Will a Prisoner Get the Swine Flu Vaccine Before Your Child Will?

Guest blogger Matthew Hoffman, MD, has written for WebMD since 2006. He is a board-certified internist and is currently a fellow in pulmonary and critical care medicine at Emory University, where he also completed medical school and residency.


That's the kind of inflammatory headline we've seen lately, as H1N1 vaccine shortages have forced public health authorities to make tough choices as to who will receive the first doses of vaccine.

The Centers for Disease Control and Prevention (CDC) provides the vaccine to states according to their population size. The CDC also advises health officials who is at elevated risk from a serious H1N1 influenza infection:

• pregnant women,


• people who live with or care for children younger than 6 months of age,


• health care and emergency medical services personnel with direct patient contact,


• anyone aged 6 months through 24 years, and


• anyone under age 65 with a chronic health condition.

The problem is, in some states, these categories include up to half of the population. That's many times the number of vaccine doses available.

State and local authorities decide where to deliver swine flu vaccine, and in what amounts. In many states, some of the first available vaccine has been allocated to prisons, to inoculate convicts at higher risk (such as pregnant women and prisoners with asthma). This has created a slight delay in vaccinating lower-risk people in the community.

Media reports and the resulting outcry from critics have put health officials on the defensive. Some health authorities have since declared that prisoners won't be given priority. Others defend the decision, emphasizing prisoners' vulnerability to flu, and their right to medical care despite their crimes.

Increased production of the H1N1 vaccine should permit vaccination of everyone who wants it - although when that will be is unclear. The shortage of vaccine raises tough questions we're not used to asking in our resource-rich medical system.

What do you think about prisoners at higher risk from swine flu getting vaccinated before the general population?

Don't Attend Swine Flu Parties

by Rod Moser PA, PhD, a primary care physician assistant with more than 35 years of clinical experience.


When I was a child in rural Pennsylvania, routine vaccinations were just beginning. We had the oral polio vaccine and tetanus, of course, but very few of the cadre of vaccines that are now being given (or offered) to our children. There were not flu vaccines. And, there wasn't a vaccine for chicken pox (varicella).

Alpha / CC BY-SA 2.0

When a child came down with chicken pox, almost an expected rite of childhood, we would be excluded from school for about a week. Parents did not think this was a good idea to miss all of this school, so impromptu "Chicken Pox Parties" were often arranged so we could get purposely exposed. As you know, once you get chicken pox (the disease), you will usually have lifelong immunity. If the children get chicken pox in kindergarten, a time when missing a week of school is not that critical, they will not get it at a time that parents consider less convenient. So, off we went to play with kids that we did not know. They were odd kids - kids with "bumps" all over them and they were scratching and sick. It was not the party we had assumed or been promised, with cake and stuff. We were puzzled, but for the parents, this was their primitive immunization program.

Like clockwork, those of us who were purposely exposed would most-likely come down with chicken pox about two weeks later. The parents were happy since we would be immune to future infections, and not come down with a random case over Christmas or Thanksgiving, for example. Chicken pox in childhood is usually a mild, self-limiting, albeit miserable for the kids, disease. There are rare complications, like meningitis or death, but for some reason, the parents were willing to take the gamble with us. There were no vaccines; this was the best they could do.

I guess I should consider myself fortunate that I was not purposely exposed to measles, which is more likely to cause serious complications or life-threatening events, or other diseases. They only had chicken pox parties. I wonder what the parents would have felt if one of their purposely-exposed kids develop a serious complication? Fortunately, none of us did.

