Now that the first doses of the H1N1 (“swine”) flu vaccine are available, many patients are asking us if we recommend the vaccine. It is a confusing issue, particularly given all the media attention and mis-information. Here are the facts as we currently know them.
The influenza virus comes in several types, and the types themselves change every year, producing different strains of the virus. The flu vaccine changes every year, with the particular strains that are thought to be the most common that year in the vaccine. However, since vaccine production starts months before the influenza strains appear, some years the vaccine is more effective than others. If the H1N1 strain had appeared earlier, then it would be in this year’s regular flu vaccine and it would not be receiving the attention it is now.
Each year, influenza kills over 36,000 Americans, some of them children. The virus is usually most severe in the elderly and somewhat worse in infants than in healthy children and adults. Some years are worse than others in terms of number of infections and/or how severe the virus is. I recall a particularly bad outbreak several years ago that killed a number of children in the Western United States. Right now, the H1N1 actually seems to be a mild virus, milder than the usual flu strains but worse than a typical cold. It does seem to be more common in healthy children and pregnant women than the typical flu viruses. While some children and adults have died from it, most of those cases have been in children with underlying medical problems.
The infection is now very common. It was an epidemic in Georgia and the rest of the Southeast United States in September, and now has spread to the rest of the country. It has become somewhat less common in Georgia now. We were seeing a dozen or more cases a day in September and early October, and are now seeing a dozen cases a week. It actually seems more common than the typical flu, probably because no one has any immunity to this strain.
The virus is receiving so much media attention because it is new and different, and because public health officials and the government are making a big deal out of it. This is mostly because it is a new strain and no one could predict how severe it would be. They tend to take a worst-case scenario approach. The vaccine is finally available, although in shorter supply than anticipated. Also, because the vaccine companies had to shift production to the H1N1 vaccine, there is now also a shortage of the regular annual flu vaccine.
One of the problems with recommending the vaccine is that by the time it is available, it seems that most people here will have already had the virus or it will have passed them by. Of course, we could have another epidemic here in Georgia later in the fall or winter. Also, it is still unclear if the H1N1 virus will somehow combine with the regular flu viruses when they arrive and produce a more severe disease.
Currently, the H1N1 vaccine is recommended for all pregnant women, children ages 6 months and up to adults age 24, everyone living in a home or caring for infants less than 6 months old, healthcare workers, and adults with high-risk medical conditions. However, states and health departments are currently giving the vaccine to select groups based on availability, and that differs among providers of the vaccine.
Given all of the available information, I think that if a person normally gets a flu shot or immunizes their children annually for the flu, then he or she should try to obtain the H1N1 vaccine. If a child or adult has asthma, diabetes, heart disease or other chronic medical problems, then they should be immunized. Pregnant women and parents of infants should consider getting immunized. If you normally do not get a flu shot or have your children immunized, there does not seem to be at this time a particular urgency or need for the H1N1 vaccine, though that may change over time. Please realize, however, that the vaccine is recommended for all children age 6 months and up. You can continue to monitor the situation at www.flu.gov.
