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The Untreatable: The Spanish Flu of 1918 (lrb.co.uk)
96 points by Vigier 3 months ago | hide | past | web | favorite | 105 comments

Last week, someone I know died of this year's influenza. He was 33 years old and reasonably healthy. He got pneumonia, and his heart failed.

This is the first time in my life I've experienced a healthy young adult dying of influenza. It's terrifying.

I'm so sorry to hear of your loss. One of my friends died at a similar age of a brain infection, another died of a rare form of Leukaemia and one died in his forties of an embolism. We are insulated from the idea of death and we have the impression we are immune. The death of the first of my friends in adulthood changed my life positively, I realised that I had to compromise and choose between my ambitions because endlessly delaying gratification might lead to a bitter and empty funeral. I found a happy and immediate, if less exalted, path. The death of my friend a couple of years ago, of the embolism, wasn't like this - I expected and hoped for more epiphany, but didn't find any meaning or change this time. All I can say to you is that your grief and fear are normal, and that you may find comfort and a way forward in time. We're all looking my friend, and we hope to find before our own end.

Pneumonia vaccine might have prevented such a death - depends on the individual, of course. This option appears to be less well-known than the flu vaccine (and is only reccomended for some of the population). https://www.cdc.gov/vaccines/vpd/pneumo/public/index.html

A health care system that isn't a cause of stark financial terror for the poor would have prevented his death. He didn't go to the doctor because he was poor and uninsured, until it was too late.

This. I didn't know about it, but the nurse at my GP practise nonchalantly said "Oh, since you're asthmatic you're eligible for the Pneumonia vaccine as well, I'll give it to you now if you want".

Sorry to hear. It seems influenza is one of the comparatively few things that can kill us as easily now as it could in the relative dark ages of medicine.

I wouldn't say that. One of the main ways flu can kill you is secondary bacterial infection (e.g. pneumonia), and we now have antibiotics for that.

74 deaths blamed on flu (correctly or not) in California thus far:


Yes, but almost exclusively those who die are immune compromised, under 5 months old, or elderly.

What's terrifying is healthy adults dying of flu.

Did he not get treated fast enough?

Did he get the flu shot?

> Computer modelling suggests that if the 1918 H1N1 virus were to break out of the facility in Atlanta it would cause around thirty million deaths.

Considering the original death toll of 50-100M deaths, and today's increased population and rapid communication (air flight), that's actually a very impressive number in how low it is.

Edit: I wonder how much of the improvement is due to the surviving population's natural immunity?

I would expect that a significant factor is that we both have better treatments nowadays and treatment is much more accessible.

In 1918 a lot of people, especially in rural areas, probably died before they even had a chance to see a doctor. A rural person could easily be a day's travel or more by horse drawn wagon away from a doctor.

It might take two people to take the sick person. One to handle the horse and wagon, and one to tend to the sick person. Having two healthy people away from work for several days, and having the wagon unavailable for that time, could be a serious hardship.

I'd thus expect such people to tend to wait until it was clear that what they had was more serious than any normal flu they had had before. News traveled much slower in 1918, especially in rural areas, so they might not know that there is an unusually deadly flu pandemic in progress.

So by the time they realize that they are going to need help, it might be logistically too late.

Even if our medical treatment was no better today than in 1918, we'd probably save a lot more just because news spreads faster and more widely, we have faster transportation, and we have faster communication.

"I would expect that a significant factor is that we both have better treatments nowadays and treatment is much more accessible."

If, by "treatment", you mean access to clean water, sanitary conditions and decent rest, then I would agree: we're certainly better off than rural populations circa 1918. I suppose access to IV fluids could be helpful if you're elderly, or otherwise immune-compromised.

Beyond that, not much has changed since 1918.

The flu is a virus and is not affected by antibiotics. Further, the two antivirals associated with influenza either do nothing[1] or almost nothing[2].

Very much like there is no such thing as "cold medicine" (contrary to what TV says) there is also no such thing as a broadly useful flu treatment. What you're most likely to receive from a doctor is relief of superficial symptoms.

