Prenatal Influenza and Schizophrenia

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Bill Glasheen
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Prenatal Influenza and Schizophrenia

Post by Bill Glasheen »

Every fall I'm preaching for all to get their influenza vaccines. Not worried about YOU getting the flu? Consider the following:

* The elderly are better protected from influenza when younger people in contact with them are vaccinated. The elderly are the ones most likely to die from complications of influenza.

And now this...

* The risk of schizophrenia for an individual is increased 7-fold when the mother is exposed to the virus during the first trimester.

Understand that by the time a woman knows she is pregnant, immediately gets a shot, and then waits for it to become effective, the first trimester is just about over.

Here's the evidence.

Serologic Evidence of Prenatal Influenza in the Etiology of Schizophrenia

And if you don't care about the elderly or your future progeny, there's always that once in a generation epidemic such as the one in 1917-1918 that seemed mostly to kill those who were young, healthy, and strong. For some reason, the body's reaction to this particularly virulent strain caused rapid pulmonary destruction which led to cyanosis (turning dark blue) and death. Very nasty!

Anyone for a flu shot? ;) Look for them after labor day, and make sure you get one weeks before your Thanksgiving vacation.

- Bill
Mark Weitz
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Post by Mark Weitz »

Hi Bill,

Interesting article though we should be careful not to make the data appear iron clad as the article you provide the link for states that "some" studies suggest a correlation indicating this is a possibility but by no means irrefutable. Still, very interesting and seems to possibly be another example of certain medical conditions that can bring about mental health disorders.

Was nice to see you at camp to put a face to the name though we didn't get an opportunity to speak at length.

Take care,

Mark
Mark Weitz
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Post by Mark Weitz »

Hi Bill,

Interesting article though we should be careful not to make the data appear iron clad as the article you provide the link for states that "some" studies suggest a correlation indicating this is a possibility but by no means irrefutable. Still, very interesting and seems to possibly be another example of certain medical conditions that can bring about mental health disorders.

You're right on re influenza, getting a shot, and the elderly being vulnerable. I practice social work with community-based elderly so I'm often harping at people to do themselves, their kids, and seniors a favour by getting the shot.

Was nice to see you at camp to put a face to the name though we didn't get an opportunity to speak at length.

Take care,

Mark
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Bill Glasheen
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Post by Bill Glasheen »

Mark

Your caution is well taken. However you need to be careful with the logic.

The whole point of mentioning the past in research is to present the perspective upon which a study is done. The fact that "some" studies suggested a correlation (in the past) while others did not could be for a number of different reasons:

* The interval of time within the pregnancy that the individual had influenza may have been defined differently.

* None of the past studies had serological documentation of the presence of influenza.

Remember that everyone thinks they have "the flu" when they get a cold. Influenza is a different animal. You don't really know you have it unless you've had your blood tested. Consequently many studies in the past with "negative" findings may have been so because some of the sick mothers had something other than the flu. With the blood tests, we knew for sure who had flu and who didn't.

Furthermore, note in this study that when you change the window of time within which the mother contracted influenza from the first trimester to the first half, the risk goes down from 7 times to 3 times. This makes sense when you think about it. Cells in a developing embryo are in the "rapidly proliferating, non-differentiated" state only in the first trimester. This is when they are most vulnerable to nuclear, chemical, and other exogenous (from the outside) insult.

The moral of the story then is that many studies in the past were either poorly done, or did not properly anticipate the window of vulnerability. To be at risk, a mother would need to have: 1) real influenza, and 2) have contracted it in the first trimester.

But...

Here is where we should be careful before absolutely claiming causality:

1) Occasionally when you flip a coin 100 times, it comes up heads 95 times. Stuff happens. One needs to repeat the study with different cohorts to be sure. Also, sometimes researchers "goof" somewhere in the study from the lab to the computer printout. When someone else can reproduce the results, there is less chance that this person was wrong.

2) All the authors have done is show a correlation between influenza in the first trimester and kids that become schizophrenic. They have not yet shown causality. There may be something unique about women who get influenza in the first trimester that is causing it. Or maybe the treatments for these pregnant women is causing the problem. We just don't know.

The only way to show causality for sure is randomly to infect women (or not) in the first trimester, and then follow what happens to the kids. But that would be unethical given what we know already.

A better solution is to use a little common sense and/or decency, and presume causality. Then we can get more women immunized before pregancy, collect data, and see if it makes a difference. Chances look pretty darned good that it will do some serious good.

Meanwhile... There's a lot of research yet to be done on the cellular level to explain this correlation. Removing a contributing cause of schizoprhenia is one thing. Understanding the mechanisms behind it all and completely preventing it would be a major breakthrough. This is one very seriously costly illness on the economic as well as the social front.

