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All is as it should be again

Yes, it’s that time of year again. Time to get my flu shot.

So that’s just what I did yesterday. I decided to brave that evil, toxin-laden, mercury-infused nastiness, all in order to protect myself and my patients against influenze. As you might recall, last year, when I was off to get my flu vaccine, I pointed out that our cancer center required the flu vaccine for all employees who deal with patients, whatever their capacity, from physician to nurse to medical aide to receptionist. Refuse to get the flu vaccine, and you get to wear a mask any time you are in teh presence of a patient. It’s a reasonable policy, particularly at a cancer center, where there are all sorts of patients who are immmunsuppressed due to chemotherapy. As I pointed out before, it’s imperfect (personally, other than medical reasons, I see no reason why employees at a cancer center, where immunosuppressed patients are cared for, should not be required to be up on all their vaccinations, including the flu vaccine every year), but it’s a reasonable compromise between patient safety and personal freedom.

I did have one problem last year, though. There was no thimerosal in the vaccines our cancer center administered, leading me to ask, “Dammit, where’s my thimerosal?” There I was, left to console myself that Glaxo-Smith-Kline’s Fluarix, which was the vaccine administered last year, did still have , formaldehyde, polysorbate 80, and TRITON® X-100, but somehow it just wasn’t the same.

As I headed to the room where they were administering flu vaccines to employees, I wondered. What would happen this year? It turns out that I was in for a pleasant surprise. I looked at the label of the vaccine. It was Novartis’ Fluvirin. And guess what Fluvirin contains?

Yep, thimerosal, baby! Not just thimerosal, though, but also polymyxin, neomycin, betapropiolactone, and nonylphenol ethoxylate. It even contains trace formaldehyde.

My faith in big pharma is restored.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

83 replies on “All is as it should be again”

They won’t put thimerosal in my flumist 🙁 I tried to get my family shots instead but my son’s afraid of the needle… Now they’ll _never_ catch autism!

I have my doctor appointment soon and one of my plan is to renew all my vaccines including the flu one; unfortunately, only the one for the flu _may_ contain thimerosal but hell, we gotta do with what we have…

A.L.

Got mine a couple weeks ago. As I was in line, a woman behind me asked if they had thimerosal-free shots, and I wondered if she actually had an allergy or if she had simply fallen for some of the anti-vaccine nonsense. The person organizing the clinic had to check with the nurses, but they did end up having some thimerosal-free flu vaccines. That’s good, because it meant that this woman ended up getting her immunization.

A fine, uplifting story, sir, and one I shall relate to my hapless GP as he struggles through the annual back-to-school jabfest.

Rest assured I shall also post what’s in my vaccine when I get it this week.

Nothing but full-on “witches’ brew” for me, thank you. Aborted fetuses, formaldehyde, calf serum, thimerosal, eye of newt, the works.

Alright, so it might not have had eye of newt, but it’s still fun to think that it did… And that it was the eye of newt that keeps me from catching the flu.

My flu shot is not yet scheduled but with Orac’s reminder, I will make the appointment.

@Ajax,
You are out of phase with us on flu shots, yes? Have you already had this variety or will you get this version next year when fall comes down under?

We just got our email notice of the dates when the hospital provides us with free flu shots.

At this hospital (and the attached research buildings and offices that make up the health system) your ID badge gets a sticker when you get your flu shot and if you don’t have a sticker then there are parts of the hospital that you can’t enter.

I win. I got my flu shot at 36 weeks pregnant, courtesy of my OB, thereby vaccinating my fetus by proxy. (Said fetus is now a week old baby and napping contentedly.) “Too much, too soon” carried to its logical conclusion!

I plan to get mine at a shot clinic at my place of work this month.

FWIW, it looks like we’ll be getting immunized for H1N1 and a couple of Australian strains this year. From the CDC website:

†† TIV high-dose: A 0.5-mL dose contains 60 µg each of A/California/7/2009 (H1N1)-like, A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like antigens.

At least if the same strains are used in the regular dose version of Fluzone and by the other manufacturers.

We’ll probably be getting flu shots in late October/early November where I live.

