Swine Flu (in the wild)

A few days ago as I was driving to work (ok, i don’t really have a job…..school), I heard on the radio that New York health care workers were protesting in Albany about being forced to get the regular seasonal flu vacine and then the H1N1 vaccine or be fired. Their argument that the vaccine has not been fully tested and may be unsafe. So is it safe and worth it? Almost definately yes.

From that same article: “State Health Commissioner Richard Daines MD, recently said in an open letter to health care workers, urging them not to resist, ‘Given the outstanding efficacy and safety record of approved influenza vaccines, our overriding concern then, as health care workers, should be the interests of our patients, not our own sensibilities about mandates.'”

Further, the CDC offers General Questions and Answers on 2009 H1N1 Influenza Vaccine Safety. From there:
Will the 2009 H1N1 influenza vaccines be safe?
“We expect the 2009 H1N1 influenza vaccine to have a similar safety profile as seasonal flu vaccines, which have a very good safety track record. Over the years, hundreds of millions of Americans have received seasonal flu vaccines. The most common side effects following flu vaccinations are mild, such as soreness, redness, tenderness or swelling where the shot was given. The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) will be closely monitoring for any signs that the vaccine is causing unexpected adverse events and we will work with state and local health officials to investigate any unusual events.”

Past seasonal flu vaccines have been very successful in preventing the flu. See, for instance, the article from the New England Journal of Medicine, “The Effectiveness of Vaccination against Influenza in Healthy, Working Adults.” There is no reason to believe this flu should be different with regards to the efficacy of the vaccine. So the benefits of receiving the flu vaccine are relatively high.

Alternatively, some people are worried about Guillain-Barre Syndrome as a result of the Swine Flu vaccine. The CDC has this to say about Seasonal Flu and Guillain-Barré Syndrome (GBS). An article, “Vaccines and Guillain-Barré syndrome,” says in its abstract: “There is little evidence to support a causal association with most vaccines. The evidence for a causal association is strongest for the swine influenza vaccine that was used in 1976-77. Studies of influenza vaccines used in subsequent years, however, have found small or no increased risk of GBS.” Another article, “Guillain-Barré syndrome following influenza vaccination“, concludes that “From 1990 to 2003, VAERS reporting rates of GBS after influenza vaccination decreased. The long onset interval and low prevalence of other preexisting illnesses are consistent with a possible causal association between GBS and influenza vaccine. These findings require additional research, which can lead to a fuller understanding of the causes of GBS and its possible relationship with influenza vaccine.” The rates of infection were extremely low. They note, “The annual reporting rate decreased 4-fold from a high of 0.17 per 100,000 vaccinees in 1993-1994 to 0.04 in 2002-2003 (P<.001)." So there MAY be a causal relationship, but the risk is extremly low relative to the benefits. The deciusion will ultiamtely depend on how you define your loss function. And, as a wise friend once told me, everyone has a different loss function.

So everyone has to weight the upside of almost definately preventing the flu versus the downside of side effects of the drug which are usually mild. Severe reactions MAY cause GBS, but this is extremly rare. You are much, much more likely to be killed by the flu than GBS caused by a swine flu vaccine, especially if you are in one of the at risk groups for the flu.


Also, if interested, here is some good information on clinical trials.


Posted on October 1, 2009, in Uncategorized. Bookmark the permalink. Leave a comment.

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