Q&A: H1N1 vaccine and Guillain-Barré risks?

Should I get the swine flu (H1N1) vaccine if I’ve had Guillain-Barré syndrome? —J.M., Irvington, N.Y.

That depends in part on your risk of getting swine flu and becoming seriously ill if you do. It’s true that some studies have associated flu vaccines with a slight increase (about one person per million) in the risk of developing Guillain-Barré syndrome (GBS), a neurological disorder. And some evidence suggests that a previous case of GBS increases your risk of getting it again. But the flu itself can also cause GBS as well as such complications as pneumonia and in rare cases, death. If you’re among the priority groups for H1N1 vaccination—including pregnant women, health-care workers, and people ages 25 to 64 with underlying conditions such as diabetes and heart or lung disease—the shot’s benefits probably outweigh its risks.

Not just for pigs and humans: Swine flu advice for your pets

Add cats to the list of animals that have caught the H1N1 (swine) flu. Last week there was a flurry of reports that a 13-year-old Iowa feline had tested positive for the virus. The cat is reported to have fully recovered. But should you be worried about your pet catching swine flu? And can you get the flu from your pet?

According to the Centers for Disease Control and Prevention, your pet should be more wary of you than the other way around. While there are reports of some animals getting the flu from their pet parents, there appears to be no evidence of pets spreading the disease to humans. Ferrets are particularly susceptible to influenza—a trait that has led to the mammal being a subject-of-choice for influenza studies.

On the other end of the spectrum, there are no reports of dogs catching the swine flu, but our "best friend" remains susceptible to a different strain of flu, canine influenza. Poultry, including turkeys, have been infected with H1N1 already, but it’s unknown if pet birds are susceptible to the virus. And while it’s known that pigs can catch the swine flu, it’s not clear if any of the potbelly variety, which are popular as pets, have come down with the H1N1 flu.

Swine flu: Wherefore art thou vaccine?

With the swine (H1N1) vaccine production and distribution slower than expected, many Americans are having trouble finding vaccine, according to a new poll. And the trickle of vaccine has caused problems for mandatory vaccination programs for health care workers, as well as some public health officials when it was reported that Wall Street firms were delivered vaccines while hospitals continue to struggle with a shortage of supply.

Public having difficulty finding vaccine

A poll from the Harvard School of Public Health conducted October 30th through November 1st found that 21 percent of high-priority adults, and 41 percent of all parents tried to get the H1N1 vaccine, but 66 percent of both populations were unsuccessful. In response to the Harvard poll, the Centers for Disease Control and Prevention’s Anne Schuchat, M.D., said, "I’m very mindful of the frustration people have had, whether from information gaps or just the basic availability of the vaccine. I think it should be getting better over the weeks ahead." According to the CDC, the number of vaccine doses available has doubled over the past two weeks, and the supply is expected to continue to grow.

Backlash against Wall Street

The lack of H1N1 vaccine availability also caused a black eye for health officials in New York City, and several Wall Street firms including Citigroup, Morgan Stanley and Goldman Sacks, when it was reported that they were being shipped substantial doses of the vaccine, perhaps ahead of some hospitals. A Wall Street Journal blog summed up reaction to the news:

"It is official: Goldman Sachs is more important than you are…At least that is the way that the public may perceive a WSJ story today that Goldman was one of several Wall Street firms that received large dosages of swine flu vaccines, while some New York City hospitals and clinics are running out of the vaccine."

Surgical masks appear to be just as effective as N-95 respirators

After much ado, surgical masks appear to be just as effective as N-95 respirators at preventing the spread of the flu. Over the weekend it was reported that a review of the data in a study that said N-95 respirator masks were superior to surgical masks negated that conclusion and the study was retracted. The study, presented last month, was, unfortunately, a critical data point that health policymakers used the study to recommend the more expensive N-95’s for flu control.

The researchers now say that there are no significant differences between facemasks and N-95 respirators at preventing flu. That confirms another recent study that we reported on last month from the Journal of the American Medical Association. In that randomized controlled trial by researchers in Canada, N-95s and masks performed about equally.

Facemasks, such as surgical masks, are designed to block large particles that may carry viruses and other pathogens that can cause illness. In addition to blocking those large droplets in sprays and splashes, N-95 respirators are designed to block even smaller particles—at least 95 percent of very small particles in testing when fitted correctly. It appears that blocking the larger respiratory droplets that are most likely to spread the influenza virus is more important than blocking smaller particles, and either mask can do that.

Video of flu shot cheerleader is misleading

"Dad, have you seen the video of this cheerleader? All of my friends have and they don’t want to get vaccinated if this could happen to them. It seems strange that she can do some things and not other things.  Is this for real?"

