A Question Of Health

Is the flu vaccine actually effective?

SPEEDY VIRUS

Q. Two weeks ago you wrote: "If flu vaccination is good for your health, why not give doctors an incentive to provide it?" But is it good for your health? Flu viruses are known for the speed at which they mutate. If the decision about what to include in the vaccine is taken more than a year before it is needed, how probable is it that the vaccination will still be of any use by February of the following year?

A. Everything you say is absolutely correct, and there is a great deal of genuine scientific doubt about the effectiveness of flu vaccine. A recent study in The Lancet showed that the influenza vaccine did not prevent flu, flu-like illnesses or pneumonia in people over the age of 65. But another research study from the Netherlands showed that vaccination was effective in younger people who suffered from other medical conditions that put them at particular risk from influenza. Even when the vaccine is not perfectly matched to the virus, it still seems to provide some protection. The bottom line is that the flu vaccination is far from perfect but, at least for some people, it is better than no vaccination.

FOAMY URINE

Q. Are there any benign causes of nocturia (getting up at night to go to the toilet)? I get up a minimum of once and up to four times a night and produce a very foamy urine with large bubbles. I am in my early forties and otherwise healthy. By day, my urine is far less foamy. My GP sent me for a renal function test, which was negative, and also a fasting diabetes test (also negative), but hasn't come up with any new theory. I think I'm too young to be getting up so often. Can you shed any light on this?

A. Foamy urine usually means there is some protein in the urine. The standard test for urine protein (dipping a specially treated plastic strip into a urine sample) measures a protein called albumin. If your urine hasn't been tested for protein by this method, it should be. It would be interesting to know if there is protein in the urine that you pass at night, which then disappears during the day. There is a condition called orthostatic proteinuria, which usually only affects people under 30. People who have this condition only leak protein into the urine that is produced when they are upright. When they lie down, the protein stops appearing in the urine. It could be that the foaminess is the result of urine that has been sitting in your bladder, but was actually produced by your kidneys during the day. Your second problem - getting up at night - may be due to a physiological inability to "close down" your kidneys at night. Some people lack the natural biochemical rhythm that tells the kidneys to produce more urine during the day than at night. I doubt that either the foamy urine or the nocturia represent kidney or bladder disease.

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AC has some further advice for the couple with muscular dystrophy in the family:

"Get in touch with the Muscular Dystrophy Campaign. They have an excellent website ( www.muscular-dystrophy.org), and supportive information and advice line (020-7720 8055)."