1. The
Flu
Vaccine
&
Alternate
Treatments
for
the
Flu
Dr.
Kelly
Han,
ND
Walnut
Creek
Naturopathic
February
2013

2. What
Causes
the
Flu?
• Influenza
virus
• 3
types:
A,
B,
and
C
• Each
type
has
many
subtypes
and
species
• Responsible
for
over
306
different
influenza
viruses
• Different
strain
predominates
every
year
• Peaks
in
January
–
February
(season
Oct-­‐May)
• Common
symptoms:
Fever,
faYgue,
headache,
body
ache,
sore
throat,
stuffy
nose,
runny
nose,
vomiYng,
diarrhea,
cough

3. How
is
the
Flu
spread?
• Respiratory
droplets-­‐
coughing,
sneezing,
touching
contaminated
surfaces
• Contagious
1
day
before
symptom
onset
and
5-­‐7
days
a^er
symptom
onset

4. How
serious
is
the
Flu?
• Severity
of
the
flu
varies
from
year
to
year
• Most
cases
are
mild-­‐moderate
and
resolve
without
complicaYon
• Severe
complicaYons
include
dehydraYon,
pneumonia,
and
inflammaYon
and
infecYon
of
heart,
lungs,
brain,
or
other
organs
• Severe
complicaYons
can
be
fatal

5. Flu
StaYsYcs
(USA)*
*staYsYcs
vary
according
to
source
• Millions
of
cases
per
year
(very
common)
– EsYmated
5-­‐20%
of
the
US
populaYon
• 100,000-­‐200,000
hospitalizaYons
per
year
• 1500-­‐49,000
fataliYes
per
year
(1976-­‐2007)
• >
90
%
hospitalizaYons
and
fataliYes
occur
in
age
65+
• Children
<
2
yrs
are
the
next
largest
group
at
risk
of
serious
complicaYon

6. The
Flu
Vaccine
• The
flu
vaccine
covers
3
influenza
viruses:
– Two
influenza
A
viruses
– One
influenza
B
virus
• Each
year
the
strains
are
updated
based
upon
predicYons
for
this
year’s
circulaYng
flu
viruses
• Data
is
collected
from
around
the
world
to
determine
the
included
strains

7. How
effecYve
is
the
Flu
Vaccine?
• Varies
from
year
to
year
• There
have
been
limited
controlled
studies
demonstraYng
a
decrease
in
influenza
disease
a^er
vaccinaYon
• Research
shows
that
it
creates
anYbodies
to
influenza,
but
there
has
been
limited
correlaYon
with
disease
prevenYon

8. How
safe
is
the
Flu
Vaccine?
• Common
Side
Effects:
Flu-­‐like
symptoms,
injecYon
site
reacYons,
irritability,
fever,
drowsiness,
loss
of
appeYte,
vomiYng,
diarrhea
• Severe
S/E:
Febrile
seizures
(esp
<
2yo),
GBS,
severe
allergic
reacYons,
especially
egg
allergy
• Pregnancy:
Not
enough
human
data;
Category
C
or
B
• Breasneeding:
Not
enough
data,
generally
considered
safe
• Generally
best
to
give
it
away
from
other
vaccines
(1
mo
apart)
• Flu
vaccine
is
not
well
studied
when
given
simultaneously
with
other
vaccines

9. All
Flu
vaccines
are
not
created
equal
• Killed-­‐virus
injecYon
– Several
influenza
strains
grown
in
chicken
eggs
– AnYbioYcs
added
to
egg
– Viruses
removed
and
inacYvated
(non-­‐infecYous)
– Virus
parYcles
added
into
saline
soluYon
– Mercury
may
be
added
as
preservaYve
– Brands:
Fluzone,
Fluarix,
Agriflu,
Fluvirin,
FluLaval

