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Wednesday, December 23, 2009

Let's discuss the H1N1 flu vaccine

Did you get yours? If not, now is the time: the CDC recently opened up stores of the vaccine to anyone who wants it, rather than just priority groups such as pregnant women or school teachers.
While you make your decision about whether or not to get immunized, let's discuss pros and cons.
We'll start with cons, because there are lots of rumors out there that we should address.
So cons -
1. RECALLS. There have been several recalls of vaccines, but only one was for side effects. That was a lot used in Canada, so USA readers need not worry. The vaccines were recalled after a higher than normal percentage of adverse drug reactions were reported. We don't actually know if this is a vaccine problem or a statistical fluke. As of today, there have been 2 recalls in the US, both children's nasal doses. Both were pulled for potency issues: One was considered potent until the FDA changed guidelines; the other appeared to lose some potency before the expiration date and was pulled today. Neither one had safety concerns. Still, the recalls are a big con because if you received a low-potency vaccine you will likely need a second dose.
2. SIDE EFFECTS. Everyone saw the video of the cheerleader with Guillain barre syndrome walking around backwards after receiving the H1N1 vaccine. The syndrome is an autoimmune disorder; it occurs with some vaccines as your body responds to the introduced antigen. Apparently your immune system is somehow activated to attack your own nerve fibers as well. GBS is a risk with all vaccines but was seen in higher rates back in the '70's with the last swine flu outbreak. It's difficult to correlate it to causes, but your risk is higher with an vaccine that contains an adjuvant (a substance included with the vaccine to increase your immune response). The vaccines in Europe and Canada contains adjuvants; the US vaccines do not. To note, GBS is also a risk when you catch the flu - in fact, the rate of GBS due to influenza infection is much higher than the rate due to vaccination. Both are very rare.
3. BRAND NEW DRUG. This is a problem. No one likes to try out a new drug first! And examples of potency issues above heighten concerns. I don't blame you. I would only get a vaccine produced by a company that usually produces vaccines. Novartis is making most of the vaccines sold at Walgreens and I trust Novartis - the know their injectables and I can't remember any FDA manufacturing citations (and lots of companies get cited!).
4. MERCURY. Like all vaccines, the preservative in the H1N1 vaccine is thimerosal, which contains mercury. Many people don't care about this - there is no hard and fast evidence that vaccinations have caused health problems such as autism, and they figure that since all the vaccines they got as a child had mercury, it must not hurt. However, I don't like the idea of injecting a known-toxic heavy metal into my body. The H1N1 is available as a preservative-free single dose injection, and you can simply request that one if you share my concerns.

Now for the pros. This is simple.
1. YOU DON'T GET A POTENTIALLY FATAL INFECTION. Let me tell you why I'm MORE concerned about H1N1 now than I was at the height of the pandemic. We saw this year that H1N1 is quite alive and active in warm weather, and in fact the CDC is predicting another surge of the virus in the Spring. I'm afraid that this next wave will be resistant to our antivirals. We only have two - Tamiflu and Relenza - and the virus has already shown signs of resistance. I am almost positive that virus will return in a mutated form that is not treatable with antivirals. I say this because of the incredible volume of Tamiflu we filled at pharmacies this year. Most of the doses were either not necessary (mild cases) or preventative; the result was a gigantic exposure of Tamiflu to the H1N1 virus. Viruses are smart for non-living things. They mutate to protect themselves. I see the return of H1N1 as a big ugly super bug. This is ok if you're planning on staying in bed for a few days and taking in lots of fluids, but it you (God forbid) end up with a severe case or have underlying health conditions - well, there is no treatment. That scares me a tad.

So, having said that, run along and get your vaccine! If you live near me, I'll even do it for you (I'm a certified immunizing pharmacist in Louisiana, so I can give vaccines). I promise it won't hurt.

Did you get your vaccine? Was it hard to find? Are you planning on getting one?

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