I got my shot last year on general principles; this year with baby Mini-Composer here (two weeks old as of this past Sunday) I will be definitely getting the vaccine (and encouraging others to do so for Mini-Composer’s sake).

My wife gets her flu shot today. I’m waiting to hear about when our hospital will have available vaccine.

I am so hoping that this year’s vaccine will have antifreeze in it. I have such trouble starting up on cold mornings, and antifreeze sounds like just the ticket. No sucrose though. That stuff’ll kill you.

Orac : Sorry, I left the thimerosal in the cabinet, next to the tongue depressors.

My institution requires flu shots. They told us that they were required. They told us that we could be suspended if we didn’t get one. They told us that we could get a medical or religious exemption and conveniently provided forms if we wanted to request an exemption. What they did NOT tell us was WHERE THE FLU SHOTS WERE BEING GIVEN! Yes, I figured it out, but it was a very, very silly thing to forget.

You lucky bastard. I’ve really enjoyed this year’s healthy all-natural influenza, giving me a much-needed week of lost income and plenty of free time to shiver feverishly in.

I got mine at work a couple of weeks ago. But I forgot to ask whether it contained thimerosal or sucrose or anything. I’m so ashamed.

As for Orac, I’m sure he’ll become autistic any day now.

Big Pharma is probably in bed with Big Drug Store Chain:

This year after shooting me up with all of those yummy toxins that lace the vaccine, the pharmacist-trained jabber informs me that I should stick around *if case I get a reaction* or faint: a likely story!

We know that the longer you stay in a shop the more likely you are to buy additional items- mostly useless crap. Traipsing around the aisles, viewing the micro-waves, lawn furniture, perfumes, and expensive skin care products ( they sell lawn furniture and real parfums- not just celebrity nonsense) Fortunately, I have will power and hate lawn furniture. Be forewarned!

In my neck of the woods, pharmacies get the vaccine a couple months before doctor’s offices do. And most insurance (including mine) doesn’t cover it from a pharmacy.

Massive pain in the neck.

I decided to brave that evil, toxin-laden, mercury-infused nastiness, all in order to protect myself and my patients against influenze

So the flu shot is for the sissies now? Must be an off-label indication. I see.

I want monkey cooties in my flu shot! oh sorry, that’s the polio vaccine. Thimerosal it is, baby!

The Phoenix area has an unholy alliance between BigRetail and BigPharma … I got my flu vaccination from Mollen’s portable clinic set up at Walmart.

They were taking any sort of health care insurance, credit cards or cash. (They must be in the pay of BigPfinance too)

But it was the real thing: Drawn straight from a multi-dose vial with thimerosol. I forgot to get the ingredient list, but I know it’s going to weaken and kill me over the next 40 years or so.

I would have taken the DTP booster, but they had unpredicted demand for it that day and were all out.

-btw-

Simon Baron Cohen has the ASQ pencil-and-paper test online: so if anyone wants to self-test prior and post- vax. It’s easy, it’s fun!

It’s about that time, isn’t it? My Institution of Evil gives the free shots usually around mid-October; they had the tasty, tasty thimerosal flavor last time. I’ll also have to badger my husband to go to Walgreen’s to get his; he procrastinated last year (I wasn’t helping) and got a nasty fecking flu.

Simon Baron Cohen has the ASQ pencil-and-paper test online: so if anyone wants to self-test prior and post- vax

If I test as already on spectrum pre-vax can I stop worrying and get further vaccines with impunity?

@MikeMa

We are so out of synch we even call it ‘autumn’. Harsh.

If the nurse giving you the shot seems a little undereducated tell her you are allergic to horse serum. 😀

If I test as already on spectrum pre-vax can I stop worrying and get further vaccines with impunity?

No, we’re all out of impunity — but you can get it with thimerosal!

I’m so glad they took impunity out of the vaccines. Think of the children.

My office sent out a big email last week to remind us to get your flu shots (even told us when and where!) and said that if we wanted the thimerosal-free, we had to ask beforehand.

Wee flu shots!