That’s the response John Santa, M.D. and Director of the Consumer Reports Health Ratings Center, got from his 23-year old son recently after being reminded to get the two (seasonal and H1N1) flu vaccines.  The concern echoed those expressed by many others after the story was released by FoxNews in mid-October. It reported that a Washington Redskins cheerleader, Desiree Jennings, was diagnosed with a rare neurological disorder called dystonia alleged to be caused by a severe reaction to the seasonal flu shot.  The online story, published October 13th, described that "Desiree now has difficulty speaking, walking, and even eating. During an interview with FOX 5, she had several seizures. The effects are irreversible."

Over the past two weeks Desiree’s story has been picked up by quite a number of other news outlets and blogs and featured on the home page of Generation Rescue, Jenny McCarthy and Jim Carrey's Autism Organization, with the title "Redskin Cheerleader Disabled by Flu Vaccine".

But this is misleading. Dystonia is a rare movement disorder in which prolonged muscle contractions cause twisting and repetitive movements or abnormal posturing. These involuntary movements may affect a single muscle or a group of muscles in the arms, legs, neck or the entire body.  But neurologists all over the country are commenting on professional listservs, saying that Desiree’s video doesn't look like dystonia at all, but rather is likely to be a psychogenic movement disorder, that is, a condition thought to have a psychological origin, and for which there is no physical explanation.

Flu vaccine FAQs: Is the swine flu mild or virulent?

Q: Depending on the source, I’ve heard both that the H1N1 virus is virulent and that it’s mild. Which is true? 

A: Both, to some degree. When experts say that swine flu appears more virulent than seasonal flu, they’re talking about the way it attacks the body—specifically, the fact that it’s more likely to cause severe symptoms in healthy people, than the seasonal flu. Some studies suggest that the H1N1 virus may have the capacity to infect deeper in the lungs than seasonal flu, which can lead to more severe respiratory infections—though many people will experience symptoms indistinguishable from those of the regular, seasonal flu.

But experts will also refer to the swine flu as “mild” or “mild to moderate”—and it is, compared to previous pandemics. The new H1N1 virus lacks the genetic characteristics that made the 1918 pandemic, for example, so deadly. And indeed thus far there’s been a lower rate of hospitalizations and deaths for the swine flu than some previous flu pandemics. Most cases of the swine flu can be treated at home, with simple over-the-counter pain relievers and fever reducers like acetaminophen (Tylenol and generics). Of course, that doesn’t mean the illness will feel mild: Even a minor case of flu can bring pure misery, complete with high fever, aches, pains, coughing, a sore throat, and in some cases, vomiting and diarrhea. That’s true whether it’s the swine flu or seasonal flu.

—Kevin McCarthy, associate editor

For more see our flu vaccine safety FAQs, and Who should get the vaccine?

Flu vaccine FAQs: Pneumonia vaccine can help prevent flu complications

Q: Should I get the pneumonia vaccine in addition to the H1N1 vaccine? And should my 3-year-old get it too?

A: Your child should definitely get the pneumonia vaccine. Whether you need it too depends in part on your age and health status. The pneumonia vaccine immunizes you against pneumococcal pneumonia, the most common form of bacterial pneumonia. Pneumonia can be a serious illness in its own right, but in combination with the flu it has been shown to be especially vicious. That’s because your immune system is already weakened by fighting the flu, increasing your susceptibility to the bacteria that cause pneumonia to infect the lungs, and in turn multiplying your risk of flu complications. Infection with both pneumonia and influenza is called a coinfection, and a recent study found it’s likely to be an important contributing factor in some of the deaths that have occurred so far from the swine flu.

Two pneumonia vaccines are available. The Centers for Disease Control and Prevention recommend that all children younger than 5 receive the pediatric pneumococcal conjugate vaccine (PCV; Prevnar), given in four doses over roughly a one-year period. (Ideally, kids should get the first dose at 2 months of age.) The other vaccine, called the pneumococcal polysaccharide vaccine (PPSV; Pneumovax), is recommended for adults older than 65 and anyone between the ages of 2 and 64 with chronic heart, lung, or liver disease, alcoholism, or impaired immunity. It’s given in a single shot, with a five-year booster after age 65 or for very people at very high risk.

Read more about the pneumonia vaccine and how it can help prevent flu complications for more information.

--Kevin McCarthy, associate editor

For more see our flu vaccine safety FAQs, and Who should get the swine flu vaccine?

What does an H1N1 national emergency really mean?

It’s déjà vu all over again. The Obama administration declared the H1N1 (swine) flu outbreak a “national emergency” over the weekend—just as it declared a “public health emergency” back in April, shortly after the outbreak began. So what’s the difference?

When the government first declared the public health emergency in April, it paved the way for a streamlined response for the swine flu threat. For example, the government was able to distribute stockpiles of antiviral drugs, and other supplies, and expand the recommended usage of those drugs under emergency authorizations.