10. All
Flu
vaccines
are
not
created
equal
• Live-­‐virus
nasal
spray
– Several
influenza
strains
put
into
egg
to
mulYply
– Fluid
removed,
purified,
and
mixed
with
sucrose
– Put
into
nasal
spray
– Live
virus
intended
to
mulYply
within
nose
and
throat
to
cause
a
low-­‐grade
infecYon
and
sYmulate
immunity
– Mildly
contagious
for
3
weeks
– Early
data
shows
works
berer
than
injecYon
– Approved
for
ages
2-­‐39
– Brands:
FluMist

11. The
Flu
Vaccine
• CDC
recommends
annual
vaccinaYon
starYng
at
6
months
of
age
•
High
risk-­‐groups
– Children
<
5
yo,
but
especially
<
2
yo
– Adults
age
65
and
older
– Pregnant
women
– Individuals
with
immune
compromise
– Healthcare
workers
– Family
members
or
caretakers
of
above
groups

12. ContraindicaYons
for
the
Flu
Vaccine
• InacYvated-­‐virus:
– CauYon
with
egg
allergy
– Moderate
to
severe
acute
febrile
illness
– History
of
negaYve
reacYon
to
vaccine
• Live-­‐virus:
– Egg
allergy
– Children
<
2
yo
– Age
2-­‐4
yrs
with
history
of
asthma
or
wheezing
in
previous
12
mo
– Adults
50
years
and
older
– Age
2-­‐18
yrs
receiving
rouYne
therapy
with
aspirin
or
salicylates
– Pregnant
women

13. Choosing
a
Brand
of
Flu
Vaccine
• Choose
proper
brand
and
dose
for
age
• Aim
for
mercury
free
• Fluzone
– Only
flu
vaccine
approved
for
use
<
3
yo;
smaller
risk
of
febrile
seizure
• Mercury-­‐free:
Fluarix,
Agriflu,
FluMist
(contains
MSG),
Fluvirin
(single
dose)
• AnYbioYc-­‐free:
Fluzone,
FluLaval

14. To
Vaccinate
or
Not
To
Vaccinate?
• Reasons
to
vaccinate:
– Elderly
– Chronic
medical
problems
or
immuno-­‐
compromised
– Infants
<
2
yrs
– Families
of
above
groups
– Financial
consideraYons
(from
loss
of
work)
– History
of
severe
flu

15. To
Vaccinate
or
Not
To
Vaccinate?
• Reasons
NOT
to
vaccinate:
– Risk
of
febrile
seizure
– Flu-­‐like
illness
as
side
effect
– Breasneeding
infants
are
less
suscepYble
to
flu
– Pregnancy-­‐
lack
of
safety
informaYon
– SensiYvity
to
chemicals
or
mercury
– Children
>
2
yo
are
less
likely
to
require
hospitalizaYon
– Research
is
unclear
if
flu
vaccine
is
effecYve
in
children
under
2
yo
– AnYviral
medicaYon
available
in
first
48
hours
– AlternaYve
opYons
are
available
for
prevenYon
and
treatment
of
flu

16. AlternaYve
OpYons
for
Flu
PrevenYon
• Set
a
strong
foundaYon
for
health
and
immunity
– Diet:
• Sugar
and
dairy-­‐free.
• Limited
intake
of
refined
carbohydrates
and
alcohol.
• Increase
intake
of
fruit,
vegetables,
garlic,
&
ginger
– Avoid
smoking
and
recreaYonal
drug
use
– Daily
intake
of
8-­‐10
glasses
of
water
– Stress
reducYon
and
management

17. AlternaYve
OpYons
to
Treat
the
Flu
• REST,
REST,
REST
• Elderberry
(no
standard
dosage)
• Vitamin
D
(1000-­‐4000
IU
daily)
• ProbioYcs
(25
billion
organisms
daily)
• Garlic
(400
mg,
3x
per
day;
standardized
to
contain
1.3%
alliin
or
0.6%
allicin)
• Colostrum
(no
standard
dosage)
• Zinc
(30-­‐50
mg
daily)
• Mushrooms
(reishi,
maitake)
(no
standard
dosage)
• Homeopathy
(see
separate
handout)

