H1N1 is bad enough without myths to make it worse

By Kris Ehresmann

In recent weeks, there have been media reports about parents who are reluctant to vaccinate their children against novel H1N1 influenza. Some Minnesota parents may be feeling the same way.

Parents have the right to make decisions about their children's health care. The vaccination program that will soon be underway is voluntary -- and in fact, any mandatory vaccination effort would be illegal under state law.

However, much of the reluctance to vaccinate appears to be grounded in misconceptions, both about the illness and about the vaccine that was formulated to prevent it. Parents should not forgo the protective benefits of vaccination for their children based on misinformation.

For example, because novel H1N1 has been described as similar in severity to seasonal flu, many people believe it isn't a significant health threat. That's far from the truth.

Seasonal influenza is a major threat, killing about 36,000 people a year nationwide. Novel H1N1 further complicates that picture by targeting groups that normally wouldn't be considered at high risk for flu -- in particular, children and young adults.

Since April, about 10,000 people have been hospitalized with novel H1N1 nationally, and more than 500 have been hospitalized in Minnesota. About 1,000 people have died of this illness, including 76 children. The median age of Minnesotans hospitalized with novel H1N1 is 12, and three of our seven deaths occurred in children. Since Labor Day, many of our state's schools have been reporting influenza-like illness in students, most likely from novel H1N1 flu.

Pregnant women also face special risks. Compared to the general population, pregnant women are four times as likely to be hospitalized if they develop novel H1N1 influenza. Nationally, a number of deaths from novel H1N1 have been reported in pregnant women.

Of equal concern are some of the misperceptions people have about the vaccine. Here are some of the major ones:

The vaccine is new and untested -- in effect, an "experimental" vaccine. Not true. It is essentially the same as the seasonal vaccine that people are given every year. It's being manufactured in exactly the same way. The seasonal vaccine is reformulated every year to cover the flu viruses that are likely to be around during the upcoming flu season. In this case, it's been reformulated to protect against novel H1N1. In fact, if the H1N1 flu virus had been identified earlier, it could have been included in the regular seasonal flu vaccine.

The seasonal vaccine has been around for many years, and it has an excellent safety record. Health officials will be closely monitoring the vaccination effort during the coming months for any side effects.

The vaccine is being manufactured in China. Not true. The vaccine is being manufactured in the United States.

The vaccine contains potentially dangerous additives, known as "adjuvants." Also not true. Adjuvants have been used safely to enhance the effectiveness of other vaccines, and an adjuvant known as squalene is being used in versions of the novel H1N1 vaccine that are being distributed in Europe and Canada. However, versions of the vaccine being distributed in the United States contain no adjuvant.

The vaccine contains thimerosal -- a form of mercury -- raising concerns about autism and other health problems. Thimerosal is used as a preservative in injectable vaccines (shots) that are packaged in multi-dose vials, including the novel H1N1 vaccine. Although many people have expressed concerns about thimerosal, the issue has been extensively investigated, and there is no evidence linking it to autism or other health problems. However, thimerosal-free versions of the novel H1N1 vaccine will be available for pregnant women and children under the age of six, for those who want it.

The vaccine may cause a serious nerve condition called Guillain-Barre Syndrome (GBS). A particular vaccine used in 1976 to vaccinate against a type of swine flu was believed to be associated with increased occurrence of GBS, and the vaccination program was halted as a result. The association with GBS was very slight, but there was no ongoing transmission of swine flu in the community, and therefore no reason to continue vaccinating people.

Later studies have found flu vaccine in general may carry a one in a million risk for GBS. People need to weigh that against their risk of dying from the flu. One American in 8,300 dies of the flu every year. As a precaution, people with a history of GBS should discuss the risks and benefits of influenza vaccination -- for seasonal flu or novel H1N1 -- with their health care provider.

The nasal spray vaccine can cause disease in the vaccinated person -- and other people. Unlike the "killed virus" vaccine given in flu shots, the nasal spray contains live virus, in a weakened form. However, neither the injected vaccine nor the nasal spray vaccine will give you the flu. Because the live virus has been weakened, it can't reproduce in the lower respiratory tract and cause disease. You can't get the disease from the vaccine.

We had an initial wave of illness caused by the novel H1N1 virus in the spring. We are now only a few weeks into a second wave, and it could last for several weeks, or even months.

Novel H1N1 influenza is going to be with us for a while. It poses serious risks for pregnant women, children, young adults and people with underlying health problems. The vaccine is safe and effective. Supplies are limited now, but we expect to get more soon.

When it does become available, please don't let the myths that are circulating dissuade you from immunizing your children -- and, eventually, yourself.

Kris Ehresmann is director of the Infectious Disease Epidemiology, Prevention and Control Division at the Minnesota Department of Health.

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