Adventures in Ethics and Science

I ended up spending a significant portion of the last several days down with something flu-like. (It included a fever and the attendant aches, chills, and sweats, as well as the upper respiratory drowning-in-my-own-mucus symptoms.)

I did not drag my ailing butt out of bed to go to the doctor and have my flu-like thing characterized. (In part, this is because I knew it would pass in a few days. In part, it was because I managed to tweak a muscle in my right side by sneezing hard and thus was unable to straighten up or be as mobile as I normally am. Someday, I swear, I am going to figure out how to sneeze more ergonomically.)

As such, I don’t know if what I had was the cool new H1N1 flu that’s been going around locally or something else.

So, here’s the question for those more plugged into public health than I am: Should I still get the novel H1N1 vaccine? (Thanks to ERV for pointing out in the comments that the “novel” is important in distinguishing the H1N1 virus that causes seasonal flu from the H1N1 virus causing the *new* swine flu.)

I’m thinking there are at least a few related questions that are relevant here. First, is there a foreseeable harm to a person from getting a vaccine against a virus she’s already had? Or, would it just be wasteful of scarce vaccine? (I’m assuming that having been infected with novel H1N1, a body would be protected from being infected a second time on account of that body’s immune system now has the virus’s number. Unless, of course, the virus mutates.)

After the flu has passed, is there a reasonable way to test (maybe by looking at antibodies) whether the virus that caused that flu was the new H1N1? Would it be a good idea to get such a test before getting the novel H1N1 vaccine (so as not to use a dose of vaccine that would do more good for someone else)? What would the cost of such a test be relative to the cost of getting a novel H1N1 flu shot?

This last question has me wondering about whether the cost structures of testing and vaccinations are set up in a way that incentivizes efficient use of our somewhat scarce medical resources. Maybe, as flu epidemics and heath care reform are at the front of people’s minds, this is something we should be thinking about.

Tara, Revere(s), PalMD, how should I go forward from here to protect my own health and the public health?

Comments

  1. #1 D. C. Sessions
    September 24, 2009

    The usual “I am not etc.” caveats apply.

    That said, it comes down to the odds. The vaccine is in limited supply, at least from a world-wide perspective if not from a wealthy US one. At the same time, the statistics are that the great majority of influenza cases currently making the rounds in the USA are novel H1N1.

    Nice ethics question, since it’s down to the margins in all directions.

  2. #2 red rabbit
    September 24, 2009

    You could get serology done, but a cost-benefit analysis says that’s probably a bigger waste than vaccinating against something you already had. Particularly if it comes back negative for both H1N1 and seasonal.

    There’s no issue with vaccinating if you had it, except like you said, it would be a waste. In Canada, there’s no shortage, but I can’t comment on your area.

    I’d do serology if you’re allergic to eggs (a component of the vaccine), or massively concerned about some other aspect, but if you were my patient I’d reassure you and ask you to roll up your sleeve.

    My 2 cents as a family doc.

  3. #3 ERV
    September 24, 2009

    ‘H1N1′ is a normal kind of seasonal flu :)

    If you mean swine flu (‘novel H1N1′), you probably had it, because its not time for seasonal flu yet.

    There is probably no reason to be tested, as I believe current tests look for viral antigen (gone, if youre better), viral culture (gone, if youre better), or RT-PCR for viral RNA (gone, if youre better).

    If you still want the swine flu vaccine, it shouldnt be a problem. I mean, you still get regular flu shots, right? Its all just ‘flu’, different stuff on the outside. But you probably got better immunity for next years flu from actually getting infected, than you would have from the vaccine.

  4. #4 Pinko Punko
    September 25, 2009

    Not knowing anything, except having to guess about whether what you had was novel H1N1, I’d say based on this: http://www.cdc.gov/flu/weekly/

    odds very high that if you had influenza, you had H1N1 swine. I would still get the normal flu shot, but am up in the air about whether to get the swine flu vaccine. Very interesting question.

    I think if I were modeling this question, I would look at available doses, estimates of who might have already had it based on reporting numbers (numbers are probably good enough at the county level to guess where clusters of outbreaks are) and then I would compare the two. I have a hunch that if I were in charge of policy, I would try to vaccinate people that hadn’t had any flu this summer and fall, prioritizing at risk populations (elderly, hospital workers, etc) then populations that are at risk but may have already had it would be next in line, then as long as there are does to give, everyone else.

  5. #5 ScientistMother
    September 25, 2009

    Yep the only flu virus that is going around right now is the novel H1N1, we haven’t hit the season for the “regular” flu. My understanding from our public health officials above the 49th, if you are a healthy adult with no underlying health issues, the novel H1N1 does not pose any greater risk to you than the “regular” flu.If however, you do have underlying health issues you should get the vaccine. However you’ve already been exposed to the virus so you should have the antibodies against.

  6. #6 ponderingfool
    September 25, 2009

    if you are a healthy adult with no underlying health issues, the novel H1N1 does not pose any greater risk to you than the “regular” flu.If however, you do have underlying health issues you should get the vaccine. However you’ve already been exposed to the virus so you should have the antibodies against.
    ************************************
    If you are an adult who is in regular contact with a large number of people, many of whom live in close contact to one another, probably also a good idea to get vaccinated. Chance of catching and spreading is so much higher especially with the flu. Given the envelope surrounding the virus air particles are the most likely culprit for its spread. Professors by nature of their jobs are thus wonderful carriers/vectors of the flu (well from the perspective of the virus).

  7. #7 jennifer
    September 25, 2009

    I thought I had read that H1N1 is going to be the predominant flu strain in circulation, even later on during “regular” flu season, so much so that public health officials are expecting 95% of “regular” flu cases to actually be H1N1. Not that they are testing now…

    If those assumptions are valid, then what is the point of vaccinating (now that you’ve been ill)? You’ve developed immunity now to something (most likely H1N1). The whole point of the vaccination is to induce that immunity. Which you already have. Would seem like a waste of resources – both yours and a vaccine that is in short supply.

  8. #8 BioinfoTools
    September 25, 2009

    Janet,

    You could touch base with your scibling Tara Smith who writes the Aetiology blog. She’s got a recent post up about the ‘flu injections, incidentally. (http://scienceblogs.com/aetiology/2009/09/why_ill_be_getting_my_kids_vac.php)

  9. #9 ChicagoMolly
    September 27, 2009

    It’s not the regular flu season yet? I’m in the midst of my first flu-like thing of the year as well, symptoms just like yours. I get nailed at least 2, 3 times each winter (but I’m such a summer baby that my body thinks winter starts two weeks before Equinox) and it seems right on schedule. I’ve never done anything special about it because it just feels like a really nasty cold, so I hide under the covers, sweating and coughing and replenishing my precious bodily fluids until it dries up and blows away. Anyway, it could be worse. If pigs had wings we could get Avian Swine Flu.
    Cough.
    Wheeze.

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