Risks and Benefits of H1N1 Vaccination

Yesterday, I received no less than twelve emails from friends and family asking whether or not they should get the H1N1 vaccine.  For some of them, I gave direct advice.  For others, I laid out the potential risks and the benefits and described what we are doing in our own family. 

I don't consider getting the flu to be a signficant risk in and of itself.  It's no fun, but most people get over it without trouble.  But when young people die of the flu, or require hospitalization and ventillation (being hooked up to a breathing machine), I sit up and take notice.  According to published reports, their are some types of patients that are at unusual risk (still low, but higher than everyone else) from having a severe complication or death from flu.

Here are the facts, questions and concerns you should consider as you make this medical decision with your own doctor. 

1) Are you in a high risk group? 

People who are severely obese have made up a disproportionate number of H1N1 victims who have died or required intensive care.  This may be related to an increase in inflammation and difficulty breathing that is modulated by inflammatory cytokines (big word, don't fret) manufactured in fat cells, or because of poor baseline nutrition and poor health that accompanies obesity.  People who are severely obese should strongly consider getting vaccinated. 

People who have chronic medical conditions such as asthma, heart disease, or chronic obstructive pulmonary disease (COPD) may have a harder time if infected with the flu.  Surprisingly, just being elderly does not appear to place people at particularly high risk of H1N1 flu complications. 

Pregnant Women are at much higher risk for complications from H1N1 influenza than from the regular flu.  It is unclear whether this has to do with the increased weight women put on during pregnancy, or the altered immune system that accompanies pregnancy, or some other factor.  Many pregnant women are rightly concerned about putting substances into their body and the effects on the fetus, but the risk of harm to a fetus from hospitalization or death of the mother is pretty darn high too. 

2) Do you have timely access to medical care? Can you Walk and Talk?

People who live alone, who have no doctor, who have difficulty with transportation, or children who cannot talk yet (pre-verbal) may be at higher risk of trouble if they develop complications of the flu simply because of communication or access issues.  Many people who have died of flu actually died of a superinfection rather than of the flu itself.  A superinfection is an infection, (usually bacterial) that occurs on top of, or after, a prior infection (usually viral).  Three common superinfections that occur after viral infections are sinusitis, otitis media (ear infection), and pneumonia.  In these cases, patients usually experience so-called double sickening, in which an illness that seems to have started to improved or even resolved for a day or two suddenly roars back worse than ever.  In this case, patients must be evaulated by a doctor, for they may need antibiotics or, if very sick, hospitalization.  People who live alone, who have difficulty with medical access, or children who cannot communicate how they feel effectively to adults, are at risk of having a double sickening unrecognized, and should strongly consider immunization

3) Have you already been exposed to Swine Flu?

Epidemiologists have estimated that more than half of the people in the US will have been exposed to Swine Flu by November.  Certainly, most schoolchildren and healthcare workers will have been exposed before then.  A healthy school-aged child in Queens (the epicenter of the initial swine flu pandemic in the US) is unlikely to benefit from vaccination as much as a toddler in rural Iowa. 

4) Have you had an adverse reaction to the a vaccine before?

One of the concerns that I keep hearing is that the H1N1 vaccine has not been sufficiently tested, so the risks of the vaccine are unknown.  I am very sympathetic with this concern, and yet I understand that we still have to make decisions about the risks and benefits of vaccination in the absence of full knowledge.  To me, the risk of having complications of  H1N1 or Swine flu for people who are obese, who have chronic medical conditions, who are pregnant, or who have access or communication issues is high enough that I would recommend that they actively seek the opinion of their own doctor.

What are your concerns about H1N1 influenza or immunization?

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knute
Posts: 3

vitamin D in lieu of vaccine
Reply #3 on : Thu November 26, 2009, 18:30:11

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I've been told that vitamin D supplementation reduces the risk of contracting influenza. It is probably less effective than a vaccine but it may be a semi-effective "middle way" for those concerned about vaccine risks.

akr
Posts: 3

restrictive lung issues?
Reply #2 on : Sat November 21, 2009, 11:30:48

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I have heard some suggestions that this is one of the reasons that pregnant women are especially vulnerable (i.e., more vulnerable to developing secondary infections - also likely to be in the age group not previously exposed to related strains of influenza).

Restrictive lung impairment would also seem to be the issue for those with significant obesity, independent of other variables.

But is it different from other influenza strains in that respect? Isn't it just that more people will get significantly ill because they don't yet have some immunity, and that among those who do, those whose baseline lung health is below average will be more vulnerable to developing complications, as always?

Mike
Posts: 3

Re: Risks and Benefits of H1N1 Vaccination or Swine Flu Vaccination
Reply #1 on : Sat November 14, 2009, 01:41:12

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Good advice, but one quibble: The H1N1 is not an insufficiently "tested" flu vaccine. It's the same as any other flu vaccine. They are all reconstituted every year for the most recent strains. H1N1 would have been included in the seasonal flu vaccine cocktail had it arisen just a tad sooner. As it happens, it's a separate vaccine because they decided that it's serious enough to make another vaccine. But it's been "tested" as much as any flu vaccine ever is, including this year's and last year's seasonal flu vaccines.

***From Barbara Lock, MD: I have no particular concerns about the safety of the vaccine at all and agree that it most likely turn out to be just as safe as the seasonal vaccine, but wanted to stress the concept that medical decisions are frequently required in the absence of full knowledge.***

Last Edit: November 14, 2009, 08:45:11 by block  

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