Lots of concerned and well-informed families have been inquiring about flu season this year. Most want to know whether they or their children should get the seasonal flu vaccine and most are especially curious as to whether they should get the swine flu vaccine when it becomes available (in October). The answer is not a simple one in my opinion, and is intricately connected to your own thoughts, concerns, and circumstances. Because of the complexity of the question, the frequency with which it is being asked, and my time limitations, I must direct your questions to this blog rather than answer each one individually. If you would like to discuss your situation in detail further, please bring it up in a future appointment or make an appointment to discuss it further, and thank you for understanding!
The illness: We all know what is like to have the flu or care for someone with the flu. It is much more than a nagging congestion and cough that you can work through. It usually forces us to stay home a bit, and the associated fatigue has been described as feeling like you were hit by a truck. Some folks get sick enough to go to the hospital, and others have such severe respiratory problems that they wind up in the ICU or worse. Swine flu is not necessarily going to be any more severe than the seasonal flu in terms of symptom severity, but it does seem to be causing more sickness in young children and young adults as well as pregnant women. The phenomena has been labeled a pandemic by the World Health Organization because of the rapid rate of spread. We believe it is spread the same way the seasonal flu is spread, but most humans do not have any pre-existing protection for this particular strain of flu virus, making it easier for the virus to infect one person after another after another. Ninety percent of the deaths associated with seasonal flu each year are in patients who are elderly. Conversely, the disease burden of H1N1 is highest in adults younger than 25 and in children. This is why those special groups are being targeted for vaccine first.
First, let’s agree that prevention of the illness is the primary goal. Preventing incidence of the illness will also prevent spread of the illness; the fewer get sick, the fewer will spread the disease. I am convinced that the data collected by the Center for Disease Control, and the World Health Organization is to be respected. Yes, the media coverage has been on the dramatic side, but since I cannot guarantee to you, my flock of patients, that this is more panic than pandemic, I feel the better part of wisdom is to recommend the H1N1 vaccine in accordance with the CDC recommendations. Influenza can be a very serious illness (an average of 36,000 patients die of flu related complications each year), and an ounce of prevention is worth more than a pound of cure, especially if you or your loved one has ever suffered serious consequences from an illness like the flu. Of course, prevention includes MUCH more than vaccinating. Please follow the suggestions about prevention below whether you choose to receive the vaccine(s) or not.
I know some of my patients are averse to non-essential vaccines, and we can only speculate at this point in time whether this should be considered essential or not. I really wish we could see into the future to know how bad this expected pandemic will be. In the last century we have had such events as the flu pandemic of 1918 in which 500,000 Americans lost their lives in one year. The CDC status report of September 11, 2009 shows that H1N1 is widespread in the southeastern United States already. The complication rates are no higher than with seasonal flu, but the number of cases is quite high for September. The conclusion seems to be that this may be the beginning of a really tough flu season.
1. If you (or your children) have significant flu symptoms (fever, cough, sore throat, runny or stuffy nose, muscle aches, extreme fatigue, etc), please STAY HOME. Do not send a sick child to school or daycare. This will decrease exposure to others and could make a huge difference in prevention on a community level! Stay home until you (or your child) have been afebrile (no fever) for a FULL 24 hours - without the use of fever reducers like acetaminophen (Tylenol), ibuprofen (Advil/ Motrin), naproxen (Alleve), or aspirin. And never give aspirin to a person younger than 18. Ever. BTW- If you are sick and must leave your home, consider wearing a protective mask- it will at least prevent touching your nose and then touching other items!
2. Wash your hands with soap and water for a good 20+ seconds under warm water frequently. If you must, use antibacterial hand cleaners, but know that soap and water are preferred. It is a good idea to wash your hands any time you are preparing food, preparing to eat, after using or even entering a restroom, and after touching surfaces in public places (doors and railings at shopping outlets, etc.) Try to avoid touching your mouth, nose, or eyes especially after touching surfaces in public places.
3. Cover your cough or sneeze - try to do it with your upper arm rather than your hand, and if you are using a tissue, please throw it away immediately.
4. Consider supporting your immune system with probiotics. Early studies seem to indicate that the benefit of keeping healthy bacteria in your gut with these supplements or “live foods” decrease the severity of flu-like illnesses. Perhaps when less of the immune system is dealing with imbalances in the digestive system, more is available to fight microbial invaders like the viruses that cause flu and swine flu.
5. Since flu viruses replicate best in colder, drier air, consider a humidifier or even a diffuser with some essential oils like Eucalyptus to “cleanse” your home breathing environment.
6. Avoid close contact with others who are ill.
7. Get adequate rest. Stay well hydrated and well nourished. Consider a mutli-vitamin supplement (not a proven strategy, but unlikely to harm) and be sure you are getting adequate vitamin D. Regular exercise can help your immune system too, but over-exercising can deplete you. Do NOT pull all-nighters this flu season, folks. Just don’t do things that you know make your immune system weaker. (Smoking is in this category, too, friends. Smoking of any kind!)
Now, about the vaccines.
