I want to talk about H1N1 vaccine.

Why do some people oppose to taking the vaccine?

When the vaccine comes along, I will probably get the shot.

Some people freak out over extremely rare, though very serious, side effects to vaccines of all types.

But the fact is, AFAIK, "herd immunity" is to my general benefit, and is worth the minor personal risk. How do I know this? Basically, because I am alive, and my odds of getting this far have been massively improved by mass vaccination against some very serious diseases.

It cuts a bit closer to home for me, odds-wise, because my DW is in the schools daily and an international airport is within view. So I am 30 minutes from nasty-bug-ground-zero.

I am personally more worried about drivers who are juggling a cell phone, newspaper, coffee and muffin at 70 MPH on the highway. If I was a betting man, I'd take serious odds on the jab.

Personally, I don't feel enough research has been done in the short amount of time H1N1 has been around. Plus the fact that I don't usually even get regular flu shots, and the normal flu is said to be much worse as far as mortality rate than H1N1.

Pretty much it.

I don't recall the last time I had the flu.. 5 years?

I got strep from flying a couple years ago... that was what I can remember.

No really good reason to *oppose* vaccination for the flu. It can help, or at worst be a wash, just a stick in the arm. There have been complaints about timerosol, a preservative included in the vaccine, particularly in complications for pregnant women. There is also a version of the vaccine without preservatives though. I think there could be arguably good reasons not to be vaccinated, but outright opposition isn't one of them imo.

Question for armchair virologists out there: if H1N1 mutates and becomes a killer (by percentage of infection, or killer of a specific age/community), will the current H1N1 vaccination provide any protection?

All things being equal, I may skip immunization on H1N1, have the flu, and develop some bit future immunity. It doesn't seem very severe (deadly to my age group), and immunization might just up the odds of becoming deblitated by a more virulent and deadly strain. I think differently for my college age daughter going off to the germ factory / college in a couple weeks. Question there is whether the vaccination ready in mid-October will be ready in time to prevent H1N1 in kids starting college in early October.

I am talking out of my arse, so need to spend some time on public health and CDC sites...

I don't know enough about the issue to give an informed opinion, but Dr Mercola's take on H1N1 and the vaccine is very informative.

This article and the ones associated with it are nothing more than fear mongering pseduo-science opinions, being expressed by individuals with agendas on anti-conventional medical practices. Could a particular vaccine generate significant side-effects? Absolutely, but the side-effects tend to be limited in terms of distribution and effect, where as the disease being vaccinated for has demonstrable and proven detrimental effects. Next time someone denounces the value of a vaccine, take a look at some video of child with whooping cough and tell me you would not take the small risk of vaccination to prevent that debilitating disease in your child.

I received my seasonal flu vaccine the other day and if at all possible plan on receiving the H1N1 vaccine. Each to his own, I have had the flu several times and if I can do something with low risk to reduce my chances of becoming infected, I plan to do so, without hesitation.

Pete

Well, since this is in the Campfire, I'll be more loose in my comments. H1N1 and particularly the topic of a vaccine has create a lot of controversy in certain circles. There are lots of different groups who oppose the H1N1 vaccine.

You've got what are often labelled the "antivax" folks who typically oppose childhood immunizations on various medical grounds, like fear of autism, although there is no credible evidence to support a link. These folks are often fans of Dr Sears, who is doing a lot to harm the health of children, not save it, IMO.

There are other antivax folks who think that vaccines just weaken the immune system in general, or in more extreme cases, are actually highly poisonous. The topic of immune system-boosting chemicals, like squalene, are the topic of much debate within these circles. Typically, these same folks usually push alternative health products (often to their own profit) which are supposed to boost your immune system. I know Dr. Mercola is popular but I lump him in this camp. Many of his articles, although referenced, do not reflect good reasoning representative of the scientific literature. Plus, he pushes his own products all the time so his credibility level with me is usually at the "huckster" level.

