There is a lot of confusion about the H1N1 swine flu shot. There is confusion, demand, and fear. I have written a column about my own experience dispensing the vaccine and trying to decide who should get it. My column is in today’s LA Times describes how I temporarily lost my cool with someone who was demanding the vaccine and might or might not have needed it. I also received a very poignant email from a 68 year old heard transplant patient in Pennsyvania who says he cannot get the vaccine despite a compromised immune system because he is more than 64 years old.
I would also like to bust a few myths regarding the vaccine:

• The vaccine is safe. It has been given to millions around the world so far and has been very well tolerated. No cases of Guillain Barre Syndrome (ascending paralysis) have yet been conclusively linked to the vaccine.
• The GSK vaccine Pandemrix, which uses a squalene adjuvant (additive) so that less vaccine material is needed to provide immunity, has been linked to allergic reactions and is being withdrawn in Canada, is not approved for use in the U.S.
• The vaccine is a very good match for the virus. The prevailing novel A H1N1 swine flu strain has not changed significantly in structure since returning in force from the Southern Hemisphere and bringing the “second wave” which we are still in the middle of.
• High priority groups are still pregnant women, children, those with chronic conditions, and health care workers. The elderly appear to have some immunity from exposure to previous flu viruses, but as more vaccine becomes available, the guidelines are being liberalized, and more will be able to receive it.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel’s new Ebook: Swine Flu; the New Pandemic, will be published in early October. Dr. Siegel is also the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.” Read more at www.doctorsiegel.com

I have been writing articles lately about the reasons for the H1N1 vaccine shortage and what to do about it. You can find these pieces in Forbes.com, Slate, and most recently as an oped in Wednesday’s NY Daily News. I believe that fear has played a major role in governing our public health response to H1N1 swine flu and the pressing need for a plentiful pandemic vaccine. I realize that it is easy to bludgeon our officials with the retrospectoscope, on the other hand, many of these nervous responses are chronic, and require significant adjustment going forward:

• Vaccine fear mongers do significant harm. Fear of thimerosal (a mercury-containing preservative that is used to bundle doses and has been shown not to cause autism) led to too much time spent trying to produce single vaccine doses without it.
• The CDC’s fear of overreacting to a possible pandemic, as they did in 1976 when 40 million people were vaccinated unnecessarily for a pandemic that never came, led to too much caution here, where instead a shift in vaccine production to the H1N1 vaccine could have led to many more million doses available now.
• Fear of seasonal flu, which doesn’t peak until much later, if at all (maybe crowded out by the H1N1 pandemic strain), led to 115 million doses of seasonal flu vaccine produced, when there is no seasonal flu around.
• Fear of new vaccines in the U.S. has led the FDA to fail to approve several new vaccines which use more up to date technologies such as mammalian cell culture instead of hen eggs, or additives known as adjuvants which make vaccines more potent so a smaller supply can be used for more inoculations. One American company, Baxter, makes a mammalian cell vaccine that will be used extensively in Europe, especially for those with egg allergies, but is not approved for use here.
• Fear of vaccines has led to poor compliance, especially for children, the group that currently seems to be most at risk for complications of the disease.
• Fear of admitting error has led our public health officials to delay in acknowledging the shortage or in correcting it, delay in accepting that it is H1N1 that is the predominant flu this year, not the seasonal strains.
• Fear of the spreading flu may be useful to combat fear of the vaccine, but a better approach would be a rational discourse based on statistics and real risk.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel’s new Ebook: Swine Flu; the New Pandemic, will be published in early October. Dr. Siegel is also the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.” Read more at www.doctorsiegel.com

If you are a child:

• Children have not shown any immunity to this new strain of flu.
• Kids are super spreaders of flu, with schools being petri dishes for spread.
• Children should wash hands frequently for at least 30 seconds with soap and water, use hand sanitizers, and sneeze or cough into their sleeve.
• Children who have fatigue, fever, sore throat, nausea, or muscle aches, should STAY HOME and the family pediatrician should be consulted.
• Rapid flu tests are about 60% sensitive for H1N1 swine flu, and a presumptive diagnosis can be made by a child’s doctor, based on symptoms.
• Kids with the flu should stay home for at least two days after symptoms resolve.
• The H1N1 swine flu vaccine will be available beginning in late October. ALL children should take it, especially those with chronic illnesses. It will likely be offered in schools. It is not clear yet whether children will require one or two shots.
• The use of Tamiflu (anti-viral) in children is somewhat controversial; recent studies from the UK appear to show that it isn’t well tolerated or effective, though previous studies have shown that it is safe, shortens the course of illness, and can also prevent spread (80-95%) if given to close contacts. This was the experience of several summer camps in Maine this summer, where Tamiflu was also well tolerated.
• Secondary bacterial infections are common, and should be treated promptly with antibiotics.

If you are an adult:

• Especially at risk are adults with chronic illnesses such as COPD, Crohns Disease, Rheumatoid Arthritis, HIV, cancer, etc. These patients should be especially careful, take Tamiflu early for flu symptoms, be on the lookout for secondary infections including bronchitis, pneumonia, sinus and ear infections.
• The H1N1 vaccine should be given to these groups as soon as available, as well as pregnant women (currently in clinical trials), health care workers, and close contacts of those with chronic conditions.
• New studies just published in the New England Journal of Medicine show that the new vaccine works in 7-10 days, is well tolerated, and provides immunity with a single dose.
• Elderly patients appear to have partial immunity to this H1N1 swine flu strain, if born before 1957, probably because of exposure to a related virus when they were younger, but should still be considered for this vaccine, especially if they have chronic medical conditions.
• Those who had H1N1 swine flu in the Spring or Summer are likely immune. There may be a blood test available to test this.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel’s new Ebook: Swine Flu; the New Pandemic, will be published in early October. Dr. Siegel is also the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.” Read more at www.doctorsiegel.com