18. Elderberry
• Contains
flavonoids
• Cooling-­‐
reduces
swelling
and
inflammaYon
• Mild
diaphoreYc-­‐
helps
opYmize
fever
and
break
a
sweat
• Expectorant-­‐
helps
expel
mucus
• AnY-­‐viral
and
anY-­‐bacterial
properYes

19. Elderberry
• An#-­‐influenza
virus
effects
of
elderberry
juice
and
its
frac#ons.
Kinoshita
E,
Hayashi
K,
Katayama
H,
Hayashi
T,
Obata
A.
• Elderberry
showed
relaYvely
strong
defense
against
IFV
infecYon.
We
conclude
that
CJ-­‐E
had
a
beneficial
effect
by
the
sYmulaYng
immune
response
and
prevenYng
viral
infecYon.
• Inhibitory
ac#vity
of
a
standardized
elderberry
liquid
extract
against
clinically-­‐
relevant
human
respiratory
bacterial
pathogens
and
influenza
A
and
B
viruses.
Krawitz
C,
Mraheil
MA,
Stein
M,
Imirzalioglu
C,
Domann
E,
Pleschka
S,
Hain
T.
• Rubini
elderberry
liquid
extract
is
acYve
against
human
pathogenic
bacteria
as
well
as
influenza
viruses.
The
acYviYes
shown
suggest
that
addiYonal
and
alternaYve
approaches
to
combat
infecYons
might
be
provided
by
this
natural
product.
• Elderberry
flavonoids
bind
to
and
prevent
H1N1
infec#on
in
vitro.
Roschek
B
Jr,
Fink
RC,
McMichael
MD,
Li
D,
Alberte
RS
• The
H1N1
inhibiYon
acYviYes
of
the
elderberry
flavonoids
compare
favorably
to
the
known
anY-­‐influenza
acYviYes
of
Oseltamivir
(Tamiflu;
0.32
microM)
and
Amantadine
(27
microM).

20. Vitamin
D
• AcYvates
the
body’s
T-­‐cells
to
seek
and
destroy
invading
viruses
and
bacteria
• Calcitriol
[1,
25[OH]2
D3]
pre-­‐
and
post-­‐treatment
suppresses
inflammatory
response
to
influenza
A
(H1N1)
infec#on
in
human
lung
A549
epithelial
cells.
Khare
D,
Godbole
NM,
Pawar
SD,
Mohan
V,
Pandey
G,
Gupta
S,
Kumar
D,
Dhole
TN,
Godbole
MM.
• The
findings
provide
support
for
the
iniYaYon
of
vitamin
D
supplementaYon
program
in
reducing
the
severity
of
influenza.
• Randomized
trial
of
vitamin
D
supplementa#on
to
prevent
seasonal
influenza
A
in
schoolchildren.
Urashima
M,
Segawa
T,
Okazaki
M,
Kurihara
M,
Wada
Y,
Ida
H.
• This
study
suggests
that
vitamin
D(3)
supplementaYon
during
the
winter
may
reduce
the
incidence
of
influenza
A,
especially
in
specific
subgroups
of
schoolchildren.

