Monthly Archives: November 2009

Should I get the H1N1 flu vaccine?


Should I get the H1N1 flu vaccine?
by Dr. Tamara Eriksen, ND
The decision whether to vaccinate yourself or your children is one that many people struggle with, for a variety of reasons. Getting quality, complete information is a challenge and often we’re left feeling that either the decision was made for us, or we made a decision half-armed.
When it comes to vaccination, there’s a fairly specific set of things to consider when you’re making your decision:
  1. How likely are you to get the disease?
  2. If you do get the disease, how severe is it likely to be? How sick could you get (or could it be fatal)?
  3. If you did get sick, how likely are you to pass the disease to someone else for whom it may be more severe?
  4. Are there other effective things you can do to reduce these risks?
  5. How effective is the vaccine?
  6. What are the risks of the vaccine – long and short term?
  7.  

2009 swine flu pandemic
The population of Edmonton is approximately 1,034,945. To date, (based on October 27, 2009 data) there have been 64 confirmed cases of swine flu in the Edmonton area. Putting that in wildly pessimistic terms, even if the incidence of H1N1 goes up ten-fold with the new round of outbreaks (highly unlikely), you have a 0.006% chance of
contracting the swine flu.
Using the Alberta data, 11 people (out of 233 cases province-wide) have died due to complications following H1N1 influenza.  That represents roughly a 5% chance of death.  That is significant especially since the people contracting the flu tend to be relatively young and healthy.
However, what you need to know about this is that people are not dying from the flu directly.  In North America, nearly all of the reported deaths are caused by bacterial pneumonia.  People’s immune systems are taxed by the flu virus and they end up developing a bacterial infection in their lungs… and it’s the bacterial infection that proves fatal.
Individuals particularly at
risk
You may be at higher of risk of getting H1N1 if:
  • You or someone in your immediate family/social network work on or around a pig farm.
  • You or someone in your immediate family/social network are a healthcare worker.
  •  

You have higher risk of severe illness and/or complications from H1N1 infection if:
  • You are a pregnant woman.
  • You have a pre-existing medical condition that affects your lungs or immune function.
  •  

How dangerous is the swine
flu?
Concern around the H1N1 virus relates mostly to world history with this virus. In 1918, the H1N1 flu (“Spanish flu”) caused hundreds of thousands of deaths all over the world. But contrary to some of the media reports on this, the 1918 outbreak wasn’t the last time we saw the swine flu.
  • H1N1 viruses reappeared in 1976/77 and caused major outbreaks mainly in those aged 25 or younger over the following few years.
  • The 2009 H1N1 virus is also closely related to a series of human virus outbreaks from 1918–1956.
  • This is why younger people are more vulnerable to the swine flu, whereas people born before 1957 have been largely protected against the new pandemic virus.
  •  

So is it really as scary as it seems? Let’s compare World Health Organization (WHO) data on the 2009 swine flu with WHO data on the regular seasonal flu.
  • As of 17 October 2009, worldwide there have been more than 414,000 laboratory confirmed cases of pandemic influenza H1N1 2009 and nearly 5000 deaths reported to WHO.
  • There are somewhere around 500,000 deaths (worldwide) attributable to the seasonal flu in any given year.
  •  

What do we know about the 2009 swine flu vaccine?
The Canadian government has set-up “fast-track” approval processes in order to ensure that the vaccine is available in time to be useful. “Fast track” approval means that a vaccine might be licensed without the usual safety/effectiveness data requirements. That does not mean it is not tested. The individual active components are tested for immediate safety, and/or historical data on safety of the individual components is used.
Preliminary data are promising:
  • Approximately 99% of adults who got the vaccine developed seroprotection. (That means it worked.) This is an excellent rate of seroprotection!
  • Typically, seroprotection provides about 85% protection against the virus. (15% of people will still get sick if they come in contact with the virus, but may have milder symptoms.)
  • A single dose of the vaccine appears to be sufficient.
  • Duration of protection has not been established.
  • The vaccine has not yet been studied in children or seniors.
  • Pregnant women are advised against the regular vaccine (should instead consider a variation that does not contain the protein-primer/adjuvants).
  • People who are severely allergic to eggs should not get this vaccine.
  • Avoid the H1N1 vaccine if you’re received another flu vaccine with the last 8 weeks.
  • However, you can get the regular seasonal flu vaccine at the same time as the H1N1 vaccine (in different arms.)
  • Public Health Agency of Canada’s website reveals findings that healthy adults that tested positive for H1N1 were twice as likely to have received seasonal vaccine. This suggests that the seasonal flu vaccine may make you more susceptible to the H1N1 virus.
  •  