We now have a vaccination for chicken pox, one that some people still feel is unnecessary. The vaccine is not perfect since it does not offer a 100% lifelong immunity. It used to be just one vaccination with promises of "pretty-good immunity" if given at age one, but lo and behold, we now have to give a second booster of this vaccine at age five, since a large number of teenagers who only received the initial "one vaccine" started getting chicken pox in high school. This vaccine is required for school entry now, not primarily to save lives (which it does), but to save money! Money is really what drives our society. This was really the first vaccine that was developed more for economic reasons, since untimely outbreaks costs umpteen millions of dollars a year in lost wages and decreased productivity as parent took off a week to take care of mildly-ill kids with the disease. Of course, unimmunized kids can infect unimmunized adults. Kids, with their less-than-ideal hygiene levels, are experts at spreading diseases. Unlucky adults who come down with chicken pox are not happy campers. They tend to be more ill, and definitely complain more than the kids. So again, the kids get vaccinated to spare adults from the inconveniences of a disease.

Now, those same kids that went to "chicken pox parties" are now grandparents, and apparently may be up to party-planning again. This time, they are having Swine Flu (H1N1) parties. In light of the fact that we now have vaccine (if we can get it!) to combat this potential killer, I find these parties very disturbing. Over 4,000 (the numbers change every day, so I am sure it is more) people have died in the U.S. from this H1N1 strain, with more to come as the height of the flu season is beginning. As far as anyone knows, none of these deaths were the result of purposeful exposures, but it can, or will happen, if this troublesome trend continues.

There are infectious forms of diarrhea, like rotavirus. Should we start having diarrhea parties? Should we purposely expose other children by discouraging hand-washing just so others can get it too? Are we doing others an immunological favor by sharing rotavirus with them, and thus saving the cost of vaccinations? I think not. Teenagers often practice unsafe sex; so in essence, they are inadvertently having chlamydia, herpes, or HPV parties, nearly every weekend. These are not the immunological gifts that should be shared. These are parties that should not get anyone's RSVP.

When I was in family practice, I treated the same young man, about five times, for recurrent chlamydia. He did not like wearing condoms. They decreased his "sensitivity", so he said. Since he had good insurance and easy access to medical care, he would just keep coming back for treatment. Warnings about HIV or herpes met with deaf ears, until of course, he did get herpes. I didn't have to say, "I told you so". He knew I was thinking it.

Humans of all ages carry diseases from time to time. We hang out with humans. Humans practice varying degrees of hygiene and common sense. Humans spread diseases. Not all humans who get diseases have mild cases or self-limiting outcomes. Some get complications. Some die. Knowing this, I am mind-boggled as to why someone would organize swine flu parties.

I think that if we have the knowledge and tools to help prevent disease, we should endorse those practices. We have a vaccine to help prevent the spread of H1N1, so maybe we should consider taking it. Vaccines are not perfect, but that's okay. Humans are far from perfect, too, so it's a good fit.

Using Antivirals to Treat H1N1 Swine Flu

by Anthony Fiore, MD, MPH, medical epidemiologist for the Influenza Division of the CDC.


We still have a lot to learn about treatment of 2009 H1N1 influenza, but fortunately the antiviral drugs we use for treating seasonal influenza - oseltamivir (Tamiflu) or zanamivir (Relenza)- are safe and effective, and very few 2009 H1N1 influenza viruses have been resistant to these drugs. Listed below are some key facts that healthcare providers and patients should keep in mind when thinking about using antiviral medicines to treat influenza.

The earlier antiviral treatment is given, the more likely it will be effective.
We know from experience with seasonal influenza that beginning treatment within 48 hours can reduce how long illness lasts. For most healthy people, the worst symptoms of influenza will be in the first 3 days of illness, so it makes sense that starting antiviral medicines 3 or more days after the start of a typical influenza illness will be less likely to help.

Patients who are severely ill should get treated right away no matter when their illness started.
Patients with severe illness should receive antiviral treatment as soon as possible regardless of when symptoms started, because illness in these patients often runs a longer course. Severe illness means concerning symptoms such as difficulty breathing, symptoms improve but then return with fever and worse cough, pain or pressure in the chest or abdomen, or confusion. For patients with severe illness that requires hospital care, treatment makes a difference, and can reduce the risk for death. All hospitalized patients with suspected or confirmed 2009 H1N1 should receive antiviral treatment with a neuraminidase inhibitor antiviral drug - either oseltamivir or zanamivir - regardless of age, risk factors or how long its been since illness started.

