The H1N1 Vaccine, again
I'm hearing some concerns from my friends about the H1N1 vaccine. People don't seem to have all the information about the vaccine, and are trying to make decisions about their health based on hearsay. Not so good. So here are some good sources of information about H1N1 and the vaccine.
Now, I'm going to start by assuming that our government is not flat-out lying to us. (If you're one of the folks who distrusts the Harper government so much that you think they may just be making things up here, I'll point out that the provinces are also highly involved in pandemic planning and the vaccine roll-out. You can check federal statements against provincial ones, if you're concerned about accuracy. In many cases, you can also check the statements against those made in peer-reviewed scientific journals such as The Lancet. Here is The Lancet's H1N1 resource page.)
Here is the federal Public Health Agency of Canada's site on H1N1.
Here is the Ontario site.
Now, here are some of the specific concerns I've heard from my friends, together with some answers:
The H1N1 vaccine hasn't been properly tested.
Canada followed its normal approval processes when it approved the H1N1 vaccine. This includes compliance with the Food and Drugs Act and Regulations, review of scientific and clinical evidence from the manufacturers that the benefits outweigh the risks, and that the vaccine is effective and suitable. In this case, Canada looked at evidence globally, and not just at Canadian trials, in deciding to approve the vaccine. Our health agencies have reviewed preliminary human trials, and continue to review new evidence as it becomes available, to check for any significant adverse effects. Based on all of the evidence currently available, the vaccine is effective, and getting it is far more safe than not getting the vaccine.
I'm worried about side effects
The majority of side-effects are minor ones like soreness at the injection site, or minor fever. Major side-effects are typically only found in people with allergies to components of the vaccine, like eggs. If you have a serious (anaphylactic-level) allergy to eggs, don't get the vaccine. If you have a minor or moderate allergy, talk to your health-care provider.
But, in short, major adverse reactions to the seasonal flu vaccine are extremely rare - approximately one for every million people vaccinated. Since the H1N1 vaccine is being prepared using a similar method to season vaccines already in use in many parts of the world, this is probably a reasonable estimate of adverse reactions for the H1N1 vaccine.
In short, the benefits of the H1N1 vaccine far outweigh the potential risks, except for people who have serious related allergies or are otherwise contraindicated. (See below under "I don't need the vaccine" for the list of people who are NOT recommended to receive the vaccine.)
There's the thing in the vaccine, not the vaccine itself, but some other stuff, and I hear it's never been tested or approved for use in humans.
Okay, I think you're talking about adjuvants here. An adjuvant is a substance that's mixed in with a vaccine to promote a more active response from the recipient's immune system. Yes, Canada's H1N1 vaccine for the general population does contain adjuvants. No, Canada's flu vaccines don't usually contain them.
However, Canada currently uses adjuvants in other vaccines, such as those for tetanus and Hep B. In addition, adjuvants have been used extensively in Europe in flu vaccines for many years. Here is a link to an article in The Lancet which reviews eleven years of use of an adjuvanted vaccine in Switzerland. Summary: yeah, it's safe.
If adjuvants are so safe, why aren't they recommended for pregnant women?
Although there have been extensive tests on adjuvants globally, there are few studies that focus specifically on their safety for pregnant women. For this reason, most health care professionals are recommending that pregnant women wait for the non-adjuvanted vaccine, which should be ready in a couple of weeks. However, the Public Health Agency of Canada recommends that "in cases where the unadjuvanted vaccine is unavailable and H1N1 flu rates are high or increasing, women more than 20 weeks pregnant should be offered one dose of the adjuvanted vaccine." In these situations, the possible negative side-effects are estimated to be less serious than the risk of not getting vaccinated.
I don't need the vaccine. That's just for high-risk people.
Actually, the Public Health Agency of Canada is recommending that everyone in Canada who is over 6 months old should get the vaccine, except:
Yes, if you're not in a high risk group, you should wait a couple of weeks so all of the high risk people can get vaccinated first. But in general, everyone should be vaccinated, not just for their own health, but for the health of the people around them. Vaccines do fail. They do not give 100% immunity. Therefore, it's important for everyone to get vaccinated, to reduce the amount of the disease circulating in any given community. That's why, for instance, there's such an emphasis on trying to get workers in old age homes to get vaccinated for the regular flu: it adds an extra layer of protection on top of vaccinating the older people themselves. See, for example, this article in The Lancet.
