Wednesday, December 5, 2018

December Newsletters: Curing Hep C May Dial Back Liver Damage


Hi folks, over the next few weeks I'll be taking a holiday break to spend time with the family. Can't wait to start my Christmas shopping, trick out my tree, and bake some millennial sugar cookies. Using Pillsbury ready to make slice-and-bake cookies, add sprinkles after baking. Bad Nana!

In any event, here's your list of December newsletters with blog updates from across the web.

News & Review 
Catch up on what you missed this week by reading one of two HCV week in review publications:
The Weekly Bull is published by the Canadian non-profit organization HepCBC, the second publication by Caring Ambassadors Program, is filled with news as well, in addition to a monthly review of relevant HCV research published on PubMed.

December Newsletters
Hep is an award-winning print and online brand for people living with and affected by viral hepatitis. Offering unparalleled editorial excellence since 2010, Hep and HepMag.com are the go-to source for educational and social support for people living with hepatitis.
Winter Issue 2018
Highlights
Curing Hep C May Dial Back Liver Damage
Hep C Testing Slowly Rising Among Baby Boomers
People Who Inject Drugs Succeed With Hep C Treatment
and more....

The HCV Advocate newsletter is a valuable resource designed to provide the hepatitis C community with monthly updates on events, clinical research, and education.
In this month's newsletter coverage of the Liver Meeting continues; read easy to understand commentary on HCV-related topics that matter most to patients. In next month's issue notable research on liver cancer presented at the meeting will be featured as well.

On This Blog
After The Liver Meeting Summary: Viral Hepatitis & Fatty Liver Disease
For patients - An index of links provide an overview of the meeting with a focus on HCV; read expert analysis of key data, interviews with leading researchers and clinicians, or listen to live presentations, view slidesets and capsule summaries. Sit back and watch daily clips or a live symposium, finally review a webinar with all the notable Liver Meeting updates. 

HCV Action brings together hepatitis C health professionals from across the patient pathway with the pharmaceutical industry and patient representatives to share expertise and good practice.
Read the latest: HCV Action e-update

The World Hepatitis Alliance goal is to achieve a world free from viral hepatitis, World Hepatitis Alliance provides global leadership in awareness-raising, advocacy and in efforts to find the missing millions.
News & Headlines 
Click here to read our latest newsletter.

The New York City Hepatitis C Task Force is a city-wide network of service providers and advocates concerned with hepatitis C and related issues. The groups come together to learn, share information and resources, network, and identify hepatitis C related needs in the community. Committees form to
work on projects in order to meet needs identified by the community.
December Newsletter: Reminder: NYC Hep C Task Force Meeting. December 5 (3-5 PM) @ 132 West 32nd St.
NYC Hep C Task Force
All - Hep Free NYC Newsletters

Hepatitis NSW provides information, support, referral and advocacy for people affected by viral hepatitis in NSW. We also provide workforce development and education services both to prevent the transmission of viral hepatitis and to improve services for those affected by it.
News Updates

GI & Hepatology News covers the world of liver disease with breaking news, on-site medical meeting coverage, and expert perspectives both in print and online. 
View all updates here....

Hepatitis Victoria is the peak not-for-profit community organisation working across the state for people affected by or at risk of viral hepatitis.
View the Latest Newsletter, or relax and listen to a short podcasts interviewing health experts and practioners on topics related to viral hepatitis - have a listen!

The British Liver Trust is the leading UK liver disease charity for adults – we provide information and support; increase awareness of how liver disease can be prevented and promote early diagnosis; fund and champion research and campaign for better services. 
View Recent Newsletters, here.

The Hepatitis C Trust is run by patients with the goal of eliminating HCV in the United Kingdom. The Trust’s mission is to reverse the rapidly increasing death toll caused by hepatitis C in the UK until no-one dies from this preventable and treatable disease and, ultimately, it is all but eradicated in this country.

