Tag Archives: vaccinate

Your Team Made the Super Bowl? Better Get a Flu Shot

As an emergency medicine physician, popular spectator events such as the Super Bowl usually mean little more than a temporary slowing in the rate of patient arrivals, especially among males, a phenomenon described in several countries in addition to the U.S.

A recent Upshot post shows that the impact of widely popular spectator events extends beyond decreased visits. The post cites a study published in the American Journal of Health Economics showing that the death rate from influenza is higher among those whose home team makes it to the Super Bowl. Across all ages, 5.6 people per million die from the flu, a rate that increases to about 6.6 in Super Bowl-contending areas. Although it is too early to tell if this is relevant this year, the mortality impact is about seven times larger when the peak of the flu season occurs closer to the Super Bowl than when it is held about three weeks or more before or after the peak.

The flu virus can spread whenever a person with it sneezes, coughs or even talks (or yells loudly at a televised referee), releasing droplets of saliva within six feet flumainof someone without it. At a Super Bowl party, people are mingling closely. Because influenza becomes contagious beginning 1 day before symptoms develop; in fact, some evidence exists that people become even more sociable than usual during that contagious, pre-symptomatic period.

Super Bowl parties are not unique in providing large numbers of people the chance to be within 6 feet of someone with influenza.  Other large gatherings have been shown to increase influenza spread, including the Salt Lake City Winter Olympics in 2002, large music festivals in Hungary and Belgium, and the Hajj pilgrimage.

As a resident of one of the towns sending a team to the Super Bowl this year, I again remind my readers it is not too late to vaccinate against influenza
. Other prevention measures recommended by the Centers for Disease Control and Prevention include

  • frequent hand washing
  • avoid touching your eyes, nose and mouth
  • clean surfaces frequently touched in your home or workplace
  • use hand sanitizer

One scourge not shown to be associated with Super Bowl Sunday is domestic violence.  The claim of a rise in domestic violence on Super Bowl Sunday was propagated by the media starting right before the 1993 Super Bowl. Myth-busting website Snopes.com traces the momentum of the myth here. For example, the AP labelled Super Bowl Sunday the “Day of Dread”, and the myth has been propagated more recently. However, the association between football and intimate partner violence (IPV) is not as unfounded as suggested by Snopes.  A study found that football game upset losses led to a 10% increase in IPV, whereas non-upset outcomes of football games led to no change from baseline rates of IPV. Of note, the study found IPV associated with other days of the year and with the weather:

The resulting estimates show large and precisely estimated effects of major holidays on the rate of IPV: for example, Christmas day +18%, Thanksgiving +20%, Memorial Day +30%, New Year’s Day +31%, New Year’s Eve +22%, and July 4th +29%. They also show a significant positive effect of hotter weather: relative to a day with a maximum temperature less than 80 degrees, IPV is 8% higher when the maximum temperature is over 80. Thus, an upset loss is comparable to the effect of a hot day, or about one-third of the effect of a holiday like Memorial Day or the Fourth of July.



Personalized preventive medicine

Much research and media attention have focused on personalized medicine.  The National Cancer Institute defines personalized medicine as “a form of medicine that uses information about a person’s genes, proteins, and environment to prevent, diagnose, and treat disease.”  Although this definition includes prevention, much of the focus of personalized medicine has been on treatments, with a focus on genetics as the key determinants of a patient’s predicted response.  President Obama’s Precision Medicine Initiative, for example, which this month is 12 months old, focuses on tailoring treatments to the individual, with little mention of personalizing preventive medicine modalities.

Per the CDC’s Preventive Care site, preventive care includes both health promotion and disease screening.

