H1N1: The GetzWell Perspective

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 826-1701 for an appointment or email [email protected].