Treatment shouldn't wait for laboratory test results to come back.
If your healthcare provider suspects you have influenza and thinks antiviral treatment is needed, then treatment should begin as soon as possible. Antiviral medications are safe and effective, and the potential benefits outweigh the small risk of side effects (which are typically minor and self limited) in any patient with risk factors for severe illness. Some rapid influenza screening tests may give false negative results and obtaining more accurate testing results can take more than a day.

You don't have to be hospitalized to get treated.
Outpatients who 1) have risk factors for more severe infection (see below for the risk factors), 2) have evidence of pneumonia, or, 3) appear to worsening or unstable, might also benefit from treatment regardless of when illness started. But as with any illness, earlier treatment is better. Healthcare providers should consider ways to reduce the time it takes for patients who need treatment to get it. Patients who are at higher risk for severe illness and who get what they think might be influenza should contact a healthcare provider as soon as possible. That's also true for any patient who takes a turn for the worse or who has high fever and other symptoms for more than a few days.

Decisions about treatment are always ultimately up to the clinician and the patient
Treating those who have severe illness or who are at higher risk for severe illness is the main goal of antiviral treatment recommendations. Treatment generally is not necessary for healthy older children and adults younger than 65 years old who don't have severe influenza. But there are potential benefits of treating healthy persons early in the course of their illness (within 48 hours of the start of symptoms), including the possibility of reducing the duration of cough or fever by a day or 2. Even healthy persons can get severe illness and early treatment might further reduce their already small risk of influenza complications. You and your healthcare provider have to weigh these potential benefits against the costs and availability of antiviral drugs and the small risk for drug side effects. Healthcare providers use their experience and judgment to give advice on treatment decisions like this all the time.

Even if you are getting antiviral treatment, you might still pass the virus to others
Patients receiving treatment can still infect others. Therefore, good hand washing and respiratory hygiene practices should continue during treatment to prevent transmitting illness to others. Information about home care of ill persons for providers and patients is available at Taking Care of a Sick Person in Your Home and Home Care Guidance:
Physician Directions to Patient/Parent.

Because many communities are now experiencing widespread flu activity, the use of influenza antiviral drugs in the United States has increased. Patients with severe influenza are getting treated more often and more quickly than at the start of the pandemic. It can be difficult to keep up with the recommendations for use of antivirals, because these have been revised several times as we have learned more about who is at higher risk for severe infection and who is most likely to need treatment. What we know so far is that certain persons are at higher risk for more severe illness:

• pregnant women and women who have given birth within the previous two weeks


• infants and children younger than 2 years old


• adults 65 years old or older


• any child or adult with with a chronic medical condition, like diabetes, heart disease, or asthma.

Several studies have also shown that persons who are very obese (body-mass index greater than or equal to 40), and possibly also persons who are obese (body-mass index greater than or equal to 30) are at higher risk for severe influenza - perhaps because many have other underlying medical conditions, or because obese persons just tend to have more complications from any illness compared to persons who are less heavy.

For more information please see the latest CDC antiviral guidance: Treatment (Antiviral Drugs)

The Blame Game

by Rod Moser PA, PhD, a primary care physician assistant with more than 35 years of clinical experience.


I am very disappointed. After spending BILLIONS of dollars, if this is a test of our country's response to the H1N1 influenza pandemic, then God help us...

