Taking a brief hiatus from my hiatus to discuss a question I’ve been asked a number of times in recent weeks by friends and family: what about flu shots? Are you getting one for yourself? Your kids? The answer is yes to both, with more explanation after the jump.
First, for readers unfamiliar with this blog, let me be frank regarding my opinion on vaccine “controversies,” such as “vaccines cause autism.” As I’ve discussed here several times already (and more can be found by searching my older posts), this assertion is completely unsupported by many scientific studies, so this is not a concern to me as either a mother or an epidemiologist. (Orac is a wealth of information on this topic as well, for anyone who would like some further reading).
Second, I will be similarly frank that, despite the false association with autism, vaccines can cause other side effects. For flu, the most common side effect is soreness at the site of injection. Some individuals can have serious reactions to the shot, and for this reason a number of people should not get flu vaccinations: those who have had a previous serious reaction to a flu shot; those with known allergies to eggs (since the virus is grown in eggs); individuals who previously developed Guillain-Barré syndrome (GBS) shortly after a previous influenza vaccination; and infants under the age of 6 months, as well as anyone who is currently ill with an infection causing a fever. Serious reactions to influenza vaccinations are, however, quite rare outside of these groups, and my kids and I have had flu shots for many years now with no adverse reactions.
Third, it should be acknowledged that the influenza vaccine isn’t 100% effective. It’s actually quite a bit lower than 100%, but the efficacy varies from year to year, depending on how well the strains of virus included in the vaccine match those which actually end up circulating during the flu season. Additionally, the point of flu vaccination isn’t only to prevent *cases* of influenza infection–it’s also to prevent the serious complications that influenza can cause, so that if a vaccinated individual does develop an influenza infection, the symptoms will be milder.
What about the virus(es) themselves? This year it looks like we’ll have several different viruses circulating: the remnants of the “seasonal” flu viruses that have been in the population for a number of years (thus far looking to be very much in the minority as far as total flu infections), and the novel H1N1 virus. We know that “regular” influenza kills roughly 36,000 Americans each year. Typically, fatalities tend to be concentrated among the youngest and oldest age groups, so I and my kids (ages 9 and 7) would be unlikely to die. For novel H1N1, however, we’re seeing something different. For the most part, it seems to be a fairly mild virus–nothing like the 1918 pandemic, or anything close to the death rates we’ve seen from H5N1. However, it appears to be spread *very* easily and rapidly, and while deaths have been relatively rare, they’re not like we’ve seen with “seasonal” influenza. Instead, most deaths have been in people between the ages of 5 and 64:
Two things should be noted here. One is that, while the numbers are highest in this middle age group, they’re still small: only 302 deaths as of July 24, 2009 (though totals now show approximately double the number of deaths). Second, in many of the fatalities, patients had an underlying condition that put them at higher risk (obesity, pregnancy, neurological conditions, respiratory conditions, etc.) A recent report looking at H1N1 fatalities in kids noted that:
Two-thirds of the children who died had high-risk medical conditions. Nearly all of them had an illness related to the nervous system, including mental retardation, cerebral palsy, epilepsy and other seizure disorders….Of 10 children who were healthy before they got swine flu, eight had a bacterial infection such as bacterial pneumonia along with the flu.
So, it’s not a perfect vaccine, and the odds of myself or my kids dying from influenza are pretty slim. Why, then, do I think it’s worth it?
I view vaccination as akin to wearing seatbelts while traveling. Though I always buckle up, odds are good that I won’t be in a car accident that day, and even if I am, I probably would only suffer minor injuries. There’s even a small chance that the seatbelt itself could cause me–or the kids–some bruising or similar minor harm, and sometimes it annoyingly digs into the skin on my shoulder if I’m wearing a sleeveless shirt, but the little discomforts are worth it because I know that it dramatically increases my odds of living through a serious car wreck. That doesn’t necessarily mean I’d be unscathed–I could still end up with whiplash, or broken bones, or even more serious injuries–but I’m doing what I can to protect myself and my family. Flu shots are the same thing–some initial discomfort from the shot and a bit of soreness for a day or so afterward, but I know that they increase the odds of staying healthy. This is especially true for my son, who has asthma and is therefore in a group with a high risk of influenza complications.
The bottom line for me is that the risks to my children that come from being infected with the influenza virus–be it novel H1N1 or the seasonal viruses–are far greater, and more serious to their health, than any risk that comes with influenza vaccination.
Getting the vaccinations
There are separate vaccines for the seasonal viruses, and for the novel H1N1. The former is rolling out right now, so it should be available in your area already, or it will be shortly. The H1N1 vaccine is expected in early to mid-October, so to be protected against all the circulating viruses this fall/winter, two different shots are required.