Influenza Virus, Vaccination and Naturopathic Practice

Hal Brown, BA, DC, ND, RAc

Influenza: from the French word, influentia, which refers to the belief that epidemics were caused by the influence of the stars.

Patient Care

In my practice as I suspect in most others, many patients each year ask whether I think they should receive the flu vaccine. Others inform me that they have just received one and blithely assume this is an act of preventive health, like exercise and taking vitamins. Still others request a homeopathic “vaccination” as an alternative protection, or request a protective immune-enhancing protocol.

Many patients are fearful of the flu for themselves or their elderly relatives and young children, and yet many are accepting of assumptions made by allopathic physicians and the media regarding the “normality” of getting an annual flu shot.

Still other patients are concerned about getting the “shot” because of negative concerns. They may question the vaccination’s effectiveness because the formulation cannot be specific for the current virus. There may be concern that negative effects may occur months or years later. These concerns are based on anecdotal evidence and, although there may be a basis in fact, to date, a cause-and-effect relationship has not been proven. Vaccines are a combination of ingredients, including egg protein, aluminum (thimersol use has been limited) and formaldehyde. Patients may react to the deactivated virus, toxins or potential allergens in the vaccination.

We also see many patients who have received a shot come down with the flu, and others who claim they haven’t been sick since receiving it. Still others report reactions and illness in relation to the shot.

The Flu

Influenza, commonly known as the flu, is often mistaken for almost anything that makes people feel ill. Influenza is an infectious disease that infects birds and mammals (primarily the upper airways and lungs in mammals) and is caused by an RNA virus of the Orthomyxoviridae family (Blakemore, 2006). The most common and characteristic symptoms of influenza in humans are fever and chills, pharyngitis, myalgia, severe headache, coughing, burning eyes and malaise (Merck Manual, n.d.). The flu differs from the common cold in both its rapid onset and the potentially serious and/or life-threatening complications that may occur, especially in babies and the elderly. It is a potentially serious illness, and it is associated with as many as 36,000 (CDC, 2006) to 69,000 (Segala, 2003) deaths per year in the U.S. The flu epidemic of 1918-’19, known as the Spanish flu, took an estimated 50-100 million lives worldwide (National Archives and Records Administration, n.d.; Johnson and Mueller, 2002), more than those who died fighting in World War I. The diagnosis of the flu is usually made by the presence of similar symptoms in the community.

The Flu Vaccine

New influenza viruses are constantly being produced by mutation or by reassortment. Due to the high mutability of the virus, a particular vaccine formulation is considered to only work for about a year. The World Health Organization coordinates the contents of the vaccine each year to include the most likely strains of the virus suspected to attack the next year (WHO, n.d.). Typically, this vaccine includes material from two influenza A virus subtypes and one influenza B virus strain (Horwood and Macfarlane, 2002). The flu vaccine is usually recommended by the allopathic community for anyone in a high-risk group who would be likely to suffer complications from influenza.

Evidence for the Benefits of Flu Vaccination

Measuring of the efficacy of influenza vaccines can be done by immunizing adult volunteers and then challenging with virulent influenza virus (Treanor et al., 1999). In studies such as these, influenza vaccines showed high efficacy and produced a protective immune response. The meta-analyses examined the efficacy and effectiveness of inactivated vaccines in adults (Demicheli et al., 2001), children (Smith et al., 2006) and the elderly (Rivetti et al., 2007; Jefferson et al., 2005). In adults, vaccines show high efficacy against the targeted strains but low effectiveness overall, so the benefits of vaccination are small, with a one-quarter reduction in risk of contracting influenza but no effect on the rate of hospitalization (Demicheli et al., 2001). In children, vaccines again showed high efficacy but low effectiveness in preventing “flu-like illness.” In children younger than age two, data are extremely limited, but vaccination appeared to confer no measurable benefit (Smith et al., 2006). In the elderly, vaccination does not reduce the frequency of influenza, but may reduce pneumonia, hospital admission and deaths from influenza or pneumonia (Rivetti et al., 2007; Jefferson et al., 2005). The measured effectiveness of the vaccine in the elderly varies depending on whether the population studied is in residential care homes or in the community, with the vaccine appearing more effective in an institutional environment. This apparent effect may be due to selection bias or differences in diagnosis and surveillance (Wikipedia, n.d.).