The National Viral Hepatitis Roundtable (NVHR) is national coalition working together to eliminate hepatitis B and C in the United States.
NVHR 2018 Year in Review
View all NVHR newsletters

Check out the latest National Institutes of Health Newsletter.
December Newsletter
Plan Your Plate - Shifting to a Healthy Eating Style

Blog Updates
Karen Hoyt is devoted to offering support and accurate information to people coping with the effects of hepatitis C.
Latest blog entry: Holiday and Health Problems
Find Karen on Facebook
YouTube Page

Lucinda K. Porter
Lucinda Porter is a nurse, speaker, advocate and patient devoted to increasing awareness about hepatitis C.
View all new blog updates, here....

Hep 
Hep is an award-winning print and online brand for people living with and affected by viral hepatitis.
Latest blog updates: 
By Lucinda K. Porter, RN
By Connie M. Welch 
Hepatitis C Cure 
By Greg Jefferys
View all blog updates, here...

AGA Blog
Gastroenterology and Clinical Gastroenterology and Hepatology
Life Beyond Hep C is where faith, medical resources and patient support meet, helping Hep C patients and their families navigate through the entire journey of Hep C.
Latest blog entry: 5 Common Questions and Answers about Hepatitis C Treatment
View all updates, here...

Canadian Liver Foundation
We strive to improve prevention and the quality of life of those living with liver disease by advocating for better screening, access to treatment, and patient care.
Latest blog entry: Tips for a struggling caregiver
View all updates, here...

The Hepatitis B Foundation is a national nonprofit organization dedicated to finding a cure and improving the quality of life for those affected by hepatitis B worldwide.
Latest blog entry: Ask An Expert: Managing Hepatitis Delta During Pregnancy
View all updates, here....

ADRLF (Al D. Rodriguez Liver Foundation)
Al D. Rodriguez Liver Foundation is a non-profit organization that provides resources, education and information related to screening, the prevention of and treatment for the Hepatitis Virus and Liver Cancer.
View all updates, here....

At HepatitisC.net we empower patients and caregivers to take control of Hepatitis C by providing a platform to learn, educate, and connect with peers and healthcare professionals.
Part 1: Doctors and Dragons: The Adventure Continues - By Rick Nash
View all updates, here....

Kevin Pho is a practicing physician and most known for his blog KevinMD. Thousands of authors contribute to his blog: primary care doctors, surgeons, specialist physicians, nurses, medical students, policy experts. And of course, patients, who need the medical profession to hear their voices.
View latest blog entry, here... 

Harvard Health Blog
The goal of our publications is to bring people around the world the most current health information that is authoritative, trustworthy, and accessible, drawing on the expertise of the 10,000+ faculty physicians at Harvard Medical School.
Latest blog entry: Safe and effective use of insulin requires proper storage

University of Michigan - Lab Blog
Providing physicians with virtual access to specialists can be lifesaving to liver disease patients.
View all updates: Lab Blog

JAMA Patient Page
This JAMA Patient Page describes recent advancements in hepatitis C treatment.
December 4, 2018
Treating Hepatitis C
From a medical point of view, almost all patients with hepatitis C should be treated.

See you soon!
Tina

Progress and difficulties in the elimination of HCV infection: A population-based cohort study in Spain

Progress in the elimination of hepatitis C virus infection: A population-based cohort study in Spain 
Regina Juanbeltz, Alejandra Pérez-García, Aitziber Aguinaga, Iván Martínez-Baz, Itziar Casado, Cristina Burgui, Silvia Goñi-Esarte, Jesús Repáraz, José Manuel Zozaya, Ramón San Miguel, Carmen Ezpeleta, Jesús Castilla

Published: December 4, 2018
https://doi.org/10.1371/journal.pone.0208554 


Abstract 
Background
The World Health Organization set targets to eliminate hepatitis C virus (HCV) infection through detection and treatment of all cases by 2030. This study aimed to describe the progress and difficulties in the elimination of HCV infection in Navarra, Spain.