Not Enough Vaccine
The government blames the manufacturers (vaccine producers). The manufacturers blame the virus. The patients blame me! The government said that the manufacturers failed to live up to their promise of sufficient doses at a certain time. We were supposed to have about 40 million doses available for distribution, but for a variety of reasons (or excuses), only 28 million doses have been released. I have heard that the H1N1 virus grows slower than the seasonal flu virus, as one excuse. Another had to do with changing from the seasonal flu orders to the H1N1 orders (whatever that means). Or, perhaps there was a shortage of eggs because of Easter? Millions of chicken eggs are used in the manufacturing of both influenza vaccines. Sometimes, I feel like I am just being egged along, too. Regardless of the reasons, those of us in the primary care trenches have to turn down requests for flu vaccine every day because we do not have it.

Yesterday, my chickens laid their first eggs - two of them. I would love to send those two eggs to the vaccine makers. They apparently need all the help they can get.

Problems with Distribution
Due to varying populations in each state, the allotment for influenza vaccine, both the seasonal and H1N1, are divvied up. The more populous states, like California, are supposed to get more than say, Alaska. When that big truck filled with flu vaccines arrives, where does it really go? The vaccine is being sent to the State Health Department, I believe, to be distributed down the county health departments. How can large medical groups run out, and the local grocery stores and pharmacies seem to have ample supplies for their flu clinics? I sure wish I knew that answer. We do not have any H1N1 vaccine in our clinic, but there is going to be a school "flu clinic" today in one of the local junior high schools. Maybe I should go, stand in line, and try to get some for my patients? Even as I wrote this blog post (during my lunch hour), an email informed me that we received a shipment of flu vaccine. It may last us the rest of the week.

Deciding Who Gets the Vaccines
I would make a bad triage person - sitting behind the desk in the ER, deciding who goes in first. People always think that the ER has a "first-come, first-serve" policy. They do not. When it comes to flu vaccines, the people most at risk have been identified - health care workers in the trenches; pregnant women, children with pre-existing health problems like diabetes, cancer, asthma, etc.; and, all other children after that. Initially, we were informed that kids from six months to 24 years were the target group. Because of the vaccine shortage, it was modified to kids from 2 to 9. I had an issue the other day that involved two children, ages 7 and 11. According to our clinic policy at the time, only the 7 year old could get the vaccine; the 11 year old had to wait. The mother was not pleased. Today, our clinic received about 500 doses of the seasonal flu, so "anyone" can have it...today, while the supply lasts. We have no idea when we will get the next shipment. Sometimes, bad timing decides who gets the vaccine. If you happen to come in to our office when that shipment arrives, you may get it. Wait until tomorrow, and you may be too late. My heart goes out to person number 501 standing in a line for hours at a flu clinic that only has 500 doses.

Deciding Who Gets Tamiflu
The Feds bought up most of the Tamiflu last year when the Bird Flu was on its way. Millions of doses were sitting in government warehouses waiting for this pandemic that did not occur. Now, the strategic horde of Tamiflu is being released. I suspect it is being released because (a) it is needed, and (b) it has an expiration date and the government wants to dump it. Of particular concern, is the shortage is the suspension form used for children. Currently, pharmacists are compounding the adult doses - grinding them up and mixing this powder with cherry syrup - so we will have antiviral medication for children. One local pharmacist charged one of my mothers an extra $75 to compound her child's prescription. Nice.

According to medical authorities fearful of creating Tamiflu-resistant strains (happening already), the antivirals should be reserved for the more risky patients - the sickest, and those most-likely to develop serious or life-threatening complications. What is really happening, of course, is that Tamiflu is going to those who (a) demand it, and (b) those who have insurance or can afford to buy it. It ain't cheap, and lately, it ain't easy to find. I had two H1N1 cases last night in evening clinic. Both children had high fevers and were very, very sick. I prescribed Tamiflu to both of them. I hope the parents were able to find and get it. I wonder where I would stand, legally, if I withhold Tamiflu for a child with H1N1 who ends up with a serious complication, simply because they are not considered "high risk"? I think we all know that answer.

For you bargain-hunters, it is possible to buy counterfeit (fake) Tamiflu on the Internet, which would certainly be effective if you came down with, say, fake (swine-ish) flu.