There will be 2 types of vaccine - one for the regular or seasonal flu, and one for H1N1 flu (also known as “Swine Flu”). They will be discussed separately below, and neither will offer protection against both types of flu.
Seasonal Flu Vaccine
- Recommended even more strongly this year by the CDC because we are expecting a heck of a flu season.
- Approved for ages 6 months and up.
- Not to be given to people who are ALLERGIC to EGGS - because it is incubated in an egg based culture.
- Recommended especially if you are caring for a child under 6 months (they have weaker immune systems) or live with a frail or elder adult. They also may have reduced immune function.
- Please consider for you and your child especially if you have concerns about your (or your child’s) immune system’s integrity or if you have chronic illnesses like asthma, diabetes, heart disease, kidney disease, cancer, or are on medicines that affect your immune system.
- I will have vaccine doses for children this year but have been UNABLE to procure doses for adults, presumably because there was such a rush on vaccine from retail outlets like Safeway who are offering vaccines. Therefore, please do get the vaccine wherever it is offered- your pharmacy, workplace, or community centers, places of worship, etc.
- If this is your child’s first flu season for vaccine, s/he will need 2 doses 1 month apart to get full immune protection. The first one introduces the virus particles, the second one boosts the immune system’s reaction to it, so that is exposed, the child will be less likely to develop the illness.
- It is worth mentioning that this vaccine is changed slightly every year- it is aimed at the strains of the virus that epidemiologists and infectious disease experts think will be the most likely to prevail in the coming flu season. It is not a perfect vaccine because the flu virus tends to mutate quickly (this is called antigenic shift), but it has been shown to decrease incidence of the influenza illness.
- Seasonal flu vaccine comes in several forms. The injectable doses are killed or inactivated vaccine- they cannot cause influenza. There is a less common vaccine that is administered by nasal inhalation. It is a live, weakened (attenuated) vaccine, so can cause mild influenza illness.
Swine Flu/ H1N1 Vaccine (estimated availability October 2009)
- I will be giving vaccine in Friday-Saturday flu clinics when it is available- look out for updates in your email.
- Most want to know about its safety. It is manufactured in the same way as seasonal flu, so I anticipate exactly the same kind of safety profile. I do NOT have reason to believe there is reason to suspect this vaccine any more than seasonal flu vaccine. It is likely also to be a killed virus vaccine, so it will NOT cause actual flu illness, though your immune reaction may cause you to feel poorly for a brief time after the injection. I do not know yet if it is safe for those who are allergic to eggs.
- Who to vaccinate? Highest risk groups include younger patients (6 months to age 24) and pregnant women. Next in line are healthcare workers and caregivers for infants under 6 months of age.
- How many shots? As of 9/11/09, we believe adults will need only one injection while children under 4 will need 2 shots separated by 4 weeks as they do with seasonal flu vaccine the first year they are vaccinated.
- When to vaccinate? As soon as the vaccine is available. Protection should be present 8-10 days after the shot.
What about treatment if you’re sick?
- Supportive treatment at home is all most people will need. It’s a really great idea to stock up NOW on tissues, anti-fever medicines, decongestants, and things of the like so you do not feel the need to venture out in an infected state.
- It is OK to give over-the-counter cold medicines to children age 5 and older. Do NOT give these medications to younger children due to safety concerns.
- Tamiflu and Relenza are the anti-virals that we have all heard about in the context of this flu and others. Right now it is recommended that only patients with illness serious enough to warrant hospitalization be given these mediations as they may be in short supply when the rubber hits the road.
What about the rationale to decline vaccination?
- There is one potentially convincing reason to avoid vaccine, and that is the possibility of immunity conferred by illness. Medical science has not yet evolved to the point that we can answer the risk/ benefit question with pinpoint precision, and honestly, that would be a lot to ask. Some thoughtful providers are recommending their patients err on the side of not vaccinating because if we get a mild H1N1 season this year, we could be better protected if and when it comes back later in life. In fact, it is estimated the about one third of adults over age 60 have some antibody to H1N1 from their previous illness with a similar flu strain years ago. It is not known whether the presence of this antibody confers protection to the current H1N1 strain, so this information is not compelling to me as a reason not to vaccinate, especially if you or your kids are in a higher risk group.
- As I alluded to earlier, I know that some of my folks are simply in an anti-vaccine place intellectually or from a “gut feeling”. That’s OK. We all decide what risks are acceptable for ourselves and our families. I hope and expect no harm will come of that position as I hope and expect no harm will come to those who choose to vaccinate. Compelling arguments are available for either position. Some families allow kids to ride motor bikes and four wheelers; others would never consider that risk - it’s nice we have the freedom to choose. However, when we take measured risks in either case, it is essential that we are prepared to shoulder the burden of potential consequences. I would be devastated as a provider and as a parent if my patient or loved one had a bad outcome from a vaccine preventable disease OR from a vaccine. I choose to vaccinate because I would feel more integrity with that decision in retrospect. As many of you know, I have not been the most adamant or aggressive flu vaccinator in past flu seasons. I have a sense that this year may be different, so I will be getting vaccinated against both.
Where to get more information?