The H1N1 (Swine Flu) Vaccine is Here: Should You Get it? Updated October 1st

This is an update written on October 1 to an article previously published on September 18, 2009.

The H1N1 flu vaccine will be available to the US public around October 6. Influenza activity, much of it H1N1, has been increasing the past few weeks in the US, so this is welcome news for all of us: individuals now have an option for protection from an unpleasant illness, health care providers have a new treatment to offer their patients, and anti-vaccine wingnuts finally have some fresh material. Here’s some answers to common questions about the H1N1 vaccine.

What is the H1N1 flu vaccine and is it different from the seasonal flu vaccine?

The H1N1 vaccine and the seasonal flu vaccine are two separate vaccines against different viruses. Health care professionals recommend that certain people get both vaccines.

The H1N1 vaccine protects only against the new H1N1 influenza virus, which is the cause of swine flu. It does not protect against other strains of seasonal flu. The seasonal flu vaccine, offered every year, provides protection against an additional three common influenza viruses. Both vaccines are expected to reduce illness, limit hospitalizations, and potentially save lives.

When will the H1N1 flu vaccine and the seasonal flu vaccine be available?

According to the CDC, the first doses of the H1N1 vaccine will ship in early October and be available to the public around October 6. This initial version is the nasal spray. The injectable vaccine will ship soon after.

The seasonal flu vaccine is already available, as a nasal spray and as an injection.

What is the difference between the injected H1N1 vaccine and the nasal spray H1N1 vaccine?

The injected H1N1 vaccine contains viral proteins-it does not contain an actual live virus. The nasal spray contains live, weakened virus.

Due to production issues, the nasal spray vaccine will be available before the injectable vaccine. Unfortunately, since the nasal spray vaccine contains a live virus, it is only recommended in healthy individuals between the ages of 2 and 50. People older than 50 and people with chronic underlying medical conditions should wait for the injectable vaccine.

Who should get the H1N1 flu vaccine?

Vaccine experts recommend that high-risk groups get vaccinated against the illness. This includes:

● Pregnant women

● Healthcare providers

● People aged 6 months through 24 years

● People who are around infants less than 6 months old

● Anyone with a chronic health condition that increases their risk of severe illness. Such chronic conditions include but are not limited to asthma, heart disease, emphysema, diabetes, and a weakened immune system.

This includes about 159 million Americans, chances are good you’re one of them.

Though the focus should be on high-risk groups, experts recommend that anyone who wants the vaccine should get it, provided there is enough leftover supply for the general population.

Who should not get the H1N1 flu vaccine?

Anyone with an allergy to eggs should not receive the vaccine, since chicken eggs are used in the manufacturing process for both the nasal spray and the injectable vaccine. Children less than 6 months should not get the vaccine (instead, people around them should get the vaccine so they are protected).

For adults over 65, the seasonal flu vaccine is highly recommended, but the recommendation for H1N1 vaccine is not as strong. For reasons that are currently unclear, older adults are less likely to suffer severe illness from H1N1 as compared to younger adults, perhaps due to a certain amount of immunity from prior exposure decades ago.

Who should receive the H1N1 injection vaccine instead of the nasal spray vaccine?

Basically, healthy people between the ages of 2 and 50 can get the nasal spray, anyone else should get the injection. Especially if you have a weakened immune system, you should not receive the live virus nasal spray; get the injection with the killed virus instead. Children who need long term aspirin therapy, such as for conditions like Kawasaki disease, should also receive the injection instead of the nasal spray.

Can I get the H1N1 flu vaccine at the same time as the seasonal flu vaccine?

You can get both injections at the same time. However, if you’re using the nasal spray, you should separate the two by about one month.

How many doses of the H1N1 vaccine do I need?

Adults need just one dose of the vaccine. Children under 10 years need 2 doses separated by a month in order to get a good immune response.

What are the side effects of the H1N1 vaccine?

Similar to the seasonal flu vaccine, the most common side effects of this injectable vaccine are pain at the injection site, muscle aches, headaches, and malaise. Rarely, patients might suffer severe allergic reactions to the vaccine.

The nasal vaccine’s side effects include runny nose, sore throat, and fevers-symptoms that resemble a very mild case of the flu, but are not nearly as severe or long-lasting as a real influenza infection.

The best data about this vaccine come from two studies recently published in the New England Journal of Medicine. Several hundred adult patients who received the vaccine have been followed for months, and initial data was published several weeks after vaccination. No serious short-term side effects were found in any of those patients.

Since the nasal spray vaccine is a live virus, can I catch the flu from it?

No. The nasal spray vaccine contains live, attenuated viruses that are cold-adapted. This means that they can live in the relatively cooler temperatures of the nose, but not warmer places deep in the body, such as in the lungs. Because they are limited to the nose, the effects of the virus are mild. Some people do get side effects that resemble a very weak, short-lived flu, but are nowhere near as serious as a real influenza infection.