I got my influenza vaccine today – thimerosal with a Tween 80 chaser. Bracing!

They didn’t offer me the option of having my vaccine with impunity – maybe that’s not available in my area.

Prometheus

Usually I get mine at Big Box Pharma Store — no hassle with appointments, waiting etc. My time is worth money & my insurance doesn’t cover it in either case (until next year, I think, when I am officially A Geezerette). This year I have to have some other vaccines to visit the Darling Daughter in Central America, so off I skip to the Travel Medicine department.

I’ll be sure to ask for the inserts.

And @Ajax at #7 —

Welcome to my autistic world. I welcome you with crossed arms.

Now that made me laugh out loud.

@ Liz Ditz: Some of us are already Geezerettes and Medicare does cover the vaccine. You will also be eligible for coverage for the adult Pneumococcal Polysaccharide Vaccine (PPSV) as well…given as a one time dose after age 65.

I got my influenza vaccine last month during a check-up with my primary care doc…single dose preloaded syringe…so I guess I didn’t boost my serum mercury level.

What they did NOT tell us was WHERE THE FLU SHOTS WERE BEING GIVEN!

I’m sure they’ll jab you in the bum if you ask.

My doctor told me that people with latex allergy shouldn’t take the flu vaccine, so I’ve been filling out the waiver at my hospital. I’m happy to wear a mask because of this. Are there other options for people with latex allergy?

Kate (if you are not a Dochniak sock puppet), get one of the four influenza vaccines without latex:

Fluzone Intradermal, NO
FluLava, NO
Afluria, NO
FluMist, NO

@ Kate: If you have only a contact (topical) allergy to latex…not a history of anaphylaxis-type reaction, it is not a contraindication to receiving influenza vaccine or any other vaccines.

I still need to get mine. Plan to this month, fingers crossed. (Can’t do it the same way as last year, so I have to figure that out.)

It’s always interesting getting my flu shot. Several years ago, I got a horrid reaction of severely limited use of the injected arm for around a week. This might not be such a big problem for most people, but with my mobility disabilities, it meant I could hardly get around. Because of that, I come prepared (shorts under my pants) and ask for my flu shot in my leg. Every time yet, the nurse that was going to do the injection has went to ask someone else if it was ok for me to get it in my leg. Every time, the answer has been yes and, half the time, the nurse higher up comes to give the injection. I’ve never had problems with it but I know when I go in that I’ll be the impetus for some production. 🙂

Bad experience with the flu shot last year:

I got mine during my lunch break. Doctor asked whether I was right- or left-handed. I said “right-handed” without thinking about it and he gave me the shot in my left arm.

That afternoon I had to analyze about 80 samples in the flow cytometer. Which means vortexing each one for a few seconds before analysis. Due to the set-up of the instrument and computer in the lab, I had to do the vortexing with my left hand.
OUCH.

Herr Doktor – I seem to remember that way back in your past that was indeed your injection site (something to do with diving headfirst into a chair to avoid the friendly needle-wielding GP)??

I got my flu shot back in April (NZer, dontcha know) – & then proceeded to pick up whatever was circulating in Taipei in July. Oh joy. Three days flat on my back & another week reclining in a lazy-boy chair 🙁

Why don’t we give injections in the butt anymore? It’s certainly got enough subcutaneous tissue on most people and a fair amount of muscle too. Pure social embarrassment? It’s quicker to roll your sleeve up than to drop your drawers?

Dianne:

Why don’t we give injections in the butt anymore? It’s certainly got enough subcutaneous tissue on most people and a fair amount of muscle too. Pure social embarrassment?

Umm, I think it’s because your butt is a lot more sensitive than your arm.

i get mine next week. i am gonna ask for the one with thimerasol and baby harp seal DNA.

harp seals are sooooo cuuuute.

Re: Butt vs. Deltoid

I recall reading somewhere that some vaccines actually have a decrease in efficacy when given in the butt rather than in the deltoid. I’ll have to try to find that info again, unless someone else pulls it up.

I recall reading somewhere that some vaccines actually have a decrease in efficacy when given in the butt rather than in the deltoid.