Going to a hospital for the cold or the flu will potentially expose you to much more serious bacterial infection.

[1] "Overall the benefits of neuraminidase inhibitors in those who are otherwise healthy do not appear to be greater than the risks." (https://en.wikipedia.org/wiki/Influenza#Treatment)

[2] "These drugs (M2 inhibitors) are sometimes effective against influenza A if given early in the infection but are ineffective against influenza B viruses" (https://en.wikipedia.org/wiki/Influenza#Treatment)

I hope you are not involved in public health because you are dangerously misinformed.

A major cause of flu death in otherwise healthy people is secondary bacterial infections and high quality home care would really help.

Your statement re: antibiotics is accurate re: the primary problem but not in terms of actual cause of death which is very often secondary infection.

I would choose hospital care over home care any day of the week, but if there were a serious outbreak then government paid time off for carers plus basically universal antibiotics would be a logical response.

I think you are being too directly logical and not thinking systemically.

"high quality home care would really help."

I am in complete agreement. Not only would high quality home care help, it is, largely, the only thing that helps.

"I would choose hospital care over home care any day of the week..."

I think that's a very bad heuristic that is widespread in the US - across a broad spectrum of socio-economic and cultural backgrounds. If you just have the flu a visit to the hospital is useless at best. At worst, that secondary bacterial infection you're (rightly) worried about is alive and well at the hospital. Hospitals are breeding grounds of such infections.

"I think you are being too directly logical and not thinking systemically."

I am indeed thinking systematically - as I have witnessed emergency rooms full of kids with colds and flu who will be given comfort and/or placebos and who are racking up healthcare costs and displacing actual emergencies. And then there's the exposure to bacterial infections ...

And treatment of superficial symptoms might even be harmful


That feels wrong to me. I don’t know how the rest of the world operates, but here in America I suspect the health system would struggle to even begin to cope with seeing a 50fold increase in patients across the board across the country. Just the strain on hospitals and respiratory support systems like ventilators alone would quickly make modern healthcare seem more or less like it was in 1918. Additionally, unlike in 1918, few households today have spare capacity to homecare gravely ill family members as in most middle class families both partners must work to provide a living wage.

I would have thought that rural folks would’ve been less likely to get the flu sine they are around fewer people.

There are still communities. People go to church, sell their goods, and pay for services. You might be exposed to fewer people in a rural location, but in a world where even electricity is a luxury (rural Spain in 1918), there's still a good deal of human interaction.

> Rural Spain

The so called "Spanish" flu was not from Spain; the first reported case was from France. It killed happily people all around the world spreading from military camps and soldiers returning home. Was tagged as spanish because many countries were in war and censored carefully any bad news about people dying in mass in their territories to avoid the enemy (and their own citizens) having this sensible information. As Spain remained neutral in the first World War, the spanish press documented the problem freely and extensively instead. Spain lost only the 1% of their population (around 200.000 people) whereas France lost 400.000, USA lost the 28% of their population (around 550.000) and 30 millions of people died in China (maybe should be called chinese flu instead? or even better the WWI big flu?).

The tag was bassically an attempt from politicians to blame a foreigner country, hide the problem under the rug and avoid assuming responsabilities in his countries. The oldest trick in the bag.

550,000 would have been about 0.5% of the US population in 1918.

I think the parent is conflating two different numbers. It looks like about 675,000 died in the US and about 25% got sick.

thanks for the correction

It’s only a model. The housing market crash and the 2016 election show how wrong models can be, even if all the inputs and the formula make sense.

They could be off by a factor of ten. In the wrong direction. We won’t know until it’s time.

The housing market formulas did not make sense. They assumed that default probabilities were uncorrelated.

I'd guess the biggest lever in the model is an assumption about using Tamiflu for prevention/treatment. Perhaps also faster detection and coordination between public health entities.

AFAIK, immunity to a particular flu strain is acquired through exposure (via infection or vaccine) rather than passed genetically.

