Almost every day, I get emails from friends or readers who are wondering what to do about the H1N1 vaccine. I'm finding that those who are generally pro-vaccine feel absolutely comfortable with receiving the vaccine and having their children vaccinated with it. Those who are generally anti-vaccine are more likely pass on the vaccine.
Those like myself who take a more selective approach to vaccines are amongst the parents who are having the hardest time deliberating about what to do about this flu pandemic and the vaccines being made available.
Shortly after I shared my post on 5 Things Parents Should Know About the H1N1 Vaccination, a friend of mine in the field working in immune systems and vaccines wrote me with some follow-up information. He gave me permission to share this with you here:
1. Fear of the H1N1 vaccine over the seasonal vaccine is really unfounded. The companies making the H1N1 inactivated vaccines (injectables) are not changing their formulations in anyway except changing the specific flu virions (a virion is just all the virus components which mostly contain the flu proteins but also their genetic material and structural components and are prepared from dead virus).
This is why these companies are the ones making the swine flu vaccine as they already have seasonal flu vaccines from which they are building. Other than the viral strain change, the basic formulations are exactly the same between the two. So if you are one to get a yearly flu vaccine and have no problems then this will be no different.
The perception that the H1N1 is "NEW" and has not been tested enough is also unfounded. Why? Well for one, the seasonal flu vaccines are also new every year in the same manner. This is why we have to get new ones every year. The flu changes year to year, and the vaccine companies just change the new flu vaccines to contain the trivalent virions that represent that year's strains (or in the case of the H1N1, its monovalent or only one strain). The proteins and other virus particles (mostly proteins) elicit an immune responses against the proteins that induce the immune system to remember the proteins (so called immune memory-one of the most fascinating parts of biology). In this case, when the real flu rears its ugly head, then your body should have memory towards its particular proteins and the resulting hyper-activation of the immune system will clear infection in enough time that the flu does not have time to create a severe infection. Forgive me, this is a general vaccinology lesson which I am sure you know.
Thus the take home is that if you get a seasonal flu shot, don't be scared by the swine vaccine shot. If you have not had any reactivity or seen any side effects from a seasonal flu shot, then you won't see them here. The same flu vaccine precautions should be noted here. Flu virions are prepared in chicken eggs so please note this if have allergies to chicken products.
The inactivated vaccines do contain some preservatives such as Thimerosal (the nasal vaccines-mists-do not). Adjuvants (which are particular agents that boost the immune system and sometimes make up the other parts of the formulation of a vaccine) to my knowledge are not used in flu vaccines in the US. All these other components in the vaccine are the agents that have caused concerns over the years. But again, the same agents that have been in all flu vaccines and have been used for several years now are no different in the swine vaccine thus, the notion that these have not been tested is not true. However, you are correct to note (or as the vaccine information notes) that there still are tests being performed. Reports have found that there have been no serious side effects to fetus from a mother receiving the inactivated flu shot.
The only other legitimate concern here with a vaccine would be possible autoimmunity induction. BUT THIS IS A VERY RARE CHANCE in flu vaccines and the same very rare chance can also occur if you are infected with flu itself.
2. Indeed a point of consideration would be which vaccine to get. The mist is not inactivated virions, but attenuated (weakened) flu viruses, weakened to not cause disease but still alive. It actually stimulates the immune system in a much more natural way and may confer a high protection rate, but since it is live virus that has been weakened, it can cause (in some people) a mild flu sickness and it can be shed. But to my knowledge, pregnant woman and infants will not qualify for this vaccine and thus will only be given the injectable version as a functioning immune system is required; pregnant women and infants are more immunocompromised.
3. Pregnant women are indeed a risk group for swine flu, and there are solid explanations to why this is. The studies done (and reported in the Lancet, one of the top leading medical journals in our country) showed the statistics of a pregnant group infected with H1N1 (that was identified as H1N1), and indeed they have a higher incidence of serious disease and even death than the general population. Now it's not a reason to get hysterical if you are pregnant, but it is something serious to consider. The CDC doesn't indicate risk groups without serious study, and pregnant women top that list for swine flu.
4. BOTTOM LINE: BE EXTRA VIGILANT ABOUT YOUR SYMPTOMS AND YOUR HEALTH. Moms, kids, dads, husbands, the guy that delivers pizzas, whoever you are. If you feel different in any way, get to the doctor, and remove yourself. Most of the time, anti-virals will work and will keep you from disease, but they only work in the first few hours of infection. Four days later and a fever of 103, and they wont do anything. Don't abandon good hygiene (all those rules your mom taught you). Wash your hands (warm water-soap-2mins-sing happy birthday twice), cover your mouth when you cough or sneeze (and cover it when someone is not doing so around you). You know what to do, just be extra aware.
The swine flu is spreading like wildfire. The docs don't even need to type it now as its become pandemic. Its the only bug spreading so rapidly RIGHT NOW. SO just be aware. As always and in all things, keep an open dialogue and establish a great relationship with your doctors, your ob/gyns, your pediatricians, and consult them on the specific details of your health. They of course are well-trained, but have also been well-versed in this flu pandemic and are intimately aware of which course of treatment is best for you, knowing your health the way they do.
So there's the perspective of someone working daily in this field.
I know the biggest concern for many families is what to do about the H1N1 if you are pregnant or have an infant at home. I know if I were pregnant right now, I would feel very unsure of what to do. On the one hand, it is risky to take chance catching it as it could be very serious, even fatal. On the other hand, we know there are no established trials on the safety of these vaccines for unborn babies.
On his most recent entry on The Vaccine Book blog, Dr. Bob Sears addresses this very legitimate concern:
What about pregnant and/or nursing mothers?
This is a little scary. The flu shots are ALREADY recommended for pregnant and nursing moms, BUT (and this is a really huge but) the vaccine product inserts make it very clear that the regular flu vaccines have never been tested on pregnant or nursing women to determine if there is any harm to fetuses or young babies (with one exception – the Flumist nasal spray brand did have some testing in this area, BUT not enough, as is stated in the product insert).
Despite this complete lack of research, it is recommended for these moms anyway. Anyone see a problem with that?
If you do get a flu shot, at least make sure it is mercury-free (or at least only TRACE mercury).
Dr. Sears has received a lot of heat over his cautious stance for pregnant women, but he maintains his belief that pregnant women should not receive this vaccine (or any flu vaccine) unless, as the vaccine manufacturers suggest, it's clearly needed.
To provide a little balance for those who generally do not vaccinate, here is the Mothering Magazine page of resources for the swine flu.
Many have asked what we are doing about the H1N1 vaccine, and I have been a little hesitant to answer because I so strongly, strongly believe each family (each individual, really) must decide what is best based on their own unique set of circumstances. I do have to say that I really believe that we have already had swine flu. Shortly after school started in August, H1N1 began going around in our community, and we had several verified cases within our church. Dacey, Kyle, and I all got very sick with a list of symptoms that read like checklist for H1N1. AJ had a touch of it, but nothing too bad.
Because of this and because we don't do the seasonal flu vaccine, we personally are opting not to get the H1N1 vaccine. We have no pregnant mamas, no infants, no people with asthma, and no elderly people in our home. So that is what we feel comfortable choosing for our family. For now.