Concerns About Safety and Efficacy of the H1N1 Vaccine
It's safe. It's as safe as any other flu vaccine, but I have to spend a lot of time defending it to my patients. True, it is not well-tested, especially in children, but the seasonal flu vaccine is never well-tested. Some parents are leery of all vaccines, thinking any of them, or combinations of vaccines will overwhelm the child's immune system, and cause autism. I find that I have less patience in dealing with these people who rely on rumors and junk-science, instead of hardcore scientific evidence. If they don't want flu vaccines, they will have to endure the risks. I wonder if they only wear seat belts if they suspect they might get into a car accident, or just try and put them on...real fast...when a tractor trailer truck is heading straight for them.

It takes about three months to determine what the seasonal strains might be, and at least another three months to whip up a big batch enough for the population. No sooner than you get the batch all cooked up, bottled, and sent off to distributors so the price can be increased, then you have to start all over for next year's seasonal flu. The H1N1 strain surprised everyone. The companies that manufacture flu vaccine (very few, I might add) already had the seasonal strain cooking then the order came through. In this economy, no one wants to turn down work - even seasonal work - so companies scrambled to take advantage of this lucrative pandemic.

Pharmaceutical companies are not high on the "trust list" for many people, so I can understand the reluctance about not be first in line for this vaccine. So far, after millions of doses given, there have been little, if any, reported adverse effects. Efficacy, of course, will really be tested in the field, but those people who are immunized. I guess you really never know what diseases you DON'T get, but if this pandemic is curtailed, then the program (and vaccine) will be extolled as a success.

I really hate flu season.

Race for the Swine Flu Vaccine

by Michael Smith, MD, chief medical editor of WebMD Health.



Given up trying to get your hands on a swine flu (H1N1) vaccine? Yes, they're a bit hard to come by, but don't give up - doctor's orders.

The swine flu vaccine isn't rolling into doctor's offices and health clinics as quickly as we'd hoped, but it's important to keep up the hunt, especially if you or your child is at high risk of flu complications.

If you need a refresher, those at high risk are:

• Everyone from 6 months to 24 years of age
• Anyone with lung disease, including asthma and emphysema, or heart disease
• Pregnant women
• Household contacts and caregivers for children younger than 6 months

That's a lot of people. So how do you find the H1N1 vaccine?

First, check the flu.gov web site. There's a map of the U.S. Click on your state and you'll find links to your state health department. While the health department might not be the first place you think of for health care, when it comes to the swine flu vaccine, it may be your best bet. Some states also have information about private providers.

Next, stay diligent. Keep checking with your health department and with other vaccine providers in your area. Check out the CDC's 2009 H1N1 influenza vaccine supply status, to see how your state compares to the rest of the country in the race for the swine flu vaccine.

There will, eventually, be plenty of vaccine. It's not clear when that will be. The CDC is hesitant to break out the crystal ball. Fingers crossed we'll have plenty of vaccine in the next several weeks.

And while you're at it, don't forget about the seasonal vaccine. Most of us are usually pretty complacent when it comes to the regular annual flu vaccine, but seasonal flu kills 36,000 American every year. Due to high demand this year, even the seasonal flu vaccine can be a bit more challenging than normal to find, but it's out there.

We haven't seen much seasonal flu yet - most flu cases have been swine flu. But you can bet by the time winter rolls around seasonal flu will come in fast and furious. No time like the present to roll up your sleeve - or take a little squirt up the nose.

You can find a seasonal flu shot locator at the American Lung Association web site.

Read about one woman's search for the swine flu vaccine for her and her baby and get more tips on how to find the vaccine for yourself in WebMD's article by senior medical writer Dan DeNoon.

2009 H1N1 Influenza Vaccine Safety

by Anthony Fiore, MD, MPH, medical epidemiologist for the Influenza Division of the CDC.



