Tuesday, October 27, 2009

Taming the Hog: Immunization or Not for "Swine Flu"

This week many people have asked me what my advice is regarding immunization for H1N1 flu. I thought it was probably easiest to just put this up on the blog, and let the conversation go where it wanted. So here is my view of things.

First, H1N1 is not a "killer flu" for the vast majority of patients who come down with it. However, it is a royal pain in the butt, carrying a great risk of missing work, sleepless nights, and attendant worry about your health or the health of your children.

H1N1 has increased risk for some demographics, most notably pregnant women and asthmatics. That doesn't mean that the risk is high, just higher. For some people, particularly those with significant lung, heart or immunity issues, any influenza can be downright dangerous, and H1N1 is no different.

On the other hand, the H1N1 vaccine is just another flu shot. There isn't anything particularly new about it ... except that it carries cut up and inactive parts of H1N1 flu instead of other types of influenza. The other (non-viral) components are frankly very similar or identical to vaccines that we have used before. Like other flu vaccines, it is grown on chicken eggs, so those individuals with egg allergy should probably discuss its use with their physician. But, otherwise, it is almost certainly a safe tool to help prevent infection.

People often get bent out of shape by the fact that injecting virus fragments into your arm doesn't seem quite .......... natural. To my mind this is fuzzy thinking. When your body encounters a live influenza virus, your immune system does all that it can to destroy the invader, which basically means chopping it up into components and then destroying those. When all the viral agents are disposed of, and the body's system is tuned to fight any new ones it encounters, the illness ends.

The difference, of course, is that the live virus has a window of opportunity in the healthy host to replicate (causing the fever, headache, sore throat and cough) and then to move on. The symptoms from the vaccine, on the other hand, include a sore arm, maybe mild muscle aches for a day or two. I have had the flu, and I have been vaccinated .... getting shot is better.

What about those individuals who "always get sick when they get a flu shot"? Well, most of those folks are getting their shots during flu season. They almost certainly are not getting sick from the shot, but because they are one of the up to 75% of the population that gets the flu each year, and the immunization hasn't had time to work yet.

Finally, what about those who are healthy, and "never get the flu anyway"? Well, as I said above, H1N1 is not a terrible disease for most, and for some it actually has quite mild symptoms. Some, undoubtedly, don't have the fever, or much of a cough or sore throat. So these individuals don't stay at home. So they can brush up against the pregnant woman, or the guy with leukemia at the bus stop, and pass the virus along. In that context, it seems to me, the responsible thing to do is to go get shot, so that you aren't a reservoir for others in your community.

Bottom line:

1) The disease isn't terrible, don't panic. But it is at least a big pain and, for some vulnerable people, maybe a lot more than that. Many un-immunized people will be missing work, school and sleep because of this virus.

2) The vaccine is not some scary, rushed process, but rather an example of tried and true techniques applied to a new virus. This is intelligent, competent medicine that will almost certainly reduce the risk of infection, not a FrankenShot here just in time for Halloween.

3) My advice: unless you have severe allergies,go get shot! And shoot everyone in your family too.

Click on the "comments" link immediately below this link to let me know what you think about this ...



Quirkymom said...

Thanks for the post on H1N1. I did have a confirmed case of it in my grade 6 classroom this week and am sure that she is not the only one who has it. I am not too stressed about it, but it does make catching up on homework tough - some have been absent already over 6 days. And unfortunately their art teacher is expecting, so I am more concerned for her. After all that we have read, it seems that most people educated in the medical or research field are all getting/recommending the shots, so I had to ask myself why some of my mom friends were "passing", I just didn't quite get it. Thanks for the post!

Chantal said...

Just one question!

My family has suffered through this virus late last week and still now. Four kids, missed work, like you said BIG PAIN. Doc said it was/is swine flu symptoms and prescribed us Tamiflu as we fell like dominoes!

Now that we've had it - one question. Should we still get the vaccine?

jessica said...

Sounds like what my pediatrician said--compelling, but still not sure what I want to do for my asthmatic 3 yr old and my 6 month old. So far, each one of the days my dr's office has had their shots in stock, they've been sick anyway...

Eleanor said...

Thanks for putting all this down calmly! As a parent iit's been hard to know what's what with all the hype around.

My 1 year old daughter was confirmed with H1N1 last week after almost two weeks of a cough and on/off fevers and we were all put on Tamiflu by the doctor although she is the only one showing any symptoms.

