Tuesday, September 8, 2009

Fear of H1N1 Flu Vaccine. Theories Why.

I'm hearing plenty of concerns from patients, particularly older patients, about the H1N1 flu vaccine. Some staff also seemed concerned.

Why? I have some theories.

The speed of developing the vaccine seems by many to have been rushed. Instead of being impressed that a novel influenza virus could be identified, sequenced, and subsequently developed into a vaccine seemed to escaped many. Does anyone remember the SARS / avian flu virus that caused problems in Asia a few years ago? No vaccine was developed as far as I know. When we watch and read about stories online and have no personal experience with the flu, then we become detached from the reality. It can't happen to me mentality.

I suspect that when faced with a choice of possibly getting a pandemic virus verus the reality of getting a real novel vaccine now and whatever problems it may or may not have (and really the vaccine should be as safe as previous flu vaccines), people not surprisingly are uneasy about rolling up their sleeves for the latter.

I would also suggest that the same type of denial occurs with other preventive measures like screening for cancer and is why many people don't get mammograms for breast cancer screening or flexible sigmoidoscopies / colonoscopies for colon cancer screening. People would rather wait until they have symptoms and then deal with the consequence, even if they are life threatening and when medical science often has no answers.

As for the H1N1 vaccine, clinical trials are already occurring in Australia which is in the middle of flu season. Safety data will come out eventually but probably not in time to allow people to truly have informed consent. It is expected that the H1N1 vaccine will be available in October.

Almost no one worried about the H1N1 uses the paralyzing condition - Guillian Barre as a reason for skipping the vaccine. Gullian Barre is a legitamate concern as a few hundred cases occurred in 1976 when a flu epidemic occurred at the Fort Dix military base. CDC found since then that the risk of Guillian Barre is small (about 1 in 1 million are potentially at risk), but there has been no strong link between flu vaccine and the condition.

Recommendations by CDC suggest that those who need H1N1 vaccination are individuals age 24 years old and younger down to 6 months old, caregivers watching children 6 months and younger, as well as those ages 25 to 65 years old who have chronic illnesses and pregnant women. Many of my older patients don't wish to have the vaccine do so on altruistic grounds, which I find rather amazing in a society where the current generation seems more focused on "me" rather than "we".

While it is true that people 65 years and older who are otherwise healthy don't the H1N1 vaccine, patients don't necessarily appear relieved when I tell them this. They seem more skeptical that the science shows they are at least risk.

I don't blame them. For years we tell those who are vulnerable, typically those who are younger and those who are older, to get vaccinated. (Recall that when there was a flu vaccine shortage a few years ago due to a manufacturing problem that President George W. Bush was on television urging Americans who were otherwise healthy to skip the shot as he was). Now, we are saying "over 65 and healthy? Don't need the H1N1 vaccine". Though my patients don't appeared to be swayed about allegations of "death panels" and rationing of medical care based on age which have appeared with the healthcare reform debate, one could understandably be suspicious about the H1N1 recommendations and the absence of including the elderly.

What to do?

At least get the typical seasonal flu vaccine which is available now (local grocery stores have it). The flu kills 36,000 Americans annually.

Think about getting the H1N1 vaccine if you are supposed to. The process of producing the vaccine is similar to that of prior vaccines. It has been more difficult to produce and as a result it requires two shots rather than one.

Still on the fence? Talk to your doctor. Check out the CDC's website for the latest information.

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