Should I get the Swine Flu Vaccine?

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By now, everyone knows there are two flus this season. First, the regular seasonal flu (for which you get an annual flu shot), as always requiring a slight change in vaccine formulation to ensure it targets this year’s flu strain. The second vaccine protects against the well-publicized H1N1 virus, better known as swine flu.

When it comes to flu shots, I admit I take a far more conventional approach than many patients at WholeHealth Chicago and regular readers of these Health Tips might expect of a doctor who calls himself “alternative” or “integrative.” I’ve recently been reading some of the alternative medicine newsletters online warning people away from flu shots. The conclusion often seems to be “…and I’ve got this product you can buy instead.”

I became a major advocate of flu vaccines in 1974 when there was a flu epidemic and my wife and I simply had forgotten to get immunized. Being in health care, I got the flu quickly from one of my patients and brought it home to share. Illness-wise, we look back on March, ‘74, as simply the worst month of our lives: four solid weeks of being housebound with fever, headaches, exhaustion, and body aches that seemed to never go away. We’d awaken in bed and ask “I wonder if we’re still sick” before coughing deeply and gasping for breath, muttering “Yep, still sick.” We staggered around the house and had friends leave groceries at the front door. Tamiflu, which can offset the seasonal flu, hadn’t yet been invented.

Since 1974, we’ve never missed a flu shot. And although we’ve had very light cases of flu despite being immunized, we’ve never been that sick again.

Let’s review a few of the sentences of protest from patients who opt not to get immunized:
• “I took a flu shot and got the flu anyway.” This is possible. Maybe you got your shot too late in the season and your immune system didn’t have enough time to make antibodies. Maybe the vaccine didn’t target the exact flu strain that year. But at least with an immunization you have a shot at protection (pun unintended).
• “I’m allergic to eggs.” Very few people have a real allergic reaction (sudden onset of hives and wheezing) to eggs. This is not the same as being sensitive to eggs, such as when eggs appear as a positive on food sensitivity testing or you don’t digest eggs well.
• “I don’t want the mercury.” Yes, thimerosal, which contains 25 micrograms of mercury, is used as a vaccine preservative. A microgram is a millionth of a gram, such a minute amount that it’s cleared out by your liver and is harmless.
• “Should I really get two flu shots?” You may not need both. Regular flu shots are always strongly recommended for people over 50, health care workers, anyone with a chronic illness (heart disease, lung disease, etc.), and those who have a lot of contact with other people. Everyone else is welcome to have a regular flu shot, which is why you see so many signs advertising “Flu Shots Here.”
• “I never get a flu shot and I’ve never had the flu.” Congratulations. You’ve apparently got an immune system like a long-range missile protection program. Since there’s no government mandate to be immunized, you can continue as-is. I hope your luck holds out.

What’s unique about the swine flu (H1N1) immunization is a recommendation profile that’s different from the one for regular flu shots. The vaccine is highly recommended for:
• Pregnant women or women who are trying to get pregnant. The swine flu hits this group especially hard and several deaths have been reported among pregnant women with H1N1. Also, immunizing mom protects her newborn, which is VERY important because little ones are especially at risk.
• Household contacts of and caregivers for infants under six months (baby-sitters, nannies, day care workers). Getting immunized provides protection for the infant, who cannot be vaccinated.
• Health care personnel and emergency medical personnel.
• Children and adults from six months to 24 years. Children have the highest incidence of H1N1 and explosive outbreaks in schools have been reported. Children under five have the highest risk for hospitalization and are also sources of infection for the larger community. Although there is no specific recommendation for elementary and high school teachers, I definitely recommend immunization for this group.
• Adults 25 to 64 with certain medical conditions: any chronic lung, heart, liver, kidney, neuromuscular, blood, or metabolic disease or disorder; anyone using an immune-modulating medication, such as HIV medications. About 70% of patients hospitalized with H1N1 have a second chronic condition. The other 30% are kids. Unlike any other flu, people over 65 are actually at lower risk of infection than the other groups listed.

The H1N1 vaccine isn’t available yet, but should be out within the next 14 days. I expect we’ll not have much need for it at WholeHealth Chicago. We do have a few pregnant patients, though generally the vaccine will be given at OB-GYN offices. Most of our patients are between 25 and 64, but because our group has been doing such a great job taking care of themselves, the percentage with chronic illnesses is actually quite small.

Next week: How to build up your immune system and what to do if you get the flu–either type.

Be well,
David Edelberg, MD