Methods
Using electronic healthcare databases, we performed a population-based prospective cohort study to describe changes in the prevalence of diagnosed active HCV infection at the beginning of 2015 and the end of 2017, the rate of new diagnoses and the rate of post-treatment viral clearance (PTVC) during this period.

Results
At the beginning of 2015 there were 1503 patients diagnosed with positive HCV-RNA, 2.4 per 1000 inhabitants, and at the end of 2017 the prevalence had decreased by 47%. In the study period, 333 (18 per 100,000 person-years) new positive HCV-RNA cases were detected, but only 76 (23%; 4.2 per 100,000 person-years) did not have anti-HCV antibodies previously detected. Prevalent cases and new diagnoses of active infection were more frequent in men, people born in 1950–1979, HIV-infected patients and in those with lower income levels. Among patients with HCV-RNA, 984 achieved PTVC (22.7 per 100 person-years). PTVC was less frequent in patients born before 1940, in immigrants and in patients with lower income levels.

Conclusions
The prevalence of diagnosed active HCV infection has dropped by almost half over three years, because the number of patients with PTVC was much higher than the number of new diagnoses. Interventions specifically targeted at population groups with less favourable trends may be necessary.

On This Blog
Efforts to Eliminate Hepatitis C

More Raw Beef Recalled After Nationwide Salmonella Outbreak

NPR
More Raw Beef Recalled After Nationwide Salmonella Outbreak 
Amy Held
More than 2,500 tons of raw beef are being added to a recall in connection with a salmonella outbreak that federal officials say has sickened hundreds of people across 25 states. 

The Arizona-based JBS Tolleson processing plant initially recalled about 3,500 tons of potentially contaminated beef in October. JBS, the top global meatpacker that owns the plant, still maintains the move ensured all of the affected product had already been removed from store shelves

New Test Could Detect All Types of Cancer in Just Minutes

This New Test Could Detect All Types of Cancer in Just Minutes

ABU SINA, LAURA G CARRASCOSA & MATT TRAU, THE CONVERSATION
5 DEC 2018

Researchers have developed a test that could be used to diagnose all cancers. It is based on a unique DNA signature that appears to be common across cancer types.

The test has yet to be conducted on humans, and clinical trials are needed before we know for sure if it can be used in the clinic.

Each cancer type, whether it be breast or bowel cancer, has different genetic and other features. A test that detects one cancer may not work on another.

Researchers have long been looking for a commonality among cancers to develop a diagnostic tool that could apply across all types.

Our research, published in the journal Nature Communications, has found that cancer DNA forms a unique structure when placed in water. The structure is the same in DNA from samples of breast, prostate and bowel cancers, as well as lymphoma.

We used this discovery to develop a test that can identify the cancerous DNA in less than ten minutes.

How our test works
Current detection of cancer requires a tissue biopsy – a surgical procedure to collect tissue from the patient's tumour. Researchers have been looking for a less invasive diagnostic test that can detect cancers at an earlier stage.

One possibility, still in development, is a liquid biopsy, testing for circulating cancer DNA in the blood.

Our test also uses circulating cancer DNA but involves a different detection method.

Nearly every cell in a person's body has the same DNA, but studies have found that cancer's progression causes this DNA to undergo considerable reprogramming.

This change is particularly evident in the distribution pattern of a tiny molecule called a methyl group, which decorates the DNA.

A normal cell DNA's distinct methyl pattern is crucial to regulating its machinery and maintaining its functions. It is also responsible for turning genes on and off. Altering this pattern is one of the ways cancer cells regulate their own proliferation.

This methyl patterning has been studied before. However, its effect in a solution (such as water) has never been explored.

Using transmission electron microscopy (a high-resolution microscope), we saw that cancerous DNA fragments folded into three-dimensional structures in water. These were different to what we saw with normal tissue DNA in the water.

In the lab, gold particles are commonly used to help detect biological molecules (such as DNA). This is because gold can affect molecular behaviour in a way that causes visible colour changes.

We discovered that cancerous DNA has a strong affinity towards gold, which means it strongly binds to the gold particles.

