H1N1 Vaccine: One dose or two?

The Pediatric Insider

© 2009 Roy Benaroch, MD

I seem to be spending a lot of time on H1N1 here, and a lot of time on H1N1 issues in my office. I can see myself, an old retired doctor in 50 years, sitting in my holo-rocking chair, listening to my octophonic MP6 player through my aural uplink (a new, never-released Michael Jackson tune!), reminiscing about the winter of 2009, the Swine Flu. “What’s a swine?” my grandchildren will ask.

 

For now, though, we’re in the thick of it. And some very smart people with brains larger than I are guessing that about a third of us in the USA are going to get this darned thing this winter. A third. Imagine that.

 

We still need to keep this in perspective. That’s a lot of sick people, but the vast majority of children and adults who get H1N1 flu recover fully in about five days. It’s uncomfortable and unpleasant and, well, pretty miserable for five days, but H1N1 has a very low rate of complications. Still, with perhaps 100 million Americans getting ill, even rare complications are going to occur more frequently than I want to see them. Some people are going to get quite ill, some people are going to be hospitalized, and some people are going to die. We should do what’s safe and effective to slow this epidemic.

 

How to prevent it? Stay away from sick people. Wash your hands. Don’t touch your face. Don’t go to work when you’re sick, and don’t send your kids to school when they’re sick. Workplaces should not encourage sick employees to work, and schools should not reward perfect attendance.

 

And please, get the dang vaccine. Forget the AM radio and internet nonsense: the government and the doctors do not want to kill you.

 

Getting all of this vaccine made and distributed has not been an easy task, and I wouldn’t call the government’s efforts one of their finest moments. At my office we’re depending on the folks at the Fulton County Health Department, who’ve so far sent us a tiny smidge of our expected order. With no advance warning, and no word on when we’ll get more. But the overall picture is improving—though the vaccine is dribbing out, it is getting out, and the trickle should become faster soon. Meanwhile, good studies continue to support the safety and effectiveness of immunization.

 

We’ve known for many years that children younger than 9 don’t seem to mount a strong immune response to flu vaccines, especially in their first year of immunization That’s why current recommendations for ordinary, seasonal flu vaccines suggest that if a child less than 9 is getting a flu vaccine for the first time, the dose should be repeated 28 days later.

 

It turns out that the swine flu vaccine is no different—and that’s no surprise, as it’s essentially the same vaccine that’s used to prevent influenza year after year, designed in this case to prevent this new H1N1 strain. The science, the development, the studies, and the factories are all the same as ordinary flu vaccines. Ignore hype that claims this vaccine is somehow more “new” than other flu vaccines.

 

So: it’s recommended by the ACIP (the advisory board on immunization practices of the CDC) that children less than 9 get two doses of the H1N1 vaccine this year for best protection. (Actually, some studies were done using a 10 year cut-off; so in some places the recommendation is up to age 10; but since that recommendation is up to 9 for seasonal flu, that’s the way most health departments and doctors’ offices are handling it.)

 

At the same time, we know that from a public health standpoint that the best way to put the brakes on the epidemic is to get as much of the population immune as quickly as possible. That will prevent the virus from spreading from person to person. Once the “herd” is mostly immune (or at least more immune), then all of us—vaccinated and unvaccinated—will be less likely to come in contact with anyone with flu, and therefore we’ll all be protected.

 

Though two doses are better than one, the CDC does not recommend that doctors “hoard” doses back to ensure that those second doses are given. We’ve been told—and it does make sense, when you think about it—that we ought to get as many kids vaccinated as possible with first doses, and continue vaccinating as long as we have vaccines, as quickly as possible. Since more and more doses are expected to be distributed in the coming weeks and months, it’s probable that second doses will be available, thought it can’t be guaranteed; and the timing might get tricky. Though a minimum of 28 days between doses is recommended, the interval can be longer than this. By the way, this recommendation is identical to what’s been recommended in previous years with ordinary, seasonal flu vaccines. Hoarding has never been encouraged by CDC or World Health Organization guidelines. Though two doses are better than one, one dose is far better than zero, and getting as many people as possible that one dose is going to help your child, and all of us, stuff this H1N1 genie back in the bottle.

 

Older H1N1 wisdom:

H1N1 vaccine after H1N1 illness?

A pandemic primer for parents

Flu: to shot, or not?

 

The CDC’s H1N1 site

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Tags: H1N1, immunization, influenza, vaccine

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