Pearls before Swine

It’s that time of year again, when everyone grits their teeth, rolls up their sleeves and gets their flu shot.  Last year was quite a year.  Let’s recap.  In June of 2009 a flu epidemic began in Mexico which was quickly identified as H1N1 influenza A.  This virus because it is one of many flu viruses that originates in the swine population, was quickly dubbed “the Swine Flu”.  By September, the United States was in a pandemic.  The peak rate of infections occurred in late October.  By the middle of October vaccine was available and by January 40% of all Americans had received an H1N1 vaccine.  It was the highest flu vaccination rate in the US of all time.  In all there were 57 million cases of H1N1 and 11,690 deaths.  That is a mortality rate of 0.02%.  Influenza B, the usual offender, was a no show this year: less than 1% of all tested cases were any other strain than H1N1.  H1N1 has proven to have a few original characteristics compared to the “regular” flu.  It is less virulent, producing a mortality rate that is significantly lower than other strains of flu (0.02% versus 0.12%).  Its attack rate was highest among children aged 5-11.  And its hospitalization rate was highest among children 0-4yrs.  In the past flu has statistically been the biggest threat to the elderly population.   This difference was mostly attributed to the 1976 swine flu outbreak in the US, with the belief that many people of school age at that time likely have antibodies which offered them some resistance. However, death rates were still highest among persons aged 50-64 years and lowest in children.  For now H1N1 seems to be gone, with only a few scattered cases reported since March 2010. 

Now let’s look ahead.  Flu vaccine is here and we hope it will be widely available.  This year it contains the previous years strains with H1N1 added in.    It is recommended for everyone ages 6 months and up with a few exceptions.  These exceptions include: people who have a severe allergy to chicken eggs, people who have a moderate to severe febrile illness, people who have previously had Guillan Barre syndrome.  Most people DO NOT fit this criteria and therefore are safe and recommended to get the flu vaccine.   The vaccine comes two ways: injection form and nasal mist.  The Nasal mist is approved for ages 2 years and up and is not recommended for anyone who is immunocompromised because it is a live virus vaccine.  It is especially important that people who have any kind of medical condition which increases their risk of severe influenza like asthma, diabetes, pregnancy etc get their vaccine early.  If it is your first time getting the vaccine and you are under the age of 9 you will need a vaccine booster 1 month after your first vaccine to guarantee a good antibody response.  If you did not receive the H1N1 vaccine last year and you are under the age of 9 you also will need a booster in 1 month.

A few important things for parents to know about flu and flu vaccine:

• You cannot get the flu from the flu vaccine.  This rumor is probably the result of coinciding infection with a cold virus which occurs commonly during flu vaccine season.  Side effects from the vaccine include 48 hrs of fever, and muscle aches.  This is typically mild.
   

• You cannot get swine flu by eating swine.  The pork farmers need to earn a living too, please go back to eating your ham and bacon (in moderation of course!).
   

• People who say they have the flu rarely actually have the real flu.  A runny nose and cough is typically rhinovirus or other cold viruses, not influenza.   Influenza is a constellation of symptoms including high fever, cough, muscle aches, and vomiting.
   

• Swine flu season in 2009 was very early.  This is expected to occur again which means it makes sense to get your vaccine in August or September.
   

• It takes two weeks for the flu vaccine to begin completely protecting your child.
   

• No matter how early it is given the vaccine protection will last through the late spring to early summer.
   

• Most newborns get the flu from a close contact, so it is worth it to ask child care providers to be vaccinated.
   

• Influenza viruses change and evolve rapidly and antibodies to these viruses do not last a lifetime which is why it is important to get a flu vaccine every year regardless of past vaccinations or infections.
   

• There has already been reported a great deal of resistance to anti viral medications (like Tamiflu) among community flu viruses. These medications also have a lot of side effects.  So planning to rely on medication instead of the vaccine is not a good plan.
   

• Getting your flu vaccine is a great reason to celebrate!  Go out for a nutritious treat, play a new game, or let your child stay up a little bit late to celebrate this healthy step!

Every pediatrician and parent in the United States is hopeful we can avoid the illness and chaos induced by H1N1 last year.   We all would much rather focus on football injuries, upset bellies from Halloween candy, and the stress of making a Christmas list than the flu!  Early and comprehensive vaccination should make that possible!

*All statistics courtesy of www.cdc.gov