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To Jab or Not to Jab

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To Jab or Not to Jab

As the availability of a swine flu vaccine approaches, people find themselves at a loss as to whether they should get it or not.

Vaccines cause autism! The swine flu vaccine can give you Guillian-Barr syndrome! Seasonal flu vaccine contains deadly, live avian flu virus! Vaccines contain aborted baby tissue! Obama’s gonna come into your house and hold you down and force the swine flu vaccine on you! These are just a few of the warnings circulating via email, fax machines, websites and alternative press. Are the warnings true? Should you get the vaccine for H1N1, or should you run screaming in the other direction?

Nothing is completely safe. Water, for example, is the elixir of life, but too much of it will kill you. Your job as a responsible member of society is to wisely weigh the risks versus the benefits in any given course of action. That includes your decision whether or not to partake in the vaccination program for H1N1 flu.

And yes, it is still your decision; at least, it is in Idaho and Montana. Neither state has made any requirement for residents to get vaccinated for the flu.

Making that decision, however, is not as easy as it first appears and the blame can well lie with the U.S. Public Health Service—drastically underfunded as it is—and the difficulty not only in obtaining relevant information, but the fact that relevant information simply does not, and can not, fully exist when it comes to a new virus.

We’ve all heard that approximately 36,000 people die from influenza each year in the U.S. But what does that mean in terms of risk to you, personally? We don’t know, because we don’t know how many people are exposed to the influenza virus every year. In fact, last influenza season (07-08), laboratory tests confirmed only 39,827 cases of the flu. Actual number of deaths from pneumonia and influenza are not given, though 83 deaths occurred in children age 18 and under. It’s estimated, however, that 5 percent to 20 percent of the population gets the flu. With a U.S. population of 304 million, the 20 percent level would suggest over 60 million flu illnesses, so chances of death are about 1 in about 8,500, increasing to about 1 in 1,667 if you actually get the flu. Ninety percent of those deaths occur in people age 65 and over.

The H1N1 is a complete unknown, but it’s assumed that a new virus, moving through a completely susceptible population, will infect approximately 30 percent (about 90 million people in the U.S.) up to 50 percent of the population (152 million people). Current information from the World Health Organization about deaths from H1N1 suggest a death rate of 1.04 percent; that’s between 936,000 and 1.5 million dead in the U.S. That makes your chances (at the lower number of dead) about 1 in 325 of dying from swine flu, your risk increasing to about 1 in 96 should you actually get the flu. At the time CDC quit counting individual cases, the U.S. death rate was right around a half percent; even at that level, that makes the risk of dying from swine flu or its complications still much higher than the risk with seasonal flu. And contrasting with seasonal flu, 41 percent of those deaths have been in people aged 24 to 49, with another 24 percent in ages 50 to 64. Which should lead most people to the realization that Novel (A)H1N1 isn’t really “just” the flu.

But how risky is the vaccine? Adverse reactions to the seasonal flu vaccine are considered very rare. For example, the Vaccine Adverse Reporting System lists just 35,000 severe reactions to seasonal flu vaccine for the period June 1990 through August 2009 (less than 2,000 per year) and the system reports any health problems after a vaccine is given, whether the problem is related to the vaccine or not.

You should not be vaccinated if you have an allergy to eggs (flu vaccines are grown in eggs) or a fever. In addition, vaccines are not recommended for children under six months of age, or for anyone who has ever had a bad reaction to a flu vaccine.

The seasonal vaccine this year is formulated to provide protection against three strains of virus (there are 1,161 identified strains): an (A)H1N3, a B virus, and an (A)H1N1 that is genetically different from the swine flu strain.

Although the swine flu vaccine has been described as “fast-tracked,” it’s fundamentally the same vaccine as prepared for the seasonal flu, with killed virus from the Novel (A)H1N1 strain used in place of the others. Tests undertaken show no results that would lead to suggest this vaccine is any more dangerous than the seasonal flu vaccines.

As the flu season gains ground in the northern hemisphere, more data brings more information. As far as the seasonal vaccine goes, WHO is looking into an unpublished Canadian study that suggests receiving the seasonal vaccine could potentially make a person more susceptible to contracting swine flu. They stress that no other information they have received has shown this type of correlation.

A potential reason for why swine flu might be more lethal than seasonal flu could be due to the way it interacts with bacteria lurking in most people’s bodies; in particular, Strep pneumoniae. A CDC analysis of autopsy tissue from 77 patients who died from swine flu showed 29 percent were also infected with other bacteria, primarily the pneumococcus.

In addition, it appears that swine flu is more likely to cause a deep lung infection, Acute Repiratory Distress Syndrome, something rarely seen in seasonal flu.