Many folks fear a repeat of the 1976 swine flu vaccine and cases of Guillain-Barre Syndrome (a link that research does not consistently support). But the H1N1 vaccine is totally different from that vaccine. It's not like they took the '76 vaccine out of the freezer, thawed it out, tinkered with it a bit, and are ready to start injecting it into people now. The H1N1 vaccine is basically just like the regular seasonal flu shot in terms of how it was designed and produced.

There are some who think the H1N1 vaccine is just another way that Big Pharma is making a huge profit at the government's (really, OUR) expense. Actually, they claim that Big Pharma bioengineered the virus, released it to create the pandemic, and are now profiting from selling the vaccine.

There's a libertarian wing that points to language in various laws which they say proves that the government is planning on forced, mass vaccinations, and those that refuse will be thrown in jail or at least fined thousands of dollars and the rest of their lives ruined. These folks seem to be same ones that go to town hall meetings and scream, "Stay out of my health care, you socialists!!!"

Then there's a whole set of tinfoil conspiracy theories out there about sinister plans to do things like: inject microscopic nano-tags in everyone through forced vaccinations so that the government can track us, massive global depopulation (i.e. killing us) through tainted vaccines, etc. Oh, I love this one--in early summer, when obesity seemed to be a risk factor for serious cases, there was serious talk about how H1N1 was a tool that health insurance companies created to kill the people who cost them the most money (i.e. the obese) before health care reform kicked in and reduced their profits. Crazy stuff.

What concerns me is a series of news reports I have read over the past few months on various surveys done in the UK, Hong Kong, and here in the US, where a very large percentage of healthcare workers say will skip the H1N1 shot. Maybe it's just the reporter cherry picking the most inane reasons, but these professionals are saying things like, "Well, I got a flu shot ten years ago and still got sick" or "I didn't get the shot last year and didn't get sick". Huh? That's the most un-scientific reasoning! And you guys are health professionals? Funny, I don't hear any big backlash against these same professionals getting their other mandatory immunizations, like for hepatitis or tetanus.

That's kinda like saying I haven't been seriously injured in a car accident so I'm not sure how important seatbelts really are...

Flu shot production has to begin long before flu season begins so they have to guess which flu to make a vaccine for. Sometimes they guess "wrong". It doesn't mean the vaccine was bad but rather it wasn't the one you wanted.

(I'm going to guess that it will take only one good flu episode to change your mind on the vaccines)

I'm not a medical expert and don't follow national and local flu trends etc. I leave that up to my GP. I got a seasonal flu shot Monday and when asked if I wanted to be on their H1N1 vaccine list told the nurse what I always say "ask the Dr, then call me if he says yes". I pay him good money for his medical opinions and I see no reason to conclude now I know better than him.

It may continue to provide some protection, but it really depends on the specific mutation, so there are no guarantees. That's exactly why the regular flu shot needs to be updated regularly. Don't forget that "protection" could also include getting sick but avoiding the really serious complications, and does not only mean avoiding coming down with it at all.


This point is not necessarily true. Allowing yourself to catch H1N1 now may not confer any more protection to a mutated H1N1 down the road, plus you're adding more risk up front that you'll be one of the unlucky ones who develop a very severe reaction to H1N1 now. And immunization could also very well protect you from a more dangerous mutated strain.

From the public health perspective, avoiding or at least delaying the spread of H1N1 is a primary goal. Allowing yourself to catch H1N1 also means that you'll likely pass it along (since you'll be infectious before and after symptoms disappear), and the highly infectious nature of H1N1 means lots of people get sick at the same time, swamping medical resources at the same time.

Edit: Lono, you mentioned age, which is something most people forget about with the H1N1 vaccine. Currently, anyone over 25 and without any health conditions like heart disease, asthma, etc. are not part of the priority group who should be vaccinated first. On the other end of the age spectrum, depending on how the flu season develops, those over 65 may not ever be recommended to get the H1N1 shot (although still highly recommended to get the seasonal flu shot). We'll see if those recommendations change as the flu season progresses.