This finding directed us to develop a test that can detect cancerous DNA in blood and tissue. This requires a tiny amount of purified DNA to be mixed with some drops of gold particle solution.

By simply observing the colour change, it is possible to identify the cancerous DNA with the naked eye within five minutes.

The test also works for electrochemical detection – when the DNA is attached onto flat gold electrodes.

Since cancer DNA has higher affinity to gold, it provides a higher relative electrochemical current signal in comparison to normal DNA. This electrochemical method is highly sensitive and could also eventually be used as a diagnostic tool.
Why this matters

For this test to work properly the DNA must be pure. So far we have tested more than 200 tissue and blood samples, with 90 percent accuracy. Accuracy is important to ensure there are fewer false positives – wrongly detecting cancer when there is none.

The types of cancers we tested included breast, prostate, bowel and lymphoma. We have not yet tested other cancers, but because the methylation pattern is similar across all cancers it is likely the DNA will respond in the same way.

It is a promising start, though further analysis with more samples is needed to prove its clinical use.

The next step is to do a large clinical study to understand how early a cancer can be detected based on this novel DNA signature. We are assessing the possibility to detect different cancer types from different body fluids from early to later stages of cancer.

We are also considering whether the test could help monitor treatment responses based on the abundance of DNA signatures in body fluid during treatment.

Abu Sina, Research Fellow, The University of Queensland; Laura G. Carrascosa, Postdoctoral Research Fellow, The University of Queensland, and Matt Trau, Professor, The University of Queensland.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Appeal lodged against decision to uphold Gilead’s patent on hepatitis C drug

Video - The story of sofosbuvir illustrates how research and development for new prescription drugs really works: When Big Pharma plays for keeps, who wins and who loses?

Appeal lodged against decision to uphold Gilead’s patent on hepatitis C drug
Press Release
5 December 2018
Paris – Six organisations, including Médecins Sans Frontières (MSF), have just appealed the European Patent Office’s September decision to uphold US pharmaceutical corporation Gilead Science’s patent on the key hepatitis C drug sofosbuvir.

The appeal – filed by Médecins du Monde (MdM), MSF, AIDES (France), Access to Medicines Ireland, Praksis (Greece) and Salud por Derecho (Spain) – states that the European Patent Office (EPO) should revoke Gilead’s patent because it does not meet the requirements to be a patentable invention from a legal or scientific perspective.

The appeal comes exactly five years after sofosbuvir was first approved for use, in the US, where Gilead launched the drug at US$1,000 per pill, or $84,000 for a 12-week treatment course.

The corporation has made more than $58 billion from sales of the drug and its combinations in the last five years.

In March 2017, civil society organisations from 17 European countries filed a challenge against Gilead’s patent on the base compound of sofosbuvir, stating that Gilead’s patent claims were not legitimate, primarily because they lack inventiveness. 

Out-of-control drug prices 
Gilead’s monopoly on sofosbuvir in Europe has allowed the corporation to charge excessive prices for the drug.

In some European countries, Gilead charges as much as €43,000 for a 12-week treatment course, when generic versions of the same course can be purchased for less than €75 outside Europe.

"What is the point of medical innovation if people and health systems cannot afford the products coming out of it? Gaëlle Krikorian, head of policy at MSF’s Access Campaign"

These exorbitant prices have forced health systems to ration sofosbuvir, leaving thousands of people in Europe with hepatitis C without treatment.

Despite compelling arguments presented by the organisations opposing the patent, on 14 September 2018 the European Patent Office (EPO) decided to uphold Gilead’s patent, thereby making it impossible to produce or sell affordable generic versions of the drug in Europe.

“The EPO is being too lenient with pharmaceutical corporations, giving them a free pass,” said Olivier Maguet of MdM’s drug pricing campaign. “There needs to be much greater scrutiny in Europe when it comes to determining whether pharmaceutical corporations deserve patents or not; otherwise, unmerited monopolies will continue to result in out-of-control drug prices.”

