Give Kids First Shot at Swine Flu Vaccine?
Sept. 10, 2009 -- An all-out vaccination program that would target children first could mitigate the impact of an H1N1 swine flu pandemic this fall, new research indicates.
Such a concerted vaccination effort could lead to coverage of 70% of the U.S. population, say researchers at the Fred Hutchinson Cancer Research Center’s Vaccine and Infectious Disease Institute.
Their analysis, aided by computer modeling, is published in the Sept. 11 issue of Science Express, an early online edition of the journal Science.
The study recommends that 70% of children between 6 months and 18 years old be vaccinated first in such a program, along with members of other high-risk groups, including health care workers and people with chronic medical problems.
The researchers say two doses of vaccine, administered three weeks apart, may provide enough protection against the virus.
A combination of factors, including the availability of an effective vaccine and the timing of an outbreak, will determine how quickly an epidemic can be slowed, according to co-author Ira Longini Jr., PhD, of the Fred Hutchinson Cancer Research Center and the University of Washington.
“Our estimates of pandemic H1N1 in households, schools, and in the community places this virus in the higher range of transmissibility,” lead author Yang Yang, PhD, of the Fred Hutchinson Cancer Research Center and the University of Washington, says in a news release.
The report also estimates that:
- Children are likely to experience the highest illness attack rates.
- The typical student will infect an average of 2.4 school mates.
- 30%-40% of flu transmission occurs in households, about 20% in schools, and the rest in the workplace and the community.
- Pandemic spread may cause illness in 25%-29% of the world population in one year, resembling what happened during the 1957-58 Asian influenza A (H2N2) pandemic.
- The average time between the onset of illness in a person and onset of illness in someone that person infects may be 2-3 days.
H1N1 already has become the dominant flu strain in the Southern Hemisphere, where flu season is under way. Vaccination increases immunity and slows spread of infection, and reduces risk for flu complications and death.
The researchers also say that social distancing and antiviral medications can be effective in offsetting spread of H1N1 when combined with vaccination on a mass scale.
H1N1 Swine Flu Vaccine FAQ
Who is first in line to get the H1N1 swine flu vaccine? continued...
So who will get the first doses? Five groups:
- Pregnancy increases a woman's risk of severe flu sixfold, so pregnant women are a priority group.
- Household contacts and caregivers of children younger than 6 months of age, including day care providers. Infants are too young to vaccinate and are at high risk of severe flu.
- H1N1 swine flu most often strikes young people, so people ages 6 months to 24 years are a priority.
- Health care workers and emergency medical personnel.
- Any adult aged 25 to 64 with a medical condition, such as asthma, that increases risk of flu complications.
States may further restrict scarce early doses of H1N1 swine flu vaccine to subgroups, such as children under age 4. However, providers are not likely to be too strict, knowing it's better to use the vaccine promptly than to let it sit in a refrigerator.
If I'm not at the front of the line, will there be enough H1N1 swine flu vaccine for me?
The first 6 or 7 million doses is the tip of the iceberg. By Oct. 12, the CDC says 40 million doses of vaccine will have been shipped. Every week thereafter, 20 million doses will ship.
Overall, the U.S. has now purchased 251 million doses of H1N1 swine flu vaccine. The U.S. has donated 10% of the supply to nations not able to afford the vaccine, leaving 226 million doses for the U.S.
Since adults need only one dose (children need two doses), and since not everyone will choose to be vaccinated, this means everyone who wants the vaccine eventually will be able to get it.
Is the H1N1 swine flu vaccine safe?
The H1N1 swine flu vaccine, both the shots and the nasal spray, are made the same way as the seasonal flu vaccine.
Every year or so, the seasonal vaccine -- which includes a component based on the seasonal H1N1 virus -- is tweaked to match a flu virus that has changed its genetic makeup. The same kind of tweaking resulted in the H1N1 swine flu vaccine.
That's why the FDA approved it: They considered it just a strain change, and not a brand new vaccine.
Even so, both long- and short-term clinical trials are under way. Results from the short-term studies already are here: Other than causing the usual soreness and perhaps redness at the site of injection, the vaccines cause no major side effects.
And like the seasonal flu vaccine, the H1N1 swine flu vaccine can't be taken by everybody. The vaccine is produced in hens' eggs, so people with egg allergies cannot take the vaccine.
