I’m still reading about vaccinations so I have not yet decided on what my daughter and I will do.  Copied below, however, is another opinion on the flu vaccinations, which is a different perspective from the last opinion that I posted.  I received it from one of my mommy email distribution groups.

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[From another mom:]  FYI, this was posted on PSP from our pediatrician, the source is AAP and CDC (I’m not sure if she wrote this or if it’s been issued by the CDC).  This opinion varies from the well-presented “wait-and-see” opinion from Tribeca Pediatrics.  Both are worth a read to help you make a decision regarding whether or not to vaccinate yourselves and your children against this year’s flu and the H1N1 flu.

FAQ regarding Flu Vaccine

1.  Why is this flu different from all other flus?
The flu virus changes (shifts) slightly every year, enough to cause annual epidemics — the normal community-wide outbreaks that we experience every winter. But every once in a while — 3 times per century on average –a major change (drift) occurs, resulting in a novel strain. It is so different from all other strains that even if you’ve been exposed to or vaccinated against all previous flu strains in your lifetime, you are unlikely to be immune to it. Therefore there are widespread outbreaks all over the world — a pandemic.

2.  Will there be a vaccine for this novel pandemic flu? Will it be safe since it is so new?

Yes — in October. Since the strain was first isolated last year, the vaccine makers have been working on it. Although it is a new strain, the vaccine is made just the way other flu vaccines are made — immunologically, every flu vaccine is specific to the strain expected to emerge that season, and therefore new every year –but the basic recipe, if you will, for the vaccine is exactly the same. So it is neither newer nor more experimental than the annual flu vaccine, which has a good safety record. Moreover, since the H1N1 strain has remained very stable since its emergence, we know that the vaccine is a good match for the virus, whereas the annual vaccine may sometimes miss the mark a bit.

3.  Will there be special chemicals that are untested added to this vaccine?

No. Some vaccines have immune- stimulating compounds called adjuvants added to them, and there was some discussion of adding these compounds to the H1N1 vaccine in the event that the vaccine supply fell short, but the discussion was theoretical only and these technologies have not been implemented in the US.

4.  Does the H1N1 vaccine contain mercury or thimerosal?
All flu vaccines are available in thimerosal-free formulations.

5.  Who should get H1N1 vaccine and will seasonal flu vaccine protect against the H1N1 strain?

Eventually, as supplies permit it, widespread vaccination will truncate this pandemic (the first of the century). For the present, vaccine is being triaged to pregnant women and children, as well as those with chronic illnesses. This is because so far, more cases have been occurring in children, perhaps because older people have partial resistance, and because pregnant women are at higher risk for complications. An added benefit is that the infants of vaccinated women will be born with some immunity to this strain. Seasonal flu vaccine is recommended for everyone age 6 months and up, especially pregnant women. Seasonal flu vaccine does not appear to give any protection against the H1N1.

6.  Since seasonal flu is usually mild, and since so far the H1N1 is tending to be clinically mild, is it necessary to be vaccinated? Why not just catch the flu, and take anti-flu drugs such as Tamiflu (oseltamivir)?

Influenza is usually a mild and self-limited disease. It tends to be more severe in young children, the elderly, pregnant women, and people with chronic illnesses. However, the majority of the 40,000 deaths and 200,000 hospitalizations per year from influenza in the USA occur in previously healthy people. Since flu is so highly contagious, eating well, taking supplements, and following guidelines for healthy living, are not helpful strategies for preventing infection , or for preventing complications of infection which may lead to hospitalization, severe illness, or death. In the current pandemic, more deaths would be expected in the pediatric age group as more cases are occurring in children. Another factor in the estimated burden of disease has to do with the number of acute or intensive care beds available, and the number of respirator machines available throughout the country. In a serious pandemic it is possible that the nation’s capacity for acute respiratory support would simply be overwhelmed.

Currently, anti-flu medications are recommended only for children under age 2, hospitalized patients, and those with underlying chronic disease. It is desirable to restrict use of these drugs to prevent viruses from developing resistance to them. Widespread use of currently available vaccines will decrease the number of cases and the duration of outbreaks, and thus the overall burden of disease in our communities.

In recent years, especially in Great Britain and the USA, vaccination has taken on other social meanings, associated with fear of environmental toxins, suspicion of the government and pharmaceutical industry, fear of neurologic damage or long-term side effects, or the desire to raise one’s children in a simple or more natural fashion. It is legitimate for individuals to take these issues into consideration as long as the risks are clearly understood — this is informed consent. Those choosing, with full knowledge of the facts, to decline the flu vaccine, are making an acceptable decision both ethically and legally, as this vaccine is not mandatory. Those who do not have such fears or objections should feel comfortable in taking the vaccine, because the more uptake of vaccine, the less disease, and the less disease, the fewer adverse outcomes will occur. Widespread uptake of vaccine not only safeguards individual health, but contributes to the health of the community.

7.  How much will the vaccine cost? Will insurance cover it? How will it be administered?

All doses of the H1N1 vaccine have been purchased by the government, and will be distributed through state and local health departments.
Strategies for distribution will vary from place to place. There is no charge for the vaccine itself, although there may be an office visit or administrative fee charged by clinics and private offices.

Both seasonal and pandemic flu vaccines are available in an injectable form which is made from killed virus, and in a nasal spray containing live virus which has been weakened, or attenuated, so that it cannot cause infection. Nose spray can be used in healthy patients aged 2 through 49 years, who do not have asthma or egg allergy.

As regards co-administration of the vaccine, most patients age 9 and up will receive one dose of each vaccine, in either or both modalities. Children age 8 and younger will need 2 doses of the H1N1 vaccine, and 1 dose of seasonal flu vaccine, and children receiving the seasonal flu vaccine for the first time in their lives will need two doses of that vaccine as well. Final details regarding the timing of multiple doses in young children and the mixing of the two forms of the vaccine will be determined and made public when the vaccine is released for administration in the next few weeks.

