a matter of pandemic preparedness, though. Our modern lifestyles make us so heavily dependent on long supply lines of just about everything (and so blissfully unaware of that fact) that huge segments of the population would be rendered helpless within hours by even relatively small-scale events.
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#50 of 51 Old 03-30-2007, 10:46 AM
 
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Maybe you could point to something you see as a good example of the CDC using fear to promote seasonal influenza vaccination, and we could consider how far over the top it should be regarded.
How about the CDC looking for pediatric deaths, and sending the media info packets about it to report, to give the impression to parents that it's very common, and that it's not the rare occurance that it is.
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#51 of 51 Old 04-01-2007, 04:16 AM
 
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I've had the flu vaccine 3- 4 times & won't do it again.

About 9 years ago I was pretty rundown & caught the flu - several days of fever, cough & running nose that took weeks to go away. That ran me down further & I caught a stomach bug & then a cold. To top it off, if I get sick with a high fever, several weeks later I go thru a bad bought of rheumatoid arthritis. I ended up missing lots of work & had so much pain & misery for two months.

The next year I got the flu shot. I got a mild cold/low fever a few days after the shot. A few weeks later, the arthritis kicked in, pretty mild, but I was still uncomfortable for several weeks.

Next year, same thing.

The next year, I skipped it, didn't get the flu, felt great.

Next year, I got the shot, got a mild cold/low fever, missed a day or two of work. Ended up with the arthritis acting up a few weeks later.

Started thinking about it & decided I seem to catch the flu every ten years or so, when I"m extremely run down (like working full time, school full time, eating only junk food, not getting anywhere near enough sleep etc). When I get the flu shot I get the arthritis reaction every time even if I was in a healthy state beforehand. Just considering which was worse for my joints, I decided not to get the flu shot again.
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