Commentary
H1N1 is bad enough without myths to make it worse
By Kris Ehresmann
In recent weeks, there have been media reports about parents who are reluctant to vaccinate their children against novel H1N1 influenza. Some Minnesota parents may be feeling the same way.
Parents have the right to make decisions about their children's health care. The vaccination program that will soon be underway is voluntary -- and in fact, any mandatory vaccination effort would be illegal under state law.
However, much of the reluctance to vaccinate appears to be grounded in misconceptions, both about the illness and about the vaccine that was formulated to prevent it. Parents should not forgo the protective benefits of vaccination for their children based on misinformation.
For example, because novel H1N1 has been described as similar in severity to seasonal flu, many people believe it isn't a significant health threat. That's far from the truth.
Seasonal influenza is a major threat, killing about 36,000 people a year nationwide. Novel H1N1 further complicates that picture by targeting groups that normally wouldn't be considered at high risk for flu -- in particular, children and young adults.
Since April, about 10,000 people have been hospitalized with novel H1N1 nationally, and more than 500 have been hospitalized in Minnesota. About 1,000 people have died of this illness, including 76 children. The median age of Minnesotans hospitalized with novel H1N1 is 12, and three of our seven deaths occurred in children. Since Labor Day, many of our state's schools have been reporting influenza-like illness in students, most likely from novel H1N1 flu.
Pregnant women also face special risks. Compared to the general population, pregnant women are four times as likely to be hospitalized if they develop novel H1N1 influenza. Nationally, a number of deaths from novel H1N1 have been reported in pregnant women.
Of equal concern are some of the misperceptions people have about the vaccine. Here are some of the major ones:
The vaccine is new and untested -- in effect, an "experimental" vaccine. Not true. It is essentially the same as the seasonal vaccine that people are given every year. It's being manufactured in exactly the same way. The seasonal vaccine is reformulated every year to cover the flu viruses that are likely to be around during the upcoming flu season. In this case, it's been reformulated to protect against novel H1N1. In fact, if the H1N1 flu virus had been identified earlier, it could have been included in the regular seasonal flu vaccine.
The seasonal vaccine has been around for many years, and it has an excellent safety record. Health officials will be closely monitoring the vaccination effort during the coming months for any side effects.
The vaccine is being manufactured in China. Not true. The vaccine is being manufactured in the United States.
The vaccine contains potentially dangerous additives, known as "adjuvants." Also not true. Adjuvants have been used safely to enhance the effectiveness of other vaccines, and an adjuvant known as squalene is being used in versions of the novel H1N1 vaccine that are being distributed in Europe and Canada. However, versions of the vaccine being distributed in the United States contain no adjuvant.
The vaccine contains thimerosal -- a form of mercury -- raising concerns about autism and other health problems. Thimerosal is used as a preservative in injectable vaccines (shots) that are packaged in multi-dose vials, including the novel H1N1 vaccine. Although many people have expressed concerns about thimerosal, the issue has been extensively investigated, and there is no evidence linking it to autism or other health problems. However, thimerosal-free versions of the novel H1N1 vaccine will be available for pregnant women and children under the age of six, for those who want it.
The vaccine may cause a serious nerve condition called Guillain-Barre Syndrome (GBS). A particular vaccine used in 1976 to vaccinate against a type of swine flu was believed to be associated with increased occurrence of GBS, and the vaccination program was halted as a result. The association with GBS was very slight, but there was no ongoing transmission of swine flu in the community, and therefore no reason to continue vaccinating people.
Later studies have found flu vaccine in general may carry a one in a million risk for GBS. People need to weigh that against their risk of dying from the flu. One American in 8,300 dies of the flu every year. As a precaution, people with a history of GBS should discuss the risks and benefits of influenza vaccination -- for seasonal flu or novel H1N1 -- with their health care provider.
The nasal spray vaccine can cause disease in the vaccinated person -- and other people. Unlike the "killed virus" vaccine given in flu shots, the nasal spray contains live virus, in a weakened form. However, neither the injected vaccine nor the nasal spray vaccine will give you the flu. Because the live virus has been weakened, it can't reproduce in the lower respiratory tract and cause disease. You can't get the disease from the vaccine.
We had an initial wave of illness caused by the novel H1N1 virus in the spring. We are now only a few weeks into a second wave, and it could last for several weeks, or even months.
Novel H1N1 influenza is going to be with us for a while. It poses serious risks for pregnant women, children, young adults and people with underlying health problems. The vaccine is safe and effective. Supplies are limited now, but we expect to get more soon.
When it does become available, please don't let the myths that are circulating dissuade you from immunizing your children -- and, eventually, yourself.
Kris Ehresmann is director of the Infectious Disease Epidemiology, Prevention and Control Division at the Minnesota Department of Health.
Comments (11)
thank you- you helped me make a decision
I wanted to thank Kris for writing this article because it provides us with more ammunition to fight people who would derail public health efforts by causing a fuss for (what seems to be) their 15 minutes of fame (see: the Health Ranger). Not only that, but by convincing people to get the vaccine, she's helping the rest of us avoid infection from people who would otherwise have a less capable somatic response to a new virus.
