A Parent’s Guide to H1N1

by Deb on November 20, 2009

I’m cross posting this here and on Fusion Parenting because I feel it is so important I want it to get out to the widest possible audience.  If you find it useful, please spread the link around or distribute it as widely as you like.

First off, I have no medical qualifications. My background is in human biology and general science, so I do understand the hows and whys of vaccines in a general sense. I’m also a parent so I’ve looked into them but not at Google University – I listen to experts, because they have spent years learning the things I don’t know.

I’m actually very uncomfortable about writing this with no references, unfortunately I’ve been reading things over the last several months and haven’t taken copies of all of them. I can search them out if anyone wants to challenge anything, but I thought it was more important to get this out there rather than wait until I found all of them again.  Hopefully I’ll be able to track them down and add them.

General Flu

The flu is not a bad cold. It is a viral infection that causes symptoms which include a runny nose and sneezing, but also headaches, fevers and general body aches. While most people are fine, they can become extremely ill directly from the flu, or they can catch secondary bacterial infections like pneumonia. Every year around 36,000 deaths are caused by seasonal flu in the US.

There are a lot of flu viruses and they recombine and mutate very easily. In fact, 1 in every 1,000-10,000 divisions is an error – one of the highest mutation rates known. If you want the gory details, flu has it’s genes on RNA instead of DNA.  DNA is a double helix and both sides have to match up, so there is a check that they are all right.  RNA is only a single helix so there is no check, so there are a lot more mistakes when RNA is replicated.

The ‘H’ and ‘N’ are names of the proteins that allow it to bind to our cells and are the bits that our antibodies recognise. They come in lots of different forms that work more or less well with different animal cells, so H1N1 just means a flu virus with the ‘1’ variant of these two proteins. There is actually a seasonal flu virus that is H1N1, but the current swine flu has other differences.

Swine Flu

The current pandemic swine flu is like the little girl with the curl. For most people, it is mild and you are miserable but fine. But for the unfortunate few, when you are sick, you are very, very sick. For these people it is acting as a severe respiratory infection, and if we didn’t have such good intensive care units our death rates would be a lot higher. The very scary thing is who it is affecting – not the old, not those who are already sick, but the young, the healthy, and pregnant women. Many people are not dying of underlying conditions – they were healthy before they had swine flu. This is one reason there is a push to vaccinate everyone – you can’t say just vaccinate those at risk, like we do with seasonal flu, because we are all at risk.

Pandemic swine flu appears to be more infectious than seasonal flu. Your chances of getting seasonal flu are usually around 10%, up to 40% if you have kids. But so far infections for swine flu seem to be running at 20-25%, more if you have children. It’s hard to tell because many places are not swabbing for swine flu anymore.

The reason there has been so much concern about swine flu has nothing to do with what it is as a disease now. The worry is that the 1918 Spanish flu was also H1N1. It killed 50 million people. Now obviously 1918 was at the end of WWI and pre-antibiotics, so that had something to do with the number of deaths. But like the current swine flu, many of the deaths were directly from Spanish flu. Plus that is only the number of deaths, the number of infections was far, far higher. And while we have antibiotics today, we also have aeroplanes and mass transportation.

Just think about those numbers for a minute – can our hospitals cope with that number of seriously ill people? Does the world have 50 million ventilators? Do we even have 50 million courses of antibiotics? In a word, No. If a pandemic such as the 1918 Spanish flu ever hit again, even our safe healthy first world would be in a lot of trouble, and there would be a lot of deaths. And developing nations would be even worse off. This is why governments are scared. This is why they are trying to stop it now, before it mutates, because history shows us this is what happens with pandemic flu. This is why they are trying to get everyone vaccinated, not just to protect the young healthy people with no risk factors who are dying now, but the less infections there are, the less chances there are for it to mutate.

Vaccines

There are a few different vaccines currently being used. The main difference is that the one in the US has no adjuvants and requires two doses, the ones in Canada, Europe and Australia contain adjuvants. These are chemicals added to a vaccine to induce a stronger immune response, which is why only one dose is needed. There is also a vaccine that has not been grown in eggs so it is safe for people with egg allergies.  Edited: Since writing this the children’s vaccine has been approved in Australia.  It is the same vaccine, but because children don’t have as strong immune response they need another shot 28 days later.

There seems to be worry over how quickly this vaccine has been produced, but in reality it is backed up by years of experience. Every year the most common strain of seasonal flu is chosen and turned into a vaccine, this has been happening for decades. The process is well known and has been approved in all countries that use those vaccines. So all that has happened is that samples of H1N1 have been used to produce a vaccine in exactly the same way as the already approved ones. In addition, the H1N1 vaccines have been tested for safety. This is not a rushed or untried new vaccine, the exact virus involved is new, but so is the flu vaccine produced every year.

