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so that less vaccine material is needed to provide immunity, has been linked to allergic reactions and is being withdrawn in Canada, is not approved for use in the U.S.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

I’ve been getting a lot of questions in response to a recent blog I wrote about monitoring H1N1 vaccine side effects, so I wanted to take the time to address some of your concerns. I know the overload of information on this pandemic can be confusing, but I’m here to help, so keep the questions coming and I’ll do my best to answer them for you.

I thought I heard that the H1N1 vaccine is bad for pregnant women as it has long term effects on the baby. Now, I find nothing on Fox about that. Can you PLEASE clear this up? My daughter is 6 months pregnant and does not know what to do!!
 
You must have heard wrong. We have been saying right from the beginning, as we say every year for the regular flu shot: Pregnant women are considered a high-risk group. Pregnant women have an underactive immune system as well as compromised respiratory capacity, so if a pregnant woman gets the flu, she could have serious side effects, which may not only jeopardize her health – but that of her unborn child. So get both flu shots!

Once you have had H1N1, can you get it again in the same season? What about next season? Can we get it again after it mutates?

We do not know the complete answer to this question however, if you have had the current H1N1 flu strain, you probably have immunity to this specific strain of the virus. So this season, you may have nothing to worry about. However, if the virus mutates or a new strain of H1N1 virus emerges, past exposures to the current flu strain may not be protective.

My son is 15 months old and he is borderline asthmatic. Should I get the vaccine? So many people say yes, and so many people say no. I’m so confused and don’t know what to do!! Please help!

The answer to your question is, yes. The CDC is specifically looking at children with asthma. Many of the complicated H1N1 cases we’ve seen have been in asthmatic children. The combination of viral pneumonia and asthma in a small child could be quite devastating and deadly. So talk to your pediatrician and strongly consider vaccinating your child. And don’t forget to get yourself immunized.

If the H1N1 vaccine is not available, will the pneumonia vaccine help protect your lungs from getting pneumonia if you get the flu?

The pneumonia vaccine is targeted to protect against bacterial pneumonia – specifically pneumococcal pneumonia. This will not offer protection against a viral pneumonia – which can be a complication of the flu. So talk to your doctor before you make any decisions.

There has been a lot of push back when it comes to the H1N1 flu vaccine. Of course, as with any medication, there could be side effects because not all immune systems are created equal.

But what people have to remember is their reasons for not supporting the vaccine – mainly because of the fear that it was rushed and long-term side effects are not yet known – are some of the same reasons preliminary reports of possible side effects could also be coincidental. For example, if someone has a heart attack after receiving their H1N1 flu shot, are they going to assume it’s directly related to the vaccine or attribute it to unhealthy lifestyle decisions?

The Associated Press recently published an article on this topic that looked at how the government will be intensely tracking the side effects of this vaccine and separating legitimate medical concerns from inevitable coincidences.

This is a proactive plan. The government is going to be putting information together for the public in an effort to stop the spread of false rumors and try to put the public at ease.

One major focus will be miscarriage since they are encouraging pregnant women to get the vaccine and miscarriages are quite common anyway.

Like the seasonal influenza vaccine, medical professionals expect the side effects associated with the H1N1 flu vaccine should be minimal. The most common side effect with all flu vaccines is soreness at the injection site, and sometimes people feel achy.

Many Americans are concerned about the safety and efficacy of the newly developed H1N1 flu shot because of a similar vaccine that was linked to a swine flu-like outbreak at Fort Dix in 1976.

Guillain-Barre occurs naturally following upper respiratory illnesses, digestive illnesses and on rare occasions – is associated with drugs and vaccines. However, the frequency is still 1-2 per 100,000 people.

I’ll be keeping a close eye on this, and if anything is reported, I’ll be the first one to let you know.

Here is the latest about the novel A(H1N1) swine flu pandemic virus, and what we are doing about it. Also check out my new Ebook: “Swine Flu; the New Pandemic.”

The best way to decrease the amount of circulating AH1N1 flu virus is to vaccinate as many people as possible. This is known as herd immunity.

The current H1N1 though mild, has infected millions and hospitalized more than 10,000 here in the U.S., killing close to 1000, so mass vaccination is warranted.

Unfortunately, once the vaccination program starts, it will be TOO easy to blame ANY deaths on the vaccine. This happened in Great Britain with the HPV Vaccine, where Cervarix is expected to cut deaths from cervical cancer by 650 and 1.4 million women have already been vaccinated, the vast majority with no problems. Yet a single death which was later found to be unrelated to the vaccine caused hysteria.