Immune response to the flu does vary across populations. The CDC considers American Indians/Alaska Natives to be at higher risk of complications than the population at large.

Can they... get rid of it? I'm feeling nervous just reading that.

I get the flu shot every year (I have asthma - otherwise healthy), and have only had the flu a few times in my life. This year, with all of the stories of healthy adults being felled by flu has me nervous.

Bah, my germophobic ways (I avoid touching door handles, my face holes, etc.) will hopefully protect me. Except maybe from those jack-holes who need to prove how 'hard' they are by coming to work with a fever. You know who they are because not only do they look like shit, they make sure to announce to everyone that they're sick so that they get 'credit.'

I have integrated the same set of countermeasures[1] in my life for the last ten years or so. And do not consider them in any way phobic. They have reduced my rate rates of infection to exactly zero.

I shall step up my defense level an extra notch or two if a serious pan- or epidemic comes around. Some will chide me for squeemishness, but really, I find not sticking my fingers in my mouth an acceptable price for a markedly reduced risk of illness and death.

[1] Shopping trolleys and baskets considered harmful

So what are those countermeasures? Do you wipe down everything you touch when you go shopping?

Simple stuff.

Maintain a flag: Did I touch some probably disgusting surface [trolley/phone/mouse/keyboard/door handle/seat/other people/whatever]? If so, do not touch mouth/nose/eyes/wounds/food until hand properly washed.

Is some idiot coughing or sneezing his heart out? Shut my fuck up and breath through the nose.

Consider everything brought home from supermarket to have potentially contaminated surfaces (checkout-conveyors are disgusting).

That kind of thing. Really just a question of habit. Not in any way going Howard Hughes. I once had a girlfriend who did that (going slightly bonkers from studying medicine (but fine today, and a practicing doctor, better for the experience)), and am well aware of the danger signs.

I used to be very much not a germaphobe. Then I started riding public transit and was endlessly sick for months at a time. I implemented your exact regimine. Lo and behold, I can now go years without getting a cold.

No arguing with those results.

Forget it if you ever have a kid. I used to do the exact same as you, but realized it was impossible to keep it up after having a kid. Unless you’re willing to wash your hands literally every five minutes.

Having brought up a child as a single parent, I am perhaps not a perfect fit for that lecture.

When you have children everything changes. Then your success depends on teaching them to adhere to the same countermeasures—there isn’t much chance of that until they are older.

I had managed not to throw up for 20 years. That all went out the window when I had a child that attended school.

Same here. ...and while I can teach some basics to my 4 year old, there is absolutely nothing I can do about my 2 year old in daycare.

Actually I do have 3 kids, and I used to be sick all the time when my kids were little.

But now that my youngest is 12, things are much better and I rarely get sick :)

I also get the flu shot every year but I always catch the flu.

A few years ago I read 'The Great Influenza' by John Barry, which includes a historical perspective of US medical history leading up to the 1918 pandemic as well as digging into the pandemic itself.

I recommend the book.

The most amazing thing I learned from this book is just how primitive medical practice and training were in the U.S. at the turn of the 20th Century: there were no requirements for doctors to have science education or clinical training. Many doctors had to go to Europe to get better educations. This started changing shortly before the big flu epidemic, and the people - doctors and philanthropists - who brought about the changes were also instrumental in the battle against the flu epidemic. The book is as much a biography of the key players as a history of the events.

Also, the book explains how huge numbers of deaths were caused by politicians and bureaucrats. The political machine in one city (Philadelphia, I think) refused to shut down a popular parade, as urged by the health authorities, to stop the spread of the flu. Lots of people needlessly got infected and died. The military packed excessive numbers of WWI recruits into camps designed for a fraction of the number of people, also against the advice of doctors; huge numbers of healthy young men caught the flu and died.

And the scientific detective story of how researchers tried to find a cure for the flu was very interesting, with ongoing controversy over what the infectious agent was (virus? bacteria?). We know the answer today, but it wasn't so clear back then.