Many people are just getting up to speed on the 2009 H1N1 monovalent vaccines, and it's quite natural to have questions about them, including about safety. It's confusing enough just to keep up with the recommendations for seasonal flu vaccine and all the other things that are recommended to promote good health. Let's consider a few of the questions I have been getting.

Is the 2009 H1N1 influenza vaccine new?

The answer is that the virus is new, but the vaccine against this virus is being made in exactly the same way, by the same manufacturers, in the same facilities, and undergoing the same pre-release testing as is done for seasonal influenza vaccines every year. The injected 2009 H1N1 vaccine (flu shot) is made just like the annual flu shot, and contains killed viruses that cannot cause flu. The nasal spray 2009 H1N1 vaccine is made exactly the same way as the seasonal nasal spray vaccine. The nasal spray vaccines contain influenza viruses that have been weakened so that they cannot cause influenza. These seasonal flu vaccines have been used for many years, and have an excellent safety record.

What are "adjuvants"? And are they used in the 2009 H1N1 flu vaccine?

Adjuvants are another thing people have been asking me about. Adjuvants are ingredients added to some vaccines (for example, DTP, a vaccine that protects against diphtheria, pertussis and tetanus) that increase your body's immune response, and they are vital to how many other critical vaccines work. But influenza vaccines available in the United States – seasonal and 2009 H1N1 – do not contain adjuvants.

So why isn't the 2009 H1N1 virus in the annual flu vaccine?

The answer to this is that it would have been, if the virus had arrived a few months earlier. Seasonal flu vaccines are made in a yearly cycle, and the process must start in February each year in order to make enough for the fall vaccination season. Because the 2009 h1N1 virus started making people sick after seasonal vaccine was already being made the U.S. government decided to make a separate vaccine to protect against 2009 H1N1.

Was the vaccine rushed out too quickly, without the usual influenza vaccine safety testing?

Absolutely not. The same steps to ensure safety that we use each year for seasonal influenza vaccines were used for the 2009 H1N1 vaccines. Vaccine experts expect the 2009 H1N1 influenza vaccine to have a similar safety profile as seasonal flu vaccines, which have a very good safety track record. Over the years, hundreds of millions of Americans have received seasonal flu vaccines.


So the 2009 H1N1 is made the same way as seasonal vaccines- but what side effects are being seen in the clinical trials?

The clinical trial results are already in or are being analyzed, and some have already been published or reported. You will be seeing more results published over the next few weeks. Just in the past few days, the National Institutes of Health has released some data from the trial conducted among pregnant women and children, and its all good and expected news. The vaccine is very good at stimulating a protective immune response. People participating in the clinical trials so far are having the usual minor and short term side effects that we see from seasonal influenza vaccines. This means that for the flu shot, some people will have arm soreness for a day or two; some will have a sense of fatigue or a headache the day they are vaccinated. Most didn't report any side effects. For the nasal vaccine, people have reported runny nose, headache, or sore throat – all mild symptoms that resolve after a day or so. Again, many didn't have any reaction to the nasal vaccine. If you put the types of side effects that people report after getting seasonal flu vaccine side by side with those that have been seen among person who have received a 2009 H1N1 vaccine, you would not be able to tell them apart.

Do the vaccines have preservatives?

Some do – those that are formulated to be in multidose vials. Thimerosal is a very effective preservative that contains a small amount of mercury. Influenza vaccines in multidose vials contain 12.5 to 25 micrograms of mercury per influenza vaccine dose. Thimerosal has been used since the 1930s to prevent contamination in some multi-dose vials of vaccines (preservatives are not required for vaccines in single dose vials or syringes). The Advisory Committee on Immunization Practices recently stated that "No scientific evidence indicates that thimerosal in vaccines, including influenza vaccines, is a cause of adverse events other than occasional local hypersensitivity reactions in vaccine recipients. In addition, no scientific evidence exists that thimerosal-containing vaccines are a cause of adverse events among children born to women who received vaccine during pregnancy". For those who remain concerned about thimerosal, preservative-free inactivated influenza vaccines are available, and the live attenuated vaccine does not contain a preservative either. The total amount of inactivated influenza vaccine available without preservatives will continue to increase in the coming weeks.