The appeal aims to put an end to pharmaceutical corporations’ abuse of medicines patenting systems to increase their own profits – including in countries outside Europe, where patent offices often follow the EPO’s decisions when they decide whether to grant a patent to a pharmaceutical corporation or not.

As some new patented drugs – such as those to treat cancer – come to market with price tags reaching €400,000 per person, there is an urgent need to reform patent systems so that people have access to the medicines they need to stay alive and healthy.

“Unmerited patents in Europe are giving pharmaceutical corporations the monopoly power that allows them to charge exorbitant prices for many lifesaving drugs,” said Gaëlle Krikorian, head of policy at MSF’s Access Campaign.

The excessive prices Gilead is charging for sofosbuvir have kept this breakthrough medicine away from millions of people with hepatitis C in Europe and around the world. What is the point of medical innovation if people and health systems cannot afford the products coming out of it?”
https://www.msf.org/appeal-lodged-against-decision-uphold-gileads-patent-hepatitis-c-drug

On This Blog
The controversy over expensive new drugs for hepatitis C
Link to a collection of current articles regarding the effectiveness and safety of generic hepatitis C medicines, as well as addressing the high cost, insurance restrictions; private insurers/Medicaid and availability of generic versions/India, Egypt and other lower-income countries or through online "buyers clubs"

Baby Boomers and the Flu

Updated
Dec 6, 2018

2018-2019 Influenza Season Week 47 ending November 24, 2018
FluView Activity Update (Key Flu Indicators)
According to this week’s FluView report, seasonal influenza activity increased slightly in the United States. The proportion of people seeing their health care provider for influenza-like-illness (ILI) is above the national baseline for the first time this season, however this increase may be influenced in part by a reduction in routine health care visits during the Thanksgiving holidays. Twenty-one states are now reporting regional or local flu activity(Alaska, Arizona, California, Connecticut, Florida, Georgia, Idaho, Kentucky, Louisiana, Massachusetts, New Hampshire, New Jersey, New York, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, and Utah). That means those states are seeing outbreaks of flu and laboratory-confirmed flu in at least one or less than half of the regions of the state, respectively. However 28 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands continue to report only sporadic flu activity, which means those states are seeing small numbers of flu or one laboratory confirmed flu outbreak. Influenza A(H1N1)pdm09 viruses have been the most commonly identified flu viruses since September 30, 2018. CDC also reported two additional flu-associated pediatric deaths for the 2018-2019 flu season. While activity is slowly increasing, it’s too early to say the 2018-2019 flu season has started.

An annual flu vaccine is the best way to protect against influenza and its potentially serious complications. There are many benefits to vaccination, including reducing the risk of flu illness, doctor’s visits, hospitalization, and even death in children. CDC recommends that everyone 6 months and older get vaccinated now; continue reading the CDC's "FluView report" for the key flu indicators week ending November 24, 2018.

Remember flu activity tends to increase between Thanksgiving and Christmas!

Public Health Agency of Canada: 
The most up-to-date influenza information from Canada is available at http://www.phac-aspc.gc.ca/fluwatch

Joint ECDC - WHO/Europe Weekly Flu Update:
https://flunewseurope.org/Severity

December - In The News
Influenza: Lessons from Last Season, Looking Ahead to the Next
DECEMBER 05, 2018
Cecilia Pessoa Gingerich
The 2018-2019 influenza season is upon us, but while there’s no way to predict when this season will peak, over the years, data has shown that the influenza season in the United States picks up in October and peaks from December to February, sometimes lasting as late as May.. 

Study analyzes all severe influenza cases in 12 Catalan hospitals between the 2010-2011 and 2015-2016 campaigns

Nov 16, 2018

Nov 12, 2018
First Universal Flu Vaccine to Enter Phase 3 Trial
Numerous experimental vaccines that aim to provide multi-season protection are in human studies.
Ashley P. Taylor
For decades, scientists have been trying to develop a universal vaccine that would protect people against seasonal flu for years, and also against pandemics, which emerge when viral strains completely novel to people’s immune systems start spreading. “A universal flu vaccine is often referred to as ‘The Holy Grail’ of influenza research, and like the Holy Grail, it is challenging to achieve,” Tamar Ben-Yedidia, chief scientific officer of BiondVax, whose universal flu vaccine is now in Phase 3 clinical trials, tells The Scientist in an email.

