Swine Flu for Parents: Real World Answers – Part II
In our last post we walked you through what we hope was everything you needed to know about the virus in general: how to recognize symptoms, avoid the virus and take care of your kids if they happened to catch it. Our goal today is to provide you with the same kind of detailed information…but on the vaccines. We’re not going to make choices or judge anyone’s decisions or tell anyone what they should believe or what actions they should take. But there is a lot of information out there, a lot of rumor and a lot of conjecture. There are polls saying that a large percent of parents are choosing not to vaccinate for the swine flu because of concerns about what is or isn’t in the vaccines…And there are numerous mixed message coming from the media. What we can do is help you sort through all the media coverage and pull together some of the best, most reliable information currently available to hopefully provide you with some much needed “real world” answers to some very important questions. AND THEN…we will let you make your own decision about what’s right for you and your child. So as we did yesterday…let’s start off with a little background, but this time… about the H1N1 vaccine…
The H1N1 vaccine for kids…
Dr Ari Brown: The vaccine will be available as both a nasal spray and a shot. Currently the FDA has approved three flu shots from three manufacturers and one nasal spray from another manufacturer. Keep in mind that all of these protect against just H1N1. They will NOT protect against the other flu strains we typically see in the fall and winter season
All three vaccine shots are inactivated vaccines and like the seasonal flu vaccines are created with egg product, so people with egg allergies need to steer clear. Here are the key differences between the 2 brands that have been approved for young children:
- Novartis Brand: FDA approved for children four years of age and older. There are two forms of this shot: The single dose uses thimerosal in the manufacturing process but then it is extracted before the final production. The multidose vials use thimerosal as a preservative
- Sanofi Brand: FDA approved for children six months of age and older. There are two forms of this shot—a single dose in a prefilled syringes and a multidose vial. Both products are thimerosal preservative free.
The nose spray is similar to the Flumist vaccine used for seasonal flu vaccine. It is also made with egg product and it does not have any preservative.
- Medimmune makes the H1N1 nasal spray. It is FDA approved for healthy people two years old up to 49 years of age. Because it is a live vaccine, pregnant women, people with asthma, people with immune deficiencies, and those with underlying medical conditions should NOT get this vaccine.
If I choose to vaccinate, how many shots or doses does my child really need?
AAP: The seasonal flu vaccine is given separate from the H1N1 vaccine and is available now for all children ages 6 months through 18 years. If your child is less than 9 years old and this is his or her first time getting a flu vaccine, s/he will need two doses.
Parents and caretakers of infants under 6 months of age should also get the seasonal flu vaccine now to protect these children who are too young to be vaccinated.
Dr Brown: For H1N1 flu, kids under ten will need a series of two shots or doses, given approx. one month apart. Ten years of age and older will only need one shot or dose for protection. Infants under 6 months are too young to be vaccinated.
It is definitely a good idea to get both vaccinations, but keep in mind all live-attenuated flu vaccines (the nose sprays) must be given at least four weeks apart so you have an adequate immune response to the vaccinations. So, if your child gets Flumist over the next few weeks for seasonal flu, he has to wait a full four weeks to get the H1N1 nose spray. Consider that before getting Flumist right now.
There is not a special time interval to receive seasonal flu shot and H1N1 shot.
My kids are not great with shots – any suggestions?
Mattel’s Children’s Hospital – UCLA: The good news is that there are several techniques that parents can use to positively impact their child’s experience when getting a needlestick – the key is to be creative and use the right combination of tactics depending on your child’s age, the particular procedure being done and the child’s fear level.
Parents of young children can bring soap bubbles and ask them to blow bubbles during the injections, suggesting they are “blowing away the hurt.”With a crying infant, if the parent places the plastic bubble maker in front of their mouth, as they cry out, they will make bubbles. “I have seen babies stop crying mid-cry because they were distracted by the bubbles,” said Dr. Lonnie Zeltzer, director of the Pediatric Pain Program.
For older children and adolescents getting the shots, but parents can help the child to breathe out slowly to relieve the pain.
Parents can ask their kids to use their imagination and experience being somewhere else really fun during the injections, such as at the park or at the beach. Other distraction ideas include jokes, video games, stories and music.
Experts have also advised parents to ask doctor for a prescription for a numbing cream or patch and put on the areas to be injected. Or if the doctor approves, parents can give the child a dose of pain reliever, such as Tylenol, about one hour before the injection.
After returning home, put an ice bag on the injection site to reduce local swelling and pain.
“Finally, do not lie to your child about getting an injection…No one likes to get poked with a needle, but if you reassure your child that there are ways to make the hurt go away, then you can help them achieve a successful, less painful experience,”
Am I better off with the H1N1 nose spray? What about antivirals and the nose spray?
Dr Brown: If someone is taking an antiviral (such as Tamiflu), he should not take the nasal vaccine until it has been at least 48 hours after completing the medication. And, if a person receives the nasal vaccine, he should not take an antiviral (such as Tamiflu) for two weeks after being vaccinated unless it’s medically necessary. That’s because the medication will reduce the ability for the vaccine to work.
What about vaccine safety concerns?