How is vaccine safety monitored after the clinical trials?

The clinical trials have included thousands of persons with no reports of severe side effects. Based on our long experience with influenza vaccines, and the information from the trials, we expect that any serious side effects following vaccination with the 2009 H1N1 influenza vaccine will be rare. But CDC and FDA, working with health departments, healthcare providers, and large healthcare systems will closely monitor the safety of this vaccine using both the usual safety monitoring systems that are already up and running, as well as additional systems that use data sources we have not used before. CDC is also working with professional organizations whose members might be more likely to see a particular kind of side effect to be sure providers know how to rapidly report anything that they are concerned about. This is being done to assure the public that safety is being taken seriously, because if people don't completely trust the way safety is being assessed, they might be hesitant to take advantage of the protection that vaccination can offer. Furthermore, we also need to respond to any hint that there is a problem - because when you vaccinate tens of millions of people its inevitable that some health event will happen to somebody shortly after vaccination. The safety monitoring systems will be critical to helping us figure out whether whatever happened was an unrelated chance event (like getting hit by lightening after getting a haircut), or possibly connected to vaccination.

Who do I tell if I think I might have had an unexpected vaccine side effect?

You or your doctor can report what happened through the Vaccine Adverse Event Monitoring System or VAERS, which takes reports from any person or clinician who has some health event happen to them after vaccination (www.vaers.hhs.gov). You don't have to prove that the event is related in order to report, because the purpose of this system is detect possible safety signals that need further investigation.

I am convinced that vaccine is safe for healthy people, but what about those who are more vulnerable, like young children, pregnant women, or persons with weak immune system illnesses?

Vulnerable persons such as pregnant women, young children, and persons with weakened immune systems have taken seasonal flu vaccines for years and have not had problems with vaccine safety. There are certain people who should get the flu shot instead of the nasal spray vaccine, such as pregnant woman and people with certain medical conditions. But young children, pregnant women, or people with weak immune systems are at particularly high risk for 2009 H1N1 influenza complications, and are among those who should be vaccinated first. Furthermore, it's also quite safe to get either form of the 2009 H1N1 vaccine if you live with or provide care for people who are more vulnerable. The one exception is if you have contact with or provide care for hospitalized patients in special protected environments like bone marrow transplant units. While most health care workers don't do this as part of their usual job, those who do should get the flu shot instead of the nasal spray vaccine.

Vaccine safety has always been taken very seriously at CDC, and the public and health care providers should feel assured that all evidence so far indicates that the 2009 H1N1 vaccines will have the same excellent safety record as seasonal vaccines. This vaccine is the key to protecting people against 2009 H1N1 flu. I hope the information I've provided in this blog helps those of you who are recommended to get it to make an informed decision. As a doctor, I recommend that anyone who is at high risk for influenza complications and anyone who wants to avoid getting 2009 H1N1 influenza and passing it on to others, be vaccinated as soon as they can. There should be much more vaccine available in the coming weeks

"I Never Get the Flu"

by Rod Moser PA, PhD, a primary care physician assistant with more than 35 years of clinical experience.


When someone uses the word "never", there is something in the universe that seems to hear it, and quickly dispute this definitive statement. When it comes to human afflictions, the word "never" is never used.

"I never give my kids the flu shot, because they never get sick. I never get them either and I have never gotten the flu."

This statement is just about as logical as, "I have never been in a car accident, so I do not see a need to wear seat belts", or "I have smoked for twenty years now, and I have never gotten cancer. My father smoked for 50 years, and he never got it either. I think our family is "immune."

I had a chiropractor as a neighbor several years ago, that told me that his three children had NEVER been ill - not one day. Why? Because he did regular adjustments of their necks in order to improve their immune system. He was convinced that his kids could kiss a person with drug-resistant tuberculosis without getting it. Whoa!

