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The Swine Flu Vaccine: When, How, and is it Safe?

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Questions about the swine flu vaccine abound: when and in what quantity will it be available? Does it work? Is H1N1 even that bad? And what are the side effects?

nurse administers flu vaccine

Dr. Cara Natterson: Almost everyone in the business of predicting what the winter flu season will look like agrees: the novel H1N1 "swine flu" will be back with a vengeance. No one knows -- or even knows how to predict -- the burden that H1N1 will bring. No one can say with certainty how it will compare to seasonal, "regular old" flu; whether it will cause mild or serious disease; or whether it will infect by the thousands or by the hundreds of thousands.

According to the CDC, to date, 9,079 people have been hospitalized with swine flu, and 593 have died from the disease. The development of a vaccine against the H1N1 strain began almost as soon as the virus was identified, and it is scheduled to be licensed in October. Because the CDC is not committing to a specific release date or to a number of doses that will be available, speculation has taken over, with reports that the number of doses of the new vaccine will be insufficient to protect against pandemic spread of the virus. Front page headlines last month claimed 90,000 could die of the infection this year.

It is possible that the speculators are right. Epidemiologists say in order to "protect" the sum total of us from a pandemic, sufficient doses of vaccine need to be administered. But it is not at all clear what this sufficient number is, who should be vaccinated first, or how much vaccine can be manufactured (let alone administered) in time for the onset of the winter flu season. According to the CDC, if the H1N1 vaccine supplies are severely limited, then the following groups should get it first: pregnant women, people who live or work with children under 6 months of age, healthcare and emergency medical services personnel, children 6 months to 4 years, and older kids (5-18 years) who have chronic medical conditions.

Here's the intriguing paradox: one of the top -- and probably the largest -- priority groups slated to get the vaccine first is not necessarily going to be lining up to get it. This is because the parents of young children have become vocal vaccine skeptics.

The CDC has focused their vaccine priority on young children because young children are among the most effective carriers of disease. Infants drool, they spit up, and they put just about everything they can into their mouths. Toddlers pick their noses, rub their eyes, and lick their fingers. Kids under the age of four are very good at sharing the bodily fluids that transmit flu viruses with everyone around them; they are far less good at washing their hands and practicing basic hygiene. If this single group can be vaccinated, not only will they be spared illness from H1N1, but their immunity should limit the rampant spread of the virus.

So who is going to be able to convince parents already reluctant to vaccinate that they should give their children this vaccine? A tremendous burden will rest with physicians, who are going to have to find the time to talk to parents about the risks and benefits of a brand-new vaccine on which we have very little data -- about its efficacy (does it work?), necessity (is H1N1 even that bad?), and toxicity (what are the side effects?). And this precious time is going to have to be found during the already busy back-to-school and winter flu seasons.

Here's another major hurdle: the majority of H1N1 vaccine will be in multi-dose vials. Any vaccine in a multi-dose vial must have a preservative. Translation: Most of the new vaccine will contain the mercury preservative thimerosal. And in some places -- like my home state of California -- it is against the law to immunize young children with thimerosal-containing vaccine. There is an aggressive attempt at producing single-dose (i.e., thimerosal-free) vaccine for pregnant women and young children, but there are no guarantees if and when this can be accomplished.

Meanwhile, seasonal influenza will also reappear as it does every year. There is no reason that the existence of the new H1N1 virus will reduce the burden of seasonal flu.

People always want to know what a pediatrician does for her own kids. Well, I took mine in for their seasonal flu vaccines last month -- something I typically do in late September or early October. This regular flu vaccine won't cross-protect against H1N1, but it should protect my kids against this year's garden-variety seasonal flu. I did this early so that if the H1N1 vaccine becomes available, and if my kids even qualify (by age) to get a dose, they will have the option to get it. No one knows yet how the two different flu vaccines need to be timed; most reports suggest that they can be given simultaneously, or that they need a 3-4 week interval between administrations. By getting a seasonal flu vaccine early, my kids will pass the 4-week mark before the H1N1 vaccine even hits the shelves. Meanwhile, as the studies of the new vaccine are completed and safety data emerges, I will have another round of decisions to make, come October.