Will getting the seasonal flu vaccine increase my risk of catching swine flu?

It’s unlikely. Media in Canada are reporting on a study purportedly showing that individuals who got the flu shot in 2008 are more likely to catch H1N1 in 2009. This study has not been published in any scientific journal, so no one knows if it’s accurate. According to Dr. Thomas Freiden from the CDC, investigators have closely looked at data from New York and Australia for similar results, and no increased risk was seen. At this point, all the reliable data and studies that have been published do not show any increased risk of catching swine flu after getting the seasonal flu vaccine.

What is the current status of research on H1N1 vaccine?

As of September 30, several studies of hundreds of healthy adult patients have been published. Research is ongoing in children and pregnant patients.

The H1N1 vaccine is manufactured using the same process as the seasonal flu vaccine, by the same manufacturers in the same factories. Years of research with the seasonal flu vaccine, including research in pregnant patients and children, have shown it to be extremely safe.

What is Guillain Barre Syndrome and why are people talking about it when they’re talking about the H1N1 flu vaccine?

Guillain Barre Syndrome is a rare neurological illness with symptoms ranging from mild muscle weakness to complete paralysis. While most people recover, some people die from the illness. Triggers for the disease include infections, most commonly by a bacteria called Campylobacter.

The influenza virus itself can also cause Guillain Barre Syndrome, and there is some debate about whether the seasonal influenza vaccine causes the disease. If the vaccine does increase the risk, the increase is very slight at about one case per million people vaccinated. The odds of developing a severe complication such as pneumonia from an influenza infection are higher than that, so even if the vaccine does cause Guillain Barre Syndrome, you’re better off getting the seasonal flu vaccine.

Unlike the controversial link between the Guillain Barre Syndrome and the seasonal influenza vaccine, there is a likely association between the syndrome and a previous swine flu vaccine. According to the CDC, the 1976 swine flu vaccine caused about one case of Guillain Barre Syndrome for every 100,000 people vaccinated.

The 1976 swine flu vaccine which resulted in an increased risk of Guillain Barre Syndrome was manufactured using different techniques than the current H1N1 vaccine. Since the current H1N1 vaccine is produced with the same process as the seasonal influenza virus, the risk of Guillain Barre Syndrome is thought to be similar to the very low or negligible risk from the seasonal influenza vaccine.

Is mercury (thimerosal) included in the vaccines?

Some, but not all, of the batches of H1N1 vaccine are thimerosal-free.

Thimerosal is a mercury compound that is added to multi-dose vials of influenza vaccines to prevent bacterial contamination of the medication. Some groups have questioned whether mercury in vaccines plays a role in the development of autism, but scientific studies have shown no correlation between thimerosal and autism.

Are adjuvants included in the H1N1 vaccines?

No. None of the current H1N1 vaccines marketed in the US contain adjuvants.

Adjuvants are additional materials that are added to the antigen in a vaccine to make it more effective. Adding these materials, such as small doses of aluminum, will increase your body’s immune response to the vaccine.

I’ve already had H1N1, should I get the vaccine? If I do, will it harm me?

If you’ve already had H1N1, there’s no point in getting the vaccine. However, if you do get the vaccine, it will not harm you-on the other hand, it won’t help either.

Many people have had flu-like symptoms over the past several months and wonder if it was H1N1, realizing that if it was, there’s no point to getting the H1N1 vaccine. Since most people who have had upper respiratory infections in the past few months did not actually have H1N1, the CDC is recommending that they still get the vaccine against H1N1. This is especially true for people in one of the high-risk groups mentioned above.

H1N1 doesn’t seem to be that lethal, I’m young and healthy, should I really get the H1N1 vaccine?

The CDC recommends that young, healthy people get the vaccine if there is supply available after vaccinating high-risk groups. Overall, H1N1 does not appear to be particularly more deadly than the seasonal flu, but there is a higher rate of infection in younger people. It also appears that young, healthy people make up a higher percentage of the deaths from H1N1 than is typical for seasonal flu. While the chances of you dying from this disease are small, the chances that you will get infected and sick enough to stay home from school or work for a few days is much higher. The vaccine could prevent both illness and death.

You’ll have to weigh these known benefits from the vaccine versus the unknown risks. Initial studies of a few hundred adults have shown no danger from the vaccine in the short-term. In the long-term, since the vaccine is made using the same techniques as the seasonal flu vaccines, the H1N1 vaccine is expected to be equally safe.

Is it possible that these recommendations will change?

Yes. While the CDC’s recommendations are based on the best evidence available, the H1N1 situation is fluid and new recommendations might be made as more information is known.

Should the virus suddenly become more lethal, the recommendation to vaccinate young, healthy adults will become stronger. If the rates of H1N1 infection are declining in the US by the time the H1N1 vaccine is introduced, the recommendation to vaccinate might become weaker. I will continue to update this webpage as more is learned.

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