Is the flu vaccine safe?

Every now and then we hear in the news about individuals and groups that are opposed to vaccinations. Some of these people claim that vaccines are linked to health problems such as autism and have formed powerful lobby groups that are questioning the safety of vaccines. More perplexing, these agitators are sometimes backed by a prominent scientist that can help them recruit more followers.

The main mechanism of a vaccine is based on eliciting an immune response that gives the body a head-start against invading pathogens. A vaccine is designed to trigger expansion of white blood cells that may include Cytotoxic T cells and anti-body making B lymphocytes (or both) that are the main mechanisms for the body in the fight against pathogens. Here the body’s natural ability to fight infection is exploited by exposing it to either inactivated pathogens or live pathogen that has been attenuated in a manner that it will not cause a severe illness.

In the United States, the CDC (Center for Disease Control) is the main agency that is responsible for the control of diseases such as the flu which is caused by the cold virus. The flu vaccine can either be the inactivated virus or a weakened virus. The inactivated virus is recommended for pregnant women and is associated with better pregnancy outcomes. Overall, according to the CDC, the flu vaccine is the best way to protect someone against the flu virus and is recommended for individuals 6 months and above. The flu vaccine is associated with some side-effects such as pain and redness at the injections site, and mild fever and respiratory symptoms but nothing compared to the health toll that is associated with the real disease. According to the CDC director, 75% of the children who died during the 2017-2018 flu season were most likely not vaccinated. Most flu vaccines are made from egg materials and is of concern in people with egg allergy, however, some authorities recommend that people with mild egg allergy receive vaccinations because the benefits outweigh the risks.

The CDC monitors the safety of vaccines through four well defined mechanisms;

·         Vaccine adverse event reporting system (VAERS)-this is an early warning system that helps the FDA and CDC monitor side-effects following vaccination.

·         Vaccine safety data-link (VSD)-collects vaccine-related data between CDC and health care organizations

·         Clinical Immunization Safety Assessment (CISA)-helps CDC collect data on vaccine-associated health risks in medical centers.

·         Emergency preparedness for Vaccine safety-this is a program that enables the CDC activate the resources it needs in the event of a need for mass vaccinations.

According to the CDC, there is no evidence of a link between flu vaccination and Guillain-Barre Syndrome.

Overall, the flu vaccine has been demonstrated to be safe and effective and its effectiveness is pronounced in some groups such as the HIV positive. Flu vaccination is recommended by the CDC and the WHO (World Health Organization) and is on the WHO essential medicines list.

References

Haber, Penina; Sejvar, James; Mikaeloff, Yann; Destefano, Frank (2009). “Vaccines and Guillain-Barre Syndrome”. Drug Safety. 32 (4): 309-23.

Kaplan, JE (1982). “Guillain-Barre syndrome in the United States, 1979-1980 and 1980-1981. Lack of an association with influenza vaccination”. JAMA. 248 (6): 428.

“U.S. CDC director urges flu vaccinations as pediatric deaths mount”. Reuters. 2018. Retrieved January, 2018.

“Weekly U.S. Influenza Surveillance Report. Seasonal Influenza (Flu). CDC”. www.cdc.gov. Jan, 26, 2018 Retrieved Jan 26, 2018.

The relationship between alcohol use disorder and depression

The relationship between alcohol and depression reminds me of John and Deborah who have been married for about 30 years. They were high school sweet hearts and started their family while Deborah was 19. John did not bother going to college and has a steady job as a foreman in a local factory while Deborah had to drop out of college because she couldn’t cope with being a mother of two as well as handle all the course work. Now they are in their late 50s and are empty nesters. With no one to parent or coach, they now turned on themselves.

Sometimes they stay late arguing about something trivial with John refusing to back down but he’s forced to when an exhausted Deborah falls asleep. The only thing they do together with dignity is Sunday mass where they enjoy the company and sermons of the local pastor. Although John always had drinks after work, it has clearly become a problem because his manager called Deborah to tell her that he drinks before he gets to work. Lately John has been very quiet at home and he hasn’t been playing his favorite songs or working in the garden as he used to.