It's a very good read on many levels.

Here's a link to the book on Amazon: https://www.amazon.com/dp/0143036491

This is a fantastic book - I can wholeheartedly concur with your recommendation.

Recommendation thirded. It's one scary and very informative book.

It’s fascinating that we had the theory of relativity and quantum mechanics at the time, yet we don’t know to this day why the Spanish flu was so deadly.

Another puzzling disease that appeared at that time and have disappeared since then was encephalitis lethargica: https://en.m.wikipedia.org/wiki/Encephalitis_lethargica

Some hypothesize that the two were in fact related.

Some years ago I got the flu and two days later I became unconscious, went to a coma for five days. It took atleast six month for the hallucinations and the body aches to stop. Doctor said it was Viral Encephalitis. Worst days of my life, but still lucky to be alive.

Wow, encephalitis is no joke! You’re lucky to be alive. May I ask how old were you at the time?

I was 26 at that time.

That's terrifying. Can I ask - how did you treat the flu once you knew you were infected?

I got the flu this year. My symptoms were almost exclusively a fever. No significant aches.

I gave myself 2-3 days of 102 fever. Taking no medication, but laying in bed, drinking water, and eating as much as I ibuprofen and the fever broke. I continued taking for the next day, and by the end of the 4th day, I felt fine.

It's scary to think I may have just gotten lucky. I don't "know" what the right course of action is. I'd like to believe that letting your body fight the infection visa vi a fever is a good idea, assuming you're healthy enough to take that kind of physical stress. I don't know.

I was treated with Acyclovir for 2 weeks and Phenytoin as a prevention for seizures. After the treatment I had liver disease because of drug toxicity, but it got better over time.

Acyclovir for influenza? Maybe your doctors thought it was a latent herpes infection activated by the influenza?

> Maybe your doctors thought it was a latent herpes infection activated by the influenza?

More likely if he went to the doctor with aches and pains then it was prescribed on the theory that it might have been shingles.

isn't that just a generic anti viral?

“Aciclovir is active against most species in the herpesvirus family. In descending order of activity:[39][40]

Herpes simplex virus type I (HSV-1)

Herpes simplex virus type II (HSV-2)

Varicella zoster virus (VZV)

Epstein-Barr virus (EBV)

Cytomegalovirus (CMV) – least activity”


Maybe, but there was no mention of herpes anywhere in the doctor's report.

The liver thing makes no sense. Unless perhaps you added more than an acceptable dose of pain medication to that, and feel no need to mention those. Take any ?

> we don’t know to this day why the Spanish flu was so deadly.

Because it caused a cytokine storm in the patient. People were killed by their own inmune system. The most healthy inmune system (young adults in prime condition), the worst.


Yeah, that's one of the hypotheses.

I think anybody that got all conspiranoid about the bird flu and swine flu alarms of the last decade should read the accounts of the Spanish flu, a bird flu.

Young adults coughing blood foam. Towns where every single person died. Cities with bodies piled up on the streets because the undertakers died or wouldn't approach them.

The WHO raised the alarms because a bad bird flu is alarming.

> read the accounts of the Spanish flu, a bird flu

The non-human source of the Spanish Influenza is still debatable.[1]

[1] https://en.wikipedia.org/wiki/Spanish_flu_research

The article and the footnotes make it sound like the real debate is whether it went directly from bird to human, or jumped to swine first.

EDIT: The abstract of the paper that questions the origin asserts:

> In light of this alternative interpretation, we suggest that the current intense surveillance of influenza viruses should be broadened to include mammalian sources.

Then there’s this study, which contrasts with the author’s anecdotal statements regarding aspirin use during the Spanish Flu Epidemic.


Doesn't aspirin also contribute to less Vitamin C absorption in the body? For example: https://www.ncbi.nlm.nih.gov/pubmed/6811490

I also remember reading an article that mentioned the 1800s led to adoption of artificial fertilizers that contributed to higher crop yields, but less nutritious fruits and vegetables. I thought these factors, plus WWI, led to weaker immune systems and great conditions for infections.