The latest declaration was done to allow the federal government to waive certain regulatory requirements so that hospital emergency rooms and other health-care providers can respond more quickly. Such waivers have been provided to hospitals in past emergencies, such as floods and hurricanes.

The “national emergency” declaration doesn’t mean that the nature of the outbreak has changed dramatically. But the flu is indeed spreading rapidly. According to the CDC this flu is widespread in 46 states, and flu activity is higher than the peak of many seasonal flu seasons. Health officials are concerned about a busier than usual flu season, and want to make sure hospitals have the tools to deal with greater volume.

Flu vaccine FAQs: Can I get two vaccines at the same time?

Q: Can I get the seasonal vaccine and the H1N1 vaccine during the same visit?

A: Yes, as long as you get the shot rather than the nasal spray. The CDC advises against simultaneous doses of the spray vaccine, which contains a live but weakened virus, because of a theoretical risk that one vaccine could interfere with the effectiveness of the other when they’re administered at the same time. The same concern doesn’t apply to the shots, so it’s fine to double up on those. But they should be given in different places (i.e., one in each arm) to reduce the potential for local side effects like soreness and swelling at the injection site.

--Kevin McCarthy, associate editor

For more see our flu vaccine safety FAQs, and Who should get the vaccine?

Swine flu scams on the rise

Whenever a public health or safety issue looms large, a certain segment of our economy tries to profit from the fear and confusion. We’ve seen it happen during the bird flu and SARS scares, and swine flu is no different. Since May, the Food and Drug Administration has warned more than 75 Web sites selling more than 135 products to stop making fraudulent H1N1 influenza virus claims—and they’ve been keeping a list of fraudulent products.

Back in May, we reported on the lack of evidence for most flu supplements. There’s little reason to believe that supplements are effective for preventing or treating any flu. And some, such as colloidal silver, can actually be dangerous.

A new article from the Associated Press reports that "products making bogus claims to prevent or treat swine flu are flooding the Internet as scam artists prey on the public's fears while the vaccine is delayed." Among the scams: air "sterilizers," photon machines, immune boosting supplements, and non-prescription Tamiflu that turned out to be powdered talc and a generic chemical, or even worse, unapproved doses of the drug that could be impure, subpotent, superpotent or contaminated.

"It's harmful, disappointing, frustrating to see folks take advantage of the public like this," our own John Santa, M.D., director of the Consumer Reports Health Ratings Center, told the AP.

—Kevin McCarthy, associate editor

For more on swine flu scam treatments, read our blog "Avoid Supplements Claiming to Help with Swine (or any) Flu".

Flu vaccine FAQ: Shot or spray?

 
This year’s swine (H1N1) flu outbreak and subsequent vaccine program has spurred a great deal of interest, confusion, and misinformation about flu vaccines. We recently discussed the five most common misconceptions about flu vaccines, but rumors and questions about this year’s swine flu vaccine persist. We’re going to continue to answer your questions, so keep them coming in the comments section.

Q: Should I get the flu shot or the nasal spray version of the vaccine?

A: Both are safe and effective according to the Food and Drug Administration (FDA), but the shot is probably best for most people. The nasal spray is not approved for those under 2 years old, those age 50 and over, or anybody with an underlying condition. This version contains a weakened live virus, rather than a dead virus, can cause some minor flu-like symptoms as a side effect, unlike the flu-shot.

--Kevin McCarthy, associate editor

For more see our flu vaccine safety FAQs, including Who should get the vaccine?

Flu vaccine FAQ: Mercury and flu vaccines

Question: I’ve heard that the swine flu vaccine contains thimerosal, a preservative that has mercury in it. Is that true, and can it cause autism and other health problems?

Answer: It’s true that some formulations of the swine (H1N1) and seasonal flu vaccines contain thimerosal.  Numerous studies have found no association between the mercury-containing preservative and autism or other health problems. Nevertheless, thimerosal has been the subject of much controversy and, unfortunately, much misinformation.

Since the 1930s thimerosal has been used in vaccines to prevent dangerous bacterial or fungal contamination,which can occur, for example, inside multi-dose vaccine vials. The preservative became a concern in the late 1990’s. That’s when research by the FDA showed that the cumulative amount of mercury an infant received from vaccines over his or her first 6 months of life could be more than the EPA’s recommended limit for methylmercury. The type of mercury used in vaccines, called ethyl mercury, has been found to be less toxic in humans than the methyl mercury you get from environmental sources (eating certain fish, for example). Methyl mercury is so dangerous because it’s difficult for the body to purge, meaning it’s more likely to build up in your system over time than ethyl mercury.

