OK, you’ve heard all of the interviews and all of the speculation. The vaccine is too new. This is just your average flu. I’ve posted them here to help you make an informed decision about whether to get the H1N1 vaccine. I hope they helped.
Now I’m offering up my opinion, for what it’s worth. I am not a doctor, just someone who talks to them a lot.
If you’re pregnant, get the shot.
I’ll let Aubrey Opdyke tell you why. She does it far better than I ever could.
She shared her devastating story of struggle and loss with The New York Times here. No, she didn’t die, though she came close.
Her baby did.
Parker Christine Opdyke lived nearly 27 weeks inside her mother’s womb. She lived seven minutes outside of it. I can’t imagine anything more agonizing.
The H1N1 virus is serious business for pregnant women. It can be deadly, for both mom and baby.
I know many of you are having difficulty getting the vaccine because of short supply. Stay on your OB. Get it as soon as you can.
I’m not trying to frighten you, and this is only my opinion, but mommy…get the shot.
(Remember, you cannot use the FluMist vaccine while pregnant. You have to wait for the shot.)
Grrrrrrrrr…Ok, preggos, you know you’re not a candidate for the FluMist form of the vaccine, because it contains a live, attenuated virus. However, it appears the injectable form of the vaccine, the one that you can get, has been delayed. Again.
Here in Texas, the counties have been warned that they won’t see any H1N1 shots until November. It’s the same everywhere else.
You can look up when the vaccine will be arriving in your state here. I caution you, however, these may not be updated. The delivery dates for Texas have not been updated.
Also, it turns out the underlying condition present in a majority of the kids who end up in the hospital with swine flu is asthma. Kids with asthma also need the shot. The can’t have FluMist.
So, again, grrrrrr……
There finally is some suggestions about why H1N1 is so hard on pregnant women. This is from Anne Schuchat at the Centers for Disease Control.
First, pregnancy itself changes a woman’s immune system, keeping her body from having an immune reaction to the baby. Secondly, as the pregnancy progresses, the baby presses upwards on its mother¹s lungs, making it harder for her to breathe deeply. Pregnant women need to contact their health care provider if they are experiencing difficulty breathing and fever, Schuchat says.
The thing is, the same is true for the seasonal flu, so I’m not sure that we’ve gotten any real info here.
The alarming figure from this story has nothing to do with pregnant women or with kids who have asthma. It’s about everyone else. The CDC says 45% of those hospitalized with H1N1 have no underlying conditions.
I have a call in to an epidemiologist to find out if this is our of an overabundance of caution because of all the coverage swine flu is getting, or because this flu is tougher on healthy people than experts thought it would be. I’ll post it to the Pea in the Podcast blog when I get it.
In the meantime, remember, a person with Swine Flu is contagious for 24 hours before they have any symptoms, so practice good clean hand hygiene. WASH OR SANITIZE YOUR HANDS BEFORE YOU TOUCH YOUR FACE. Seriously, that’s hard because we touch our faces all the time. But it’s important.
If people are coughing or sneezing, walk away.
If you are coughing or sneezing, please do it into your sleeve and not your hands. After all, you may be the one who is incubating H1N1!
My previous blog postings on H1N1 can be found at the following links…
Listen to the advice of an obstetrician here…
Listen to the inside scoop about the clinical vaccine trials on pregnant women with one of the doctors working on them here…
And listen to a nationally recognized pediatrician give some controversial advice regarding the H1N1 vaccine here…
I urge you to add the Pea in the Podcast blog to your internet favorites. I will keep you hooked up with all of the latest news on pregnancy and parenting…and I am following the H1N1 vaccine story for you very closely. Everything you need to know is here.
I spoke with Doug McBride at the Texas Department of Health last night. He says the feds will start shipping out small allotments of H1N1 vaccine to states next week. Out of the 15 million doses Texas expects to eventually get, it may only get 270,000. More likely, it will get 170,000…and they expect that shipment to contain only FluMist vaccines.
Why is that important to you, preggo (I say that lovingly)? Because you can’t take a nasal spray vaccine. FluMist contains a live, attenuated virus. It could make you sick.
You can only get the shot.
What’s happening in Texas will happen everywhere. Each state will get a small batch next week, which will be divided between the counties. They expect the batches they are shipped to get larger every week until they get all the vaccine they expect to get.
Each state will decide on its own what to do with the first small shipment. In Texas, they will begin immunizing toddlers.
The World Health Organization wants you to get the H1N1 vaccine. So does the Centers for Disease Control and Prevention. Most obstetricians want you to get it. But Dr. Jay Gordon, a noted pediatrician who is on the faculty at both UCLA Medical Center and Cedars-Sinai Medical Center, is encouraging everyone to slow down, take a deep breath, and think about this decision.
Even pregnant women.
Dr. Gordon and I talked today about his controversial position on the H1N1 Virus, the vaccine, and who he thinks should get it. We spoke specifically about the vaccine and pregnancy, but also about whether I (you) should get it, whether my child (your child) should get it, and — if not — what kind of risk are we facing?