The Case Against the Vaccination Evidence

An analysis and comment on public health in the British Medical Journal, written by Tom Jefferson, co-coordinator of the vaccines area of highly respected healthcare researcher Cochrane Collaboration, said “an ‘urgent’ review was now needed of the government’s vaccination campaign.” He finds three serious problems with the current research claiming efficacy:

  1. Heavy reliance on non-randomized studies that are suggestive of protection, but the extent was impossible to measure because of the weak methods used in the primary studies.
  2. Either the absence of evidence or the absence of convincing evidence on most of the effects. In children younger than age two, inactivated vaccines had the same field efficacy as placebo; and in healthy people younger than age 65, vaccinations did not affect hospital stay, time off work or death from influenza and its complications.
  3. The small and heterogeneous dataset on the safety of inactivated vaccines, which Jefferson finds surprising given their longstanding and widespread use. Also it is noted that there appears to be no evidence that annual revaccination is harmful. Such a lack of knowledge is surprising (Jefferson, 2006).

In response to the Canadian government proposing to spend $125 million on immunizing the population, the Globe and Mail published an article: “Universal flu shots; the $125-million question.” It was written by Alan Cassels, a drug-policy researcher with the University of Victoria, and Jim Wright, a professor in the departments of pharmacology and therapeutics and medicine at the University of British Columbia. “A recent systematic review of more than 25 studies of flu immunization came to conclusions quite different than those recent front-page headlines would suggest. The internationally recognized Cochrane Collaboration (which accepts no money from the pharmaceutical industry) did a systematic review of all randomized trials studying the effectiveness of influenza vaccination, and concluded that the evidence does not support universal immunization of healthy adults. This study found that the flu shot reduced the incidence of clinical influenza on average by 6%, but there was high variability in effectiveness. There were not enough hospitalizations or deaths in the data to come to any conclusions as to what kind of payback the vaccines are delivering. So the jury is still out on whether a flu shot for all Canadians is a good use of scarce healthcare dollars” (Cassels and Wright, 2004).

Allopathic Treatment for Flu

The usual advice is to get bed rest, drink plenty of fluids and take aspirin to diminish the fever. Many physicians routinely prescribe antibiotics to treat the flu, a viral infection, although secondary bacterial infections may benefit. Several anti-viral drugs have been developed. The FDA has approved oseltamivir phosphate to treat the flu. Several studies have shown it to be effective in preventing and treating the influenza virus. It is up to 92% effective in preventing influenza in adolescents, adults and the elderly (Peters et al., 2001). As well, ribavirin, a Hep C drug, has been used for more than 20 years to treat the flu (Segala, 2003).

Naturopathic Therapy

Naturopathic treatments and preventive approaches to treating the flu are numerous. I like to joke that for every dozen NDs there are two dozen flu treatments. The principles are similar, but everyone has his or her own favorite approach; homeopathic prophylaxis and remedies, hydrotherapies, immune-enhancing diets, herbs, vitamins, injections, mushrooms, hormones and many other nutrient supplements. Philosophical variations occur with the Pasteur “viro-centric” perspective, which utilizes natural therapies to stimulate immune function and provide anti-viral treatments. This may be contrasted with the milieu model and the homotoxicology approach, which states that the terrain is everything. In this model, the influenza infection is categorized as being in the cellular impregnation phase of mesenchymal tissue. In this phase, inflammation is present and decomposition of the mesenchymal basic substance has occurred. The inflammation is due to the overload of homotoxins and the virus may be considered to be a homotoxin itself. The reversal or regressive vicariation to a more benign phase begins by allowing the “stimulation therapy” of the fever (Reckeweg, 1984). The disease symptoms and the healing effects are viewed as being part of a “unified reaction process of the ‘holistic body’” (Kirkman, 2006).

However varied our therapeutic approaches are, many are the results of collective anecdotal experience, therapeutic and philosophical biases, home remedies, a synthesis of available research or the last seminar attended. No matter the approach, the ND surely has much more to offer a patient than simply bed rest, fluids and aspirin.

