Flu Season

Steven Woloshin and Lisa Schwartz, physician-researchers in the VA Outcomes Group, were online Tuesday, Oct. 25, at 11:30 a.m. ET to discuss statistics of flu deaths and the effectiveness of vaccines. Gilbert Welch, also a physician-researchers in the VA Outcomes Group, was unable to join the discussion.

From The Post:

Read the Article by Woloshin, Schwartz and Welch:

A Shot of Fear (Post, Oct. 25)

About This Series: Medical research often becomes news. But sometimes the news is made to appear more definitive and dramatic than the research warrants. This series dissects health news to highlight some common study interpretation problems we see as physician-researchers and show how the research community, medical journals and the media can do better.

More From The Post: Flu Basics

NOTE: William L. Atkinson, medical epidemiologist at the National Immunization Program of the Center for Disease Control (CDC), and William W. Thompson, Ph.D., epidemiologist with the Immunization Safety Office of the CDC, were online Thursday, Nov. 3, at 3 p.m. ET to answer your questions about flu season and to discuss the statistics of flu deaths and the effectiveness of vaccines.

A transcript follows.

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Silver Spring, Md.: From what I have read over the past few weeks the flu vaccine isn't all that effective in older people. The flu seems to be mostly spread by children -- for whom the vaccine IS highly effective.

Seems like children should all get vaccinated to protect their elders. Is this another example of our political system catering to those who vote over those who don't?

Steven Woloshin and Lisa Schwartz: the idea of focusing vaccination on school kids has been proposed by others. it makes some sense in that kids are probably doing a lot to spread the virus around. we wonder if it would make sense to do a trial testing your hypothesis -- that is, randomize some school districts to get flu shots and others placebo. we don't know about the political aspect of your question.

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Flu the coop?: Hello: every year the same questions ... can we get some straight answers, please. I'm 49, nothing chronic (yet), do I need a flu shot? Do I need a chicken flu shot? Do I need to get shots for both? Thank you. By getting a shot(s), am I depriving someone needier?

Steven Woloshin and Lisa Schwartz: hi - it does seem crazy that the same questions come up each year. it doesn't sound like you are high risk for flu or flu complications -- for you the benefit of vaccine would be to reduce (by very little) your chance of being sick for a short while. by chicken flu shot do you mean a vaccine for the avian flu? there is no such shot yet. as for depriving others, if there is a limited vaccine supply then it is possible that you might. we haven't heard that the supply is limited this year.

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Washington, D.C.: While the statistics you cite may say three days of work, many people end up missing a week or more of work when they get the flu. This has both a human and economic impact that can be lessened or avoided with vaccination.

You also fail to mention that pregnant women and infants below vaccination age are extremely susceptible to the flu and serious complications, including death. Nor do you mention the latest studies showing that flu peaks in young children several weeks before it hits the elderly population, which have suggested that vaccinating THAT group might significantly reduce deaths from the flu in the elderly.

I also note that you all are based in a non-urban area. Those of us who ride public transit in big cities are very pro-flu vaccine, with good reason! It's hard enough to get people to take basic health precautions, such as getting vaccinations and STAYING HOME WHEN SICK. An article like this just makes it harder, even though the logic is sound.

Steven Woloshin and Lisa Schwartz: we tried to acknowledge the potential economic value of the vaccine (ie, reducing days lost from work) and the fact that it might save someone from feeling sick. sorry if that didn't come through clearly.

with regards to vaccinating school kids, see our prior answer.

its true we are in a rural area -- the studies we cited were done in a variety of settings -- we didn't conduct them up here in Vermont.

we agree that basic precautions like good handwashing make sense - there may be a benefit and its hard to see any downside.

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Jackson, Mich.: Why does it seem that few insurance companies will pay for flu vaccines? It would seem that this would pay off in lower hospital costs for their members.

Steven Woloshin and Lisa Schwartz: Your flu shot is free, if you are enrolled in Medicare Part B and your health care provider accepts Medicare assignment (see http://www.medicare.gov/Health/FluDetails.asp).

don't know why some companies would refuse to pay.

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Pregnancy: Flu shot or no?: I've heard lots of different opinions on this one. I've never had the flu, never had the flu shot. I'm currently 22 weeks pregnant. What is your opinion?

Steven Woloshin and Lisa Schwartz: pregnant women are included in the CDC's list of priority groups for vaccination (see CDC Web site).

we have not specifically reviewed the data supporting this recommendation.

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Falls Church, Va.: Can you please shed some light on "high risk groups"? I have a form of arthritis (I'm 56, if it matters), and my rheumatologist recommends the shot, as arthritis is an immunological disorder. I've gotten one for the past couple of years, but don't necessarily view it as a benefit.