Vaccines are not unlike insurance. We have car insurance just in case we are involved in an accident (that, and the fact that it is required by law). We have health insurance (some of us) just in case we need it. The same goes for fire insurance, earthquake insurance, flood insurance, or alien abduction insurance. Some people are willing to take chances; others are not.

As a firm, anti-smoking zealot, I tend to challenge close friends or relatives who smoke. One response that sticks in my mind over the years was from my old college roommate: "Anyone can stop smoking, but it takes a MAN to face cancer!" Yes it does.

We never know what the flu season is going to be like until it is upon us. The experts at the Centers for Disease Control and Prevention work feverishly trying to anticipate the seasonal strains. Sometimes, they get it; sometimes they do not. This is usually due to the rapid ability of the influenza virus to change (adapt). Once the flu batch is in the cooker, this will be the vaccine for a particular year. If the virus changes - even a little bit - the vaccine will be less-effective, or even worthless. This is not a perfect or exact science, but it is the BEST we have, and influenza vaccine has saved umpteen millions of lives. We only know the diseases we get. We do not know the diseases we do NOT get.

Many people count on "herd immunity". If most of the people in a population are immune to a particular disease, then you are considerably less-likely to encounter it, or acquire it. Unfortunately, in today's very mobile world, it is difficult to control this herd, unless we put up biological barriers and keep the unimmunized people out. Unless enough people take flu vaccine, it is not likely that our country, or any country, will be able to control an out-of-control pandemic. America is based on freedom, so people tend to harp about their rights or freedom NOT to take vaccines. Of course, they want everyone else to do it, including their medical providers, so they will not get exposed. And, high on this list of vaccine-refusers are the growing cadre of "I never get the flu" people.

Several MILLION young and healthy young men and women in 1918, a time when flu vaccines were considered science fiction, didn't think they would get the flu either. A healthy person would show up at a clinic at 9 AM with a high fever and other flu-like symptoms, and be dead by the end of the day. I can assure you, if there was an effective influenza vaccine, it would have been in very high demand. Take a walk through an older cemetery some day and look at the dates. Also, do a little math and look at the ages of those that died in 1918. May they rest in peace. I rest my case.

Maybe this pandemic will be a bust? Maybe it will not be as bad as experts say it will be. So far, less than a thousand (that number changes so fast, that I hesitate to be specific) have died from the H1N1 strain. In a typical flu year, the seasonal flu takes the lives of over 35,000 people in the U.S. The worldwide toll may be difficult to calculate, but it is in the millions.

Influenza is nothing to sneeze about. It is a killer. Sadly, it is also preventable, if people will take that simple step, accept that extremely tiny adverse effect risk, and just get the vaccine. If you don't really want to take it for yourself, at least take it for those you love. How would you feel if you contracted the flu, inadvertently exposed your fragile grandmother or a child who ended up dying from complications? Knowing that influenza is contagious a day or so before you really know you have it, or before you are officially diagnosed, really should make a difference.

I see about 40 patients or more a day in my 12-hour clinic shifts. If I were to come down with influenza a day later, I would have exposed any unimmunized patients - some who may not be able to survive this deadly strain. For those who came down with the flu and survived, they may expose a hundred more people, who, in turn, will expose hundreds more, and so on and so on. This, my healthy friends, is a pandemic. Theoretically, a worldwide pandemic really starts with ONE. Think of what happens when a pandemic starts with millions.

I was born in 1951. Some experts believe that a certain proportion of our population born before 1950 may have some residual influenza immunity from prior exposures. I missed it by a year. Damn. I estimate that I have been exposed to the H1N1 strain at least fifty times already in my clinic, so maybe I am one of those people with some residual immunity to this strain. I still plan on taking the H1N1 vaccine as soon as we get it. I took the seasonal flu vaccine over a month ago. I need all the immunological help I can get.

Okay flu...I'm ready for 'ya.