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October 28, 2009

The H1N1 muddle

Just received, in the mail, John Muir Health’s advice to get vaccinated against the seasonal flu and H1N1.

This advice about the H1N1 vaccine might be useful—if the vaccine were readily available. And it sounds like it’s not. I haven't been looking, though, for reasons I'll explain below.

An older woman was at my gym the other day, telling how she had gone to her doctor, insisting she get the H1N1 shot, because she looks after her young grandchildren. “They didn’t want to give it to me!” Someone at my job sent out a company-wide email, asking co-workers if any of us knew any doctors who were dispensing the vaccine.


Yesterday, the New York Times describes the “willy-nilly” distribution of the swine flu vaccine and, in an editorial, says that the availability of the vaccine “is running way behind the original expectations."

In any event, the Times says it is not time to panic--that President Obama’s declaration of a national emergency is a procedural maneuver to make it easier for hospitals to transfer any sudden crowds of sick people to alternate sites for triage and treatment.

Am I panicking?

No.

Maybe I should be?

Back to the Times editorial, which says that, yes, H1N1 so far has killed more than 1,000 Americans and sent more than 20,000 to the hospital. Most recently, the recent death of a first-grade student in Vacaville prompted the closure of two schools in that town. As of October 23, eight people have died of possible swine flu deaths in Contra Costa County, and 196 have been hospitalized with possible H1N1-related illnesses. Such numbers can be "frightening," the Times editorial acknowledges. But the season's "final tally is still likely to be less than in a normal flu season, when the circulating strains typically cause around 36,000 deaths and 200,000 hospitalizations.”

H1N1 is indeed spreading rapidly, but, so far, appears to be no more virulent or deadly than regular, seasonal flu, the editorial says.

The backlash against the vaccine urgency also continues with an excellent article in the Atlantic this month. “Does the Vaccine Matter” asks whether the swine flu vaccine really works, whether it prevents infections or will reduce the number of people who will die.

This article suggests what I have long suspected: that flu vaccines don’t really work that well, or as well as we'd like to believe, and for a whole host of reasons. The thing is, the authors say, placebo-controlled studies of flu vaccine and those flu medications prescribed by doctors every year, to test their efficacy, have never been conducted.

This is the curious state of debate about the government's two main weapons in the fight against pandemic flu. At first, government officials declare that both vaccines and drugs are effective. When faced with contrary evidence, the adherents acknowledge that the science is not as crisp as they might wish. Then, in response to calls for placebo-controlled trials, which would provide clear results one way or the other, the proponents say such studies would deprive patients of vaccines and drugs that have already been deemed effective.

Students of U.S. medical history will find this circular logic familiar: it is a long-recurring theme in American medicine, and one that has, on occasion, had deadly consequences.


The article asserts that vaccines and flu treatments give the U.S. population a false sense of security. “Little discussion has appeared in the press to help people understand the measures they can take to best protect themselves during a flu outbreak—other than vaccination and antivirals.”

Well, I don’t think our public health officials have been remiss in reminding us again and again about the importance of washing our hands frequently or of staying away from work, schools, and other public places if we’re experiencing flu-like symptoms. Still they have been beating the “get the vaccine” message pretty hard.

I’m not saying people shouldn’t get either the seasonal flu or H1N1 vaccine. My husband always gets the seasonal flu vaccine because he’s in one of the vulnerable populations: he has asthma and is prone to upper respiratory illnesses during the winter months. Another co-worker, who gets hit with the flu every season, believes it keeps her from being hit as hard as she normally would.

On the other hand, I don’t get the seasonal flu vaccine. Knock on wood, but so far, I seem to be one of those lucky people who is not prone to getting achy, feverish flu-like illness. At most, I suffer one or two bouts of the common cold every season.

As for my son? He is 11, and the Centers for Disease Control and Prevention recommends that children from six months to 18 years receive the vaccination. However, he is not in one of the "priority populations," mentioned by the Contra Costa Public Health Department. This would include kids his age, but with chronic health conditions.

He seems to have inherited my immune system. Of course, it's one thing to take a chance with my own health, but it's another to do the same with his. But then, I believe it's possible--based on reports from parents in the Walnut Creek schools, and which I reported on a few weeks back--that the swine flu has already swept through at least one elementary school and his middle school campus.

Knock on wood, he was spared in this round.

Actually, what is disturbing is that my cross-my-fingers approach to this pandemic may be as reasonable or scientifically sound as the CDC's statement that vaccines are the best way to prevent influenza.

11 comments:

Alan said...

Very interesting article, SM! Very different perspective than I've been getting from everywhere else. I had previously not been exposed to these issues regarding flu vaccine viability, or at least well tested viability.

I wish more blogs were like yours... actually put up fairly original content, editorial style. It actually takes some effort to do that, so most casual bloggers don't. Hats off to you for bringing this possible issue to broader awareness!

Anonymous said...

After you get a vaccination, wear a medical mask when you are around coughing people.