Other relevant historical data:
The 1976 H1N1 vaccination program in the US resulted in unusually high incidence of Guillain-Barré Syndrome (GBS) following vaccination. That vaccination program was ultimately suspended due to safety concerns.
GBS presents as progressive neurodegeneration and ascending paralysis, which can ultimately progress to paralysis of the muscles of respiration and death.  Severity/progression of symptoms varies widely among affected individuals. Some people spontaneously recover completely. Some are paralyzed for life. Some die fairly swiftly. (And there is a full spectrum in between.)
  • GBS is an auto-immune reaction against myelin, which is the sheath around nerve cells.
  • In Canada, the current reported risk of developing GBS after regular seasonal influenza vaccination is around 1 in 1,000,000.
  • In 1976, the incidence of GBS after H1N1 vaccination was more than 1 in 100,000.
  • While there is evidence of causal link between the vaccine and the increased incidence of GBS, the definitive reason was never established.
  •  

What about “additives” in the vaccine?
Most of these “additives” are nutrients contained naturally in our regular diets. The exceptions would be formaldehyde and thimerosal.  Here’s a complete list of all of the additives in the Canadian 2009 H1N1 vaccine:
  • formaldehyde
  • thimerosal
  • sodium chloride
  • disodium hydrogen phosphate
  • potassium dihydrogen phosphate
  • potassium chloride
  • trace residual amounts of egg proteins
  • sodium deoxycholate
  • sucrose
  •  

Formaldehyde is a byproduct of your body’s normal metabolism. It is very reactive and readily bonds to proteins and nucleic acids, but your body has mechanisms to deal with this chemical in minute doses. Formaldehyde does not accumulate in your body. It is rapidly metabolized and excreted.
Thimerosal is a mercury-based preservative that is present in this vaccine (and most combination or multi-dose vaccines in Canada.) The safety of thimerosal preservative remains an issue of heated debate:
  • Thimerosal remains “associated” with a number of neurological conditions (eg: Autism spectrum disorders.)
  • This association has not borne out to be conclusively “causative.”
  • Because causation can not be clearly attributed to thimerosal, many medical professionals assume minute doses are safe.
  • Others would suggest that the compelling association is reason enough to be wary until the link between thimerosal and neuro-degeneration is definitively resolved.
  • We used to think of risk of toxicity in terms of dosage. Tiny doses of even major toxins were considered fairly safe. Recent studies on Bisphenol-A make it clear that our understanding of dose-dependent toxicity is far from concrete.
  •  

Making the decision
Take some time to digest this information! Consider whether you (or your family) fall within the higher risk categories. Consider how you are affected by the regular seasonal flu or other communicable illnesses – do you tend to fall very ill every time the flu comes around? Or do you usually experience a few mild symptoms and
recover swiftly?
Weigh the benefits of the vaccination against the potential risks and decide what is best for you and your family, given your own specific situation.
Need more information?
If you require additional information, or if you have questions about the information provided here, you are encouraged to discuss your concerns with your doctor or primary health care provider. Or please feel free to contact me via email with any questions at dr.teriksen@gmail.com
Dr. Eriksen is a registered, licensed Naturopathic Doctor, currently in general and family practice in north/central Edmonton, Alberta. Contact her at dr.teriksen@gmail.com
References (no authors listed):
·
“Supply and safety issues surrounding an H1N1 vaccine.” Lancet. 2009 Aug 1;374(9687):358)
·
Alberta Health and Wellness website information on H1N1 virus, statistics and vaccine (http://www.health.alberta.ca/health-info/influenza-H1N1-cases.html)
·
Canadian Centre for Occupational Health and Safety website MSDS sheet for Formaldehyde solutions (http://www.ccohs.ca/oshanswers/chemicals/chem_profiles/formaldehyde/health_for.html#_1_10)
·
GlaxoSmithKline2009 Canada. Arepanrix H1N1 (AS03-adjuvanted H1N1 pandemic influenza vaccine) Product Information Leaflet. 2009.
·
Hébert P, MacDonald N. “The H1N1 vaccine race: Can we beat the pandemic?” CMAJ. 2009 Oct 13; 181
(8)
·
Langmuir AD, Bregman DJ, Kurland LT, et al “An epidemiologic and clinical evaluation of Guillain-Barre syndrome reported in association with the administration of swine influenza vaccines.”
Am J Epidemiol 1984;119(6):841-79.
·
Pellegrini M, Nicolay U, Lindert K et al. MF59-adjuvanted versus non-adjuvanted influenza vaccines: integrated analysis from a large safety database. Vaccine 2009 Sep. 12. (Epub ahead of print). doi:10.1016/j.vaccine.2009.08.101.
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