  • Health promotion includes proper immunizations, managing one’s weight, being physically active, eating a healthy diet, not smoking, drinking moderate amounts of alcohol, wearing seat-belts/helmets, getting enough rest, surrounding oneself with family and friends, driving safely, managing stress, and, in general, living what most would agree is a healthy lifestyle. These are activities that often do not require medical personnel–they are often individually guided, or can be policy-related, such through laws requiring seatbelt use, taxing cigarettes, and restricting the availability of sugary drinks at schools.
  • Disease screening includes health services like mammograms, colonoscopies, Pap tests and regular tests of blood pressure and cholesterol.  These services generally involve medical personnel.

The CDC site also includes a tool you can use to identify the recommended disease screening services by age and gender, reflecting a basic level of preventive care personalization by these two factors.  A Health Affairs article provides a more detailed overview of preventive health modalities and the potential cost-benefit for them.

PrintA recent NY Times post highlights the value of personalized preventive medicine:  it summarizes recent studies that show the way we absorb and metabolize various foods is highly variable and thus dietary advice is not one-size-fits-all.  Some of the factors that determine an individual’s response to various foods include demographics, genetic makeup, gut bacteria, body type, medications, family history, lifestyle, and chemical exposures. A video summary of one study featured, “Personalized Nutrition by Prediction of Glycemic Responses” is available here.  Although recently we have learned more about the ideal “dosing” of exercise for the population, the recommendations are not personalized.

One of the more controversial attempts at personalizing preventive care was the U.S. Preventive Services Task Force guidelines on mammography.  After review of existing research, the Task Force decided against recommending mammography for some women in their 40s.  The personalized preventive medicine approach also took into account family history: the Task Force recommended that women with mothers or sisters with a history of breast cancer may benefit more from screening in their 40s.mh-strat-determinants-of-health-en

Times Square and Influenza

On this New Year’s Eve, I wanted to share this factoid from the CDC on the benefits of influenza vaccination in the 2014-15 flu season.  As you see the nearly one million people counting down to 2016 in Times Square, remember that the flu vaccine prevents that many people from needing medical visits in one season. If you want to track this season’s influenza numbers, there is a great interactive feature at the CDC’s website, featuring mapping of influenza activity, as well as hospitalizations and deaths.

Vaccine-preventable illness

As a pediatric emergency medicine provider in a state with a high proportions of vaccine-refusers, I often treat vaccine-preventable infections. This week was no exception, with one of the cases particularly severe.

A New York Times piece reminds us that vaccine refusal is most prevalent in white, higher income regions. The lowering of herd immunity in clusters like this allows vaccine preventable diseases to spread to the unimmunized as well as to their vulnerable neighbors–people too young for vaccines or immune compromised through cancer or other conditions.

The vaccine risk-benefit numbers are among the best in medical science and yet still many patients and families don’t believe the science.  The most common reactions I hear in these cases are “I had no idea this disease could be so bad” and “I thought you could just wipe out the infection with medicine.”

The first reaction demonstrates one issue contributing to vaccine refusal: that vaccines are a victim of their own success. Thanks to vaccines, most have not seen or known people who experienced vaccine-preventable diseases, and thus the benefit of vaccination seems remote.  One exception is influenza–the most common vaccine-preventable killer in our country–as those who suffer the greatest risk of death are at the extremes of age, pregnant women, the very obese and the medically frail. This is also the most common vaccine-preventable illness I treat, and the cause of the most vaccine-preventable deaths in my clinical setting.

Here is where I hear the most of the second reaction–the realization that antiviral medications, like oseltamivir, can help reduce the risk of influenza-related death, but not eliminate the risk completely. Many on the list of vaccine-preventable illnesses–such as measles, tetanus and polio–have no antimicrobial treatments, just supportive care.  For others on the list–including influenza, pertussis, epiglottitis and meningitis–antimicrobials can improve outcomes, but not eliminate risk once the patient has the illness. One reason these conditions were targeted for vaccination development is precisely because they are both dangerous and difficult to treat–prevention is essential to reducing mortality. This is a similar scenario for cancer, as a recent commentary notes, but financial pressures incentivize pharmaceutical companies to focus on treatment rather than prevention.