Nadia said...

This is what I found on the CDC website. H1N1 actually hits people aged between 5-24 more than the usual (ie children and the elderly).

"Who will be recommended to receive the 2009 H1N1 vaccine?

CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended that certain groups of the population receive the 2009 H1N1 vaccine when it first becomes available. These target groups include

-pregnant women,
-people who live with or care for children younger than 6 months of age,
-healthcare and emergency medical services personnel,
-persons between the ages of 6 months and 24 years old,
-and people ages of 25 through 64 years of age who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems."

This site might also be helpful to you. It's a search engine that helps you find out where to get vaccinated in your neighborhood.

www.medtipster.com

Anonymous said...

The vaccine is in short supply and many people cannot even find it. Healthy people who do not fall into one of the high risk categories cannot get it.

I called the Kaiser flu hotline and they said that H1N1 vaccines are available right now for only those at most risk. They will give it to pregnant women, children up to age 24, people with health conditions, health care workers, and those who live with babies less than 6 months old.

There are many negative articles that question the flu vaccine's effectiveness. People are entitled to their own opinions. However, none of those articles are backed up with scientific fact. If people say negative things about the vaccine everyone will listen. If people say positive things about it, people will be skeptical. People love conspiracy theories and will believe any dirt they hear.

I watched the news and a pregnant woman caught H1N1. She was in the intensive care unit and she was near death. The baby took up room in her abdomen and did not allow the mother's lungs to expand enough for her to breathe. They had to choose whether to save her life or the life of her baby. The husband chose to save his wife. The baby was cut out early and only lived a few minutes. It was really tragic.

A placebo study would be similar to this. Give half of a group of pregnant women the real flu vaccine. The other half will get a fake vaccine. Count how many of each group dies from the flu.

That would be unethical, because half of those women might catch the flu and the babies might also die.

The flu vaccine is made with the actual flu virus, but it is inactivated. The flu vaccine does work, and all of those negative people are just spouting conspiracy theories that vaccines don't work. For example, measles vaccines work. Why don't people say we need to do placebo trials and see if people really are protected from measles? Half will get the real vaccine and half will not. Let's see if people really die from it.

The best way to prevent H1N1 is by washing your hands. The paranoia over germs had led people to wash their hands and use hand sanitizer. This is probably why there are so few cases of H1N1 right now.

We need a vaccine for some people. If there were no vaccine, many at risk people will die. Those who are not in the high risk categories, you can choose not to get the vaccine. That is your right, however if you do get sick I suggest that you all stay home and not infect other people who have other health conditions.

Anonymous said...

Makers Of Vaccine Refuse To Take H1N1

http://www.youtube.com/watch?v=B4SmFxyust0

Don't pay attention to what these people say, pay attention to what they do.

Kimo C said...

http://www.skeptic.com/eskeptic/09-09-23

In this week’s eSkeptic, Dr Harriet Hall, MD, (aka the Skepdoc) explains why fearmongering about the swine flu vaccine is both wrong and dangerous.

Dr Harriet Hall, MD is a retired family physician and Air Force Colonel living in Puyallup, Washington. She writes about alternative medicine, pseudoscience, quackery, and critical thinking. She is a contributing editor to both Skeptic and Skeptical Inquirer, an advisor to the Quackwatch website, and an editor of ScienceBasedMedicine.org, where she writes an article every Tuesday. She recently published Women Aren’t Supposed to Fly: The Memoirs of a Female Flight Surgeon. Her website is www.skepdoc.info.

Anonymous said...

I blame Obama.

Anonymous said...

Kaiser is following the CDC's recommendations. My husband and I are not eligible, but our children 22, 9, and 7 are. The 9 and 7 have had the seasons flu shot so they could get the H1N1 mist. They return in a month for their second dose of H1N1 (recommended for kids 9 and under). I have to figure out how to get the 22-year-old, who is immortal (what 22-year-old isn't?) his.

Kaiser has plenty apparently.

Anonymous said...

6:59,

I was cruising through and though I don't know if you'll see it, I had to comment on your post. You're right. Don't immunize your child. Your child's immunization can go to a child whose parents want him/her to live.

Sorry, but I'm sick and tired of the paranoid nutjobs who won't immunize their kids -- which means the rest of us who do vaccinate our kids are keep those other kids safe.

It'll take a return of polio to get people on the vaccination bandwagon again. Too many people don't know what it was like before vaccinations. I'm middle-aged, so my parents saw deaths and disabilities that resulted from now preventable diseases. I have a friend whose mom had polio and her legs were severely crippled from the disease.

Anonymous said...

"The 9 and 7 have had the seasons flu shot so they could get the H1N1 mist."

What does that mean? They could get the H1N1 mist regardless of whether they got the seasonal shot or not.

Sheldon said...

H1N1 can really be so deadly so we should really prevent it as much as possible.Let us have regular consultation and having a test using elisakits. These help detecting many kind of diseases.