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41 comments so far | Post a comment now
Natalie September 30, 2009, 4:07 AM

If this vaccine is NOT recommended for babies under 6 months old, why would I, as a pregnant woman, get this vaccine? That doesn’t make sense. The baby inside of me would still be getting the effects of the vaccine, and I’m not willing to risk the health of my unborn baby on a vaccine that no one knows anything about. Parents with young children are correct in questioning this vaccination because we know nothing about it. I do not selectively vaccinate my kids (they get all the vaccines they’re supposed to get), but I’m not having them get this one, or the regular flu shot. If they get sick, we’ll take care of it. And from people that I know who’ve already had the swine flu, as long as you get to the doctor in the first few days of having symptoms, they give you medicine, and you’re fine.

Jenni/mom2nji September 30, 2009, 5:10 PM

I completely agree with Natalie. Do you really think pregnant woman should be given double doses of MERCURY? Hell NO. I WONT give this vaccine to my kids.

Anna September 30, 2009, 5:16 PM

People concerned about the vaccine should take a reality check as to how many people, including normally healthy children, die every year from the flu. It’s not “just a cold” — it can have very serious and deadly effects. Flu can also be deadly for pregnant women and unborn babies. Do weigh the possible side-effects of vaccine, but realize that the dangers of flu are nothing to sneeze at!

Anonymous September 30, 2009, 6:12 PM

I agree with Anna. People are way too paranoid about shots and vaccines.

Anonymous September 30, 2009, 7:54 PM

To those skeptics and paranoids, please remember that physicians, nurses, pharmacists and vaccine developers are making and administering this vaccine to protect you and your children, not harm you. There is information about this vaccine, there is a lot known about it. no, it isn’t a well known immunization such as measles/mumps/rubella, however it isn’t like you are going to be the “guinea pigs”. in a sense, there is little known, in comparison but it wouldn’t be handed out if it wasn’t safe. it is up to us all to provide what is called “heard immunity” for us all to be safe and disease free. do your part, immunize yourself and your children.

Natalie October 1, 2009, 3:58 AM

People need to remember that the flu is only deadly if it’s not treated. I had the flu as a child, and I’m still here. The swine flu is no different. It’s just a different strain of the regular flu. It’s not some superbug that attacks and kills everyone in it’s sight. As long as you get to the doctor, you’ll be fine. Just like the people who’ve already had the swine flu. I give my children the regular vaccines because they’re proven to work. I’m not going to give my children a brand new vaccine that no one knows what will happen with. I’m also no interested in getting a vaccine that hasn’t been properly tested on pregnant women. I’d rather get the stupid flu, go to the doctor, be sick for a week, and then be fine than possibly die from the vaccine, or hurt my unborn baby. I’m just not interested in any of it.

Samoys October 3, 2009, 1:06 PM

lot about you

Moriah October 5, 2009, 2:04 PM

The shot is scary. I just try to prevent sickness by hand washing and all natural diinfectants. I use Sol-U-Guard which was just clinically tested and KILLS H1N1!! YAH!!

Moriah

Carolyn October 7, 2009, 9:48 AM

I have memories of thalidomide, which was also a well intentioned treatment. Its a bit scary to have your young children be the first generation recipients. I think I will wait, but I do feel torn about it.

Jeanne October 8, 2009, 11:10 AM

To those that are concerned about this vaccine versus seasonal - it’s really not any different other than the *strain*. Had 2009 H1N1 emerged late last year instead of early this spring, after the 3 strains had been selected for this year’s seasonal, then it simply would have been INCLUDED in this year’s seasonal shot.

So if you normally get the seasonal shot, you really shouldn’t have any concern about this shot.

Now if you are against vaccines for other reasons then……..

Sanjay Gupta October 15, 2009, 3:58 AM

To those skeptics and paranoids, please remember that vaccine developers are making and administering this vaccine to make money. To the rest of you, you will believe anything you hear on TV so I won’t even try to educate you on the horrors of modern day vaccines.

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