Sources: Red Book of the American Academy of Pediatrics, CDC.gov, Mandell’s Principles and Practice of Infectious Diseases,Elsevier 2005.

From one of my “mommy email groups,” I received the following email which I’m keeping in my notes.  I’ve started reading about vaccinations but am still uninformed about them.

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Dear Families:

I hope you had a nice and relaxing summer.

Well, we were busy at Tribeca Pediatrics with two exciting projects: our new offices in Midtown Manhattan and Park Slope, which are both set to open September 15.  We look forward to welcoming those of you who live in our new neighborhoods.

But that’s not the reason I’m writing to you.  I want to address the flu and flu vaccinations, since I know these topics are among your main concerns in this hectic back-to-school season.

This spring, we started seeing large number of kids of all ages with flu symptoms.  This was true at each of our Tribeca Pediatrics offices in Manhattan and Brooklyn.  The numbers have tapered off now, but it’s September, and we’re still seeing an unusually high number of kids with the same flu.  The virus causes about four days of very high fever but few other symptoms.  The kids who caught it fared surprisingly well, and in our practice, all of them recovered without any complications.

Back in the spring, we didn’t know whether we were facing swine flu or another virus.  Looking back, it’s clear that we were seeing the H1N1 (aka swine flu) virus, which was widespread in New York.  The good news is that whatever virus it was, it appears to have been no more virulent than the regular flu.  Although there were some complications and even deaths from the swine flu in New York, those complications were no worse than we’ve seen with previous flu strains.  This is  quite reassuring.

Should we be scared of the swine flu?
So far, H1N1 seems to be moderately virulent and is behaving like a regular flu.  Health experts don’t expect it to become more virulent in the months to come.  No reason for an orange alert!

A pound of prevention …
As you may know, the flu vaccine is not foolproof.  It is made every year well in advance of flu season, based on which flu strains are expected to be prevalent that year.  The effectiveness of the vaccine depends on the accuracy of these predictions, which varies from year to year.  For example, this past year was a miss, since the vaccine didn’t account for the year’s main flu, the H1N1 virus.  Despite this lack of effectiveness, the CDC recommends flu vaccination for pregnant women, households with kids younger than six months, healthcare workers, children ages six months to 18 years, young adults, and people over 25 with health conditions.  In short, practically everyone.  Most doctors adhere to these guidelines by recommending flu vaccination in general, saying that even if it’s not perfect, at least it’s good protection.

This year, the Centers for Disease Control and Prevention (CDC) announced that the regular seasonal flu vaccine still won’t protect against H1N1.  Working with the CDC, pharma giant GlaxoSmithKline is developing a separate H1N1 vaccine, which they say will be widely available.  Its effectiveness won’t be guaranteed, however, because there’s not enough time for extensive clinical  trials.  When this vaccine becomes available, the CDC plans to recommend immunization for the same groups of people who get the regular flu vaccine … in short, practically everyone.

My reservations
My opinion of the flu vaccine is more reserved: It’s no miracle shot.  If the vaccine were as efficient as it’s said to be, by now we’d have seen a marked decrease in flu cases, since rising numbers of vaccinated people should decrease contagion.  But this is definitely not the case: Every year, we see the same number of flu cases, and many of them in vaccinated kids.  Also, the vaccine doesn’t protect against new flu strains that appear periodically, as they did this year.  You have to wonder if the flu virus is mutating as we add new strains to the immunization mix.

As much as I am a proponent of vaccinations overall, I hesitate to recommend widespread flu immunization for children.  First, contrary to common belief, children — even young ones — are able to fight the flu very well.  For example, every winter, many mothers who’ve just had babies coincidentally get the flu right after birth.  I’ve observed that while the moms are generally in bed with 104º fever for a few days, their weeks-old babies have much milder symptoms.  Second, I believe that when we administer the flu vaccine to children (and when it actually protects against the illness), we prevent them from developing  natural immunity.  Because the vaccine is not that efficient, they may very well contract the flu later in life.  And since they’ll have had fewer chances to build natural defenses, they may be more susceptible to a severe course of illness.  Swine flu provides a good and recent example of this: Those who fared best against the H1N1 virus were people in their 50s who’d been exposed to a similar virus when younger.  As a result, they’d developed some immunity to this new strain and handled it better than those who’d never been exposed.

In short, I believe that the flus you fight in childhood can make you stronger against the ones you encounter later.

Our recommendations
For regular flu vaccines:  At Tribeca Pediatrics, we will offer the flu vaccine to parents and children, while explaining its limitations.  If you are very concerned about the flu and want to be more proactive, go ahead and give your child the vaccine.  Apart from an occasional soreness at the site of injection, it has almost no side-effects, and it may prevent a case of flu.  In any event, it won’t hurt.  But if, like me, you’re on the fence about the flu vaccine, we will support your decision to opt out based on the above argument.  No matter which path you choose, if your child catches the flu, we will monitor the illness carefully to avoid complications and ensure full recovery.

For the H1N1 vaccine:  Let’s take it one day at a time.  First, let’s see if it becomes available.  And if does, we’ll carefully review the research data before we recommend it.  Bear in mind that this is a new vaccine developed in very little time to fight an illness that has so far proved quite benign.  As of now,  I don’t see any reason for you to roll up your sleeves and rush to the swine flu immunization lines.

Stay tuned.  For the latest updates on this subject and others, please visit us online at www.tribecapediatrics.com … or follow us on Twitter at www.twitter.com/tribecapeds

Cheers,
Michel Cohen, M.D.
Tribeca Pediatrics | 46 Warren Street | New York | NY | 10007