I was going to see if he had a disciplinary record at the FDA but his About Me says


Oh yeah. He's not a practicing doctor, hasn't been for a few years, and doesn't seem to be even working in the field any more.

As with any vaccine for viruses, there are many factors that may or may not influcnce the effectiveness of a vaccine. There are enveloped viruses and non-enveloped viruses, there are RNA viruses and DNA viruses, some viruses can have an almost immediate effect such as the flu virus and there are others like the slow viruses which can take 20 years or more to cause disease, these as well as whole of other factors can add significant challenges in making an effective and safe vaccine. Some commentators will use the failures or complications of past vaccines in support of their anti-vaccination point of view. Bottom line - Although it is not possible to prove a negative effect, I think I am safe in saying: Vaccinations have prevented more deaths than any other protective measure including the use of seat belts.

Pete

Excellent response, thanks for the clarifications and corrections Arney!

Since squalene in the H1N1 vaccine is a hot topic in alternative health circles as a reason not to get the shot, I thought I would mention that the four vaccines that were just cleared by the FDA for use in the US do NOT contain squalene as far as I have been able to determine from press releases. GSK's vaccine should be approved shortly. So regardless of what you think about squalene, it's not an issue here in the US.

Novartis and GSK do have versions of the H1N1 vaccine with squalene, but those are not the versions that were just approved. Other countries may use the versions containing it, but since early clinical trials show unexpectedly good immune response to just a single dose of the non-squalene version, it's possible that those countries may switch to a non-squalene version, too.

I find it somewhat ironic that squalene from shark liver has been touted as a beneficial nutritional supplement (fairly large doses) to stimulate the immune system and as a powerful antioxidant by many who use alternative or nutritional therapies, but then condemn it when used in vaccines (relatively small doses when compared to nutritional supplements) because of purported over stimulation of the immune system leading to autoimmune conditions.

Pete

I know that Mercola doesn't do much for you guys, but here is his take on squalene and may answer the question of why it can be both beneficial and dangerous. FWIW.

It is a highly personal choice when it comes to vaccines. When I retired from the military I decided that I would no longer get the seasonal flu shots; 26 of them was enough for me. I only got/get "sick" about once every three years for about 3-4 days. I will not be receiving any vaccinations unless required by law. I HAD (NYS law) to get an MMR shot to attend college because I could not prove I had two of them in my life of 47 years. Either way, no voluntary vaccinations for me.

I'm currently just days away from turning 40. It's safe to say I've had the flu a few times. It's never been the end of the world before, and I only get it about every 5-10 years or so. So I prefer not to bother with the vaccine.

As of right now, H1N1 has nothing on the regular yearly flu season. If there is tested, proven, scientific data out there to prove that H1N1 is worth me worrying about, I'd like to see it.

"As of right now, H1N1 has nothing on the regular yearly flu season. If there is tested, proven, scientific data out there to prove that H1N1 is worth me worrying about, I'd like to see it."

First, it all about you. Getting immunized also helps protect others and while it may not be "worth [you] worrying about" just about everyone has friends and relatives and part of living in a civilized society is protecting others.

Second while the overall rate of death from H1N1 is not greater than the average seasonal flu it has some unique characteristics. In addition to attacking the normal risk group it also seems to disproportionately effect young adults and overweight people. Interestingly it doesn't seem to have as much effect as is typical of flu on people with HIV.

But that is just half, or a quarter of, the story. Because while while half of the people ending up in ICUs are in the expected vulnerable group for this strain; half are not. Half of those who end up in the ICU with it have no known risk factors. In a few cases people who appeared perfectly healthy and with no known risk factors essentially keeled over and died in a few hours. Too rare to track effectively the question as to how and why some people react this way remain unanswered.

Worth worrying about?