Final Question: To Vaccinate or Not?

It is the policy of the B.C. Naturopathic Association to neither advocate for nor against vaccination. This, I believe, is the right position to take. The decision is one for patients to make based on the most reliable information available to them. It is our ethical responsibility to assist patients in making their own decisions, without influence of our own opinions or biases, and to continue care no matter their choice. Some doctors are passionately anti-vaccine, but keep in mind that the patient is asking for our advice and educated opinion, not a rant against a cavalier “medical-industrial” pharmaceutical industry.


brownHal Brown, BA, DC, ND, RAc graduated from the Ontario College of Naturopathic Medicine in 1989. Prior to that, he received his DC degree at the Canadian Memorial Chiropractic Medicine in Toronto, and he received qualification as an RAc by the British Columbia College of Acupuncture in 2001. Dr. Brown teaches at the Boucher Institute of Naturopathic medicine as chair of and instructor in the physical medicine department. He is co-founder of Integrative Healing Arts in Vancouver, and is a member of various naturopathic and alternative medicine organizations.

 References

Blakemore C: Battle of time, luck and science, The Sunday Times – Britain Apr 9, 2006. Retrieved online June 22, 2006.

Merck: Viral Infections: Merck Manual Home Edition: www.merck.com/mmhe/sec17/ch198/ch198d.html.

CDC: Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR Recomm Rep Jul 28;55(RR10):1-42, 2006.

Segala M (ed): Influenza virus, disease prevention and treatment (4th ed). Ft. Lauderdale, 2003, Life Extension Media, p.1049.

National Archives and Records Administration: www.archives.gov/exhibits/influenza-epidemic/.

Johnson NP, Mueller J: Updating the accounts: global mortality of the 1918-1920 “Spanish” influenza pandemic, Bull Hist Med Spring;76(1):105-15, 2002.

Hilleman MR: Realities and enigmas of human viral influenza; pathogenesis, epidemiology and control, Vaccine Aug;20(25-26):3068-87, 2002.

World Health Organization (WHO): www.who.int/csr/disease/influenza/influenzanetwork/en/index.html.

Horwood F, Macfarlane J: Pneumococcal and influenza vaccination: current situation and future prospects, Thorax 57 Suppl 2: 24-30, 2002.

Treanor J et al: Evaluation of trivalent, live, cold-adapted (CAIV-T) and inactivated (TIV) influenza vaccines in prevention of virus infection and illness following challenge of adults with wild-type influenza A (H1N1), A (H3N2), and B viruses, Vaccine 18 (9-10): 899-906, 1999.

Demicheli V et al: Vaccines for preventing influenza in healthy adults, Cochrane Database Syst Rev CD001269, 2001.

Smith S et al: Vaccines for preventing influenza in healthy children, Cochrane Database Syst Rev, CD004879, 2006.

Rivetti D et al: Vaccines for preventing influenza in the elderly, Cochrane Database Syst Rev 3:CD004876, 2007.

Jefferson T et al: Efficacy and effectiveness of influenza vaccines in elderly people: a systematic review, Lancet 366(9492):1165-74, 2005.

Clinical trials of vaccines: Retrieved from http://en.wikipedia.org/wiki/Flu_vaccine#_note-Demicheli.

Jefferson T: Analysis and comment, public health, influenza vaccination: policy versus evidence, BMJ Oct 28 333:912-915, 2006.

Cassels A; Wright J: Universal flu shots: the $125-million question, Globe and Mail, November 29, 2004. Retrieved from www.theglobeandmail.com/servlet/story/ RTGAM.20041129.wfluu29cm/BNStory/specialComment/.

Reckeweg H: Homotoxicology (2nd ed), Albuquerque, 1984, Menaco Publishing Company, pp 23, 51, 116, 122.

Kirkman: What is homotoxicology and bio-regulatory medicine all about?, Academy of Homotoxicology and Bio-Regulatory Medicine 24, 2005. Retrieved from www.sochomotox.com/whatis.pdf.

 

 

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