Steven Woloshin and Lisa Schwartz: hi, unless you are taking an immune system suppressing drug to treat your arthritis you are probably not in a high risk group. the kinds of chronic medical conditions doctors mean are things like: chronic heart or lung conditions, including asthma, a metabolic disease (like diabetes), chronic kidney disease, or weakened immune system (including immune system problems caused by medicines or by infection with human immunodeficiency virus [HIV/AIDS]).

we got this list from the CDC Web site: http://www.cdc.gov/flu/about/qa/flushot.htm#priority

good luck.

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Bethesda, Md.: As a health economist, I applaud your series and The Post's decision to run it. In case you don't get enough 'typical' flu questions, I'd be interested in your take on the risk of an avian flu pandemic. Everyone talks about the danger of it becoming human-to-human transmissible but no one gives a probability of it happening. Is there some past experience or data to give us an estimate? If it does develop such a variant, would there be enough time after that point to take the preventive actions necessary?

Steven Woloshin and Lisa Schwartz: great question. unfortunately nobody knows the answer. I don't think there is a credible way to estimate the probability of such a pandemic. it is a big concern about whether effective treatments/vaccines could be disseminated quickly enough.

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Arlington, Va.: Can you explain the depth of your research? When did you start researching this and how did you go about it? Thanks.

Steven Woloshin and Lisa Schwartz: we started with the Cochrane Collaboration evidence reviews (the Collaboration is an international group of experts who review and summarize the evidence for various medical interventions -- see http://www.cochrane.org/index0.htm.

then we followed up by reading relevant primary source articles cited. we also read a variety of background papers, spoke with local experts and drew on our own experiences as physicians (general internists) and researchers.

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Washington, D.C.: Yeah, I'm in my mid-40s and afraid of having needles stuck in me. I back mandatory flu shots for small children.

Steven Woloshin and Lisa Schwartz: good thing you are not a small child! one of us hates needles too.

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Sterling, Va.: I haven't been sleeping well lately, and have been feeling pretty "blah" in general. Nevertheless, I got a flu shot yesterday. Should I have waited until my immune system was up to full strength? Am I at increased risk of contacting the flu from the vaccine as a result?

Steven Woloshin and Lisa Schwartz: The viruses in the flu shot are killed (inactivated), so you cannot get the flu from a flu shot.

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Washington, D.C.: I see that pregnant women are encouraged to get flu shots. Does it matter which trimester you're in?

Steven Woloshin and Lisa Schwartz: CDC recommends the shot for pregnant women -- they don't make a proviso about which trimester -- you should check with your OB.

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Avian flu: Does the CDC recommend a flu shot for some protection against avian flu? I'm headed to Vietnam next month so I'd like to prepare myself. What are your thoughts about Tamiflu?

Steven Woloshin and Lisa Schwartz: no one knows if tamiflu would work against avian flu in humans. there is some animal/lab studies suggesting it might, but we really don't know.

For info about avian flu vaccines go to

the WHO's Web site

. We got the following there:

What is the status of vaccine development and production?

Vaccines effective against a pandemic virus are not yet available. Vaccines are produced each year for seasonal influenza but will not protect against pandemic influenza. Although a vaccine against the H5N1 virus is under development in several countries, no vaccine is ready for commercial production and no vaccines are expected to be widely available until several months after the start of a pandemic.

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Maryland: Are flu shots statistically more effective than placebos?

Steven Woloshin and Lisa Schwartz: many of the studies were statistically significant (ie, the findings were not likely to be due to chance). but the magnitude (as you see in the Post) of the differences between placebo and vaccine were small. also, keep in mind that statistical significance does not mean the results are true -- there are other issues besides chance to think about, like whether the study was a randomized trial or an observational study, for example.

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Ashburn, Va.: Look, the flu shot is created by a bunch of scientists who 'guess' what strains will hit in a given year. In my opinion, this concept alone make the flu shot a long shot.

I've never had a flu shot and can't say that I've ever really had the flu.

Let me ask a question......If the medical profession is concerned about mis-represented information, then how are the misconceived concepts getting into the news? Someone needs to be held liable for the mis-information about the flu shot and it's success rate. According to the charts reflected in the recent Post article, the increased use of the flu shot hasn't done anything for the total number of people fatally affected by the illness itself.

Steven Woloshin and Lisa Schwartz: different people may interpret the magnitude of the benefit of the vaccine differently -- what looks like a small benefit to you may look substantial to someone else. we think the main thing is getting the data to people so they can make informed decisons.

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Falls Church Again: I take Enbrel for arthritis. Does that clarify the desirability for getting a flu shot?

Steven Woloshin and Lisa Schwartz: this drug does have some immune suppressive activity. many people would recommend a flu shot for you.

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Steven Woloshin and Lisa Schwartz: we have to go....sorry.

thanks for your interesting questions.

S & L

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Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.