Flu vaccines do contain thimerosal/thiomersal as a preservative, which contains mercury.  However there are several points to keep in mind here. Firstly, the amount of mercury is less than you receive from a tuna sandwich. Secondly, thanks to scaremongering thiomersal in vaccines has been intensively studied. There are literally dozens of high quality studies from around the world which have shown it is safe. There is no credible evidence at all that it is dangerous. Finally, it shows a misunderstanding of chemistry. There is no mercury floating around in vaccines, it is all in the form of a compound. Common table salt is a compound of sodium and chlorine. On their own, sodium is explosively reactive and chlorine is highly poisonous. But when they are chemically bonded in a compound they are safe. Thiomersal contains mercury in the same way salt contains sodium and chlorine.

Side effects

There is also worry over side effects of the vaccine. The main one that is due to the vaccine only is a sore arm, or possible allergic reactions that can cause anaphylactic shock. This is an extremely rare side effect – for example there has been one death in Canada out of millions of immunisations given. This is an acute reaction, which means it comes up within a few minutes of the vaccine, and is the reason you are asked to wait at the clinic when you have your needles. If you have waited and have not reacted, you aren’t going to.

The other side effects are not really effects of the vaccine, they are effects of the virus. An example of this is febrile convulsions caused by a fever spiking. But the fever isn’t caused by the needle, it is caused by the small dose of swine flu. This is a dangerous effect, definitely, but the question then becomes – if a child reacted to a small, mild dose of swine flu by spiking a fever, how would they have reacted to a full infection? No-one can know, but chances are exactly the same thing would have happened. If you are prone to fevers or convulsions then it is still safer to get the vaccine, because it is a milder form and a smaller dose so you are much less likely to have problems.

Guillane Barre syndrome (GBS) is another dangerous side effect caused by the virus. This is a form of paralysis that resolves in 95% of cases, though it takes weeks or months of therapy and is dangerous. It is possible that there is a 1 in a million chance of developing GBS syndrome after a flu vaccine, although I’ve recently seen a researcher say there is no link. That sounds dangerous, but there is a 40-70 in a million chance of developing GBS because of flu. Once again, it is safer to have the vaccine.

Summary

  • Currently H1N1 is mild for most people, but it is more dangerous than seasonal flu and is seriously affecting people who are not considered at risk for seasonal flu – people who are young and otherwise healthy.
  • It is more infectious that seasonal flu.
  • A major worry is that it will mutate and become more deadly, like the 1918 Spanish flu. Our health system could not cope with a pandemic on that scale.
  • The vaccines are based on very well known and studied technology and have been tested.
  • Most of the dangerous side effects are caused by the virus itself. You are less likely to react to the vaccine virus than you are if you actually catch the flu.
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{ 5 comments… read them below or add one }

Annie November 25, 2009 at 6:35 am

wow this can be a very emotive issue and I have found it really hard to find information for either side of the debate that doesn’t try to scare parents into make one choice or the other. I’ve done lots of research myself from a lot of sources and I have decided not to vaccinate – that’s what seems the right decision for us and I’m not wanting to start debate, just reinforcing that everyone will have different priorities and motivators which (hopefully coupled with information) will lead them to their own choice one way or the other

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Deb November 25, 2009 at 9:09 am

I purposely didn’t put a recommendation in, because I know everyone’s circumstances are different and different families will make different choices. It’s pretty obvious where I fall, but while I am generally in favour of vaccination this is the first time we’ve considered a flu vaccine, and we are doing it because of the evidence.

Unfortunately we seem to have lost our ability to judge risks – few of us consider that going in a car is one of the most dangerous things our kids can do, and worry about all sorts of other things that are comparatively safe. Spanish flu was dangerous and we don’t know why, so we can’t stop it happening again. If that many people are sick it will be extremely dangerous. This is one that people should be scared of.

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claire November 27, 2009 at 9:41 pm

Thanks Deb, that is some really good information. I didn’t have a lot of understanding about the swine flu and I thought that is was a bit of over reacting but the info that you have posted has certainly made me think. It makes sense to me to immunise against the swine flu…thankyou

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KittyB May 28, 2010 at 7:36 pm

Hi Deb, just wanted to add that in addition to the fact that there is limited space in in ICU’s and limited amounts of ventilators, there is also the issue about what happens if masses of health professionals get sick?
Also, for those working in essential services- who runs them if we have a pandemic and many of those workers get sick?

A pandemic wouldn’t just be a strain on the health industry- it would be a strain on pretty much *every* industry.

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Deb May 29, 2010 at 3:27 pm

I agree, especially because I’ve just seen this: “Swine flu put hospitals ‘on edge’ last year”. I knew we had been lucky and there would have been a much higher death rate without intensive care facilities, but I didn’t realise how close we were. Some of the stats in that article are scary.

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