Should you vaccinate your children or not?

Now that the swine flu (H1N1) vaccine has arrived at doctor's offices around the country, parents are wondering whether they should vaccinate their children.

The answer from the CDC and other federal and state agencies is clear: Yes, the vaccine is safe.

But even though hospitals are getting flooded with children sick with H1N1 - and are making preparations for even more - there is still a lot of uncertainty among parents.  

Understanding the vaccine, how it is made, its history, and issues around safety are crucial to help make the right decision.

Here's a simple rule that can help with the decision: if you are comfortable giving your child the seasonal flu shot, then you can feel comfortable giving them the swine flu H1N1 vaccine - they are made the same way and meet the same safety standards.

Is the swine flu vaccine safe?

It's just like the seasonal flu vaccine: The swine flu vaccine is made and distributed just like the seasonal flu vaccine - which has been safe for years. According to the CDC, the main side effects of the injected vaccine are local to the injection site: "The most common side effects following flu vaccinations are mild, such as soreness, redness, tenderness or swelling where the shot was given." (ref #2)

What about adjuvants? There are no adjuvants used in the H1N1 swine flu vaccine. Adjuvants are chemicals used in vaccines to increase the immune response - none are present in either the injected or nasal flu vaccines produced to date.

What about mercury and Autism? There has been a wide-held belief, now disproven, that mercury in the preservative thimerasol used in vaccines causes Autism. One of the strongest pieces of evidence against an association between thimerasol and Autism has been the ban on thimerasol in children's vaccines since 2001. Despite the ban, there has been no decrease in the number of new cases of Autism, suggesting thimerasol does not cause Autism. (Ref #3)

Most doses of the vaccine contain thimerasol. If you are concerned about thimerasol you can request a dose without thimerasol (you should call your pediatrician ahead of time, since they may not have these doses in stock).

What about Guillain-Barre Syndrome (GBS)? Here's a summary of what is know about GBS and a previous (1976) vaccination that was given for a different virus (although also called swine flu, the vaccine, the diseases and the virus that cause the disease are different now than in 1976).

In 1976, there was a small risk of GBS following influenza (swine flu) vaccination (approximately 1 additional case per 100,000 people who received the swine flu vaccine). That number of GBS cases was slightly higher than what is normally seen in the population, whether or not people were vaccinated. Since then, numerous studies have been done to evaluate if other flu vaccines were associated with GBS. In most studies, no association was found, but two studies suggested that approximately 1 additional person out of 1 million vaccinated people may be at risk for GBS associated with the seasonal influenza vaccine. FDA and CDC will be closely monitoring reports of serious problems following the 2009 H1N1 influenza vaccines, including GBS. (ref #2)

Has the H1N1 vaccine been tested?

There has been more testing done on the H1N1 vaccine than for the seasonal flu. Because the H1N1 vaccine is produced exactly like the seasonal flu vaccine produced every year, no additional testing is needed, but there were clinical trials to determine the appropriate dose. There is also now substantial experience from other countries - experience that is not usually available for U.S. seasonal flu vaccines. According to a report in the New York Times:

Of the first 39,000 Chinese to get shots, only four had side effects, including muscle cramps and headaches. “You could argue that this is better tested than seasonal flu vaccine,” said Dr. Paul A. Offit, chief of infectious diseases for Children’s Hospital of Philadelphia. (ref #4)

What's the difference between the injected H1N1 vaccine and the nasal H1N1 vaccine?

The injected vaccine and the nasal vaccine are quite different. In addition to being delivered differently, they are made differently.

The injected vaccine is made with dead viruses, broken up and purified into parts (the "chicken nuggets" of the vaccine world). The nasal vaccine is made with live, but weakened (attenuated) viruses. So while non-immunocompromised people can take either vaccine, anyone with an immune system problem should NOT take the nasal vaccine. (Ref. #2)

Is there anything else I should know about the vaccine?

Talk to your physician about the vaccine and swine flu if you have any questions. This FAQ is just an introduction to the H1N1 vaccine - it is not meant to be a complete discussion of the swine flu or the H1N1 vaccine.

Are physicians giving their children the swine flu vaccine?

Like the general population, moms and dads who are physicans are debating whether they should give their children the vaccine. The majority of physicians who responded to our inquiry (will doctor's vaccinate their children for H1N1?) said they would give their children the vaccine. For some this was urgent - they wanted to get the vaccine to their kids ASAP. A few even said they wouldn't vaccinate their kids. For others it was not an urgent issue - they got on their pediatrician's list for the vaccine and will take their kids when convenient.

References

1. CNN: H1N1 kids flood hospitals.

2. CDC: General Questions and Answers on 2009 H1N1 Influenza Vaccine Safety.

3. CDC: General Questions and Answers on Thimerosal.

4. As Flu Vaccine Arrives for the Season, Some Questions and Answers.