Other studies suggest swine flu might be more contagious than previously thought; while official recommendations still say that sick people should stay home until 24 hours after the end of fever, some studies show that patients are still shedding live virus after that time. Reflecting the lack of data available this early in the season, it is not known how effectively that live virus will infect others.

If you think you wash your hands enough not to need a vaccine, think again: because hand washing does next to nothing to protect you from H1N1. “Don’t kid yourself that you’re going to protect yourself from the flu completely by washing your hands,” said Arnold Monto, a professor of epidemiology at the University of Michigan School of Public Health That’s because there’s almost no evidence you can pick up swine flu from virus on your hands (though plenty of evidence of other illnesses you can get that way), and plenty of evidence that swine flu is transmitted through the air—you get it from breathing in virus particles expelled by someone else. The message here is not to quit washing your hands, but don’t rely on hand washing to protect you from the flu.

So what about autism? And Guillian-Barr syndrome?

There is no evidence that links childhood vaccines with autism. What the debate over autism and vaccines highlights, however, is a profound misunderstanding of science that occurs in many different areas—a belief that correlation equates to causation. Because neurological disorders like autism show up in children in the same time frame that children receive vaccines, it’s easy for a distraught parent to blame the vaccine for a condition that often has no clear-cut cause. But that’s the same as believing that, for example, because many soldiers smoke, military service causes smoking.

Those concerned that vaccines are linked to autism place a portion of the blame on a mercury-based preservative called thimerosal. Thimerosol is used in multi-doses of vaccines; single dose vaccines do not contain thimerosol, and those concerned can request a thimerosol-free vaccine when it comes to the swine flu vaccination.

Guillian-Barr syndrome is a little more complicated. In 1976, the last time a widespread swine flu vaccination effort was undertaken, an inexplicable number of people developed GBS. When 56 people developed the syndrome after vaccination, the swine flu immunization program was discontinued. Eventually, 1,100 cases of GBS were reported, with 25 deaths; the average in a year is 215. Although it is believed that GBS is linked to the ‘76 swine flu vaccine, over half of the cases that appeared that year were in people who did not get vaccinated, so some other or additional explanation is necessary.

Still, if all cases of Guillian-Barr arose from the swine flu vaccine, 1,100 cases out of the 40 million doses given puts your risk of contracting GBS at 1 in about 36,000; the risk of dying from it due to a vaccination is 1 in about 1.6 million. Apparently, you’re much more likely to die from swine flu because you didn’t get vaccinated than you are to die from Guillian-Barr after receiving a vaccination.

If you heard about a live avian flu virus contaminating a vaccine that’s... sort of true. Baxter International sent experimental virus material to several labs that was contaminated with live, H5N1 flu virus. But this was not a vaccine, nor was it intended to be—the contamination occurred in a product developed for testing. While a serious breach and under investigation, the incident has nothing to do with vaccine safety.

The “aborted fetal tissue” rumor is also not all that it appears. In the lab, viruses are grown in human cell lines; for 35 years vaccine makers have used two self-perpetuating cell lines in which to grow viruses; and yes, they initially came from aborted tissue. Utilizing a killed virus that was grown in a human cell is a far cry from a vaccine “containing aborted fetal tissue.” Those bothered by science derived from human cells, by the way, would have to refrain from utilizing most scientific advances made since the early 40s.

Most decisions surrounding the treatment of illness and disease involve trade-offs; antibiotics kill the bad bacteria making you sick, but also kill good bacteria that helps your body to work. Do you refuse to take an antibiotic? Individuals make health choices based on the best information they can get and, ideally, with the help of a medical professional who can point out areas of risk and benefit.

Although information continues to come in about swine flu and the Novel (A)H1N1 vaccination, nothing is contradicting early reports: In most cases, swine flu is relatively mild. It’s mostly affecting a different age group than seasonal flu. Serious reactions to flu vaccines are so rare, it’s hard to give odds on the risk. You must make the best decision for your response to this flu season based on your own personal health history. The health police are not planning to invade your home and forcibly immunize you. If you have serious concerns about the swine flu and the vaccination available to help prevent it, consult your doctor.

Panhandle Health District will offer Novel (A)H1N1 vaccines at no charge in a series of clinics, probably in November and December. Vaccines will be offered first to those considered to be at high risk should they catch the flu.

If you become ill with flu-like symptoms, please limit your contact with others. In the event of serious complications (difficulty breathing, blue tinge to lips, dehydration, seizures or confusion) seek medical attention immediately.

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Landon Otis

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health, public health, H1N1, swine flu, vaccinations, risk

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