After so much fanfare about swine flu and the availability of the H1N1 vaccine, getting vaccinated today was somewhat anticlimactic. When I stepped into our administrative offices earlier this afternoon to get my shot, I half-expected a movie-like scene: a retinal scanner, liquid nitrogen, gold-plated syringes. Instead what I found was a simple sign-in sheet and a dozen clear liquid-filled plastic containers in a Styrofoam tray. After filling out a short questionnaire in which I attested to not having an egg allergy or a history of a severe reaction to the flu vaccine or Guillain-Barre syndrome (a rare neurologic disease), I was handed one of the plastic vials. It was at that moment when I saw the label that read “H1N1 vaccine” that an eerie sensation passed over me. Over the past few months, I had heard and read so much about the H1N1 “swine” flu, and here I was holding the vaccine in my hands. After a quick primer, I cautiously sprayed half the contents of plastic vial into my right nostril, and a few moments later, the other half into the left. The whole process took less than 10 seconds and was almost too simple, given the implications. Regardless, I am now protected against H1N1.
Millions of people in the United States are estimated to have been infected with the H1N1 virus to date, with over a thousand deaths. Last Summer the WHO declared H1N1 a global pandemic (see http://beyondapples.org/2009/06/14/swine-flu-strikes-close-to-home/), and the President just this past week declared the contagion a national emergency. While an H1N1 vaccine has been developed, there is widespread skepticism about its benefits and safety. Added to the chaos has been the scarce availability of the vaccine, much to the chagrin of public health authorities and frustration of the general public. These challenges have fueled much uncertainty and misinformation about the flu. While the CDC and local authorities have done a good job making reliable information widely available, their message has not consistently reached the general public. Here is what you need to know:
- There are many viruses that can cause “flu-like” symptoms. The most deadly infections are caused by the influenza virus. It is this virus that the flu vaccines protect against.
- There are two flu vaccines this year — one against seasonal influenza and the another against the H1N1 “swine” flu.
- Seasonal influenza is the flu that we deal with every year. It occurs seasonally and typically hits hardest between December and February. Everyone is at risk for infection, but the most serious cases occur in young children, the elderly, and those with chronic medical diseases.
- The seasonal flu vaccine is recommended by the CDC for anyone under age 18 or over 50 and for adults ages 19-49 who have young children at home, work in health care, are pregnant, or have chronic illnesses such as asthma or diabetes. It is also recommended to anyone who simply wants to get vaccinated. It is best to get the seasonal flu vaccine before flu season, ideally before December or January.
- H1N1 or “swine flu” is the new strain of influenza that struck last year. Unlike the seasonal flu, the H1N1 pandemic is expected to continue for the next two years. The rate of infection, however, is not constant and occurs in waves. We are currently in the second major wave of H1N1. The virus seems to disproportionally affect younger people, which may be in part because older people have been exposed to this strain before. The most serious cases have been in young children and babies, pregnant women, and those with other major illnesses.
- The CDC is recommending the H1N1 vaccine to everyone who does not have a medical reason not to get vaccinated (e.g., serious egg allergy). Because the H1N1 outbreak is ongoing, it is best to get the vaccine as soon as possible. However, due to delays in manufacturing and distribution, the vaccine is not yet widely available.
- Both the seasonal flu vaccine and H1N1 vaccine are available as an injection or intranasal spray. Most people can safely receive the vaccine shot. However, only healthy people ages 2 to 49 who are not pregnant can safely receive the intranasal form. The shot contains killed virus; the intranasal vaccine attenuated or weakened virus. In the right population, the intranasal vaccine is just as safe and effective. Because there is a limited supply of the both vaccines, I encourage anyone who can safely receive it get the intranasal form.
- Although the H1N1 vaccine is “new,” it is being made by the same manufacturing process, the same manufacturers, the same factories, and with the same safeguards as the seasonal flu vaccine. Therefore it is widely accepted as safe.
- The U.S. government has purchased 250 million doses of H1N1 and providing them free of cost. However, there are delays in manufacturing and distribution. To date, approximately 25 million doses have been shipped. Thus the vaccine is first being administered to high risk groups: pregnant women, young children, health care workers, and people with chronic medical conditions. As the supply increases, the vaccine will be made available to everyone who wants it.
I hope this helps to clarify some important questions about the flu. Below are links to the CDC vaccine information sheets and the official CDC flu website.
While the vaccine is our best protection against the flu, keep in mind that the vaccine does not substitute for “common sense” approaches to protecting yourself: staying hydrated, getting proper sleep, avoiding sick contacts, and regular hand washing. If you are sick with a cough or cold, help protect others by covering your mouth and nose and staying at home (see http://beyondapples.org/2009/05/01/washing-our-hands-of-the-swine-flu/).
Oh, and one more thing: if you go to the doctor’s office to get the H1N1 vaccine, stay for a full check up. With the right mindset, you can take this opportunity not only to protect yourself against the flu, but also to get your preventive health care on track. And that’s not something to sneeze at.
- Shantanu Nundy, M.D.
Inactivated H1N1 vaccine (injection shot):
http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-inact-h1n1.pdf
Live, attenuated H1N1 vaccine (intranasal):
http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-laiv-h1n1.pdf
Seasonal flu vaccine (injection shot):
http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-flu.pdf
To learn more visit www.cdc.gov/flu.
I'm an internal medicine doctor passionate about keeping people healthy and out of the hospital. For a brief bio 