Wild. Too much chance of giving subq rather than IM maybe? If you could find the article without too much work I’d be interested.

@ Dianne: re your question ( @ 28) yesterday-
I have a suspicion that you ( and many here) can make the ASQ say whatever you’d like it to say, if you catch my drift. Thus we might generate some “test scores” to show anti-vaxxers: they would hate our conclusions but would admire the “methodology”- so familiar to them.

In other news: CNBC announces that Walgreen’s, despite the current economy, managed to make 3.1% last month! I rest my case.

The only childhood vaccine that children get that still contains thimerosal is the flu vaccine, which is given in the autumn.

Now I understand why it’s called autism.

I guess “fallism” sounded too silly.

Well, this isn’t where I first saw it, but a CDC publication on vaccine administration (PDF) states:

Deviation from the recommended route may reduce vaccine efficacy or increase local adverse reactions.

I also found a study on PubMed titled “Deltoid versus buttock as preferred site of injection for hepatitis B vaccine” (PMID: 2529345) which says:

The site may be important in provoking an appropriate antibody response. The deltoid is recommended rather than the gluteal. It is suggested that recipients of gluteal vaccinations receive revaccination in the deltoid.

I can keep looking for other info, but IIRC, I first saw it in one of the Pink Book chapters on one of the vaccine preventable diseases.

RTContracting:

The only childhood vaccine that children get that still contains thimerosal is the flu vaccine, which is given in the autumn.

Actually there are several available without thimerosal. Each and every pediatric vaccine has a form available without thimerosal.

I have a suspicion that you ( and many here) can make the ASQ say whatever you’d like it to say, if you catch my drift.

Indeed, self-assessment tools are notorious for over and under-diagnosis, especially when the person filling them out has an agenda. And this one appears to have no internal controls to ensure the patient isn’t simply presenting a “sick profile” (exaggerating their symptoms to make sure you take them seriously: a common and entirely natural tendency that’s a real pain in the butt-even without flu vaccines in the gluteal region.) It’s pretty easy to figure out, for example, that if you say “yes” to “I find it difficult to know what others are thinking by watching them” you’re going to get an aspie point.

But I’d still like to see what an anti-vaxxer would say if you said, “But I’ve already scored a 36 on the autism scale so why should I worry about the vaccine anymore, even if it does cause autism? Been there, done that.” Whether the score represents a true diagnosis or not.

The only childhood vaccine that children get that still contains thimerosal is the flu vaccine, which is given in the autumn.

Most healthy kids are given the inhaled live vaccine which, naturally, has no thimerosal.

@ Dianne:

I would bet real money that they would say that it’s dangerous to everyone, making people more “autistic”, and would probably include a laundry list of other problems it would cause *a la* the Canary Party.

I think you will find the answers to proper routes of administration of vaccines and the reasons for recommended routes of administration of vaccines in the CDC Pink Book:

Appropriate Vaccine Administration-Pink Book Appendix D

The reason why IM vaccines are not given in the buttocks is the potential of injury to to the sciatic nerve. Many of the inactivated vaccines contain adjuvants that can cause an exaggerated (pain, swelling and redness) reaction if given SC rather than the recommended IM route.

@55: Probably. I wonder if they include the risk of turning into the Incredible Hulk or Wonder Woman in their list. It was in VAERS…

The other reason not to give it in the buttocks is that it is a intramuscular injection. Most americans have more of a problem with the needle reaching their muscle through their butt than the needle hitting their sciatic nerve. Plus this year the flu shot needles are smaller than ever. As for latex, as an allergist I would be worried about giving a health care worker a vaccine that does come in a package that contains latex but there are many available that do not. This includes Fluria (CSL Biotherapies), FluLaval (GSK), and Flumist (Medimmune). As for egg allergies, while this was previously a contraindication, it has been shown that most severely egg allergic patients can get the flu shot without issue, though use of a low egg content vaccine would be preferable (Fluarix). I hope that helps increase immunization levels.

I am scheduled for my flu shot at work on the 18th. The consent asks about thimerosal allergic reactions, so hopefully I’ll get my mercury dose. I’ve been so lacking since they pulled Mertiolate off the market.

