Sunday, August 16, 2009

Current Thoughts on H1N1 Influenza: "Swine Flu"

I've been following the news about the swine flu since it first started making headlines last spring. The media have repeatedly drawn our attention to the fact that the 1918 flu pandemic began much the same as the current one: With a mild version of the virus in spring and summer. And we all well know, by the fall of 1918, that strain turned suddenly deadly. It's difficult to escape drawing a very frightening parallel to the H1N1 strain making the rounds.

Although the government has been cautious about predicting the impact of swine flu this fall, the FDA is nonetheless putting the H1N1 vaccine on a fast track to approval. The call for the population to immunize may well happen before human clinical trials of the vaccine have been completed. And that, for me, is where things get very scary. Do I want to be in the position of being a guinea pig for a brand new vaccine? Do I want my children to be guinea pigs too?

The other concern I have with the H1N1 vaccine (aside from it being untested) is that it will be the first influenza vaccine to contain an adjuvant. A few other FDA-approved vaccines contain adjuvants, which help boost immune system response and allow less antigen to be included in the vaccine. That means the amount of antigen can be stretched to allow for more doses of the vaccine to be produced. And if you recall the flu vaccine shortage of 2004, this is a potentially fantastic development. But! The adjuvant in Glaxo's swine flu vaccine is not FDA approved, and while some clinical data exist from its use in Europe, it has not been studied here. More alarming: The government has made vaccinating pregnant women a priority, but the vaccine will go untested in pregnant women.

I am not anti-vaccination. I understand that vaccines are one of the most important medical developments of the modern era. My kids are fully vaccinated, with the exception of seasonal flu vaccines, mostly because those vaccines tend not to be highly effective due to strain mismatch. And (knock on wood) my kids have never had the flu despite being in daycare/preschool with dozens of other nose-picking little petri dishes like themselves. To my knowledge, I've only had the flu once, an unconfirmed case in 1999. I spent two days in bed, using copious amounts of NyQuil to maintain a semi-vegetative state until the worst had passed.

At present, H1N1 has not demonstrated itself to be any more virulent than any other strain of seasonal influenza. If the virus does not mutate into something more deadly, I have no plans to take part in what amounts to a mass clinical trial. If people start kicking the bucket left and right, however, I may be persuaded to get the vaccine. Let's not engage in mass hysteria and allow safety to fall by the wayside.

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