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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Date: September 1, 2009 9:45:18 AM EDT
Subject: Flu Talk
Reply-To: contact@tribecapediatrics.com
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
