Now that the H1N1 pandemic seems to have peaked, and Texas no longer has widespread illness, what is the current recommendation about vaccination?
Vaccine supplies for H1N1 are finally adequate to meet the needs of the priority groups, and vaccination is now being offered to individuals at less risk. But is it still necessary?
Visualize, if you will, the plot of number of illnesses per week. The number starts at zero, and steadily climbs well above the usual number of influenza-like illnesses for a typical season.
Even now, when we are in the beginning of the downturn of the number of cases, there are still more cases than in a typical flu season. In fact, because we are barely past the peak, about half of those who will become ill from this virus haven’t become ill yet – the downslope covers as much territory, in general, as the upslope.
In previous pandemics, spring outbreaks were followed by bigger outbreaks in the fall (as occurred this year) and again by renewed activity in mid-winter and the following fall.
Immunizations were not widely available for prior pandemics, so it is possible that if we do a really good job getting the population immunized, we might be able to prevent history from repeating itself.
It is also important to remember that the reason a flu virus causes a pandemic because most of the population is susceptible, and the virus doesn’t really stop circulating until nearly everyone has caught it or been immunized. This process will take longer, and more people will become ill, if we stop vaccinating against H1N1 now.
While you are in getting your H1N1 vaccine, get a seasonal influenza vaccine as well if you haven’t already done so. Seasonal influenza illness is likely to ramp up following the winter holidays.
Individuals with chronic illnesses, such as diabetes, asthma, COPD and heart disease who haven’t had the pneumococcal vaccine should take the opportunity to get that as well. Pneumococcal pneumonia often attacks influenza victims just as they start to recover and can also lead to hospitalization and death.
Wednesday, December 2, 2009
Monday, November 9, 2009
Get the Facts About H1N1 Vaccine
Concerns about the safety of H1N1 vaccines, especially the FluMist version, are hindering efforts to vaccinate vulnerable members of our community. I’m worried that fear of the vaccine will keep people from getting protected.
A common worry is that the vaccines were “produced too quickly” or weren’t tested thoroughly. In reality, both the injectable and nasal forms of the vaccine were produced in exactly the same way as the seasonal vaccine, using the same techniques and safeguards. The H1N1 vaccine was licensed in the same manner as the seasonal vaccine. In fact, additional studies not usually needed for seasonal vaccine were performed.
Since this new strain of influenza is not closely related to recent seasonal strains, there were concerns that more than one dose might be needed, and because large supplies were needed quickly, lower doses and doses with “adjuvants” – inert compounds added to improve immune response - were tested to see if they were effective.
It was determined that adjuvants work well, but they weren’t added to vaccines in the U.S. Two doses are needed for children under age 10, but not for adults. In those trials, and among people immunized so far, there have been no unusual or unexpected reactions.
Nearly every year, influenza vaccines contain new strains to keep up with the tendency of the virus to change its surface proteins, or “drift.” This year’s seasonal vaccine, in fact, contains new strains for all three of the influenza viruses it contains.
The bottom line – H1N1 vaccines represent a “strain change,” not a new or experimental vaccine, and are as safe and effective as the seasonal vaccine.
FluMist, the “live” version of the influenza vaccine, consists of a weakened, cold-adapted virus. This means that the virus has lost its ability to live in the warmth of the human body, and can only replicate or infect the nasal passages – where the temperature is much cooler. No instances of transmission of this virus from one person to another have been documented in the United States.
While it can cause a bit of a runny nose or sore throat for a few days, and even a mild fever in a few individuals, it cannot cause influenza because it can’t live in the warmth of your body. This vaccine has the advantage over the shot of inducing immunity where the infection starts – in your nose, as well as in your bloodstream.
It is not offered to individuals with chronic illness simply because they might experience a flare-up of their asthma or diabetes, or respond with less protection or more side effects to the immunization compared to a shot, if their immune system is compromised.
H1N1 injectable vaccine is in short supply in Texas and is the only vaccine that can be given to most of the people at highest risk from H1N1 influenza – pregnant women, children 6 months to 2 years, and those over age 2 through age 24 who have chronic illnesses.
