Several very recent polls have indicated that 40% of American families do not plan to vaccinate their children against the H1N1 flu.  Meanwhile, CDC and state health officials continue to stress the need for children, teens, pregnant mothers and other high risk groups to obtain the vaccine.  Who is right?

Many of our families initially concluded they weren’t going to vaccinate against the H1N1 flu subtype, but some are starting to revisit the question largely because of the steady stream of government, network TV, and pharmaceutical industry news regarding the flu and its risks.  We wanted to share our current thoughts in order to try to provide some perspective regarding the H1N1 flu and the vaccine.

At GetzWell, we don’t believe in a “one size fits all” approach.  Some of you may conclude that a few or all of the members of your family should be vaccinated.  Others families will decide to skip the vaccine altogether.  Many of our patients are obtaining the seasonal flu vaccine, but will skip the H1N1 vaccine.  All of these options may be reasonable depending on your circumstances.

How widespread is the H1N1 virus and what are the highest risk factors?

The H1N1 vaccine appears to be a very good match against the actual virus that is now widespread, and it is made in the same manner as the seasonal flu vaccine which has been given to hundreds of millions of people over the last decade. The CDC now recommends H1N1 immunization for the same groups who should get the seasonal flu vaccine and then some…in short, practically everyone.

The latest CDC data for the period from August 30, 2009 to October 17, 2009 indicate that the H1N1 flu is widespread in 46 states including California.  Almost all influenza that we have seen since school started in late August has been the H1N1 subtype. Virtually no cases of the seasonal flu have been seen because it’s too early in the season.  During this 7 week period, the CDC reported that the number of pediatric deaths was small at 53.  Older Americans (those above 50) are particularly unaffected by this virus, unlike seasonal flu virus.

For the period beginning September 1, about 42% of reported pediatric deaths have been teens (ages 12 -17) and 3 of the 53 pediatric deaths have involved children under 2 years of age.  It is worth noting that of the children who died, most had underlying chronic illness.  Our own observations, based on our experience and discussions with medical colleagues, is that almost all of the children contracting the H1N1 virus recover without any hospitalization or medical intervention.  Nonetheless, we believe that families with very young children and new mothers should discuss with us whether they or their children should receive the H1N1 vaccine in addition to taking other measures.  (See below section on An Ounce of Prevention.)  In cases of underlying risk factors such as asthma, diabetes, or lung disease, for example, we do recommend the vaccine.  If your child experiences a high fever for more than 24 hours or has respiratory distress, we want you to call us immediately.

Additionally, for pregnant mothers in our practice, we suggest that you call us for a consultation about whether to obtain the H1N1 vaccine.  While only 1% of the US population is pregnant, the latest CDC statistics show that 6% of the deaths associated with the H1N1 flu involved pregnant women.

How alarmed should I be?

Early this year, the public health and political risks of not adopting a plan to address a possible pandemic were very high.  Now, some eight months later and with the swine flu widespread, we know that it is quite contagious, but for almost all of our population it is not very severe and recovery is usually complete in 4 or 5 days. This is reassuring.

Well into the month of October we’re seeing an unusually high number of kids with what we think is H1N1 flu and we expect the numbers will increase over the next few months.  The virus typically causes a high fever and body aches for children and adults, but there are few other symptoms.  Some people report much milder symptoms.  The kids who have caught it have fared surprisingly well, and in our practice all of them have recovered without any complications.  We continue to believe that the symptoms of the seasonal flu (stay tuned for the winter) may be more severe than those caused by H1N1, and we don’t know what it will look like should an individual simultaneously contract both viruses.

What is not reassuring is the media coverage of this flu which has tended to hype the risks and hasn’t provided much balance.

An ounce of prevention

The first step in protecting our children from H1N1 influenza, or any infection for that matter, is common sense prevention:

• Wash your hands with soap and water (or use an alcohol based hand sanitizer) thoroughly and often.
• Avoid touching the face, especially eyes and nose.
• Cough or sneeze into your elbow or a tissue (that gets disposed of), not into your hand.
• Avoid contact with others for at least 24 hours after being free of fever if you or they are sick.
• Daily nasal saline washes and gargling with warm salt water may be helpful.

We also recommend that you ensure that you and your child are receiving adequate amounts of the following to provide optimal immune system support:

• Probiotics
• Vitamin C
• Vitamin D
• Fish oil

For specific recommendations to support your child’s immune system, please call to schedule a consultation.

