An ongoing dialogue on HIV/AIDS, infectious diseases,
September 8th, 2012
People Fear EEE and West Nile, but not Influenza — Can Someone Explain Why?
OK, here’s a quick quiz — match the viral infection with the average annual US deaths:
| 1. Eastern Equine Encephalitis | A. 36,000, mostly in the elderly |
| 2. Influenza | B. < 10, mostly in the elderly |
I know, it was an easy one — 1 goes with B, and 2 with A. Here’s a good reference for more on flu deaths, if you don’t believe me.
I completely understand it’s been a bad year for arbovirus infections, in particular West Nile.
Yet as we’ve just had our first deaths from EEE and West Nile in the state, prompting widespread news coverage, mosquito spraying, and warnings from the Department of Public Health, the annual flu vaccine has quietly arrived.
And once again it’s remarkable how many people refuse the vaccine. Can someone please explain?
Thank you.
2 Responses to “People Fear EEE and West Nile, but not Influenza — Can Someone Explain Why?”
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
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I think the media has a lot to do with it. While there are only a handful of EEE encephalitis cases reported each season, the majority are reported on by the media and many of them have bad outcomes. The general public don’t hear a lot of ‘happy endings’ when it comes to EEE, even though most people infected by a mosquito carrying EEE do fine and never realize they were infected by the virus. On the other hand, most of the 36,000 influenza deaths never make it to the newsroom b/c the expectation is that influenza is just a nuisance virus rather than a potentially deadly one. I think a substantial number of elderly patients who die of heart failure and COPD every winter have undiagnosed influenza as the trigger for their heart or lung failure. Some of these could have been preventable with the flu shot. The flu shot is not perfect, but it is quite safe. CDC estimates that 10 percent of the US is infected with influenza each year. Most people do well, but the prognosis is more guarded in the elderly. In the 2009 pandemic flu strain, we observed a higher proportion of deaths in younger patients. Influenza remains unpredictable from season to season, but the safety of the flu shot is predictable, and we have overwhelming evidence of the safety of this vaccine, meaning the benefits almost always outweigh the risks. As I prepare to walk outside with my family at dusk, I make sure we all spray ourselves with DEET (don’t want to be the 1 in a million with EEE), but the slight chill in the air reminds me that its time for me to get my flu shot–after all– winter is coming.
I think it’s because so many people have had the flu, been miserable, but survived, with no apparent ill aftereffects. (And it’s kind of like childbirth — the pain and misery memories fade away over time.) I agree with the first poster that many deaths from CHF and COPD each winter likely have a flu trigger, but the families and loved ones only know that the person died from CHF and COPD; the flu does not get “credit”. The media tends to play up deaths from EEE and West Nile, which strikes fear in people’s hearts, when as we can see, it is the flu they should fear.
And I still have patients telling me they won’t get a flu shot because of fears of GBS. Time for a little educational chat. 🙂