The Plague was one of the major causes of the contraction of Eastern Roman empire. Never underestimate the ability of a disease to shift the balance of political power in the world.

Bear in mind, another 1918 like flu will come - and even modern medicine is basically helpless to stop it - we just know better how to treat it.

There is a flu almost every year. And we're pretty good at making vaccines. A couple of years ago there was a "training" in Sweden where every citizen was called in for mass vaccination. You didn't have to take it, but most people did. First medicine personnel, then pregnant, children and elders, then everyone else. If there is a dangerous flue like the Spanish Flu again, this is probably what will happen.

I'm surprised they don't mail the injections out instead of requiring people to assemble (a great place to spread disease).

The movie Contagion was partially set where I live in Minnesota - it contained depictions of people assembling for food, vaccines, treatment, and mass burial. Seeing local landmarks in the movie made it feel very real and made me think more about emergency preparedness.

Exactly, we have knowledge now and this knowledge will help us - everyone has heard of the swine flu for instance

The 1976 Swine Flu[0] is not a vaccination success story.

[0] https://en.wikipedia.org/wiki/Swine_influenza#1976_U.S._outb...

With global instant communication we could now can quarantine ourselves in our homes universally and on very short notice.

We can, yes. However, many people will not have the decency and self-restraint to actually do so, I fear.

This - you see many people clogging up GP surgeries in the UK with suspected flu, instead of doing the right thing and staying home, staying hydrated and taking paracetamol. It puts people who are also visiting the doctor for conditions where they have a compromised immune system, young children, pregnancy etc. at far greater risk. All the doctor is going to say is "yeah, you've got the flu, stay home, drink water and take paracetamol".

or the ability for money reasons.

Global instant communication is why we will all die. One person who knows what he’s talking about will be drowned out by fifty naysayers shouting fake news.

I read somewhere that the Spanish flu was basically what ended the first World War. Not sure if I believe it. In school, I had this history teacher who made a point of telling us - repeatedly - that major historical events can rarely, if ever, be traced to a single cause. But it might have played a significant role.

Also, I had no idea at all that it had spread globally. And a lot more people died from it than I had thought.

What would happen if such a disease came along today? Are we just lucky that it has not happened, yet?

IMHO, no, I don't think it ended WWI, it was probably the end of WWI that spread it globally so fast (plenty of malnourished soldiers going back home).

Maybe a bit off-topic, I wholeheartedly agree with your teacher, but even if a historical event has several causes, it's very common for there to be a single trigger that starts the whole thing. Everybody "knows" that the first world war started with the assasination of the archduke Ferdinand, but the causes were many (the alliance between France and Russia, between Germany and Austro-Hungary, the problems in the Balkans between Russia, the Ottoman empire and Austro-Hungary...)

As for your question, it probably has happened a few times (avian flu a few years ago?), but medicine is much better now and, on average, the population is healthier. Just these two facts alone make it much more difficult (but not impossible) for something like that from happening again.

Another off-topic, but I find it weird that it's called the Spanish flu when, apparently, it started in France. Spain was not part of WWI and didn't have wartime censorship at the time, so it was the first place that started reporting cases of it, but it didn't originate there.

> Maybe a bit off-topic, I wholeheartedly agree with your teacher [...] it's very common for there to be a single trigger that starts the whole thing. Everybody "knows" that the first world war started with the assasination of the archduke Ferdinand, but the causes were many

Yes! That is exactly what he tried to make us understand!

I loved that teacher. To him, learning history was not about memorizing dates and places[1], but understanding causal relationships. Also that us Germans had kind of lost our historical memory after World War II.

Also, he taught me the important lesson that two people can have diametrically opposing opinions (I was very left-wing at the time, he was "conservative"[2]) and still respect each other as human beings and acknowledge that the fact I disagreed with him on some important issues did not make either one of us an idiot or a bad person. When I look at the people often "debate" on the Internet, I think lesson might be more important than anything else he taught me.