Before my daughter got the cough we were slightly leaning towards getting the H1N1 shot and now we are assuming that she doesn't need it- but what about the rest of us? Any suggestions?

You can see our H1N1 gong show story at my blog www.themouseintheattic.com
Thanks again!

Mighty Mama said...

My question is, isn't this like other flu vaccines that only create antibodies for certain strains of virus? So people who are immunized against some strains could still contract another strain, could they not?

amotherworld said...

Great post - thank you for writing it.

Petra said...

I like your advice & I'm glad that this wasn't just another scary blog post about H1N1 and the vaccine. Some people are really bent on finding reasons against rather than reasons for!

Heather McNeil said...

Our 10yr old son has H1N1 and I have a few questions
1. How will I know when he doesn't have the H1N1 anymore? will his cough just disappear when he's done?
2. when he startes going back to school can he get the H1N1 again?
3. does this mean that the rest of us in the family will definitely get it too?

RookieMommu said...

Thanks that's a real down to earth summary - great advice

Anonymous said...

Dear Virtual Pediatrician,
Great post. I am an infection control RN in a kids' hospital and agree wholeheartedly with your position.
The line ups are long right now in Ontario for the public clinics - but I definitely urge parents to pack some colouring and toys, bring a snack (and some hand sanitizer) and brave the line ups. The sooner we get more kids vaccinated, the sooner we'll all feel better!

Loukia said...

Well said. Thank you. I have not stopped researching and reading for the last 72 hours, and my head hurts. I just want to do what is best for my children. I am scared of this flu, especially because so many young people have died from it. I do understand that most cases are mild, but I'm not going to risk it. I will get my boys vaccinated tomorrow. I have to have some trust in my children's pediatrician who says it is safe to get this shot - the one that contains thimerosal, the one that has the added adjuvant. I have to believe no harm will be done.

Lainey said...

Thanks for this. I am one of those who rarely gets the flu, and I was a bit concerned about the fact that flu shots change every year. I'm not against vaccines, though. There really is a lot of bad science out there regarding them, and it seems that some people will only believe stuff if it IS bad science.

The lineups to get the shot are about 6 hours here, though. :o( So I might have to wait a bit anyway.

Anonymous said...

Hi Brett,

Great post - thanks!

In Canada we're only being offered the AS03-adjuvanted vaccine. My young son has an active auto-immune disease (and we have a family history of a-i problems), and sticking an adjuvant into him scares me witless. Do you have any advice on this? I can't find the topic in any reputable Q&A anywhere! Thanks

Anonymous said...

Thank you for this post - I found it very helpful.

Anonymous said...

Thanks for being a voice of calm in a storm of anxious rhetoric.

Brett Taylor said...

Hi Chantal:

"Now that we've had it - one question. Should we still get the vaccine?"

Short answer: if there are no medical contraindications, yes. No one knows whether what you had was H1N1 (although it sounds very likely). The last thing you want is two such episodes this winter. The vaccine is safe, so the advice I am giving as people leave the ED is to get shot once they are well.

Brett Taylor said...

Hi Eleanor;

The current advice is to shoot everybody ... Even the one who got the flu. See my answer to Chantal above.

Brett Taylor said...


Yep, you are right. The H1N1 vaccine won't protect you against the regular Influenza A expected in December / January, or against next year's flu. But the flu in town right now is H1N1 nearly exclusively.

Brett Taylor said...

Hi Heather;

"1. How will I know when he doesn't have the H1N1 anymore? will his cough just disappear when he's done?"

Generally, once the fever is gone for 24 hours (with no acetaminophen or ibuprofen) you can say your kid is well.

"2. when he startes going back to school can he get the H1N1 again?"

Nope. Unless your son has a major immune deficiency, he now will be protected against H1N1. Mind you there are lots of other uglies out there ...

"3. does this mean that the rest of us in the family will definitely get it too?"

Probably. Go get shot! If you can, now that there are shortages and rationing.

Brett Taylor said...

Re: Adjuvants in active autoimmune diseases .... sorry, not a clue. I will do some research and try to get back to you, but the best bet is to contact your rheumatologist or immunologist and get a read from them that applies to your specific circumstances.

Brett Taylor said...

Sorry to be so late in responding to some of your posts, folks! Now that I know how to work this thing .....