Tuesday, October 13, 2009

Seasonal Flu and H1N1: To Vaccinate or Not?

On a couple of the email lists I read, people are discussing the flu vaccines. Parents are thinking about seasonal flu, and H1N1 (Swine flu), and whether getting vaccinated is the right course for their families. I can't answer that question- it's a personal decision with a lot of variables involved, and a lot of strong opposing opinions that I feel have merit. However I have been researching facts that can help me make the decision for my family, and I can share what I've learned and the conclusions that I have drawn. Perhaps my words and these statistics will help you as you decide the best course for your own family's health.

As of right now, I do not plan to get the H1N1 vaccine for anyone in the family, nor do I plan on getting the regular flu vaccine. I am open to changing my mind if the situation changes, however. I've been doing research to help me be more informed in my decision. I live in Georgia (USA), where H1N1 is particularly prevalent right now. The situation certainly deserves my thoughtful attention.

A little background: my children are all vaccinated. (Meaning the "normal" required vaccinations for children.) I have altered the vaccination schedule to delay certain vaccines, and to spread the shots out more so that each visit is limited to one triple-vaccine only, or no more than 3 single-vaccine shots. (I feel that this makes for an easier load on the child's immune system at any given time, and also makes it easier for me to watch for and pinpoint adverse side effects, if they occur.) I have opted out of the varicella vaccine for now. I think I'm a little behind on my schedule right now, but in general we've kept up with the vaccinations pretty well. My decisions are based on a combination of my own bias, research, the AAP recommendations, what feels like common sense, and gut instinct. It's not terribly scientific.

The only time I have gotten the flu vaccine for myself or the kids was when there was an infant in the house. Those years, I had myself and the older brother(s) get the thimerosal-free flu vaccine. All other years we've gone without, and only had mild flu one year. I avoid nasal-mist vaccines, as they have a higher rate of adverse side-effects than the injected flu vaccines. Also, I prefer flu vaccines that are free of adjuvants.

Based on my research, no one in our household is on the list of high-priority candidates for the H1N1 vaccine. The kids, being 6, 4 and 2, are arguably "school-age", so they could be considered high priority. However some researchers think that the higher incidence of H1N1 in school-age children has a lot to do with the fact that most of them are in school, where diseases are spread quickly and easily. Kids are germy. I think that makes sense. So as homeschoolers I feel pretty comfortable that we aren't priority number one in needing the H1N1 vaccine. We are all in good health, and none of us has a neurological or an immunological disease (thank goodness), so that's in our favor. (Mortality rates from H1N1 are higher for those individuals.) I'm pretty sure none of us has a bacterial infection (nasty if combined with flu). I hope to maintain good health and hygiene as much as possible. I am more vigilant about everyone taking their vitamins each day, and I plan to check our vitamin D3 and vitamin C intake and add extra if necessary. So far, H1N1 is mostly a mild case of flu for most individuals that contract it. For now, my risk-benefit analysis tips me toward not vaccinating for flu. However if the morbity of the flu this year starts to look really alarming (not just alarmist, which is what we have right now) then I will certainly consider the thimerosal-free flu vaccines. Also, if I fear the supply here will run out early in the season, I may decide to go ahead and vaccinate just in case.

There are some risks from the H1N1 vaccine (as with all vaccines), and specifically there is concern that it could be linked with a neurological disease called Guillain-Barre Syndrome (GBS). There was an H1N1 vaccine in the 70s that seems to have caused a higher rate of GBS in vaccinated individuals than in the normal population. Whether the newer H1N1 vaccine carries the same risk remains to be seen, although health officials assure us that the new vaccine will be safer. Either way the risk is small, so if H1N1 proves to be a strong danger than the risk-benefit analysis may still favor the vaccine.

I hope you find this helpful as you make your own decisions. I've looked up a bunch of statistics that have helped me come to these conclusions- I cited my sources but didn't bother to keep actual links, I'm afraid. I'll copy and paste what I have, though it will make this a very long post indeed. One particular statistic I looked for was the average mortality rate of seasonal flu in past years. I started wondering, because I kept hearing news reports about people dying from H1N1, and it sounded really scary. But then it occurred to me that probably lots more people die every year from regular flu, but it's not reported. Sure enough:
"normal" flu yearly averages: From WHO (World Health Organization): "With seasonal flu, we see in the United States over 30 million cases. We see 200,000 hospitalizations and, on average, 36,000 deaths." (During the entire fall and winter flu season.)