It has been about 20 years in the making to get to the point of a Phase 3 study—the first universal flu vaccine to have progressed to that stage—and there are numerous others following behind. All of these vaccines employ variations on a similar strategy, which is to generate immunity to parts of the virus that are the least variable from strain to strain...

Maryn McKenna
At first glance, that response makes sense: If a vaccine won’t protect you from illness, why take it? But the effectiveness of flu vaccine is more complex than the binary of Sick or Not Sick. People who get the shot may still end up with flu infection, yet because they got the shot, they are less likely to experience grueling symptoms, be admitted to the hospital, or die.

Nov 8, 2018
Are you prepared for another flu season? 
Test yourself on essential core components of influenza and refresh your knowledge of best practices with this quick quiz. Although the quiz is aimed at physicians, patients may find the information beneficial as well.
Begin here: https://reference.medscape.com/viewarticle/904316

Video:
Nov 4, 2018
This flu season should serve as a wake-up call – we need to redouble our efforts to prevent and treat the flu
Seasonal outbreaks of the flu cause thousands of deaths even in a good year, and the last flu season, 2017-2018, was a terrible one. It killed 80,000 Americans and sent 900,000 to the hospital, making it the worst influenza season in decades.


Baby Boomers and the Flu 
Did you know that you are more susceptible to flu-related complications if you're over 65, living with chronic liver disease, or viral hepatitis? Yep, I knew it too. 

Currently information on this blog is aimed at people living with or treating hepatitis C, for the most part that is the baby boomer generation; born between 1946 to1964. 

Speaking of baby boomers, if you haven't read the CDC's eye- opening report on last years flu season, it was reported 80,000 flu-related deaths occurred in the US, the highest in 40 years. The death rate among young baby boomers, aged 50 to 64 were shocking as well; 
"Death rates were highest in the over-65 age group, which is typical, but the second most affected group comprised those aged 50 to 64 years old; normally, the second highest death rates occur in children, from birth through age 4 years. The ferociousness of the flu season overall, combined with above-average impacts on younger baby boomers, made 2017-2018 one for the record books."
Read the article: Flu Season 2017-2018: A Look at What Happened and What's to Come, CDC report, here. Or read this more recent article, updated Oct 19, 2018: 80,000 Americans died of the flu last winter.That’s more than the number killed in traffic collisions, from gun violence, or from opioid overdoses.

Liver Disease & The Flu
As we age our immune system is less effective in fighting infections, and new infections can have a severe impact on the liver. This can be especially serious for liver transplant recipients and people who have cirrhosis. Flu-related complications could develop into bronchitis or pneumonia, which in rare cases can also be fatal.

Even though the flu vaccine won’t keep everyone from getting sick, it helps prevent serious flu complications. For instance people over 65 who were vaccinated had a lower rate of flu-related death, according to a 2017 study, found on the CDC's website.
"Flu vaccination reduced deaths, intensive care unit (ICU) admissions, ICU length of stay, and overall duration of hospitalization among hospitalized flu patients; with the greatest benefits being observed among people 65 years of age and older."
October - In The News
October 29, 2018
Getting Flu Vaccine One Year Doesn't Reduce Vaccine Effectiveness the Next Year
By Amy Orciari Herman
Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH
Getting the flu vaccine every year doesn't reduce its effectiveness — and might even boost its performance — suggests a study in JAMA Network Open.

Researchers examined the vaccination status of nearly 3400 children who presented with acute febrile respiratory illness during one of three successive flu seasons between 2013 and 2016. About one-fourth had flu confirmed on reverse-transcription polymerase chain reaction testing; the rest were considered negative for flu.