Though the 1976 swine flu vaccine was linked to several hundred cases of Guillain Barre Syndrome (paralysis) for a pandemic that never happened, this time there is a real pandemic, and the vaccine has been well studied in clinical trials and found to be very safe and has not been linked to GBS.

This vaccine is made the same as the yearly flu vaccine, with hen eggs, and will be just as safe, with the major complication in the vast majority of cases being local irritation around the injection site.

In discussions with senior officials at the CDC I have determined that it is acceptable to give both the seasonal flu shot and the H1N1 swine flu shot at the same time.

The CDC also recommends H1N1 vaccines even for those who believe they have had the disease. Serological tests to confirm immunity are considered unreliable and are not readily available.

The flu mist inhaled vaccine is being released this week. Since it is using an attenuated (weakened) live virus, it should not be given to pregnant women, those with chronic conditions, or those who are immunocompromised. It has also not been tested in the elderly.

The injectable inactived H1N1swine flu vaccine will start becoming available in two to three weeks. It uses an inactivated (dead) virus, and can NOT give you the flu. It is safe in all except for those with severe egg allergies. It should be given first to health care workers, pregnant women, children, and those with chronic conditions. 250 million doses should be available by sometime in November, and I will be recommending it for all.

Swine flu parties are a bad idea. They are an example of deliberate infection to provoke immunization. Since flu is so easily transmissable, it can easily get beyond the party and spread to someone who is more likely to have a severe outcome, such as a pregnant woman, a young child, or someone with a chronic condition.

The risk of the flu is far greater at this point than the risk of the vaccine. It is still a very mild virus, but must be taken seriously, as flu is tricky, and can kill. Coming out of the southern hemisphere, whose winter just ended, the prevailing strain of H1N1 swine flu is a good match for the vaccine.

For daily updates on the H1N1 swine flu strain, twitter me at marcsiegelmd.  I will post my latest articles, updates, and answer questions.

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’ve been getting many e-mails over the past couple of days concerning swine flu.  So I’ve decided to answer a few of them here.

Dear Dr. Manny,
If I had the swine flu in 1976 after I received the swine flu vaccine as a college student, do I have any anti-bodies that may help ward off this version of the virus?
                  —Amy Gorman
                  Lutherville, MD

Probably not. This current swine flu’s genetic makeup is different from the swine flu from the ‘70s, and therefore the vaccination won’t be protective for you. But the silver lining is that this current swine flu is less lethal, and there may components in it that more Americans have been exposed to. So you may have a greater chance of being protected already which can minimize the symptoms.    

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Dear Dr. Manny,
We have friends who have returned from a trip to Mexico City two weeks ago. How long would it take for swine flu symptoms to show up if they were infected?
Thank you for your time,
—Alan

The typical incubation time for a virus is 48-72 hours.  So if your friends have been back for two weeks, and don’t have any symptoms, you can feel confident that they are safe. 

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Dr. Manny,
My wife and I are very concerned of the complications swine flu/treatment would pose to her pregnancy. Are the approved drugs for treatment approved for use during pregnancy?
Thanks,
Ben Demaline
Jacksonville, FL

Yes, all of the current flu treatments can be given to pregnant women. As a matter of fact, we tend to be more aggressive in treating the flu in expectant mothers because pregnancy can make flu symptoms worse and put the patient at higher risk. That’s why it’s recommended that all pregnant women get flu shots annually.

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Dr. Manny,
I will be flying to Las Vegas next week with a two-hour layover in Atlanta. I had a liver transplant five years ago and have done really well. Do you think that I should wear a mask at the airport and on the plane? I am very concerned about the large crowds and would like your opinion.
Thank you for any answer!
G. Savage

As a liver transplant recipient you are probably taking immunosuppressant therapy drugs and therefore you do have to take precautions to avoid exposure to the swine flu ― or any kind of flu. Even though I’m not a big advocate of wearing masks, I do feel that you should wear one. But remember: Not all facial masks are created equal, so get one that has been proven to protect against viruses. There are many supply stores that carry this specific mask for viruses. Also, try to wipe down all the surfaces on your airplane seat with antibacterial wipes. Be sure to wash your hands before, during and after the trip. And avoid any contact with anyone who you suspect might be sick. I know that this is a big stretch, but until we know exactly the extent of the spread, in your particular case, I would be extra cautious. I hope that this doesn’t ruin your vacation! 