Family members of infants younger than 6 months old who are healthy and less than 50 years old and children age 2-5 without asthma or other health problems should be vaccinated with FluMist vaccine so that the injectable vaccine can be utilized for individuals who have chronic illnesses or are out of the age range for the mist.
Either way, the time to be immunized for H1N1 is now!
A common worry is that the vaccines were “produced too quickly” or weren’t tested thoroughly. In reality, both the injectable and nasal forms of the vaccine were produced in exactly the same way as the seasonal vaccine, using the same techniques and safeguards. The H1N1 vaccine was licensed in the same manner as the seasonal vaccine. In fact, additional studies not usually needed for seasonal vaccine were performed.
Since this new strain of influenza is not closely related to recent seasonal strains, there were concerns that more than one dose might be needed, and because large supplies were needed quickly, lower doses and doses with “adjuvants” – inert compounds added to improve immune response - were tested to see if they were effective.
It was determined that adjuvants work well, but they weren’t added to vaccines in the U.S. Two doses are needed for children under age 10, but not for adults. In those trials, and among people immunized so far, there have been no unusual or unexpected reactions.
Nearly every year, influenza vaccines contain new strains to keep up with the tendency of the virus to change its surface proteins, or “drift.” This year’s seasonal vaccine, in fact, contains new strains for all three of the influenza viruses it contains.
The bottom line – H1N1 vaccines represent a “strain change,” not a new or experimental vaccine, and are as safe and effective as the seasonal vaccine.
FluMist, the “live” version of the influenza vaccine, consists of a weakened, cold-adapted virus. This means that the virus has lost its ability to live in the warmth of the human body, and can only replicate or infect the nasal passages – where the temperature is much cooler. No instances of transmission of this virus from one person to another have been documented in the United States.
While it can cause a bit of a runny nose or sore throat for a few days, and even a mild fever in a few individuals, it cannot cause influenza because it can’t live in the warmth of your body. This vaccine has the advantage over the shot of inducing immunity where the infection starts – in your nose, as well as in your bloodstream.
It is not offered to individuals with chronic illness simply because they might experience a flare-up of their asthma or diabetes, or respond with less protection or more side effects to the immunization compared to a shot, if their immune system is compromised.
H1N1 injectable vaccine is in short supply in Texas and is the only vaccine that can be given to most of the people at highest risk from H1N1 influenza – pregnant women, children 6 months to 2 years, and those over age 2 through age 24 who have chronic illnesses.
Family members of infants younger than 6 months old who are healthy and less than 50 years old and children age 2-5 without asthma or other health problems should be vaccinated with FluMist vaccine so that the injectable vaccine can be utilized for individuals who have chronic illnesses or are out of the age range for the mist.
Either way, the time to be immunized for H1N1 is now!
Friday, October 23, 2009
The Vaccine Confusion
Confused about flu vaccine and what you should do? You are not alone. My head is spinning!
Not only are there two different types of flu vaccine, seasonal and H1N1, but there are two different forms of vaccine, live (nasal) and killed (injection). On top of that, there are injections in multi-dose vials, with the preservative thimerosal, and those in single dose syringes, without it. Plus, the single dose syringes come in two strengths, one for infants 6 months through 35 months, and one for children age 3 through adulthood.
Injectable vaccines from different manufacturers have different age ranges for which they are approved, all of which are different age ranges than the age groups that can get nasal vaccine. Nasal vaccine is also free of preservatives, but isn’t used for pregnant women or infants – the populations which most often demand preservative-free vaccine (even though thimerosal has been shown to be safe in pregnancy and for infants.)
Seasonal and H1N1 vaccines are also both in short supply now, so getting them may also be a matter of whether you are in one of the high risk categories, at least until the supply improves. To really confuse things further, the high risk categories for the two vaccines aren’t the same!
We have limited supplies of vaccine for seasonal influenza in nasal form for healthy folks ages two through 49 and even less injectable vaccine for those with chronic diseases over age 50, or 6 months to 18 years.