…and I have spoken with a doctor working on one of them. Dr. Flor Munoz-Rivas is a specialist in pediatric infectious diseases. She tells us about how the vaccine is made, whether it contains a controversial mercury-containing preservative, and why the women involved in the trial will also be giving up some of their baby’s umbilical cord blood when it’s born.
Six percent of swine flu cases so far have been in pregnant women, even though they represent only about 1.6 percent of the adult population. One study estimates that pregnant women have been hospitalized with swine flu four times more often than the general population. Their risk of dying from swine flu is 13 times higher.
Those are some seriously sobering numbers, and make the shot worth strongly considering, to protect both you and your baby.
If you decide against getting the H1N1 vaccine, please listen to my interview with Baylor College of Medicine obstetrician Kjersti Aagard in my blog posting Some Moms-To-Be Fear Swine Flu Shot More Than The Flu. Toward the end of the interview she offers some tips on how to avoid the flu if you don’t get the vaccine.
So the Centers for Disease Control wants you to get the swine flu vaccine, just like it wants you to get the seasonal flu vaccine.
The problem? The H1N1 vaccine is in clinical trials now. When pregnant women line up for the vaccine, they will be getting a shot that is new. A lot of women don’t like that. They don’t like that at all. They are afraid to expose their unborn baby to a relatively untested vaccine. I spoke with Baylor College of Medicine obstetrician Kjersti Aagard about this. She offers her recommendations, and tells you what to do if you don’t plan to get the vaccine.
Listen to Dr. Aagard’s advice here…
Dr. Gordon: I have seen more children and adults with influenza-like illness: 104 degree fevers, muscle soreness, sore throat and negative tests for strep, than in any summer I can remember. I haven’t used the “flu swab” to test anybody, but I’m sure that many if not most of these sick people had Swine Flu. They all felt miserable, and they are all feeling just fine now.
Preventing outbreaks of this “novel H1N1″ influenza may be a mistake of huge proportions. Yes, sadly, there will be fatalities among the 6 billion citizens of the planet. Tens of millions of cases of any illness will lead to morbidity and mortality, but this is completely (tragically) unavoidable. The consequences of not acquiring immunity this time around, however, could be really terrible and far outweigh a mass prevention program.
Here’s my rationale for not using Tamiflu: If (if, if, if) this virus circles the globe as the rather innocent influenza it now appears to be, but mutates and returns as a very virulent form of influenza, it will be quite wonderful and life-saving to have formed antibodies against its 2009 version. These antibodies may be far from 100% protective, but they will help. This is incredibly important but being ignored in the interest of expediency.
In 1918, it appears that influenza A (an H1N1, by the way) did this globe-trotting mutation and killed millions. The times and state of medical care are not comparable, but a milder parallel occurrence is possible. Perhaps this happens every 100 years or so, perhaps every three million.
Whenever possible, we should form antibodies against viruses at the right stage of their existence and at the right stage of our lives (For example, chickenpox in childhood and EBV/mono in early childhood. There are many other examples.) Getting many viral illnesses confers lifetime immunity, and very few vaccines do.
Tamiflu is a very powerful drug with little proven efficacy against this bug, and with its major side effect being tummy upset. I’m not using it at all. Psychiatric side effects are also possible.
I also won’t be giving the flu shot to the kids and parents in my practice unless there are extraordinary risk factors. I anticipate giving none at all this year. I doubt that there will be any really large problems with the vaccine, but I also doubt any really large benefits. As I said, I think that this year’s version of this particular H1N1 is as “mild” as it will ever be and that getting sick with it this year will be good rather than bad. The chances that a new “flu shot” will be overwhelmingly effective are small.
I consider this, and most seasonal and novel influenza A vaccines, as “experimental” vaccines; they’ve only been tested on thousands of people for a period of weeks and then they’ll be given to hundreds of millions of people. Not really the greatest science when we’re in that much of a hurry. Yes, one can measure antibodies against a certain bacterium or virus in the blood and it may be associated with someone not getting sick, but there are very few illnesses common enough or enough ethics committees willing enough to do the right tests. That is, give 1000 people the real vaccine and 1000 placebo shots, expose all of them to the disease and see who gets sick. Seriously. I know it sounds terrible.
This is, obviously, a difficult public discussion because it touches on the concept of benefits and risks, again, of morbidity and mortality. Few public officials have the courage or inclination to present all facets of this difficult decision. I give vaccines to my patients every single day, but I always err on the side of caution. Implying that this is a dangerous new shot is not scientifically or statistically correct and represents hyperbole and even dishonesty on the part of the so-called “anti-vaccine” camp.
It sure isn’t “sexy” to suggest handwashing, good nutrition, hydration, extra sleep and so on. It’s not conventional to suggest astragalus, echinacea, elderberry and vitamin C. Adequate vitamin D levels are crucial, too.
I just think that giving this new H1N1 vaccine is not the cautious nor best thing to do.
Jay Gordon, MD FAAP