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Dr. Manny,
I have no choice but to commute using public transportation everyday.  How should I take precautions against the swine flu?
                  Thanks,
                  —Paul

If you can avoid public transportation, especially crowded subway cars, then do it.  But if you can’t here’s what you can do:

• If you are a healthy individual you can just use antibacterial products, including wipes and gels, chronically throughout your trip.
• Avoid contact with people who are coughing or appear sick.  If they are in your car, move to another one. 
• As soon as you get home or to the office wash your hands, wipe down your cell phone, iPod or any device that you used during your trip. 

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Dear Dr. Manny,
I’m a chronic nail biter and I’m really concerned about the swine flu.  What should I do?
Best,
                  —Mel

First and foremost — wash your hands. Your hands are the most common tool for picking up germs and viruses in general. So if you are a nail biter, this would be the perfect incentive for you to quit. Also, biting your nails can make you ingest things other than viruses that you don’t want to have in your body.

There’s no doubt that this H1N1 flu, also known as swine flu, has been a real doozy. With more than 1 million people infected in the U.S. alone and approximately 263 deaths, attention must be paid to a potentially worsening condition.

I typically don’t like to scare people into paying attention to health care issues, but I do think that as soon as a vaccine becomes available here in the U.S. for the H1N1 virus, you should get it.

I recently learned of two alarming cases where pregnant women became affected with the H1N1 virus. Any type of flu can be quite devastating for a pregnant patient. The reason for the significant effect in pregnancy is that pregnant women typically have suppressed immune systems and their pulmonary compliance is significantly altered due to the pressure from the pregnant uterus. So when they get the flu, it could very quickly turn into a deadly pneumonia with very high degrees of complication for both the mother and the unborn child.

That was just the case with these two recent reports — one from Australia where a mother fell ill from the swine flu and ultimately the baby died in utero, and in the other case, a woman in Florida had to deliver at 27 weeks of gestation due to the flu, and the infant ultimately died from complications associated with his prematurity.

So the message is loud and clear: This new virus is very contagious. We don’t have natural immunity, and if you have any risk factors — especially if you’re pregnant — get the vaccine as soon as it is available.

Click here to read the full story.

The following statements are where I think we are currently on the new swine flu H1N1 influenza A strain. I’ve also communicated with Drs. Ann Schuchat and Nancy Cox at the CDC, who responded that they agree with these comments.

• The H1N1 influenza A is a new strain — a swine flu strain — with some genetic components that are characteristic of human and bird flu viruses. It bears watching and tracking, as any new influenza does.
• It is spreading human to human, and may have the attack rate of a typical yearly influenza A, but this is particularly difficult to determine because of both the overreporting (everyone thinks they have it), and under reporting (we are not really tracking the full spectrum of disease as we are not testing those with mild symptoms). It is also too early to really determine transmissability, because there are too few cases.
• Virulence appears to be low and if this continues, it will be a mild pandemic at worst. It currently appears to be very transmissible, but the outbreak could wane further if transmissability decreases. A severe pandemic will likely result only if it mutates into a more virulent strain. But assessment of the strain’s virulence is also based on a limited number of cases.
• It is worthwhile to begin preparing a vaccine, but we don’t yet have the upgraded technology (mammalian cell culture, reverse genetics) in regular use for flu, so we may have to rely on the older technologies (using hen eggs to provide a medium for growing the dead virus). This has yet to be determined.
• It is likely to wane soon due to summer weather, but bears watching carefully over our summer in the southern hemisphere, and mapping carefully for resurgence in the fall.
• Since the WHO designations for pandemic alert don’t include severity of illness or even true extent of illness, raising the pandemic alert levels have led to the public misperception that massive deaths are about to occur, which is part of the reason why the fear level is so high. It is best to provide calm accurate contexted information to avoid this, as I point out in “False Alarm; the Truth About the Epidemic of Fear.”

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 is 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

The FDA found contaminated children’s vaccines and other potentially serious concerns at Merck & Co.’s vaccine plant in the Philadelphia suburbs.

The Philadelphia Inquirer reported FDA inspectors found unwanted fibers on vaccine vial stoppers also were among the areas of concern cited

FDA inspectors visited the plant, in West Point in Montgomery County, on 30 separate days from November through January.

In December, Merck recalled 1.2 million doses of its vaccine against Haemophilus influenza type B, made at the same plant, because of a sterility problem discovered in October. It also quarantined nearly a year’s worth of other, possibly suspect doses.

Tell us what you think below.