- Bill
Mark Weitz
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Post by Mark Weitz »

Bill, your points are well taken and you're right in saying that a correlation, not causality, is what's being shown. No argument that it's better to assume causality in terms of immunization.

I'm aware you have a science background but I wasn't sure what your main gig is. You have an understanding of research that is clearly beyond what most people have.

Mark
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Bill Glasheen
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Post by Bill Glasheen »

I'm aware you have a science background but I wasn't sure what your main gig is.
I am a biomedical engineer by training. That makes me a Jack of all trades, and master of none. :) My specialty within BME is a field called systems physiology. Basically I'm trained to use sophisticated mathematical, statistical, and technical tools to do the kind of research that a normal physiologist does. After grad school, I did research in heart muscle physiology - especially during heart attacks - using sophisticated imaging (contrast echocardiography) and image processing techniques.

With time and opportunity, I have developed an expertise in a new area called health services research. I have access to lots of health care data, and I look for patterns and report on them. Sometimes I help design software products that make it easier for nontechnical people to get data to tell them what they want to know. Lately I've been doing a lot of work on predictive modeling (who is going to get very sick) as well as the relationship between quality care and efficient care.

With health care financing being in crisis mode and baby boomers about to enter their sickest years, I've got a little bit of job security. :)

- Bill
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Bill Glasheen
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Influenza hospitalizations increasing

Post by Bill Glasheen »

Influenza-Associated Hospitalizations in the United States

William W. Thompson, PhD; David K. Shay, MD, MPH; Eric Weintraub, MPH; Lynnette Brammer, MPH; Carolyn B. Bridges, MD, MPH; Nancy J. Cox, PhD; Keiji Fukuda, MD, MPH


JAMA. 2004;292:1333-1340.

Context Respiratory viral infections are responsible for a large number of hospitalizations in the United States each year.

Objective To estimate annual influenza-associated hospitalizations in the United States by hospital discharge category, discharge type, and age group.

Design, Setting, and Participants National Hospital Discharge Survey (NHDS) data and World Health Organization Collaborating Laboratories influenza surveillance data were used to estimate annual average numbers of hospitalizations associated with the circulation of influenza viruses from the 1979-1980 through the 2000-2001 seasons in the United States using age-specific Poisson regression models.

Main Outcome Measures We estimated influenza-associated hospitalizations for primary and any listed pneumonia and influenza and respiratory and circulatory hospitalizations.

Results Annual averages of 94 735 (range, 18 908-193 561) primary and 133 900 (range, 30 757-271 529) any listed pneumonia and influenza hospitalizations were associated with influenza virus infections. Annual averages of 226 054 (range, 54 523-430 960) primary and 294 128 (range, 86 494-544 909) any listed respiratory and circulatory hospitalizations were associated with influenza virus infections. Persons 85 years or older had the highest rates of influenza-associated primary respiratory and circulatory hospitalizations (1194.9 per 100 000 persons). Children younger than 5 years (107.9 primary respiratory and circulatory hospitalizations per 100 000 persons) had rates similar to persons aged 50 through 64 years. Estimated rates of influenza-associated hospitalizations were highest during seasons in which A(H3N2) viruses predominated, followed by B and A(H1N1) seasons. After adjusting for the length of each influenza season, influenza-associated primary pneumonia and influenza hospitalizations increased over time among the elderly. There were no significant increases in influenza-associated primary respiratory and circulatory hospitalizations after adjusting for the length of the influenza season.

Conclusions Significant numbers of influenza-associated hospitalizations in the United States occur among the elderly, and the numbers of these hospitalizations have increased substantially over the last 2 decades due in part to the aging of the population. Children younger than 5 years had rates of influenza-associated hospitalizations similar to those among individuals aged 50 through 64 years. These findings highlight the need for improved influenza prevention efforts for both young and older US residents.


Author Affiliations: Epidemiology and Surveillance Division, National Immunization Program (Drs Thompson, Shay, and Bridges and Mr Weintraub) and Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases (Ms Brammer and Drs Cox and Fukuda), Centers for Disease Control and Prevention, Atlanta, Ga.
Dr Shay is now with Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases.
- JAMA

Let us not forget the number of individuals who live and work around the very young and very old, and serve as disease vectors for these folks whose vaccinations may not work as well.

Planned your flu shot yet?

- Bill
KZMiller
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Post by KZMiller »

I'm going to get mine soon. I hope they don't run out like some other years. I'll ask the NP what s/he suggests when it comes to my kids. I'll take them with me ... I'm sure they won't be happy if the NP says yes, sure, let's give them a shot too. I'll then be bad mom and soothe their looks of anger and betrayal with ice cream afterward. :lol:

Kami
One seed, many lives.
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Bill Glasheen
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Post by Bill Glasheen »

Yep - this is most definitely an ice cream moment. Been there, done that. :)

- Bill
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Bill Glasheen
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Post by Bill Glasheen »

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