Sunday, November 08, 2009
News, Health + Fitness, In this Issue..., Atlanta

Public Persuasion

Atlanta doctors and scientists work to convince the public that swine flu is more dangerous than its vaccine

Friday, Nov. 13
3:30 and 5:30 p.m.
Porter Sanford III Performing Arts and Community Center
3181 Rainbow Drive in DeKalb County
Requires parental permission

YOU CAN GO TO THE FRONT OF THE VACCINE LINE IF YOU’RE   

• Pregnant
• Living with or caring for children under 6 months old
• A health care or emergency medical services professional with direct patient contact
• Between the ages of 6 months and 4 years old
• A child (especially 5 or younger) with high risk of medical complications or at increased risk for influenza-related complications

By Diane Loupe

The H1N1 flu strain currently widespread in 48 states is particularly lethal to children and pregnant women.
 
But more than two-thirds of the 114 children who have died from H1N1—otherwise known as “swine flu”—across the nation had other medical conditions, according to officials with the Centers for Disease Control and Prevention (CDC). So how do officials convince parents that getting their usually healthy kids vaccinated against it is important? Or persuade pregnant women that the flu itself is more dangerous than the side effects of the vaccine?
 
For the DeKalb County Board of Health, the answer to the first question is a puppet show. DeKalb children are invited to free performances of “Captain Healthy & Safety Dog,” an original show created by the Center for Puppetry Arts to help teach children how to stay healthy and prevent the spread of viruses.
 
Puppet dogs are just one way health officials hope they can overcome public concerns about the safety and effectiveness of the vaccine so that kids, pregnant women and other high risk groups will get it. Demand has been strong and supplies plentiful for the seasonal flu vaccine, but that’s not what’s making most people sick.
 
“There's almost no seasonal flu so far; a few strands here and there,” Thomas Frieden, director of the Centers for Disease Control told journalists during a Nov. 3 briefing. “Overwhelmingly, it's still H1N1.”
 
Supplies of the H1N1 vaccine have been limited and the problem of coaxing the public to get it, when it does materialize, looms large.
 
Many people are reluctant to get vaccinated even for regular old seasonal flu, fearing complications. Vaccine opponents were alarmed by one Canadian study that suggested that getting a seasonal flu vaccination might increase a person’s chances of becoming infected with swine flu, although CDC officials are quick to point out that “no other country has reported that seasonal vaccine has any positive or negative effect on the risk of getting 2009 H1N1 influenza.”
 
In fact, other U.S. studies and one Australian study found that a seasonal flu shot didn’t increase or decrease a person’s risk of getting swine flu, while a small study from Mexico suggested a seasonal flu shot actually “provided some protection against 2009 H1N1,” according to the CDC.
 
Researchers at Emory University and other institutions claim the vaccine is even safe enough for pregnant women in all three trimesters. Since pregnant women are at an increased risk of death or complications due to any strain of the flu, Kevin Ault, an obstetrician and gynecologist at both Grady Hospital and the Emory Clinics, has been encouraging them to get vaccinated.

The swine flu/H1N1 vaccine has shown no evidence of increased risk to the mother or baby. It’s much more dangerous for pregnant women and infants to get the flu than any potential complications from the vaccine.

Ault and other Emory researchers reviewed past studies of flu vaccination during pregnancy, and looked at deaths following flu infection. In an article published online in the American Journal of Obstetrics & Gynecology, the researchers found no studies that showed an increased risk of complications to the mother or her fetus after getting a flu vaccination, but pregnant women were at a much higher risk of death from the flu itself in previous pandemics and seasonal epidemics. 
 
This spring, a third of the 34 pregnant women with confirmed or probable cases of H1N1 had to be hospitalized, and pregnant women accounted for 13 percent of all deaths from H1N1 during that time. Half of the pregnant women who contracted the flu during the 1918 pandemic later developed pneumonia, and almost half died. And during the influenza pandemic of 1957, nearly half of all women of childbearing age who died were pregnant, even though most had been healthy before being infected with influenza.
 
Caregivers of pregnant women should urge them to get the H1N1 vaccine, according to Saad B. Omer, an assistant professor of global health at Emory’s Rollins School of Public Health and senior author of the articles in the American Journal of Obstetrics & Gynecology.
 
“There is substantial evidence that vaccination is not only safe for pregnant women but that it is critical for protecting women and their infants against serious complications from the flu,” said Omer, according to an Emory press release. “Physicians and other providers should talk about risks and benefits with their patients and help alleviate any unfounded fears.”