Depends on how much you value those around you, any sense of duty you may have toward the surrounding society ... and, perhaps, how much you value your life and health.

It's true that the numbers on H1N1 are not particularly scary compared to seasonal flu, but we haven't even been through a full flu season with H1N1 yet. I'm not saying this to be alarmist, but the potential impact from H1N1 does seem worse than seasonal flu, though. It has traits like:

• It's more infectious than seasonal flu. Even if H1N1 stays mild for the rest of the flu season, it will likely cause more hospitalizations and deaths than seasonal flu simply because more people will get infected than usual, even if any single person's risk of hospitalization or death is lower than with seasonal flu.
• People stay infectious longer with H1N1 which also increases everyone's chance of catching it (I cited the article in Art's H1N1 thread)
• The age distribution of deaths or cases with severe complications is more like past pandemic influenza's rather than seasonal flu. Instead of killing the elderly and very young children, it is hitting older children and adults younger than 50 the hardest. If H1N1 infects enough people, history will be recounting how H1N1 struck the young.
• H1N1 causes lung damage which seasonal flu cannot inflict. This story describes one expert's experience after 90 autopsies of H1N1 deaths and likens the damage he has seen with avian flu, and this article describes the mechanism of why H1N1 can directly attack deep lung tissue that seasonal flu cannot do. If we're lucky, H1N1 will not develop a stronger affinity for lung receptors later on. If it does, then it will be sending a lot more younger adults to the ICU.
• The fact that H1N1 stuck around during the summer months and is causing fresh outbreaks in August and September is pretty unheard of for the flu, and suggests the possibility of a long, tough flu season ahead.

Overall, we're lucky because not a whole lot has happened. At least so far. The typical flu season is not usually even considered open until at least October and most years, the peak months are January and February.

And even for people who don't catch H1N1 directly, it could still affect them. For example, maybe you need to go to the ER for something else like a car accident, but all the ones closest to you could be swamped with flu patients and they turn you away. It's already happening right now in places with fresh outbreaks. (Not that getting a flu shot can prevent car accidents. Wish we could develop a vaccine for that!)

Now that's what I'm talking about. Thank you for posting links to actual information about the H1N1 situation. Rather than the Chicken Little-type folks who just run around posting about how the sky is falling.

I'll get mine, but then again, I usually get my flu shot, and had mt pneumonia shot while I was in the hospital in the winter

My daughter is one of those lucky folks who already GOT H1N1 (yes, she goes to one of the schools that got closed in NYC last year). HER case was fairly mild, 2-3 days of the yucks/fever etc, and then just some mild residual "I feel a bit tired today" for another day or so - came down with it on a Thursday night, by Monday was fine (and then the week AFTER that they closed the school)

I get my shots because I'm in a risk group - overweight, health problems, etc

While it possible that becoming infected with H1N1 will only result in mild flu-associated symptoms for a few days, do not under estimate (nor should you panic) the potential complications from viral infections. The complications, while usually rare can be devastating. I have a friend, who a number of years ago had the seasonal flu, he suffered damage to heart tissue, resulting in reduced efficiency in his heart output. The damage put further stressors on his heart to the point he had to receive a Left Ventricular Assist Device (LVAD) to compensate for the reduced efficiency. A month or so ago he suffered a stroke, which can be a complication of this device and is currently undergoing rehabilitation. I am sure many of the “older” folks can remember or know friends or family that suffered complications from polo, measles, mumps, chicken pox, etc. No, vaccinations are not without risk, but I suspect if you talked with individuals who suffered complications from these viral infections, most would have been happy to accept the small risk of complications from vaccination rather than the complication of the infection.

Pete

To add to Pete's latest post, there is some medical speculation and consequential research being conducted that suggests links between viral infection and chronic diseases, such as Diabetes Mellitus and Parkison's Disease. My point here is that we are learning more and more about the etiology of illnesses, and it may well be the case that a simple flu vaccination reduces your chances of developing a chronic illness later in life.