Folks, here I will depart from providing information – only because this topic could be a post unto itself. I will say that Dr Brown, The American Academy of Pediatrics, Public Health of Canada and Pediatric Safety’s own Dr Kim among others feel confident in their recommendations to immunize (please read Dr Kim’s comments at the end of this article). I will also say that other professionals – including some in the medical profession – feel differently. What I can do is provide you with several links that should hopefully give you some useful reference points to consider… For my family, I feel safer with the H1N1 vaccination than taking a chance without one.
Dr Ari Brown on vaccine safety, thimerosol concerns, adjuvants and Guillain-Barre Syndrome: http://www.basilandspice.com/journal/usah1n1-vaccines-195-million-doses-availability-safety-issue.html
Safety questions on vaccines – Children’s Hospital of Boston: http://childrenshospitalblog.org/thimerosal-squalene-and-guillain-barre-expert-answers-to-your-seasonal-and-h1n1-flu-questions/
Health Canada Flu Watch on vaccine safety, thimerosol concerns, and adjuvants for Canadian citizens: http://www.phac-aspc.gc.ca/fluwatch/index-eng.php
AND Weighing Possible H1N1 Vaccine Risks – Dr. Jennifer Ashton on Both Sides of Flu Vaccine Coin: http://www.cbsnews.com/stories/2009/08/17/earlyshow/health/main5246940.shtml
We hope our vaccine overview has been a help. We know you’ve got some tough decisions in the weeks ahead…and we hope we gave you some useful information that makes it a little easier for you to make some of them. We also know it can be a bit scary…and that no matter how good the information we provide, sometimes it just helps to hear a few words of advice from someone who speaks from the heart…and while she may not be your own pediatrician, she’s really great with kids and she cares an awful lot… So here is Dr Kim, our own in-house pediatrician, to give you her thoughts on the H1N1 vaccines. In the end…we leave it up to you and your pediatrician to decide on the best path forward for your kids…
Here’s my take on the upcoming flu season and influenza vaccines for children this year.
First, every single year the regular seasonal influenza kills approximately 35,000 people in America. And it is responsible for severe illnesses and hospitalizations, as well as the missing of school and work days, for many more kids and families.
As much as we may wish, we cannot prevent your children from getting sick each winter. There are more than 200 cold viruses and we have no vaccines to prevent these illnesses. But influenza is among the most severe and the most miserable of the viruses, and we can prevent severe illness with vaccinations.
But is it safe doctor?
I have fielded questions from worried parents and watched the media stir up fears for the past months about the safety of the H1N1 vaccine.
Many patients and writers in the press have expressed concerns about the “new-ness” of the H1N1 vaccine. That concern is based on a lack of understanding of the way that flu vaccine is made. Every year a “new” influenza vaccine is made based on the circulating strains of virus and given to millions of people with excellent safety and efficacy. The H1N1 vaccine has been made in the same way, at the same companies and factories. We know how to do this well and safely.
Some people worry that there is not enough safety data. In my opinion, there is never “enough” safety data. But again, given the track record of similarly-made flu vaccine in the past, there is not reason to be concerned that this vaccine will be unsafe at all.
Others worry that the vaccine will not be effective, citing concerns that the virus may mutate and change. Virologists know that this is rare in a single flu year, and we have watched the virus through the spring in Mexico, the summer here and the winter in the southern hemisphere, and the virus has not changed; there is no reason to expect that it will do so this winter.
Other concerns relate to preservatives used in childhood vaccines, such as thimerisol. Please keep in mind that many studies have been done to evaluate the safety of these compounds, and no good scientific study has ever shown that the very small amounts of thimerisol used in vaccines are harmful to children.
Finally given the recent media attention, questions have been raised about the 1976 flu vaccine and Guillain-Barre Syndrome. What isn’t being given as much attention is that the 1976 flu vaccine was made in a completely different way than the current swine flu vaccine, with less sophisticated and safe vaccine technology. So there’s no reason to suspect that GBS (which is typically present at a mild level in the general population), would increase at all with this year’s H1N1 vaccine.
In summary, as I mentioned in my previous post on this topic, I am strongly recommending both the regular seasonal flu vaccine and the H1N1 vaccine to my most vulnerable patients this winter: young children, those with chronic illnesses like asthma, pregnant women, and the parents and caregivers of babies younger than 6 months old who cannot yet be vaccinated. I think that these vaccines are safe, and I think that they are important. They will save lives and decrease pain and suffering this winter. And as always I recommend to families getting enough rest (sleep-deprived bodies are much more vulnerable to illness), staying well hydrated, practicing extra-vigilant hand hygiene, and reducing stress and increasing joy (both of which have measurable impacts on the immune system)!
I hope that you all have a fun and safe fall and winter! -Dr Kim
Dr Kim Newell is a pediatrician in a busy outpatient practice in San Francisco. She attended medical school at the University of Pennsylvania to learn the practice of medicine in a busy urban teaching hospital. Along the way she lived in India for a year and worked at hospitals in Guatemala, Uganda, and on the Navajo reservation in New Mexico, where she learned to be grateful for the luxury that allows her patients to fret over the small things. She completed her pediatric residency at the University of California at San Francisco (UCSF). Dr. Kim would like to help parents build healthy families by arming them with knowledge and tools, as well as a bit of lightness and laughter. She believes that the joys of parenting should outweigh the worries.