21. ProbioYcs
• 60-­‐80%
of
your
immune
system
is
located
in
lining
of
your
gut
• ProbioYcs
are
essenYal
to
maintaining
the
integrity
of
your
gut
lining
• ProbioYcs
enhance
acYvity
of
natural
killer
cells
• Enhance
digesYon
to
opYmize
nutrient
absorpYon
and
uYlizaYon

22. ProbioYcs
• A
new
chance
of
preven#ng
winter
diseases
by
the
administra#on
of
synbio#c
formula#ons.
Pregliasco
F,
Anselmi
G,
Fonte
L,
Giussani
F,
SchieppaP
S,
SoleQ
L.
• These
results
demonstrate
that
a
regular,
long-­‐term
intake
of
various
synbioYcs
may
improve
health
by
reducing
the
incidence
and
severity
of
respiratory
diseases
during
the
cold
season.
• Lactobacillus
plantarum
CECT7315
and
CECT7316
s#mulate
immunoglobulin
produc#on
aYer
influenzavaccina#on
in
elderly.
Bosch
M,
Méndez
M,
Pérez
M,
Farran
A,
Fuentes
MC,
Cuñé
J.
• L.
plantarum
CECT7315/7316
has
an
immunosYmulaYng
effect
and
could
be
used
to
improve
the
response
to
influenza
vaccinaYon
in
elderly.
• Lactobacillus
GG
as
an
immune
adjuvant
for
live-­‐a[enuated
influenza
vaccine
in
healthy
adults:
a
randomized
double-­‐blind
placebo-­‐controlled
trial.
Davidson
LE,
Fiorino
AM,
Snydman
DR,
Hibberd
PL.
• Lactobacillus
GG
is
potenYal
as
an
important
adjuvant
to
improve
influenza
vaccine
immunogenicity

23. Garlic
• Warming-­‐
moves
the
blood
and
lymph
• Rich
in
selenium,
criYcal
to
immune
funcYon
• AnY-­‐viral,
anY-­‐bacterial,
anY-­‐fungal
properYes
• May
be
contraindicated
with
blood-­‐thinning
medicaYons

24. Garlic
• Supplementa#on
with
aged
garlic
extract
improves
both
NK
and
γδ-­‐T
cell
func#on
and
reduces
the
severity
of
cold
and
flu
symptoms:
a
randomized,
double-­‐blind,
placebo-­‐
controlled
nutri#on
interven#on.
Nantz
MP,
Rowe
CA,
Muller
CE,
Creasy
RA,
Stanilka
JM,
Percival
SS.
• SupplementaYon
of
the
diet
with
aged
garlic
extract
may
enhance
immune
cell
funcYon
and
that
this
may
be
responsible,
in
part,
for
reduced
severity
of
colds
and
flu.

25. Colostrum
• Augmenta#on
of
cellular
immunity
and
protec#on
against
influenza
virus
infec#on
by
bovine
late
colostrum
in
mice.
Uchida
K,
Hiruta
N,
Yamaguchi
H,
Yamashita
K,
Fujimura
K,
Yasui
H
•
These
results
indicate
that
oral
administraYon
of
SCBLC
acYvates
not
only
systemic
cellular
immunity
but
also
local
cellular
immunity,
such
as
in
the
respiratory
tract,
and
that
acYvaYon
of
cellular
immunity
is
one
of
the
mechanisms
of
amelioraYon
of
Flu
infecYon.

26. Homeopathy
for
the
Flu
• Please
see
separate
handout
• Epidemic
Updates
by
Paul
Herscu,
ND,
MPH

27. How
to
opYmize
a
fever
• Please
see
separate
handout

28. References
• Dr.
Sears,
The
Vaccine
Book
• CDC
website:
– hrp://www.cdc.gov/flu/index.htm
• Epidemic
updates
from
Paul
Herscu,
ND:
– hrp://www.paulherscuepidemics.blogspot.com/
2013/01/current-­‐influenza-­‐epidemic-­‐
january-­‐2013.html#more
• Vaccine
Preventable
Diseases
and
Vaccine
Counseling
by
CANDACE
AASAN,
ND
at
CASCADE
NATURAL
MEDICINE
KIRKLAND,
WA
• Pediatric
VaccinaYons
by
Heather
Zwickey

29. THANK
YOU!
• Any
quesYons,
comments?
• Interest
in
future
topics?
Dr.
Kelly
Han,
ND
Walnut
Creek
Naturopathic
February
2013