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Please look at the science.

I RESPOND to Sandra Hickmott's letter published in the July issue--"More research needed on why staff don't get vaccinated", p3.

This letter has no basis in scientific critique and has multiple incorrect statements.

The first claim--that influenza vaccines are not effective--quotes a Canadian observational study. It is known that previous vaccination history may reduce the effectiveness of the vaccine immunogenicity response in subsequent seasons, but this does not add up to influenza vaccines not working. (1,2)

Secondly, influenza vaccine effectiveness data estimates are generated from systematic analyses from national and international organisations who are academic, government and World Health Organization-supported, and importantly, committed to independent critique. (3,4) These data show that influenza vaccine is moderately effective in around 50-60 per cent of healthy adults and children. These estimations are not coming from pharmaceutical companies and Tamiflu is not a vaccine! Supporting this international data, the Immunisation Advisory Centre has published New Zealand influenza vaccine effectiveness data. (5,6) This research is fully funded by the United States Centers for Disease Control and Prevention.

The influenza vaccine is not a magic bullet, nor does the science promise that. A very important limitation is that those who are more vulnerable to severe influenza disease are less likely to have an effective response to the vaccine--in particular, the very elderly, the immune-compromised and those with comorbidities, ie many of our patients. This is a real problem. The reason for vaccinating frontline staff is because we can pass the influenza virus on to these most vulnerable people, even before we are aware we have symptoms. The ethics behind health-care professional vaccination is the rights of an individual to refuse a vaccination vs the rights of the patient to have as much protection as possible.

The statement that "those who are unvaccinated have never been responsible for the spread of communicable diseases" is just bizarre and contrary to a large body of evidence. The German "study" Hickmott quotes that states vaccinated children have more disease than those who are unvaccinated is a news item. It is based on an internet data collection that is hopelessly biased in its sample selection. This is not science! How this can be quoted, as if it has any basis in evidence-based thinking at all, is incredible!

I endorse the last statement in the letter: "We need to keep up to date and give unbiased information to people." Yes, please have the courtesy to actually look at the science. Current influenza vaccines are far from perfect in their effectiveness but, alongside hand-washing and other appropriate infection control measures, they are the best option we have right now to help protect our patients.

Let's have an informed sciencific debate in our journals, not propagate personal opinion pretending to be science.

Nikki Turner, MBChB, MPH(Hons), director of the Immunisation Advisory Centre, University of Auckland


(1) McLean, H.Q., Thompson, M.G., Sundaram, M.E. et al. (2014) Impact of repeated vaccination on vaccine effectiveness against influenza A (H3N2) and B during 8 seasons. Clinical Infectious Diseases; 59: 10, pp1375-85.

(2) Ng, S., Ip, D.K., Fang, V.J., Chan, K-H. et al. (2013) The effect of age and recent influenza vaccination history on the immunogenicity and efficacy of 2009-10 seasonal trivalent inactivated influenza vaccination in children. PloS one; 8: 3, e59077.

(3) Osterholm, M.T., Kelley, N.S., Sommer, A. & Belongia, E.A. (2011) Efficacy and effectiveness of influenza vaccines: a systematic review and metaanalysis. The Lancet Infectious Diseases; 12: 1, pp36-44.

(4) Manzoli, L., Ioannidis, J.P., Flacco, M.E., De Vito, C. & Villari, P. (2012) Effectiveness and harms of seasonal and pandemic influenza vaccines in children, adults and elderly: a critical review and re-analysis of 15 meta-analyses. Human Vaccines & Immunotherapeutics; 8: 7, pp851-62.

(5) Turner, N., Pierse, N., Bissielo, A., Fluang, Q.S. et al. (2014) Effectiveness of seasonal trivalent inactivated influenza vaccine in preventing influenza hospitalisations and primary care visits in Auckland, New Zealand, in 2013. in Euro Surveill; 19.

(6) Turner, N., Pierse, N., Bissielo, A., Huang, Q.S. et al. (2014) The effectiveness of seasonal trivalent inactivated influenza vaccine in preventing laboratory confirmed influenza hospitalisations in Auckland, New Zealand in 2012. Vaccine; 32: 29, pp3687-93.
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Title Annotation:letters
Author:Turner, Nikki
Publication:Kai Tiaki: Nursing New Zealand
Article Type:Letter to the editor
Date:Sep 1, 2015
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