John is an example of the paradox that confronts scientists when it comes to alcohol use disorder and depression. Depressed mood is known to lead to alcohol seeking behavior in college students but it has not been demonstrated in non-college adults (Kenney et al, 2018). In John’s case it is difficult to tell if his alcohol abuse led to his depression symptoms or if his depression symptoms led to alcohol use disorder. One thing is clear; there is a causal link between alcohol use disorder and depression. Alcohol abuse disorder has been shown to lead to major depression (Boden and Fergusson, 2011). Neurophysiological and metabolic changes induced by alcohol are thought to be behind the depressive effects of alcohol abuse. That said, about one third of patients with major depression have substance abuse as a co-morbidity making it important to consider alcohol use disorder while managing major depression patients (Davis et al, 2008).

Here are some of the effects of harmful and hazardous alcohol use;

·         Brain/Central nervous system-dependence, depression, memory loss, irrational behavior, arguments, violence, anxiety, paraesthesia, loss of sensation, numbness, position sense abnormalities

·         Accelerated aging- drinker’s nose

·         Immune system-frequent colds, Pneumonia, Cancer of the throat, mouth, breast.

·         Heart-cardio-myopathy, heart failure, anemia

·         Nutrient deficiency- bleeding, severe inflammation, vomiting, diarrhea, malnutrition

·         Gastro-intestinal tract-ulcer, pancreatitis, liver cirrhosis and cancer.

·         Genito-urinary-impaired sexual performance. In women; birth abnormalities

(Adapted from AUDIT, WHO)

Ideally, the goal would be to prevent alcohol abuse because it will cut the risk of depression.

Overall, it is important to screen for alcohol abuse as well as depression because of the causal relationship between the two.

Is alcohol good for you?

Alcohol (ethanol) is an interesting compound and is a subject of enjoyment, fun, pain as well as controversy. According to evolutionary biologists, organisms on earth developed the ability to metabolize alcohol about 10 million years ago from the need to utilize fermented fruits as food.

Alcohol is synthesized in the body as a byproduct of other metabolic reactions and it is estimated that humans make about 3 grams of alcohol daily from the fermentation of food material in the digestive system. The main pathway for alcohol metabolism involves the oxidation of ethanol into acetaldehyde by the enzyme alcohol dehydrogenase. Acetaldehyde is then converted to acetic acid which is then converted to acetyl-CoA. Acetly-CoA is then funneled through the energy generating pathways in the cell mitochondria which is the power house of the cell.

While the body can handle small amounts of alcohol without incident, problems arise when we introduce large quantities of alcohol into the body. Build up of large quantities of ethanol metabolic products such as acetaldehyde is believed to be responsible for the deleterious health effects of consuming excess quantities of alcohol. Acetaldehyde is highly toxic and is even more so in the absence of Vitamin C or Thiamine (Vitamin B1). Hangover and altered consciousness are believed to be mediated by these agents. In addition, ethanol inhibits the enzyme ADH (anti-diuretic hormone) which is responsible for absorbing water in the kidneys into the blood stream and is responsible for the dehydrating effects of heavy alcohol consumption.

When it comes to alcohol, quantity is very important. While there are some health claims for moderate consumption of alcohol such as reduction of heart disease, those who don’t drink should not start drinking for health benefits. Resveratrol is an important anti-aging compound that is present in wine.

Here are the recommended limits for alcohol consumption;

·         One drink a day for women of all ages and men over 65 years of age.

·         Two drinks a day for men 65 years of age or younger.

This represents about 12-14 grams of alcohol.

Examples of one drink sizes are;

·         Wine- five ounces.

·         Beer= 12 ounces

·         Spirits- 1.5 ounces

Even if you have a risk of heart disease, you should not use alcohol as a drug. Best results are obtained when diet, exercise and when the right supplements are incorporated as part of a positive lifestyle.