The researchers found that while vaccine effectiveness varied by vaccine type (e.g., live attenuated influenza vaccine [LAIV) or inactivated influenza vaccine) and flu virus strain, past-season vaccination did not reduce vaccine effectiveness. In fact, in some cases — for example, the effectiveness of LAIV against influenza A(H3N2) — previous vaccination appeared to improve the vaccine's effectiveness.

Of note, residual protection from past-season flu vaccine alone was observed only for influenza B.
A commentator writes, "The results thus suggest additional support for the current Advisory Committee on Immunization Practices' recommendation that children be vaccinated annually against influenza."
LINK(S):
JAMA Network Open article (Free)
JAMA Network Open commentary (Free)
Background: Physician's First Watch coverage of American Academy of Pediatrics recommendation of inactivated flu vaccine over LAIV (Free)

Oct 28, 2018
New Flu Drug Offers Convenience, Fast Activity, and a Novel Mechanism — at a Price
Last week, the FDA approved a new drug for treatment of influenza, baloxavir marboxil (Xofluza).
The drug is indicated for treatment of symptomatic influenza in patients 12 years of age or older. As with existing treatments, it should be started within 48 hours of symptom onset....

Oct 24, 2018
"I figured [the flu] was something that's dangerous to the elderly and the young, not somebody who is healthy and in their 30s," says Hinderliter, who is 39 and the director of government affairs at the St. Louis Realtors association
"Turns out, I was wrong," he says
Read the article, here.....

Should I or Shouldn't?
September 27, 2018
"People say they never had the flu until they got the shot. That argument doesn’t hold water. Either you got your shot too late, you got a strain of the flu that isn’t covered by the vaccine, or you had a one-day immune response which may make you feel like crap for the day, but isn’t anywhere like having the flu. If you are over 65, high dose flu shots are recommended, and some people feel a bit low and fluish the next day. This is not the flu – it is an immune system reaction"
Read the article: The Flu Shot Debate, written by HCV advocate Lucinda Porter.

CDC Information
People 65 years and older should get a flu shot and not a nasal spray vaccine.
They can get any flu vaccine approved for use in that age group with no preference for any one vaccine over another. There are regular flu shots that are approved for use in people 65 and older and there also are two vaccines designed specifically for people 65 and older:
High Dose Flu Vaccine:
The “high dose vaccine” contains 4 times the amount of antigen as a regular flu shot. It is associated with a stronger immune response following vaccination (higher antibody production). Results from a clinical trial of more than 30,000 participants showed that adults 65 years and older who received the high dose vaccine had 24% fewer influenza infections as compared to those who received the standard dose flu vaccine. The high dose vaccine has been approved for use in the United States since 2009.
Learn more about high dose flu vaccine here.

Adjuvanted Flu Vaccine:
The adjuvanted flu vaccine, Fluad, is made with MF59 adjuvant an additive that creates a stronger immune response to vaccination. In a Canadian observational study of 282 people aged 65 years and older conducted during the 2011-12 season, Fluad was 63% more effective than regular-dose unadjuvanted flu shots. There are no randomized studies comparing Fluad with Fluzone High-Dose. This vaccine was available for the first time in the United States during the 2016-2017 season. Learn more about adjuvanted flu vaccine here.

For Adults with LIVER DISEASE: Important information about a dangerous infection
If you have chronic liver disease, you are more likely to have serious complications if you get pneumococcal disease

Get pneumococcal vaccines 
People who are 65 years of age and older should also be up to date with pneumococcal vaccination to protect against pneumococcal disease, such as pneumonia, meningitis, and bloodstream infections. Talk to your doctor to find out which pneumococcal vaccines are recommended for you. Pneumococcal pneumonia is an example of a serious flu-related complication that can cause death. 

You can get the pneumococcal vaccine your provider recommends when you get the flu vaccine.

CDC - Got Questions?
Flu vaccines recommended this season.

Detailed flu and flu vaccine information specific to the current flu season

If you have HIV, you are at high risk of serious influenza-related complications and should get an injectable influenza vaccine (a flu shot).

Stay healthy!
Tina