Some information Ms. Ehresmann left out;
0.5 parts per billion (ppb) mercury = Kills human neuroblastoma cells (Parran et al., Toxicol Sci 2005; 86: 132-140).
2 ppb mercury = U.S. EPA limit for drinking water
20 ppb mercury = Neurite membrane structure destroyed (Leong et al., Neuroreport 2001; 12: 733-37).
200 ppb mercury = level in liquid the EPA classifies as hazardous waste based on toxicity characteristics.
25,000 ppb mercury = Concentration of mercury in multi-dose, Hepatitis B vaccine vials, administered at birth from 1991-2001 in the U.S. but no other industrialized countries
50,000 ppb mercury = Concentration of mercury in multi-dose DTaP and Haemophilus B vaccine vials, administered 8 times in the 1990's to children at 2, 4, 6, 12 and 18 months of age and currently "preservative" level mercury in multi-dose flu, H1N1 meningococcal and tetanus vaccines. This can be confirmed by simply analyzing the multi-dose vials.
Michael Wagnitz
Chemist
Lisa, Another good article. I suggest that you talk with your doctor about taking the vaccine w/o thimerosal. I will continue to do some research on the vaccine and send it to you so that you can discuss it with your doctor before you get the shot or nasal spray, whichever.
Love
Mom
What Mr. Wagnitz fails to address is the fact that we are talking about mercurial compounds or "mercury containing" compositions that don't affect the body the same way elemental mercury and other mercury compositions do.
The autism/vaccine debate is over, sir.
the last published data from 2006 shows influenza deaths at 849 - I don't know why the goverment groups influenza and pneumonia - there is no data showing a number of 36,000
Thank you for a thoughtful presentation of the information.
Mr. Wagnitz: the last paragraph of your post confused me regarding 'analyzing the vials'. Are you citing 50,000 ppb as the concentration of the vaccine (which doesn't change, despite the size of the container)? This strikes me as odd, since my previous experience in manufacturing vaccines is different.
(I'm also a chemist & industrial hygienist)
The question was posed as to why the government combines influenza with pneumonia in its statistics. I don't know if this is true or not, but in a recent discussion with a microbiologist, she told me that frequently, it's not the flu that kills people. It's the secondary infections that come along with the flu, like pneumonia. She pointed out that the deadly flu epidemic in, oh what was it, 1917?, most people who died had such complications that were the cause of death but were brought on by first having the flu.
Everybody gets to make their own decisions about vaccination but I'll definately be standing in line when it's available--if I haven't had it already.
One thing's proving true for me so far that's recommended by health officials--washing your hands frequently reduces the risk of getting the flu. Right now, my co-worker and the woman I commute to work with are both home sick with H1N1. I carry alcohol based hand wash with me and use it frequently through the day. I no longer use shared pens like the ones at check out counters. I'm not normally this crazy about other people's germs, but folks are dropping like flies around me and so far, I'm not sick. That may not last, but I'm just saying--especially if you're skeptical of the vaccine, do the right thing and take care of yourself. You owe that at least to the people who live around you.
An article titled "Does the Vaccine Matter"? in the November 2009 issue of the Atlantic Monthly (http://www.theatlantic.com/doc/print/200911/brownlee-h1n1) brings
up some interesting points about the effectiveness of even getting a vaccination for the "regular" Flu or H1N1 (as opposed to polio or smallpox).
A quick snippet from the article:
(start quote)
The history of flu vaccination suggests other reasons to doubt claims that it dramatically reduces mortality. In 2004, for example, vaccine production fell behind, causing a 40 percent drop in immunization rates. Yet mortality did not rise. In addition, vaccine "mismatches" occurred in 1968 and 1997: in both years, the vaccine that had been produced in the summer protected against one set of viruses, but come winter, a different set was circulating. In effect, nobody was vaccinated. Yet death rates from all causes, including flu and the various illnesses it can exacerbate, did not budge.
(end quote)
I'm not saying the vaccine is harmful, I'm not saying it doesn't work, I'm saying that I lack confidence about the testing which has or has not been done. I can see financial, political, and emotional based motivations for giving "the public" a vaccine that may not work. In short, something seems amiss here.
Perhaps we need another program where we invite someone to talk about "Evidence-based medicine" and "the Flu vaccine(s)".
I've been tracking comments on this thread, and I find Leo's comment interesting--of substance, rather. I think it would be very interesting to have some specialists on the radio discussing exactly what Mr. Schmidt calls "evidence-based medicine." It's especially relevant today, when a margin of several percentage points in response rates from clinical trials of drugs suggests a "statistically significant" difference. Let's talk about how drugs are developed, from the Uni to the small cap business, to licenses, and on to Big Pharma's distribution and marketing of drugs.
That's a program I would tune into.
I agree Leo Schmidt and Johathan Hatch! also, i am so tired of having a doctor tell me that there is "less mercury in this vaccine then your tuna sandwich"
I don't eat tuna often, for that reason, oh...and I also don't inject it into my blood stream, I digest it!
Also, if I am a nursing mother, and I get the h1n1 vaccine, and I "will only pass on antibodies, none of the vaccine itself" according to my son's Doctor, then why can't I just get the vaccine and not him? i am curious what exactly a mother can pass on.
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