Our reservations

Our opinions of the flu vaccine are nuanced.  Much of our population has some immunity to the typical seasonal flu, which is why most deaths from the seasonal flu involve the elderly and others who are immune compromised.  On the other hand, almost no one under the age of 50 has been exposed to the H1N1 virus (except in the last year).  Generally, the flu vaccine is no miracle shot.  For example, the 2008 seasonal flu vaccine turned out not to be a perfect match and many people who received the vaccine still contracted the seasonal flu.  The H1N1 vaccine, on the other hand, appears to be a pretty good match.  If this continues to hold true, by the end of the year when millions of Americans will either have had the flu or received the vaccination, we should begin to see a marked decrease in H1N1 flu cases, since rising numbers of vaccinated people and those with natural immunity (because they already recovered) should decrease contagion.  From a public health standpoint  all of us should obtain the vaccine to protect each other.  The counterpoint to that idea is the following: those of us who are not in high risk groups or who do not need to care for those in high risk groups might reasonably conclude that contracting the H1N1 flu could provide long term protection, particularly if the virus mutates.

In short, although some new mothers, pregnant moms, certain adolescents and caregivers should consider obtaining the H1N1 vaccine, we believe that in many cases by fighting influenza viruses naturally we may have the opportunity to develop defenses against strains we encounter later.  This may be especially important should the H1N1 virus becomes more virulent via mutation in the future.

Our recommendations

If you’re on the fence about the H1N1 flu vaccine, we will support your decision to opt out based on the above considerations.  However, as we’ve said, we don’t know what it will be like to have both viruses at once, so we’ve been recommending the seasonal flu vaccine more than usual.  We still have some preservative-free seasonal flu vaccine available to our families.  No matter which path you choose, if your child catches the flu, we will monitor the illness very carefully to avoid complications and ensure full recovery.

As of now, we don’t see significant reasons for most of you to rush to swine flu immunization clinics. If you are in a high risk group or need to care for those in a high risk group, please contact us for a more individualized discussion.  At present we do not plan to carry the H1N1 vaccine at GetzWell.  For those GetzWell families who want to be vaccinated against H1N1, we recommend that you visit one of several locations throughout San Francisco.  As of 10/26, here is a list of SF H1N1 vaccine sites:

• Castro Mission Health Center: 3850 17th St.
• Maxine Hall Health Center: 1301 Pierce St.
• Ocean Park Health Center: 1351 24th Ave.
• Potrero Hill Health Center: 1050 Wisconsin St.
• Silver Avenue Family Health Center: 1525 Silver Ave.
• Southeast Health Center: 2401 Keith St.
• Mission Neighborhood Health Center: 240 Shotwell St.
• North East Medical Services: 1520 Stockton St.
• St. Anthony’s Free Medical Clinic: 150 Golden Gate Ave.

• The H1N1 vaccine is also available for $15 at the Department of Public Health: 101 Grove St.

We are continuing to monitor the information and recommendations on a weekly basis. If you would like an individualized consultation, please call the office at 826-1701 for an appointment or email reception@getzwell.com.

Currently Dr. Solley has an office in the GetzWell Pediatrics medical facility.  He loves working with all kinds of couples including new parents and the special challenges and stresses they inevitably encounter.  For more information, visit his website at www.Solutions4Couples.com.

Checking your vitamin D level is accomplished via a simple test your doctor can order.  Once you know your vitamin D level, your doctor can help you with a supplementation plan, if necessary, to ensure you and your baby are getting adequate amounts of this vitamin.

At GetzWell, we provide nutrition counseling for pregnant women in order to optimize nutritional status at this crucial time in your baby’s development.  We believe whole kid care starts before your baby is born and want to be involved as early as possible in your child’s health.

Here’s what the American Academy of Pediatrics is saying:

“Given the growing evidence that adequate maternal vitamin D status is essential during pregnancy, not only for maternal well-being but also for fetal development, health care professionals who provide obstetric care should consider assessing maternal vitamin D status by measuring the 25-OH-D concentrations of pregnant women. On an individual basis, a mother should be supplemented with adequate amounts of vitamin D3 to ensure that her 25-OH-D levels are in a sufficient range (>32 ng/ml). The knowledge that prenatal vitamins containing 400 IU of vitamin D3 have little effect on circulating maternal 25-OH-D concentrations, especially during the winter months, should be imparted to all health care professionals.” (Pediatrics. 2008 Nov;122(5):1142-52.)