I got my two flu shots (swine & regular) at the same time at City Hall last year. They asked us to sit down for 15 minutes in case we had any reaction, but there was no merchandise to browse.

The mercury was taken out of most Canadian childhood inoculations ten years before the U.S. did it, with no effect on our autism rates. So there ha!

I certainly hope that any exemption for religious reasons carries the reminder that if you get the flu, it will be unpaid sick leave.

@ Monado, FCD: Just a small correction to your excellent post; The H1N1 strain of influenza was first incorporated into the seasonal 2010-2011 influenza vaccine used in the USA and Canada.

There was a shortage of the separate H1N1 flu vaccine during calendar year 2009…and most people were not eligible to receive it. During January 2010, after the shortage of the vaccine was past, it was then offered to the general population.

I got mine!! Last month, early I believe. Didn’t even feel it but the nice lady still had to tell me to breathe.

I got mine last autumn. But I later found out that it didn’t take – no antibodies. So everybody else plz have yours to keep me safe kthks!

Maybe it didn’t have enough thimerosal. Or impunity.

Or impunity.
Who knows what change those imps could achieve if only they would rise above their factionalism for once and learn to act in a coordinated way.

You mention personal freedom, but is there really anyone working at a cancer center who doesn’t believe in vaccinations? And if so, are they allowed to care for actual, real people?

Oh well. More thimerosal for you, right?

Knightly Q. Blowguns:

You mention personal freedom, but is there really anyone working at a cancer center who doesn’t believe in vaccinations?

The health of the patients is much more important than your beliefs. If you do not wish to participate in valid public health measures, then stay away from immune compromised persons.

Or, did you not know that those undergoing cancer treatment often have suppressed immune systems? They don’t need unwanted illnesses in their midst.

Do you also believe washing your hands is an assault on your freedom?

Ack! I think you are right. My most sincerest apologies.

Okay, time for more coffee.

@Chris: Not a problem. 🙂

I myself am a cancer patient and have had to deal with a compromised immune system. Going to the mall in the middle of a course of Temodar was fun. Little kids started to look suspiciously like plague rats.

Put the link in the box under “URL:”, the one below where you put your email address.

I was donating blood (#176) Sep 17 and noticed a small sign saying “Free Flu Shot”.
Got the shot after they pulled out the donor needle.

@ Todd W.

You can find the updated ACIP Recommendations at:

MMWR General Recommendations on Immunization January 28, 2011

Under the header “Nonstandard Vaccination Practices”

Variation from the recommended route and site can result in inadequate protection. In adults (but not in infants) (117), the immunogenicity of hepatitis B is substantially lower when the gluteal rather than the deltoid site is used for administration (90). Hepatitis B administered intradermally might result in a lower seroconversion rate and final titer of hepatitis B surface antibody than when administered by the deltoid intramuscular route (118,119). Hepatitis B administered by any route other than intramuscular, or in adults at any site other than the deltoid or anterolateral thigh, should not be counted as valid and should be repeated. Similarly, doses of rabies vaccine administered in the gluteal site should not be counted as valid doses and should be repeated (120). MCV4 should be administered intramuscularly; however, revaccination is not necessary if a vaccine dose is administered subcutaneously (121). Inactivated influenza vaccine is immunogenic when administered in a lower than standard dose by the intradermal route to healthy adult volunteers (122). However, the immunogenicity for persons aged ≥60 years is inadequate, and varying the recommended route and dose is not recommended.

I believe it was about 15 years ago when ACIP changed their Recommendations to limit “invalid route” immunizations to just the Rabies and Hepatitis B vaccine; prior to that all the childhood and adult vaccines when administered via a wrong route were considered “invalid”.

Sorry about not linking.

OOOOHHHH Jackpot! I had Side Effects!

Woke up next morning with a headache that nothing would relieve and a runny nose. It lasted all day, gone now.

Mind you, I’m prone to headaches of that sort, so no big surprise, and I had a bit of a sniffle beforehand as well.

Still not dead, though.

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