Flu: To shot, or not

The Pediatric Insider © 2009 Roy Benaroch, MD

Good news: today, the FDA announced the approval of vaccines to prevent novel H1N1 influenza. It sounds like these immunizations will be available in the coming weeks, and studies in adults performed so far show excellent and rapid immune responses with minimal side effects. Studies looking at children are currently underway, and confirmation of the safety and effectiveness of these vaccines for all ages should be available by the time they’re distributed.

Phew.

My state has one of the highest rates of H1N1 influenza, probably thanks to our twisted, evil preoccupation with starting school too early (oddly, the school boards have not sought my opinion on this matter.) So we’ve been seeing dozens, maybe hundreds, of H1N1 cases in my office. The good news is that no one has been super-super-sick; the bad news is that many kids have been pretty-super-sick, and their parents and siblings are getting it too. Tamiflu can help some, if started early, but really hasn’t proven to be particularly effective. Probably better for most victims to just head to bed, and have chicken soup, tea with honey, and maybe a popsicle or two. Best case scenario: a 4 or 5 day illness, and hopefully no trips to the hospital for children or the parents when they get it.

Other parts of the country have barely started experiencing a spike in H1N1 cases, so the vaccine may indeed be able to avert a huge epidemic—if it’s distributed and used quickly. If a community can get a big chunk of its citizens vaccinated, especially the children, the spread of the virus can be halted.

That’s still a big if. It’s going to be logistically difficult to distribute enough doses of the vaccine quickly enough. Furthermore, some people seem reluctant to accept the vaccine.

Myth: This H1N1 vaccine is new, so it might not be safe.

Fact: Every year’s flu vaccine is “new,” in the sense that they’re made from different flu strains. But the technology and method to make them is identical from year to year, and has been identical for decades. Rates of adverse reactions, serious and non-serious, do not vary from year-to-year, and don’t seem to depend on the strains involved. Nonetheless, safety testing is an essential part of vaccine development, and the H1N1 vaccine has been tested both here and abroad in thousands of patients. Side effects are uncommon, and almost all of them have been very minor.

Myth: Some people “get the flu” from the vaccine.

Fact: The commonly used injected vaccine is not live, and cannot transmit influenza. A small percentage of people run a brief fever or feel a little achey after the flu shot, but that’s not nearly a full-blown case of the flu. The newer, nasal mist flu vaccine is a live vaccine, but the virus used has been adapted so it cannot survive at normal human body temperatures. It cannot transmit the flu.

Myth: Only people who are infirm or elderly get the flu; or only weak people die from the flu.

Fact: Though you’re more likely to die of flu if you have pre-existing illnesses like heart or lung disease, many healthy young adults get very seriously ill with influenza, especially in pandemic years like the one we’re having now.

The best ways to protect yourself and your children against the flu are to practice good hand washing and hygiene, to avoid sick people, and to get flu vaccinations. The flu vaccine not only protects the recipient, but also the whole family, and the community. Where uptake of flu vaccines has been good, there’s a dramatic drop in influenza cases for everyone—including very young babies, who can’t get vaccinated, yet are at very high risk of complications, and including the elderly, in whom vaccinations are ineffective.

It’s not clear now how much H1N1 vaccine can be distributed, or what risk groups will be targeted. It is clear that from a public health point of view, the most important vaccine recipients are school-aged children, because they serve as the reservoir and source of spread of infection for communities.

Right now, immunizations against other flu strains are available—though the injectable kind is running in short supply, as many manufacturers have focused their efforts on H1N1 vaccine. Please, if you have children, get a winter flu vaccine administered as soon as you can, and keep in touch with your pediatrician’s office to find out when H1N1 vaccine will be available in your community. We’re all in this together. Go get your shots.

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Tags: H1N1, immunization, influenza, swine flu, vaccination, vaccine

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