H1N1 update: Can we relax now?

The Pediatric Insider

© 2009 Roy Benaroch, MD

While no one is ready to call it over, H1N1 season seems to winding down in most parts of The United States. In my practice, we’ve seen only a handful of cases in the last few weeks. We’re also getting far fewer panicked phone calls for Tamiflu (the wonder-drug, as in “I wonder why so many people think this stuff works so well?”) The vast majority of children and adults who had H1N1 (or “Swine”) flu recovered after four or so days of fever and misery.


There are definitely some sobering statistics. About 1 in 6 Americans probably came down with this flu by mid-November, an astonishing number that reflects just how rapidly and thoroughly a new virus can spread. There have been far too many deaths among children: about 212 at last count, a number that is certain to rise as further reports are processed. Obese adults and pregnant women also turned out to be particularly vulnerable.

The vaccine turned out to be both safe and effective, but probably didn’t reach a “critical mass” of widespread availability until a little too late for most people. Cases of H1N1 are waning just as the vaccine is becoming easy-to-find, and it’s difficult to know for certain just how big an impact the vaccine has had on the epidemic. The Swine Flu of 2009 illustrated some important lessons for dealing with an epidemic: it takes too long to make influenza vaccines using current technology, and it’s difficult to distribute millions of doses of vaccines through 50 states and thousands of health departments. Hopefully lessons from this pandemic can spur development of improved vaccine technologies and public health infrastructure to support a massive delivery of vaccines, medicines, and  other stuff needed to keep a country healthy.

Some dosing issues for the H1N1 vaccine were confusing. Early studies showed that a single dose was effective in adults, but that two doses were needed in children. Because of poor availability and quirks in the FDA licensing, getting two doses into children proved quite challenging, and I’m doubtful that even now most families have gotten both doses for their kids. A more recent study from Australia trumpeted in the headlines just this week announced that a single dose is effective for most children—but that formulation used twice as much influenza antigen in each dose, so the results really don’t apply to the H1N1 vaccines available in the United States.

At this point, I still recommend that children who haven’t yet reached their ninth birthday get two doses of the H1N1 flu vaccine. Though the epidemic is winding down, in some years flu comes back when the coldest part of winter hits, after children return to school in January. Also, H1N1 is not going to disappear after this year—you can bet it will be part of next year’s flu season. Getting two doses this year means that your child is primed for good immunity next year (when presumably H1N1 will be included in the ordinary seasonal flu vaccine.)

There was also a recent recall of some lots of children’s H1N1 vaccine, about 800,000 doses in total. These lots were found to be a little less potent than they were supposed to be, by about 10-12%. The affected lots were only designed for children less than three, who all are supposed to get a second dose. Even if your child got one of these sub-par doses, as long as you get that second dose of vaccine your child will be well-protected.

So: yes, H1N1 was pretty bad—many people got sick, and some died. But it wasn’t a huge catastrophe. Hopefully, the worst is behind us. Keep washing your hands and using that hand sanitizer, and if you haven’t been immunized yet, it’s still a good idea. Children less than 9 still ought to get two doses of H1N1 vaccine, which has been remarkably free of serious side effects.

Not that anyone wants to hear about this, but there’s the “regular” flu season, still to come! Just because H1N1 has overshadowed other causes of flu so far, don’t expect that we’ll get to skip the ordinary flu season. That’ll be here, probably in January. Did I mention you ought to keep washing your hands?

I know the kids are delighted to have to get two kinds of flu vaccines this year, for both H1N1 and for ordinary seasonal flu—so plan to stop by QuikTrip for a tasty chocolate-mint milkshake on the way home. Or pick up a box (or three*) of Trader Joe’s Candy Cane Joe-Joes. Either one will put a smile back on a child who had to get a shot. Heck, they’re probably more effective than Tamiflu for a child who ends up getting the flu.

*One for child, one for you, one to mail to me!

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