Swine Flu Vaccine? I’m Undecided

Dear Mamas,
We live in a suburb of Los Angeles that has already seen its share of swine flu. There were two confirmed cases in our local middle school last week and I’ve talked to friends who say there are lots of folks at home with flu-like symptoms.

We have a three-year-old and all the moms in her preschool are talking about how they can’t wait until the vaccine is available for their kids. They’re already planning how to guarantee that theirs are among the first to get it.

I’m not so sure. It seems to me that since our daughter is healthy with no medical problems, and so far the illness seems to be pretty mild, she might be better off getting the flu and getting it over with. Which is more protective, having the flu or getting the vaccine? Are we sure it’s safe? Are there risks we don’t know about? What are the pros and cons?

The other moms would be horrified if they knew I was even considering not getting the vaccine. There’s SO much peer pressure out there … am I making a big mistake?

Confused in CA

Dear Confused,
You’re asking great questions and you’re in good company. The fact that the H1N1 flu virus is so new, with no existing natural immunity, makes the learning curve pretty steep for all of us.

There are two main issues that need to be considered here: the individual health of your child and family members, and the overall health of the larger community, so let’s consider each separately.

First, you and yours. What we know so far that’s important for you to consider includes the following: The H1N1 virus is extremely contagious, probably because it was so recently introduced into the population that pretty much everyone is vulnerable.

For those who are healthy, the illness does seem to be fairly mild, with fever, cough, and muscle aches usually lasting from 3 – 5 days, and if you’ve had it you’re extremely unlikely to get it again. Those with underlying medical conditions like asthma or any chronic illness (including pregnancy and other situations affecting the immune system) seem to get hit much harder, sometimes becoming extremely ill or worse.

So if you have other family members — grandparents, aunts and uncles, cousins — or friends with medical conditions, consider the likelihood of your daughter passing the virus on to them if she were to become ill.

Based on the research trials, the vaccine seems to be very effective, with up to 97% of those receiving the first injection mounting a strong immune response. In fact, they’re now considering reducing the number of required doses from two to only one. In the world of vaccines that’s considered a home run.

So far, the vaccine seems to be as safe as the routine seasonal flu vaccine, but the expedited time schedule makes it hard to know for sure. Safety issues and side effects tend to show up over time as the pool of treated individuals grows, and we just don’t have enough data to rely on yet. The CDC feels strongly that significant problems are unlikely, because the new vaccine is so similar to the vaccines for seasonal flu that we’ve been offering for years.

Now for the community considerations: again, the ease with which this virus travels from person to person is a huge concern. If you look at the experience on college campuses, the spread is rapid and far-reaching. At the University of Washington suspected cases went from zero to over a thousand in a matter of weeks. Most of these cases are mild, and most twenty-somethings bounce back quickly, but just last week a death was reported at Cornell University.

Just today the CDC announced new evidence that shows that patients may spread the virus for at least a week, from just before symptoms begin ’til they’re well on the way to recovery. This means that if you become infected, and happen to be in the grocery line with a cashier who’s undergoing chemotherapy for breast cancer, for example, you could pass the illness on without even knowing you have it and the results could be devastating.

The best way to combat this spread from a community standpoint is widespread immunization, along with meticulous hand washing and isolation of those who are sick.

So as you can see, the story is complicated and we’re learning something new every hour, it seems. But knowledge is power, and you need to have all the facts to make the best decision for your family.

Remember … your judgment is as good as anyone’s. Consider the pros and cons and don’t let the peer pressure get to you. Your daughter will need your help with that in about 10 years!

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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?


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One response to “Swine Flu Vaccine? I’m Undecided”

  1. Update on Swine Flu, Please??

    […] our friends, AND in the medical community.  A few weeks ago we answered a question from a mom (Confused in LA on Sept. 9th) who was undecided about the vaccine for her preschooler.  We’ve learned more about the […]

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