Will there be long-term side effects? That's not likely -- but the CDC is taking no chances. The CDC and vaccine manufacturers have beefed up their safety monitoring process to look for anything unusual in people who get vaccinated against the new flu.
Millions of people are going to get the vaccine. Odds are, something bad is going to happen to some people around the same time they get their vaccine. If they have a car wreck two days after getting the vaccine, it's not likely to be blamed on the vaccine.
But what if, say, a pregnant woman has a miscarriage soon after vaccination? There will be scary media reports and the CDC will investigate. Public health experts are warning people to understand that events such as miscarriages are not all that uncommon; it will take some time to learn whether they are more common in women who get vaccinated than in women who do not get vaccinated.
Who should get the H1N1 swine flu vaccine?
Because it is a new virus to which humans have never before been exposed, everyone is vulnerable to H1N1 swine flu. That means everyone could benefit from the vaccine.
But cases among people over age 65 have so far been rare. And few healthy adults over age 24 have suffered serious swine flu illness. These groups are asked to wait until others have had a chance to get vaccinated.
Eventually, there will be enough H1N1 swine flu vaccine for everyone who wants it.
If I think I've had swine flu, do I need the vaccine?
Even during a flu pandemic, colds and all kinds of flu-like illnesses circulate. In fact, most flu-like illnesses are NOT caused by the flu.
If you came down with a flu-like illness since April 2009, you may have had the H1N1 swine flu. But the only way to know for sure is if your doctor took a nasal or throat swab, sent it off to a lab, and had that lab confirm the infection.
If that didn't happen, it's not safe to assume you already had the flu. Especially if you're at risk of severe flu illness, it's a very good idea to get your H1N1 swine flu shot AND your seasonal flu shot. The vaccine is perfectly safe for people who actually had swine flu.
What's the difference between the nasal spray and injectable vaccines?
The traditional flu shot contains proteins separated from the flu virus. Those proteins can't cause illness. But your immune system learns to recognize them, and mounts a protective reaction if a real live flu virus tries to infect you.
The FluMist nasal spray works differently. It contains a live flu virus that has been weakened to the point that it can't cause the flu. That sounds pretty scary, but millions of people have safely taken this kind of vaccine.
The advantage of the nasal spray is that in children who have never had the flu or a flu vaccine before, it seems to elicit a stronger immune response than the flu shot.
The disadvantage of the nasal spray is that in older people who've had the flu or flu vaccines before, it may not be quite as protective as the flu shot. That finding is based on a single study, based on just a single flu season. And since nobody has had the H1N1 swine flu before, the FluMist H1N1 swine flu vaccine is expected to work just as well in adults as the flu shot does.
I know studies show vaccines preserved with thimerosal are safe, but is there an alternative?
Tiny doses of a mercury compound called thimerosal keep multidose vials of flu vaccine safe from contamination with bacteria. Before thimerosal was added to multidose vials, contamination caused serious adverse events.
Exhaustive studies fail to find any reason to believe that thimerosal is unsafe. But if you don't want thimerosal, you don't have to have it. Single-dose syringes of flu vaccine don't need thimerosal and don't have any. Neither does the FluMist nasal spray vaccine.
If you prefer a thimerosal-free vaccine, check with your provider to see if one is available. If not, check with your state or local health department to see where you can find one.
I've heard that something called squalene is in the vaccine. Is that true?
None of the U.S. H1N1 swine flu or seasonal flu vaccines contains squalene.
Squalene isn't a very nice sounding word, but it's an oil that's a natural part of many body processes. It's widely used in cosmetics because it penetrates the skin easily without leaving an oily feel.
Squalene is also used in substances called adjuvants. When mixed with vaccines, adjuvants make vaccines work better at lower doses.
The U.S. purchased millions of doses of these adjuvants in case the H1N1 swine flu vaccine had to be boosted to be effective. That turned out not to be necessary. Unlike current H1N1 swine flu vaccines, a vaccine with adjuvant would have to be specifically approved by the FDA. Such vaccines could be used this year only under the FDA's Emergency Use Authorization. No such authorization has been issued.
However, adjuvants already are approved in Europe and other areas. They've been used safely in millions of people, although they may cause a bit more of a reaction at the site of injection that vaccines without adjuvant.
Vaccine makers likely will file for FDA approval of adjuvants, but this approval will be subject to rigorous safety analysis. In any case, no adjuvant will be used in any flu vaccine given in the U.S. this flu season.