Inadequate vitamin D has also been associated with rickets in children, osteoporosis, muscle weakness, fractures, common cancers, autoimmune diseases, cardiovascular diseases, and depression.  One recent study conducted by Harvard researchers showed that if mothers take vitamin D while they are pregnant, their children are less likely to have wheezing illnesses during the first 3 years of life.  Another study indicated that the median adult intake of vitamin D in the US is only 230 IU per day versus the 2000 IU daily dose which is recommended by the Mayo Clinic and the Vitamin D Council.

Vitamin D is not found in many foods, but we are able to make lots of vitamin D in our skin when we spend just 10-15 minutes in the sun (without sunscreen).  The lower back is an ideal part of the body to expose to the sun so that we make plenty of D vitamin but don’t need to worry about wrinkles!  Unfortunately, between October and march in San Francisco the sun is too far away to allow us to make vitamin D and much of the summer in SF is foggy, preventing the sun’s rays from reaching us.  So, for most of us a vitamin D3 supplement is necessary.

The Vitamin D Council contains a wealth of information: www.vitamindcouncil.org.

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“Even though we were impressed with her when we met with her during my pregnancy, it was another thing altogether to watch her interact with our newborn. I really feel like we made the right choice.” Laura L.

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“Julia Getzelman is our pediatrician and we love her. We switched to her after we were unsatisfied with the more ‘old school’ practice we were taking our 3 month old to. She really takes the time to cover everything at the appointments and does not rush us.” Jenifer B.

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“Julia is the doctor that we all wish we had (pediatrician or otherwise). Kind, patient, smart, open to alternative practices and vaccination scheduling. She listens carefully to moms and trusts their intuition. So many other doctors write off new parents’ concerns about their babies as being hyper-nervous.” Lisa V.

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“We use Dr. Getzelman for my 4 month old son. We really love her. She is easy to talk to, very relaxed, and almost hyper responsive! She responds to email day and night, which is awesome. She is flexible regarding vaccines–we use an alternative vaccine schedule (more visits, less shots per visit) and she is great with that. Her background is in functional medicine–gut health, probiotics, etc.”
Rhian B.

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“We’ve been clients of Dr. Julia Getzelman for over a year and we’re THRILLED to be in her practice. She’s one of the newer breed of doctors who acts like a person, with a great sense of humor, and a welcoming manner that invites the participation of the parents in the entire process of raising kids healthy.”
Alex B.

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“We LOVE Julia and her staff…I cannot say enough! We started at another practice and after 3 miserable experiences switched to Julia. Her clinical skills are excellent and she is great with babies (our daughter is 5 months old). She gives us a lot of reading materials, etc. She is pro-active, not reactive! She responds to emails 24/7–it’s really unbelievable.” Jennifer K.

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“With Dr.G you never feel hurried, she knows all of her patients because of the small client base, and she frequently checks on patients via email. Also, Dr.G is really good with keeping the toddler happy and not forcing things to happen if the child does not want something poking his body.” Yukie F.

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“Dr. G is absolutely amazing, extremely knowledgeable, and my 16 month old is mesmerized by her.” Wayee C.

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Julia is our (wonderful!) pediatrician; we joined her practice about a year and a half ago. Julia diagnosed our (now) 2yo’s dietary sensitivities and helped change him from a subdued boy that always, ALWAYS had a runny nose and hardly ever even tried talking, to a busy, active, happy, clear-breathing little guy who just yesterday told his dad a long, complicated story that lasted at least 2 full minutes.” Lara W.

Before refrigeration, cultures throughout the world ate fermented foods rich in probiotics on a daily basis.  In contrast, our modern diet often lacks such foods (except yogurt, miso and kimchi, for instance).  Some experts say we can make up for the dearth of dietary sources of probiotics by taking a daily supplement (in addition to eating fermented foods and a high fiber diet on a regular basis).  There are reputable companies making probiotic supplements that are available for purchase at Whole Foods, Rainbow Grocery, and other health oriented stores.  At GetzWell Pediatrics we carry pharmaceutical grade probiotic supplements manufactured by Klaire and Pharmax.  We believe the universe in our bellies needs careful tending, just like a garden.

For more information and scientific references on probiotics go to the National Center for Complimentary and Alternative Medicine at the NIH: www.nccam.nih.gov.