It's Time To Review Vaccination

This summer the drug industry solicitated the doctors to help them roll out a new shot for respiratory syncytial virus (RSV). This weekend the world and national news is ramping up another COVID scare. And now I have reviewed the topic of influenza vaccination. This newsletter summarizes my present take on the situation. Recall that highlighted text often is linked to more detailed articles or sites supporting my statements. This is an interactive newsletter.

Despite the hype, the above graph documents that we are actually below average in influenza illness. Further, the same is true for influenzae like illness -which includes COVID, and many other seasonal respiratory viruses.

From the following pie-chart and my review form the government and world monitoring sites it looks like the predominant flu strains are/will be H1N1 A strain and recently a rising number of Victoria B strains.

I did some reviewing on the facts for influenza and how helpful is vaccination for the flu. There are several reviews and various methods but the bottom line appears to be the following:

1. 20-60% benefit as measured by medical access, hospitalization and mortality.
2. If there isn't an antigenic match (meaning the "guessed" strains made in the vaccine turn out to be not exact to what is circulating), the benefit is on the low end/nil.
3. Looking at some studies it appears the more frequently you are vaccinated there appears to be less benefit.

Below is a link (click highlighted) summary of the data:

Last year's efficacy in the US per the CDC was dismal.

A cost analysis done by a work group in the CDC in June 2022 advocated FOR higher dose vaccinations in the elderly primarily based upon their assessment that the acceptance and demand from the elderly was high. A cost analysis of this choice was that it cost the system $43,000-195,000 per quality of life year (that is not a mortality measure mind you). To me that sounds like the work group doesn't understand the value of a dollar.

This year's influenza vaccines will have some modification. From the CDC site itself they state: "All current U.S. flu vaccines protect against a flu A(H1) virus, a flu A(H3) virus, a flu B/Yamagata lineage virus and a flu B/Victoria lineage virus. Each of these four vaccine virus components are selected based on the following:

• which flu viruses are making people sick prior to the upcoming flu season,
• the extent to which those viruses are spreading prior to the upcoming flu season,
• how well the previous season’s vaccines may protect against those flu viruses, and
• the ability of vaccine viruses to provide cross-protection against a range of related flu viruses of the same type or subtype/lineage."

They go on to explain all flu vaccines will be 4 strain vaccines. Most will be thimersol free (91%).

As I review the data, I note there is some benefit/value in considering an influenza vaccine. It appears that benefit is most consistently favorable for the elderly and especially with comorbid illnesses.

An important point I wish to make is that we also have very effective treatment for acute influenza. The data supports at least 80% treatment efficacy and better than this for preventing spread in house contacts who take prophylaxis from contact cases. That medication is now generic and name branded as Tamiflu. We have this test available to us if we suspect influenza diagnosis.

Photo is Doctor Kordonowy in his weekend finest? 

GlaxoSmithKline has approval to provide Arexvy which is an adjuvant enhance vaccine against Respiratory Syncytial Virus.

My bottom line take on this vaccine is that it has a very limited role for my patients. I would recommend it only be considered in the most severely lung compromised patients AND you need to have a full disclosure of the present (and limited number of subjects studied) regarding side effects.

From reading the package insert summarizing basically three clinical trials here is what I have gleaned:

1. Indication is for 60 years and above.
2. 15,845 vaccine recipients studied.
3. Significantly higher incidence of pain and local reactions in vaccinated group.
4. Within 30 days after vaccination, atrial fibrillation was reported in 10 participants who received AREXVY and 4 participants who received placebo (of which 7 events in AREXVY arm and 1 event in placebo arm were serious); the onset of symptoms ranged from 1 to 30 days post vaccination. The insert goes on to say this isn't necessarily a statistically meaningful difference. (looks like it to me).
5. There were three persons who had severe adverse events- one case of : Guillain-Barré (immune inflammatory neuropathy) and two persons with acute disseminated encephalomyelitis. One of the encephalomyelitis cases died.

From my point of view and in light of the COVID mRNA vaccine debacle, I don't think the trade off of 60% sore arms, 25% or so feeling sick for days, probable short term increased atrial fibrillation and immune mediated serious inflammation of the nervous system sounds like a good trade. I wouldn't be buying GlaxoSmithKline stock on this bet. I won't be offering this in my office for sure.

COVID 19 Update

As we all have gone through the novel virus pandemic and I have been able to correlate my real practice experience along with the various claims of success and failure as it relates to the mRNA vaccines, I cannot in good conscience condone further injections with this novel technology.

Never in my medical career has such a controversial subject been at the forefront of the public conversation. If our leadership hadn't panicked to such an extent as to decide to forgo all we have learned about safety analysis, the doctor community would not ever have let this charade move forward.

Despite whatever we individually think or have read about these vaccines, it is factually the case that there was literally no possible way for our government agencies to honestly claim these vaccine were going to be safe or effective given the extremely shoddy "science" put before us by Pfizer and Moderna.

Until they put the genie back in the bottle and actually conduct a multi-year safety and efficacy study with this technology, my position is that there is serious theoretic problems using injected messenger RNA. This stuff harnesses our live and functioning cells to artificially and unpredictably generate programed proteins designed to intentionally stimulate antibodies that have numerous potential immune responses/outcomes.

I have been seeing or getting calls from a few patients over the past 2 weeks. It seems the people getting sick have recently travelled or have visiting family and they also often haven't had clinical COVID before. Three are a couple of people who had COVID before as well. I will remind everyone that early into the pandemic I explained that prior understanding about the Coronavirus family (COVID is a coronavirus) people tend to lose full immunity to this virus family on average 18-23 months. This is likely explained by the fact that these viruses mutate and adapt which allows them to reenter a human host under the right circumstances. COVID is unlikely to ever fully stop circulating given this knowledge of coronavirus in general.

Some more fun facts about respiratory illnesses.

• More than 50% of the time, we cannot confirm a specific infectious cause for community acquired hospitalization for pneumonia. In fact, only 38% of cases had confirmed causes.
• Rhinovirus explained the highest confirmed cases (9%).
• Influenza was isolated next highest at 6%.
• Strep Pneumoniae was next at 5%. This is the bacteria strain that our pneumococcal vaccines are geared towards.
• Vitamin D helps the body produce to up-regulate the anti-microbial peptides LL-37 and human beta defensin 2. These peptides impair RSV and other viruses from attaching to our cells.
• Ribavarin is an antiviral presently prescribed for hepatitis C. A generic 42 capsule prescription is about $45 dollars. There is evidence that this works against most (but not all) strains of rhinovirus.
• A recent review article from Future Virology indicates there are plenty of molecules studied and being studied that can work against the various viral respiratory illnesses.
• Hospital mortality statistics indicate the RSV has similar mortality rates as COVID (5-6% of admitted cases).
• Influenza has a mortality statistic of about 3% for hospitalized cases.

My position regarding the respiratory and pneumonia illnesses is that we can and should use PCR point of care testing at the medical office to confirm the pathogen when we can. The government and insurance payment schemes have resulted in our inability to access our prior full panel test at an affordable price.

Further, pharma needs to get off the idea of trying to create a vaccine for constantly evolving viruses and instead create an expansion of the anti-viral oral antibiotics that allows the doctors a targeted therapeutic approach to diminished viral replication/load and disease in clinically ill patients.

I hope everyone finds this newsletter helpful - and be prepared for a media and commercial blitz asking you to line up for more shots. Now you have some facts to help you consider that proposal.

To your health!

Dr. Kordonowy MD