Emory is part of a federally funded vaccine research network, and Omer’s colleague, Ault, is one of the physicians who work with clinical trials of flu vaccine in pregnancy.  
 

Ault says he’s urged his patients to get the vaccine, and most have agreed.

“I think Emory and Grady have done a pretty good job with regular vaccines, promoting them among their patients for the past few years,” says Ault, who was vaccinated a week ago. His own children have gotten the regular flu shot, and he plans to have them immunized for H1N1 when supplies are more plentiful.

The CDC does not expect a shortage of the vaccine, but due to limited initial quantities, it has recommended sending the following to the head of the vaccine line: pregnant women, parents and caregivers of babies younger than 6 months of age; health care and emergency medical services personnel with direct patient contact; children 6 months through 4 years of age; and children 5 through 18 years of age who have chronic medical conditions.

Antiviral drugs including oseltamivir, the main ingredient in the brand Tamiflu, and zanamivir, marketed as Relenza, continue to work on the swine flu “with rare exception,” according the CDC, but the unusually high risk of H1N1 for children has created a demand for the kid-friendly, liquid version of Tamiflu.

On Oct. 1, health officials released 300,000 courses of liquid Tamiflu from the strategic national stockpile, and later released the remaining 234,000 courses, CDC officials say, seriously depleting the supply. To help meet demand for the vaccine, the CDC is asking pharmacies to compound, or manufacture, Tamiflu syrup from adult doses of the antiretroviral.

“Please don't try this at home,” warns CDC Director Frieden. “This is something that should be done by a professional pharmacist.”

 WHY DON’T WE HAVE ENOUGH OF THE RIGHT VACCINE?

Research from the University of Georgia may help public health officials do a better job of predicting new flu strains and anticipating which vaccines will be needed most. Andrew W. Park, who holds a joint appointment in the University of Georgia Odum School of Ecology and in the College of Veterinary Medicine, led the research that links sub-molecular changes in the influenza virus to the likelihood of influenza outbreaks. The paper, published in the Oct. 30 issue of Science, shows the relationship between the evolution of the virus and immunization rates needed to prevent an outbreak in the population.

“Public health officials will be able to assess the usefulness of a vaccine based upon its relationship to the current influenza strain and the population’s immunity level,” according to Park.

Many people already have some immunity to certain strains of influenza, either because they’ve had flu vaccinations or have had that particular version of the flu, Park says. But the virus is constantly evolving and changing. When amino acids inside the virus molecule change, it enhances the ability of the virus to play hide-and-seek with the body’s immune system. When the virus “learns” how to get past the immune system’s defenses, it can reproduce, spread and make a person sick.

Despite public criticism of the limited supply of H1N1 vaccine, the CDC is sticking to its guns in relying on egg-based methods of vaccine production, rather than newer methods.

The CDC’s Frieden defended this stance, saying he hopes newer methods “will be ready within the next couple of years. They’re not ready now. We’re not cutting any corners.”

The complex and cumbersome methods for developing vaccines “take a long time to be done,” said Frieden. But he believes the new methods won’t be ready in time for this year or next.

Health officials usually decide in February which strains of virus are likely to hit the following winter, and that’s when they choose what goes into the seasonal flu shot. But if the virus changes, or another virus erupts, that window of opportunity is missed and the seasonal flu shot can be ineffective.

“So whether it's for a pandemic such as H1N1 or for the changes in flu that happen each year, we do need better technologies,” admitted Frieden.

In the late October media briefing, Frieden noted that the virus circulating hasn’t mutated into a more deadly strain. And he promised that “we're all working as hard as we can to get the vaccine out as rapidly as possible.”

Meanwhile, there’s “something that every one of us can do: stay home if we're sick, cover our cough and sneeze, and wash our hands,” Frieden said. “If you have asthma or heart disease or lung disease, if you're pregnant and you get the flu, see your provider right away, it's important.”

But, he said, “if you're sick with flu and you wouldn't have gone to the hospital emergency department before you ever heard of H1N1, you probably shouldn't go now.” SP

Utahan Spencer Whatcott (left) pulls away after a nurse gives a nasal spray of the H1N1 vaccine, while his father Cameron (right) holds him.
 George Frey/Getty Images

TO FIND THE SWINE FLU VACCINE SITE NEAREST YOU VISIT

http://sendss.state.ga.us/sendss/!immuprov_track.h1n1_prov_locator

FREE VACCINE AND PUPPET SHOW FOR CHILDREN AGES 2 THROUGH 10