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Wednesday, October 28, 2009

Update: H1N1 & Flu Vaccinations - should we or shouldn't we? Pros & Cons

In light of the recent death of a 13 year old boy in Toronto, I've gotten a lot of questions about whether we should vaccinate. Should we vaccinate for H1N1? Seasonal flu shots?

The public is looking for answers and unfortunately I cannot make that decision for you. I do understand your frustration though with so many conflicting points of views, what is one to think. There are possible pros and cons (some theoretical & some not) for getting the vaccine(s) and for not getting the vaccine(s). Parents and individuals need to sift through this information and be at peace with the decision that they make.

Hopefully I can shed some light on this topic.

Dual flu & H1N1 vaccinations:
Ontario and a few other provinces have decided to separate the two and in Ontario, public health officials have decided to delay the seasonal flu vaccine in light of some preliminary (Cdn) data showing that those who received the seasonal flu shot last year had an increased risk of contracting H1N1. In addition, the seasonal flu does not usually lead to fatalities in healthy adults and the young.

Pros & Cons of H1N1 vaccinations:

PROS
  • H1N1 can affect certain segments of the population more severely than the seasonal flu (ie. pregnant women, young children). The elderly and immunocompromised individuals have always been at greater risk of complications from the seasonal flu virus.
  • Technically, this vaccine should be more effective than the seasonal flu shot because there is no guess work involved as to which strains should be used. In the past few years, the seasonal flu shot has been largely ineffective. To be fair, the "gold standard" of evidence-based double-blind placebo control trial studies, that are often lacking from natural therapies (and thus used by many to dissuade people from using natural medicine), are not really used to test flu vaccines. If you go to the CBC article that I have linked below, you can read about what Dr. Jim Wright from the University of British Columbia has to say about this.

CONS
  • Preservatives/adjuvants (ie. thimerosol, squalene) are in the vaccines being given out. Only pregnant women are being given adjuvant-free vaccines. There is debate about whether these pose any risk.
  • Some people believe that the H1N1 vaccines were rushed to production and not enough research has been done on them. However, to be fair, the same process used to create seasonal flu shots were used for the H1N1 vaccines so if you have/don't have concerns about the seasonal flu shot, then those same arguments for or against still hold for the H1N1 vaccine.
  • One con in general regarding vaccines (1 in one million) is the risk of contracting Guillain-Barre Syndrome (GBS), where certain neurological symptoms appear.
  • People with egg allergies should not get the flu shot
  • This vaccine is not recommended for children less than 6 months old
  • Many believe that the swine flu risks have been exaggerated and the statistics seem to indicate that so far. In fact, the World Health Organization (WHO) states that 250 000 - 500 000 people die every year from influenza (seasonal) vs. 5000 deaths this year to H1N1. CBS recently ran a story stating that "the swine flu cases were seriously overestimated." Most people who do get the swine flu will recover. Unfortunately, we are in an age of constant media where we see the worst case scenarios all the time. Having said that, even though the risks are low these worst-case scenarios are present. The CBC recently ran two worst-case scenario stories: 1) the death of the 13 year old boy 2) a gentleman who got GBS from the flu shot and has had complications with his health ever since.
Many families are split on this topic. Dr. Oz (who has somehow become the guru of complementary medicine) has stated that he will vaccinate himself, whereas his wife has refused the vaccination for herself and their children. In the end, you need to make a decision that you are comfortable with and can live with.

Other things to Note

Statistics seem to indicate that many people born before 1957 already have immunity to the H1N1 swine flu as scientists hypothesize that the kind of flu that infected individuals before this date was more like the swine flu. The H1N1 virus was the culprit in the 1918 flu pandemic and continued to circulate in the population til 1957, when an H2N2 virus displaced it as the dominant virus.

Health Canada's full description of the H1N1 vaccine by GlaxoSmithKline can be found here. This is a must read if you want to form your own opinions. It's pretty frank and quite thorough. Hope you like science!

I found this CBC article to be pretty informative. Dr. Jim Wright at the University of British Columbia makes an interesting point.

If you want to read about the "anti-vaccine" side, you will want to read Dr. Tom Jefferson, MD interview.

A list of vaccine clinics in Peel Region & Toronto. You can even check wait times. If you're not in one of the at risk groups, please let pregnant women, health care workers, the elderly and parents with kids go first. There's nothing worse than seeing a pregnant lady or an elderly person waiting in line for 4-6 hrs with no place to rest.
    Naturopathic Perspective

    There are many people who consider themselves healthy because they have no overt signs & symptoms of disease. But I often tell my patients that health is more than the absence of disease. A person who isn't sleeping properly or has a poor diet and is under constant stress is not in a healthy state of being. If you fall in this category, you are definitely putting yourself at greater risk of contracting the flu. Make sure that you're doing everything you can to optimize your health. Naturopathic doctors can certainly help you with this and have many tools to help you should you fall ill.

    Important Warning Signs you should be Aware of

    The U.S. Centers for Disease Control says patients showing these symptoms should seek medical care immediately.


    CHILDREN: Fast or troubled breathing; skin turning bluish; not drinking enough fluids; being unusually hard to wake up or not interacting; being so irritable that the child doesn't want to be held, flu-like symptoms improve but then return with fever and worse cough; fever with a rash.

    ADULTS: Difficulty breathing or shortness of breath; pain or pressure in the chest or abdomen; severe or persistent vomiting; sudden dizziness; confusion.


    Know the Difference between a Cold and H1N1 Flu Symptoms

    Symptom Cold H1N1 Flu
    Fever Fever is rare with a cold. Fever is usually present with the flu in up to 80% of all flu cases. A temperature of 100°F or higher for 3 to 4 days is associated with the H1N1 flu.
    Coughing A hacking, productive (mucus- producing) cough is often present with a cold. A non-productive (non-mucus producing) cough is usually present with the H1N1 flu (sometimes referred to as dry cough).
    Aches Slight body aches and pains can be part of a cold. Severe aches and pains are common with the H1N1 flu.
    Stuffy Nose Stuffy nose is commonly present with a cold and typically resolves spontaneously within a week. Stuffy nose is not commonly present with the H1N1 flu.
    Chills Chills are uncommon with a cold. 60% of people who have the H1N1 flu experience chills.
    Tiredness Tiredness is fairly mild with a cold. Tiredness is moderate to severe with the H1N1 flu.
    Sneezing Sneezing is commonly present with a cold. Sneezing is not common with the H1N1 flu.
    Sudden Symptoms Cold symptoms tend to develop over a few days. The H1N1 flu has a rapid onset within 3-6 hours. The flu hits hard and includes sudden symptoms like high fever, aches and pains.
    Headache A headache is fairly uncommon with a cold. A headache is very common with the H1N1 flu, present in 80% of flu cases.
    Nausea, Vomiting, Diarrhea Nausea, vomiting and diarrhea are fairly uncommon with a cold Nausea, vomiting and diarrhea are sometimes present in H1N1 flu.
    Chest Discomfort Chest discomfort is mild to moderate with a cold. Chest discomfort is often severe with the H1N1 flu.




    Yours in health,

    Ian Koo, ND
    Doctor of Naturopathic Medicine

    Naturopathic Essentials Health Centre
    "The care you want, the health you need"