Where can my children and I get the swine flu vaccine?
Medical practices and clinics that want to offer the H1N1 swine flu vaccine have already registered with their state health departments. Check with your doctor to see if she or he is offering the vaccine.
Because children are especially vulnerable to H1N1 swine flu -- and are especially likely to spread the disease to others -- many states will be offering H1N1 swine flu vaccinations in schools. In some states, permission slips already have been sent to parents.
Some states are also planning vaccinations at public sites. These plans will be announced locally.
Different state, territory, and tribal health authorities have different plans. There is no one-size-fits-all plan; the CDC advises local health departments to adapt their H1N1 vaccination plans to local needs.
That goes for retail chains as well. National retail outlets, such as pharmacy chains, may offer
How much will the H1N1 swine flu vaccine cost?
The U.S. government purchased the vaccine from manufacturers and is providing the vaccine at no cost.
The CDC has asked providers NOT to charge for administering the vaccine. Even if they do, several large insurance companies have said the costs would be covered.
I've heard H1N1 swine flu shots are mandatory. Is that true?
Swine flu shots are voluntary for most Americans. For those not in the military, there is no federal requirement to get the H1N1 swine flu vaccine.
Active-duty military personnel, National Guard troops on active duty, and civilian Defense Department employees in critical jobs will be required to get the vaccine.
Health care workers may be required by their employers to get vaccinated. The state of New York, for example, has mandated both seasonal and H1N1 swine flu vaccinations for all health care workers.
OK, you talk a good game. But would YOU get the swine flu vaccine yourself?
This WebMD reporter was a guinea pig in the swine flu clinical trial. You can watch me get my first shot.
What happened? Nothing. There wasn't even soreness at the site of injection. I did catch a cold (sniffles, cough, no fever, no muscle aches) about three weeks after my first shot -- unfortunately, flu shots don't protect against that. But I haven't had the flu, even though I live in a city (Atlanta) that's had a lot of cases.
H1N1 swine flu vaccine in some areas but not in others.
Fact v. Fiction: Answers to Swine Flu Questions and Rumors
September 28, 2009 10:41 AM
On Friday, federal health officials gave the most detailed information yet on the roll out of the H1N1/swine flu vaccine. The first doses are heading to 90,000 locations across the country -- but days before they arrive, many parents are saying they don't want the vaccine for their children. So we brought our Senior Medical Editor Dr. Richard Besser in, as a truth-squad about the rumors. Watch out the clip below where he separates fact from fiction.
http://blogs.abcnews.com/theworldnewser/2009/09/fact-v-fiction-answers-to-swine-flu-questions-and-rumors.html
Does seasonal flu vaccine protect against swine flu or make it riskier?
Who you gonna trust, Canadians or Mexicans? Or maybe neither.
Less then two weeks ago, Canadian researchers reported in a paper that has not been published in a journal yet that immunization with the seasonal flu vaccine increased the risk of contracting pandemic H1N1 influenza and of developing more severe complications. Although most experts pooh-poohed the findings, which are often referred to as the "Canadian problem," some provincial health authorities postponed their seasonal flu vaccination programs.
Now, Mexican researchers report today in the British Medical Journal that vaccination for seasonal flu actually protects against infection by swine flu. In a small study of only 240 patients, Dr. Jose Valdespino of the Laboratories de Biologicos y Reactivos de Mexico in Mexico City and his colleagues found that those who received the seasonal flu vaccine were significantly less likely to contract swine flu and that, even if they did contract it, they were less likely to develop severe complications.
The problem with both studies--aside from the fact that they directly contradict each other--is that they run counter to everything we already know about the two viruses. Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said recently that there is no plausible mechanism by which vaccination could increase the likelihood of contracting swine flu. Furthermore, researchers in the United States, Australia and elsewhere have scoured their data and find no similar effect.
As for protection, researchers had fervently hoped that seasonal flu vaccination would provide some, thereby limiting the fatalities that might be associated with the pandemic. But every laboratory experiment they have performed shows there is none. The two viruses are simply too different for antibodies raised against one to affect the other. And again, according to CDC spokesman Joe Quimby, researchers have scoured their data and found no support for the new findings.
So where does that leave us? Back where we started. The most likely scenario is that both the Canadian and Mexican results are wrong and that seasonal flu vaccination provides no benefit against swine flu and no harm. Bottom line: get both vaccines.
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