[1] Those are important, too, obviously. But knowing the exact date World War I broke out was not nearly as important to him as understanding why it broke out, and why it would have broken out sooner or later, even if Archduke Ferdinand hat not been killed.

[2] Note that "conservative" in Germany does not mean the same thing as in the USA. My teacher was, for example, vehemently anti-Marxist, but he also pointed out to us that Marx's analysis of capitalism and its inherent contradictions was spot-on in many ways and still very relevant today.

We are much better equipped to deal with it. They didn't even know what caused it. We know what genes make the virus more lethal, have a good idea how it spreads, have a somewhat effective vaccine and have better supportive care.

Wow, I wish more articles were like this. Just two quick paragraphs of story time, then: fact, fact, fact, fact, fact.

This is going to sound insanely insensitive, but did he get the vaccine?

Actually, it is insensitive, because I would like to either use it in my arguments against anti-vaxxers, or learn where I went wrong.

I honestly worry about friends who don't vaccinate their kids, and I'd appreciate either vindication, or piece of mind that I shouldn't look for goblins ;)

Anti-anti-vaxx is pure flameland of the most tedious sort, and therefore off topic on HN.

Although I appreciate the self-awareness in your comment, it's also a pretty uncivil thing to post; so while it's good that you phrased it that way, better still would have been not to post it at all. Moreover, the data point you're asking for would rather obviously not have the significance you're ascribing to it.

We detached this subthread from https://news.ycombinator.com/item?id=16190609 and marked it off-topic.

I apologize if it was inflammatory, I didn't know that it was a flame bait topic (which I guess shows my own bias).

Thank you for your response and the info :)


Anti-vaxxers kill people, dang. I don't disagree with this, but I sure hope you mod anti-vax even more agressively.

C'mon, the whole point is that if it's a topic that elicits an aggressive response or an insistence on aggressive moderation (with indignant use of the world kill thrown in), it doesn't belong here.

There's unlimited opportunity to prosecute that cause elsewhere. Let's keep this place for discussing and learning interesting new things.

IMHO getting vaccinated is more about herd immunity. Everyone I've ever heard who proclaimed heartily that they don't get vax either said it makes them sick or they never get sick.

The first is unlikely, but some people do have reactions. It's more likely they had a coincidental cold or a psychosomatic reaction.

The second is irrelevant. Getting a vaccination isn't about YOU, it's about the vulnerable people around you and the vulnerable that will interact with the people around you. Also you could be infected and have no symptoms, so pass it around without knowing.

But I'm sure you already know that. I'm only mentioning it for fuel against the antivaxers you engage with, because they're endangering us all and need to be stopped.

>IMHO getting vaccinated is more about herd immunity. Everyone I've ever heard who proclaimed heartily that they don't get vax either said it makes them sick or they never get sick.

Its not a psychosomatic reaction. People frequently get minor, flu-like symptoms for a few days after getting a vaccine. While its not as severe as having the flu, people feel "sick" and so they accurately describe themselves as having gotten sick from the flu vaccine because it makes far more sense to talk about these things in the context of the way they make us feel, and no sense at all to talk about the underlying science behind vaccines that doesn't magically make us feel better just because its technically correct.

I get minor, flu like symptoms, which are still a pain in the ass, about 85% of the time when I get a flu vaccine (which is every year). Its still significantly better than getting the flu, but its pretty obnoxious that the medical community tries to shame people for noting the objective fact that getting a vaccine is still rather unpleasant. Its like our society is incapable of understanding nuance. You're forced to either take the side of anti-vax lunatics or pretend that vaccines have no side-effects.

Also, about your comment on the vaccination being for the good of the "herd". That's mostly correct, but it doesn't tell the whole story. According to the CDC, if you get vaccinated and then get the flu, the severity of it will be somewhat lessened and the chances of it becoming a severe illness will be reduced. So its still allegedly worth it for the individual.

> Its like our society is incapable of understanding nuance.