The impact of depression

Depression is a serious medical condition that warrants meticulous attention to ensure adequate care of those afflicted with the condition. Depression is a potentially fatal condition because it raises the risk of suicide. According to the National Institute of Mental Health, about 16 million adults over 18 years of age were afflicted with at least one major depressive episode in 2015. This represents about 6% of the US population. These patients have depressed mood or loss of interest or pleasure for at least two weeks. In addition they have disturbances of sleep, energy, appetite, concentration and self image.

According to the latest information from the American Psychiatry Association, Major Depressive Disorder is estimated to cost as much as $210.5 Billion per year. Depression is estimated to become the leading cause of disability in 2020.

Depression has a major adverse impact in the lives of people (Kessler, 2012). Depression can lead to;

·         Decreased educational attainment

·         Lower income

·         Teenage pregnancy and childbirth

·          Unemployment

·         Low productivity

Further, depression hampers the ability of an individual to maintain healthy workplace and personal relationships. At the work place, depression has a negative impact through two recognized pathways;

·         Absenteeism- not showing up for work.

·         Presenteeism-low productivity while at work.

For employers, depression does not just lead to lower productivity; it also leads to increased health care costs. Over 60% of health care costs attributed to depression are spent managing conditions that are related to depression (Greenberg, 2015). Depression is associated with anxiety disorders, adjustment disorders, and post-traumatic stress disorder. More strikingly, depression is associated with non-psychiatric conditions such as Chronic pain, Sleep problems, Hypertension and Diabetes Mellitus.   

Ideally, mental health interventions should focus on activities and educational services that can prevent depression, however, current efforts to prevent depression are modest at best. Some of these activities include;

·         Healthy diet

·         Regular exercise

·         Leisure including engaging in practices such as meditation

·         Reasonable work hours.

Invariably, there’s a subset of patients that will require medication with anti-depressants. It is important to note that Psychotherapy is preferred over drugs especially in individuals younger than 18.  Anti-depressants are a major class of drugs that include;

·         Tricyclic anti-depressants (TCAs)

·         Tetracyclic anti-depressants (TeCAs)

·         Monoamine oxidase inhibitors (MAOIs)

·         Select Serotonin re-uptake inhibitors (SSRIs).

·         Norepinephrine reuptake inhibitors (NRIs)

·         Serotonin antagonists and reuptake inhibitors (SARIs)

·         Serotonin modulators and stimulators (SMS)

·         Serotonin-norepinephrine reuptake inhibitors (SNRIs).

·         Norepinephrine-dopamine reuptake inhibitors (NDRIs).

·         Atypical anti-psychotics

Before the prescription of anti-depressants, the severity of the depression should be determined. The Beck depression inventory is the most widely used psychometric test to determine the severity of depression. It is based on 21 questions and has undergone a number of revisions since its introduction in 1961. There are many other Psychometric tests that have been validated as sensitive and specific for Depression. Practicality is the key to determining which inventory a practitioner or provider would adopt. In addition to practicality, screens that generate anxiety, energy level, and cognitive data should be considered because of the expansive nature of depression. Some depression screening tools have to be administered by the provider or practitioner while some can be partially administered by a computer or electronic system. For example, the PHQ 2 and PHQ 9 have to be administered and scored by the practitioner. Patient administered inventories can be delivered by paper or through electronic devices such as ipads and similar devices.

There are some potential advantages of electronic administered systems;

·         Time sparing for the physician or provider

·         Patient privacy may lead to more honest answers.

·         Increase in number of questions and scope of data collection.

·         Portability of the electronic report.

However, provider supervision is a requirement to ensure that the patient understands the questions and that the correct response is made.

Overall, it is important that providers institute a practical system for screening for depression. Positive patients can be managed by the provider or can be referred to a Psychiatrist or Psychotherapist for further management. Each provider should discuss depression preventing activities with their patients with the intent on enrolling them on one or more activities that can prevent depression.