By contrast:
H1N1 this year: On August 8, 2009 (most recent confirmed data from CDC I could find), CDC is reporting 477 deaths due to H1N1 in the US.
Of course, that number hasn't even begun to reflect the actual cold and flu season here, so expect a much higher number before this is done. However it's quite small compared to the number of flu-related deaths in the US on a normal year. One thing about all my research on this: it may not have made me fear H1N1 overmuch, but it's taught me to have greater respect for the flu in general.

More statistics:
(CDC reports) In pediatric deaths (36 as of Aug 8) due to H1N1:
67% had at least one high-risk medical condition. Among those with high-risk medical conditions, 92% had neurodevelopmental conditions (e.g., developmental delay or cerebral palsy).
43% had a laboratory-confirmed bacterial coinfection (usually a staph infection or strep throat)
52% had received at least 1 dose of the 2008--09 seasonal influenza vaccine
and 61% had received anti-viral treatment

(CBS News reports) More than 80% of the pediatric deaths due to H1N1 in the US so far have been children over 5 yrs old. Almost two-thirds of the children who died with swine flu had epilepsy, cerebral palsy or other neurodevelopmental conditions. In a previous flu season, only a third of pediatric deaths had those conditions.

(CBS News reports) Swine flu has caused more than 1 million illnesses in the United States, the CDC estimates. More than 550 deaths and 8,800 hospitalizations have been reported to date.

(CBS News reports) The risk of death from H1N1, CBS News medical correspondent Dr. Jennifer Ashton said, is roughly 1 in 1000 people. She said you should weigh that risk against getting vaccinated, which, however safe the vaccine may be, the risk is never zero. It is possible that swine flu vaccine could cause GBS (Guillian-Barre Syndrome), a brain disorder. She also says that the risk of getting GBS from the H1N1 vaccine is very low -- one in every million vaccinations. (Earlier in the article the rate of GBS infection is stated as 1 case in every 100,000 to 1 million vaccinations.)

(The Rhode Island Dept of Health reports) The majority of H1N1 vaccine will be packaged in multi-dose vials and will contain thimerosal, a preservative found in some vaccines. . . . because some women are concerned about being exposed to preservatives during pregnancy, a limited supply of preservative-free seasonal flu vaccine and H1N1 vaccine will be available for pregnant women and small children.

That's all I have now. I've been saving it as I have time to look things up. Hope it helps!


dulcetry said...

I've been on the fence about H1N1 vaccine for Joey. On one hand, the adverse effects of the flu on some populations is especially frightening. I've seen some very harrowing cases working on L&D and NICU this semester. On the other, the novelty of the vaccine are also scary.

I asked one of my nursing professors about this situation because I am so torn. She basically highly recommends getting both seasonal and H1N1 vaccinations this season. This is what she wrote to me:
" The H1N1 vaccine will be made in the exact same way the seasonal vaccine is made and these are not live viruses. I will be getting one myself and will strongly encourage my son and daughter-in-law to vaccinate my grandson. I think any risk associated with the vaccine is far outweighed by the benefits. About 76 children have died thus far r/t H1N1. "

Here is a link she included: http://www.ed.gov/admins/lead/safety/emergencyplan/pandemic/index.html

I value her opinion greatly, but I'd be lying if I said I am not undecided. I will be getting the seasonal flu vaccine tomorrow, because they are now requiring them of all pediatric healthcare employees. I'll be starting on a pediatric respiratory unit tomorrow. Joey will also get the seasonal flu shot.

You put up some great statistics I hadn't yet seen. Thanks for another great post:)

Kit said...

Glad it was useful! Yeah, it's a tough decision- vaccinating for flu or not, there are good arguments on both sides of the debate. It seems like this has been going on so long that I feel flu season must be over soon- I have to keep reminding myself it's not even winter yet! Now (complicating my decision making process) I have the uncertainty as to whether we've already had H1N1. We've all been sick and I keep finding conflicting reports on the exact symptoms of H1N1. If we have had it, there's no need to vaccinate. But did we? Do we? I don't know.