Nope, it's the side effect of having bodied cognition. We're optimized to make good-enough decisions in less than a second with three pounds of expensive to maintain rarefied material.

Short cuts within hacks within crufty work-arounds. It's amazing that it works so well, naturally. But it's not American, it's not Western, heck, it's not even human, it's the nature of thought and action in an ever changing world.

Thinking in binaries is a supremely powerful way to chop up the world and let's not discount it as a first approximation towards survival.

"I get minor, flu like symptoms, which are still a pain in the ass, about 85% of the time when I get a flu vaccine (which is every year)."

Just another data point: I've never gotten flu-like symptoms from the vaccine, and I've gotten vaccinated every year for many, many years now. At worst, my shoulder (around the injection site) is sore for a day after I get the shot. I've never had any symptoms at all from the nasal vaccine.

> our society is incapable of understanding nuance.

That's the pattern I see in a lot of public discourse. What I see all the time is: X may be a better position than Y, even though argument A for X is wrong and argument B for Y is very well thought out.

"if you get vaccinated and then get the flu, the severity of it will be somewhat lessened and the chances of it becoming a severe illness will be reduced."

I know of absolutely no science that supports that oft-repeated claim about influenza as a whole.

If the flu infection is from a different strain from any that person was vaccinated for, there is no demonstrated cause-and-effect from the vaccine that provides blanket mitigation for different strains.

It might not be supportable, but I was reading an article where some guy from the CDC said you're much better off if you've gotten it. I might be able to find it, but I suspect you're right that its not necessarily based on research.

In light of the fact that this person's friend died last week, perhaps you might lead with condolences for their loss before trying to figure out how you can use this death as a data point to vindicate your argument...

The flu vaccine is made by educated guess for which strains will be prevalent for the following season. It is not always correct. It is important, especially for certain groups of people, but not as essential as some other vaccines. We are not going to cure or eradicate influenza with vaccines like we have/can/are with many other diseases.

This is going to sound insanely pedantic to this commenter, but was the fatal strain in this case even present in this year's vaccine?

I'd bet that it wasn't. Fact is, for the past several years, the three/four candidate strains chosen for the USA vaccine were badly mismatched for what strains actually circulated in the wild.

Flu vaccines aren't like genetic vaccines (like for HPV), which are essentially foolproof for the targeted strain(s) and carry little risk of side-effects. Flu vaccines are more of a scattershot approach, with the "misses" generally ignored by the media.

CDC is estimating this year's vaccine is ~30% effective against the A(H3N2) virus in circulation.


In addition, influenza vaccine effectiveness (VE) in general has been lower against A(H3N2) viruses than against influenza A(H1N1)pdm09 or influenza B viruses. Last season, VE against circulating influenza A(H3N2) viruses was estimated to be 32% in the U.S. CDC expects that VE could be similar this season, should the same A(H3N2) viruses continue to predominate.

That's overall effectiveness against all H3 viruses, meaning that it isn't even totally effective against the strain it was specifically designed to protect against.

Plus, it's very early in the season. That's 70% failure already, and every new case grows that number.

Edit: typo

I think you mean H3 viruses.

Yes, sorry.

It probably was. H3N2, mentioned in the article, is the most prevalent and deadly this season - "2017-18 vaccine component strains are A/Michigan (H1N1), A/Hong Kong (H3N2), B/Brisbane (all vaccines), and B/Phuket (the quadrivalent vaccines)."

The vaccine isn’t particularly effective this year.

I've recently read that at best flu vaccines only offer 60% immunity. They are far from guaranteeing you won't get infected.

On the other hand, 60% is better than 0%. I always get my flu shots each year.

This year's vaccine is only 10% effective at preventing the worst strain. Part of the reason is we incubate the vaccine in eggs(?) and that doesn't work as well for this particular strain.

Flu vaccination cuts rate of infection by 2/3. You can't draw any conclusions from a single incident.

> or learn where I went wrong

Statistics and probability.

It might have been a biological weapon. I don't think anyone want to take credit for it though.

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