As a precaution, in 1999 health officials recommended that vaccines typically administered in early childhood should have their thimerosal content reduced or eliminated. Manufacturers responded. Since 2001, all vaccines recommended for children 6 and under have been produced with either no thimerosal or only trace amounts, with the exception of  some versions of the flu shot. Newer studies have overwhelmingly found that the amount of thimerosal used in the childhood vaccines before 2001 did not cause neurological damage. Today, influenza vaccines are the only ones given to young children that may contain more than trace amounts of thimerosal as a preservative.

Swine flu vaccine FAQ’s: Is the vaccine safe?

We recently discussed the five most common misconceptions about flu vaccines, and answered questions about who should get the vaccine. Today we answer some common questions about the safety of the vaccine. We’re going to continue to answer your questions, so keep them coming in the comments.0

Q: Isn’t the swine flu vaccine untested and being rushed into use?

A: No. Here at Consumer Reports, we’re often skeptical about new drugs and treatments since they don’t yet have a long track record to establish their safety and effectiveness. But the 2009 H1N1 vaccine isn’t really a new drug, any more than the regular (seasonal) flu vaccine is. That vaccine is made from scratch each year using the strains of influenza virus most likely to circulate in the coming season, and decades of evidence show that it’s quite safe and moderately effective (some years are better than others) at preventing cases of the flu. The H1N1 vaccine is just like the regular vaccine, except it contains the new virus that causes the swine flu. Several clinical trials have shown the vaccine’s effectiveness at preventing H1N1 infection, and they revealed no significant safety problems, according to researchers. Those studies weren’t big enough to rule out rare adverse effects, which usually don’t emerge until a drug or vaccine has hit the market and been used by a large number of people. But there’s no reason to suspect that the swine flu vaccine is any more likely to produce such events than the seasonal flu vaccine. Health officials have put monitoring systems into place that are designed to catch any rare side effects that occur once the vaccine becomes available.

Q: I heard the swine flu vaccine has an untested ingredient called squalene. Is that true?

Swine flu FAQs: Who should get the vaccine?

Q: I’ve heard the swine flu is especially dangerous to children and pregnant women. Is that true?

A: Very much so. While pregnant women make up only 1 percent of the population, they’ve accounted for 6 percent of deaths due to swine flu this year. Children, too, appear to be at a greater risk: Since May of this year, swine flu has killed at least 76 children, according to the CDC, and flu season probably hasn’t even peaked yet. In contrast, seasonal flu in a typical year takes the lives of between 45 and 90 children, and that’s for the whole season. So it’s extra important for both expectant mothers and kids to get vaccinated promptly this year.  

Q: I've heard that people between ages 24 and 64 who are at higher risk for swine flu complications should get vaccinated. How do I know if I'm at risk?

A: You’re considered high risk if you’re in that age group and have any of the following conditions:

• Asthma or other chronic lung disease
• Cardiovascular disease (excluding high blood pressure)
• Disease of the kidneys, liver, or blood (such as sickle-cell disease)
• Neurologic or neuromuscular diseases such as muscular dystrophy and multiple sclerosis
• Diabetes or other metabolic disorders
• Weakened immunity,  including HIV infection, or caused by medical treatment (e.g., chemotherapy)

Unfortunately, not everyone in those groups realizes they’re at increased risk. A poll we conducted last month found that more than half (55 percent) of adults who reported that they had medical problems such as asthma, diabetes, or heart disease didn't realize that those medical conditions put them at higher risk for problems from the flu.

For a full list of groups at higher risk from the flu, see our Flu Risk Factors.

Q: I’ve heard that people born before 1957 have some immunity to the H1N1 virus. Is this true?

ConFLUsion: How to sort out swine flu facts from fiction

It seems that swine flu has infected YouTube. When I was on the Brian Lehrer Show recently, a caller claiming he was a pediatrician announced that the H1N1 (swine flu) virus was "man-made" and another caller urged me to look into this on YouTube because "college students are all over it...". Dangerous rumors like this outlandish conspiracy theory are causing concern all over the country and may be one reason that our swine flu poll found that 43 percent of Americans are on the fence about getting the vaccine. Other ridiculous notions floating around cyberspace include: "there is no swine flu", "a girl got the swine flu vaccine last month and died an hour later", "and you’ll be fine if you don’t eat bacon".

To clear up the misconceptions and give you the facts, we collected a number of rumors we’ve heard on our blog and elsewhere in the media about the swine flu and the swine flu vaccine:

Rumor: It’s better to build up your own natural immunity than gain immunity from a vaccine.

Fact: That was the top reason almost two thirds of those who were unsure or said they would not get their children vaccinated gave for not getting a flu vaccine last year. But that logic misses the whole point of immunity—avoiding disease. When your body is exposed to a virus, it creates antibodies that help fight the disease, When you’re given the vaccine your body makes antibodies that help prevent the disease. In other words, vaccines produce the same antibodies that an infection does, without the inconvenience and misery of having the illness or its life-threatening complications.

Rumor: I’ve never gotten the flu before.