We also have some H1N1 vaccine in nasal form. The high-risk groups that can also get the nasal form are health care workers, household members of babies under 6 months old, and children age 2 through 4. The limited H1N1 vaccine shots we have received are already allocated for the pregnant women we care for, though we won’t have enough for all of them, either.
We are working hard to direct vaccines to those who need it most and as soon as possible once we receive it. We will continue to update the information on our Web site as we receive more vaccine and, of course, appreciate your patience!
Not only are there two different types of flu vaccine, seasonal and H1N1, but there are two different forms of vaccine, live (nasal) and killed (injection). On top of that, there are injections in multi-dose vials, with the preservative thimerosal, and those in single dose syringes, without it. Plus, the single dose syringes come in two strengths, one for infants 6 months through 35 months, and one for children age 3 through adulthood.
Injectable vaccines from different manufacturers have different age ranges for which they are approved, all of which are different age ranges than the age groups that can get nasal vaccine. Nasal vaccine is also free of preservatives, but isn’t used for pregnant women or infants – the populations which most often demand preservative-free vaccine (even though thimerosal has been shown to be safe in pregnancy and for infants.)
Seasonal and H1N1 vaccines are also both in short supply now, so getting them may also be a matter of whether you are in one of the high risk categories, at least until the supply improves. To really confuse things further, the high risk categories for the two vaccines aren’t the same!
We have limited supplies of vaccine for seasonal influenza in nasal form for healthy folks ages two through 49 and even less injectable vaccine for those with chronic diseases over age 50, or 6 months to 18 years.
We also have some H1N1 vaccine in nasal form. The high-risk groups that can also get the nasal form are health care workers, household members of babies under 6 months old, and children age 2 through 4. The limited H1N1 vaccine shots we have received are already allocated for the pregnant women we care for, though we won’t have enough for all of them, either.
We are working hard to direct vaccines to those who need it most and as soon as possible once we receive it. We will continue to update the information on our Web site as we receive more vaccine and, of course, appreciate your patience!
Monday, October 19, 2009
Wednesday, October 14, 2009
The Scoop on the H1N1 Vaccine
Some H1N1 nasal flu vaccine has finally arrived at Kelsey-Seybold Clinic, as well as other immunization providers around town. This is the live virus version of the vaccine, which is great for healthy folks ages two up to 50, but not useful for those at highest risk from H1N1 – pregnant women, children under age two and those over age two who have chronic health conditions such as asthma, diabetes, COPD and immune suppression.
As the injectable vaccine becomes available in the upcoming weeks, it will be provided to pregnant women and children six months up to their 5th birthday, as well as to older, at-risk individuals with chronic illnesses. Once there is plenty of vaccine available, youth ages 5-24 will be a top priority to be vaccinated, with older individuals being offered the vaccine soon thereafter.
The good news for those over age 65 is that you already have a 50% chance of being immune to this virus – but if you do get sick, seek treatment with antiviral medications early in your illness. H1N1 flu is just as capable of putting you in the hospital as seasonal flu. Also be sure to let your doctor know if you aren’t getting better in a few days, as bacterial infections like pneumonia commonly follow any flu infection in older adults, especially those with chronic illnesses.
As the injectable vaccine becomes available in the upcoming weeks, it will be provided to pregnant women and children six months up to their 5th birthday, as well as to older, at-risk individuals with chronic illnesses. Once there is plenty of vaccine available, youth ages 5-24 will be a top priority to be vaccinated, with older individuals being offered the vaccine soon thereafter.
The good news for those over age 65 is that you already have a 50% chance of being immune to this virus – but if you do get sick, seek treatment with antiviral medications early in your illness. H1N1 flu is just as capable of putting you in the hospital as seasonal flu. Also be sure to let your doctor know if you aren’t getting better in a few days, as bacterial infections like pneumonia commonly follow any flu infection in older adults, especially those with chronic illnesses.
Friday, October 2, 2009
Flu Shot Myths
It is incredible to me how many myths surround the flu shot. People have a real fear of shots in general. Health care workers are no exception. This month, I have been spending a lot of time talking to nurses and physicians who worry that they can get sick from the flu shot.
