Multi-dose flu shot has only 25 mcg of mercury - most commercial fish contain 23 mcg of mercury per 8 ounces of fish

Multi-dose flu shot has only 25 mcg of mercury - most commercial fish contain 23 mcg of mercury per 8 ounces of fish

Are multi-dose vials less expensive?

Economics are a bit complicated due to wastage with multiple vials:

Single versus multi-dose vaccine vials: an economic computational model

Most of the Western world, apart from the US, has moved on to single vials:

Whenever possible, CDC recommends that single-use vials be used and that multi-dose vials of medication be assigned to a single patient to reduce the risk of disease transmission (

Where to get a thimerosal/mercury-free flu shot?

Many local Costco stores carry only single vials and the cost is $14.99 if no insurance is used. The availability of additional options may improve immunization rates.

Search for a Costco pharmacy near you here, and call them to verify availability: Warehouse Locations - Costco:

Personal Flu Stories - CDC:

Each year in the US, nearly 20,000 children under age 5 are hospitalized due to flu-related complications. CDC recommends that children aged six months through 18 years old get a flu vaccination. Moving personal stories help parents and caregivers learn about the dangers of influenza to children and the benefits of vaccination.

Image source: Influenza virus, Wikipedia, public domain.

How to Pick the Right Bedtime - select a wake up time, count back 7 hours and add 10 minutes to fall asleep

Given the importance of a good night's sleep, how do you pick the best possible bedtime? WSJ's Heidi Mitchell and Stanford University's Dr. Rafael Pelayo discuss with Tanya Rivero.


What Makes A Great Bedtime? | Craig Canapari, MD
Shift workers and people who get jet lag may gain weight because they dusturb their "inside garden" (gut microbes)

65-yo patient received a standard-dose flu shot already this season. Should she get the high-dose shot too? Or get a second regular flu shot?

A 65-yo female patient received a standard-dose flu shot already this season. Should he get the high-dose shot too? Or try to get a second regular flu shot?

The simple answer is no. The patients should consider herself immunized. Studies show that getting a delayed second dose doesn't necessarily increase antibody response, and there's some concern that it might actually have a negative effect on the immunity. If you've already had the regular seasonal dose, wait until next year for another dose.

Image of the H1N1 Influenza Virus, CDC.

From CDC's website:

Sometimes patients age 65 years and older who have received the standard-dose influenza vaccine hear about the high-dose product (Fluzone High-Dose, sanofi) and want to receive that, too. Is this okay to administer?

No. ACIP does not recommend that anyone receive more than one dose of influenza vaccine in a season except for certain children age 6 months through 8 years for whom two doses are recommended.

Would giving an older patient 2 doses of standard-dose influenza vaccine be the same as administering the high-dose product?

No, and this is not recommended.


New High-Dose Flu Shot for Older Americans: Answers to Flu Season Questions - AARP

Ask the Experts about Influenza Vaccines - CDC experts answer Q&As;

Fluzone High-Dose Seasonal Influenza Vaccine | Seasonal Influenza (Flu) | CDC

How to get your research published: The BMJ's tips (video)

In this video, the BMJ's research team discuss what they look for in a paper submitted for publication.

They discuss some of the pitfalls authors fall into when writing up their research, and how to present some of the information that all journals will require.

More BMJ-specific info here:

Healthcare social media #HCSM - top articles

Here are my suggestions for some of the top articles related to healthcare social media (#HCSM) in the past 2-4 weeks:

15 Lessons from 15 Years of Blogging: Link to everything you create elsewhere on the web. And if possible, save a copy of it on your own blog. Things disappear so quickly, and even important work can slip your mind months or years later when you want to recall it. If it's in one, definitive place, you'll be glad for it.

Always write with the idea that what you're sharing will live for months and years and decades. Having a long-term perspective in mind is an incredibly effective tool for figuring out whether a topic is meaningful or not, and for encouraging a kinder, more thoughtful perspective.

Your blog can change your life in a month. If you want to understand an idea, or become a meaningful voice on a topic, or change your own thinking about a concept, write a little bit about it every day for a month.

Too many crying babies: a systematic review of pain management practices during immunizations on YouTube

Unprofessional behavior is prevalent among surgical residents who use Facebook (study)

Support network: People discussing their weight loss are happier with Twitter (more support, less negativity) than Facebook and in-person relationships

A Facebook teaching forum was set up in a London Hospital for undergraduate medical students: 92% approved

Why Wikipedia matters for healthcare: it dominates search results for medical information - BMJ

YouTube as a source of patient information for lumbar discectomy.

The Anatomy of a Scientific Rumor

Email Alerts Services You Should Use

Are You Tweeting Your Marriage Away? Time spent on social media can create friction in relationships (study)

Twitter: an opportunity for public health campaigns : The Lancet

Do you "like" my photo? Facebook use may increase eating disorder risk

Cleveland Clinic has a blog for patients - Health Hub and a blog for physicians - Consult QD

The articles were selected from Twitter @DrVes and RSS subscriptions. Please feel free to send suggestions for articles to clinicalcases at and you will receive an acknowledgement in the next edition of this publication.
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