This fear is really quite understandable. Those of us who work in health care have a lot of experience not just in treating and preventing illnesses, but in catching them! Just like kids starting daycare or school catch many colds and stomach viruses in their first few years, physicians and nurses catch many infections when they start their clinical rotations or go into practice, even if they are meticulous about washing their hands. For many of them, the first time they ever received a flu vaccine was prior to those first patient contacts. Every fall when kids are going back to school congregating and sharing their germs, we get our annual influenza vaccine. At the same time, the office starts to see more with strep throat and a variety of viruses, including influenza. Often, we health care workers catch something. The close timing of vaccination with illness makes us blame that vaccine.
Coincidence is not proof of cause. However, I remember seeing a graph of two identical rising lines: one, the cases of measles in Greenland in the 50s and the other refrigerator sales in those same years, also in Greenland. Do refrigerators cause measles? No, but the shipping traffic to Greenland increased with sailors incubating measles arriving along with new refrigerators! Anyone can catch an illness in the doctor’s office the same day they get a vaccine, leading them to blame the vaccine. This year, it is particularly likely that you will get the flu around the time you get your flu shot. We’re vaccinating now for seasonal strains, but novel H1N1 (swine) flu is already widespread. When the H1N1 vaccine comes out, it will just about be time for the seasonal strains to start circulating. Talk about poor timing!
Can the flu vaccine cause the flu? No, that’s just a myth. Flu vaccine is made from dead virus, meaning it’s incapable of giving you the flu. You might get a sore arm, or a local reaction with some low-grade fever, but you won’t get billions of baby viruses throughout your system! Even the nasal flu vaccine, which is live and whole, is modified so it won’t cause the flu. It is “cold-adapted,” so that it can infect your nose, but dies in the heat of lungs and body, so the infections stop at the nose. Understandably, you can get a runny nose and mild sore throat, but nothing approaching the flu.
With four strains of influenza likely to circulate this year, it is well worth taking both seasonal flu vaccine and the H1N1 vaccine when it is offered. Even if you think you “got the flu” after a vaccine in the past, the risk of getting the flu this year is much higher if you don’t choose to vaccinate!
This fear is really quite understandable. Those of us who work in health care have a lot of experience not just in treating and preventing illnesses, but in catching them! Just like kids starting daycare or school catch many colds and stomach viruses in their first few years, physicians and nurses catch many infections when they start their clinical rotations or go into practice, even if they are meticulous about washing their hands. For many of them, the first time they ever received a flu vaccine was prior to those first patient contacts. Every fall when kids are going back to school congregating and sharing their germs, we get our annual influenza vaccine. At the same time, the office starts to see more with strep throat and a variety of viruses, including influenza. Often, we health care workers catch something. The close timing of vaccination with illness makes us blame that vaccine.
Coincidence is not proof of cause. However, I remember seeing a graph of two identical rising lines: one, the cases of measles in Greenland in the 50s and the other refrigerator sales in those same years, also in Greenland. Do refrigerators cause measles? No, but the shipping traffic to Greenland increased with sailors incubating measles arriving along with new refrigerators! Anyone can catch an illness in the doctor’s office the same day they get a vaccine, leading them to blame the vaccine. This year, it is particularly likely that you will get the flu around the time you get your flu shot. We’re vaccinating now for seasonal strains, but novel H1N1 (swine) flu is already widespread. When the H1N1 vaccine comes out, it will just about be time for the seasonal strains to start circulating. Talk about poor timing!
Can the flu vaccine cause the flu? No, that’s just a myth. Flu vaccine is made from dead virus, meaning it’s incapable of giving you the flu. You might get a sore arm, or a local reaction with some low-grade fever, but you won’t get billions of baby viruses throughout your system! Even the nasal flu vaccine, which is live and whole, is modified so it won’t cause the flu. It is “cold-adapted,” so that it can infect your nose, but dies in the heat of lungs and body, so the infections stop at the nose. Understandably, you can get a runny nose and mild sore throat, but nothing approaching the flu.
With four strains of influenza likely to circulate this year, it is well worth taking both seasonal flu vaccine and the H1N1 vaccine when it is offered. Even if you think you “got the flu” after a vaccine in the past, the risk of getting the flu this year is much higher if you don’t choose to vaccinate!
Wednesday, September 23, 2009
Who needs the flu vaccine?
Are you due for the flu vaccine? Many folks believe that getting an influenza vaccine is not a priority for them because they consider themselves healthy and at low risk. It used to be that this vaccine was recommended mostly for those ages 65 and up or younger individuals with serious chronic illness.
In recent years, the recommended groups to receive the influenza vaccine have dramatically changed. Currently, over 80 percent of the US population is recommended to be vaccinated annually. Even individuals who are not themselves at risk often live with those who are and can help protect them by getting immunized.
So, who is at high risk of severe complications from influenza? Infants and children under the age of 5, especially those under two, are at just as high of a risk of being hospitalized as those over age 65 along with pregnant women and they should be immunized. Unfortunately, flu shots and nasal vaccine are not approved for infants under 6 months, so it is especially important to immunize family members when a young infant is at home. Daycare providers need immunization as well. Adults over age 65 are at the highest risk of death from influenza, so they and their household members need to be vaccinated.
Adults ages 50-65 usually have one or more chronic health conditions that put them at risk of complications from the flu. Asthma, diabetes, COPD, heart disease, immune system problems from medications or illness, neuromuscular problems that interfere with coughing or breathing and kidney or liver diseases are all considered chronic health conditions, even if the disease is in control. Unfortunately, we still do a poor job of vaccinating chronically ill individuals less than age 50 – only about a third get the shot. Again, household members of these folks should also be immunized.
Children in school are among the first to catch and spread influenza in a community. The close quarters at school, the large number of schoolmates each child is in contact with daily and the tendency of kids to share drinks and not wash their hands or cover their coughs all contribute to the rapid spread of germs, and heightens the chance of the child bringing the flu home. In Japan, the universal immunization of school children against the flu dramatically reduced the number of deaths among the elderly, simply by reducing the spread of disease. Now immunization of children up through 18 years is recommended annually in the US.
Health care workers need to be immunized because as anyone who has visited a doctor’s office in winter knows, where sick people congregate, infection can spread. Health care workers can protect themselves and their patients by staying healthy.
So who needs the flu vaccine? There’s a good chance that you do!
In recent years, the recommended groups to receive the influenza vaccine have dramatically changed. Currently, over 80 percent of the US population is recommended to be vaccinated annually. Even individuals who are not themselves at risk often live with those who are and can help protect them by getting immunized.
So, who is at high risk of severe complications from influenza? Infants and children under the age of 5, especially those under two, are at just as high of a risk of being hospitalized as those over age 65 along with pregnant women and they should be immunized. Unfortunately, flu shots and nasal vaccine are not approved for infants under 6 months, so it is especially important to immunize family members when a young infant is at home. Daycare providers need immunization as well. Adults over age 65 are at the highest risk of death from influenza, so they and their household members need to be vaccinated.
Adults ages 50-65 usually have one or more chronic health conditions that put them at risk of complications from the flu. Asthma, diabetes, COPD, heart disease, immune system problems from medications or illness, neuromuscular problems that interfere with coughing or breathing and kidney or liver diseases are all considered chronic health conditions, even if the disease is in control. Unfortunately, we still do a poor job of vaccinating chronically ill individuals less than age 50 – only about a third get the shot. Again, household members of these folks should also be immunized.
Children in school are among the first to catch and spread influenza in a community. The close quarters at school, the large number of schoolmates each child is in contact with daily and the tendency of kids to share drinks and not wash their hands or cover their coughs all contribute to the rapid spread of germs, and heightens the chance of the child bringing the flu home. In Japan, the universal immunization of school children against the flu dramatically reduced the number of deaths among the elderly, simply by reducing the spread of disease. Now immunization of children up through 18 years is recommended annually in the US.
Health care workers need to be immunized because as anyone who has visited a doctor’s office in winter knows, where sick people congregate, infection can spread. Health care workers can protect themselves and their patients by staying healthy.
So who needs the flu vaccine? There’s a good chance that you do!
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