There's mercury in the vaccine. That's dangerous.Well, yes, there is a small amount of thimerosal in the H1N1 vaccines prepared for Canadian use (both adjuvanted and unadjuvanted). But it's well within the recommended daily safe maximum. In fact, there is less mercury in a dose of H1N1 vaccine than in a single can of tuna (see Q4 in this link).
Seriously, the risks of not getting the vaccine are way worse than the risks of taking it.
Of course, it's your health and your decision. Deciding whether to get vaccinated is a personal choice. But if you bloody well don't get vaccinated[1] and then you die, I am going to be seriously pissed off.
I like you, and I want to keep you around.
[1] Assuming you're not contraindicated.
Now, I'm going to start by assuming that our government is not flat-out lying to us. (If you're one of the folks who distrusts the Harper government so much that you think they may just be making things up here, I'll point out that the provinces are also highly involved in pandemic planning and the vaccine roll-out. You can check federal statements against provincial ones, if you're concerned about accuracy. In many cases, you can also check the statements against those made in peer-reviewed scientific journals such as The Lancet. Here is The Lancet's H1N1 resource page.)
Here is the federal Public Health Agency of Canada's site on H1N1.
Here is the Ontario site.
Now, here are some of the specific concerns I've heard from my friends, together with some answers:
The H1N1 vaccine hasn't been properly tested.
Canada followed its normal approval processes when it approved the H1N1 vaccine. This includes compliance with the Food and Drugs Act and Regulations, review of scientific and clinical evidence from the manufacturers that the benefits outweigh the risks, and that the vaccine is effective and suitable. In this case, Canada looked at evidence globally, and not just at Canadian trials, in deciding to approve the vaccine. Our health agencies have reviewed preliminary human trials, and continue to review new evidence as it becomes available, to check for any significant adverse effects. Based on all of the evidence currently available, the vaccine is effective, and getting it is far more safe than not getting the vaccine.
I'm worried about side effects
The majority of side-effects are minor ones like soreness at the injection site, or minor fever. Major side-effects are typically only found in people with allergies to components of the vaccine, like eggs. If you have a serious (anaphylactic-level) allergy to eggs, don't get the vaccine. If you have a minor or moderate allergy, talk to your health-care provider.
But, in short, major adverse reactions to the seasonal flu vaccine are extremely rare - approximately one for every million people vaccinated. Since the H1N1 vaccine is being prepared using a similar method to season vaccines already in use in many parts of the world, this is probably a reasonable estimate of adverse reactions for the H1N1 vaccine.
In short, the benefits of the H1N1 vaccine far outweigh the potential risks, except for people who have serious related allergies or are otherwise contraindicated. (See below under "I don't need the vaccine" for the list of people who are NOT recommended to receive the vaccine.)
There's the thing in the vaccine, not the vaccine itself, but some other stuff, and I hear it's never been tested or approved for use in humans.
Okay, I think you're talking about adjuvants here. An adjuvant is a substance that's mixed in with a vaccine to promote a more active response from the recipient's immune system. Yes, Canada's H1N1 vaccine for the general population does contain adjuvants. No, Canada's flu vaccines don't usually contain them.
However, Canada currently uses adjuvants in other vaccines, such as those for tetanus and Hep B. In addition, adjuvants have been used extensively in Europe in flu vaccines for many years. Here is a link to an article in The Lancet which reviews eleven years of use of an adjuvanted vaccine in Switzerland. Summary: yeah, it's safe.
If adjuvants are so safe, why aren't they recommended for pregnant women?
Although there have been extensive tests on adjuvants globally, there are few studies that focus specifically on their safety for pregnant women. For this reason, most health care professionals are recommending that pregnant women wait for the non-adjuvanted vaccine, which should be ready in a couple of weeks. However, the Public Health Agency of Canada recommends that "in cases where the unadjuvanted vaccine is unavailable and H1N1 flu rates are high or increasing, women more than 20 weeks pregnant should be offered one dose of the adjuvanted vaccine." In these situations, the possible negative side-effects are estimated to be less serious than the risk of not getting vaccinated.
I don't need the vaccine. That's just for high-risk people.
Actually, the Public Health Agency of Canada is recommending that everyone in Canada who is over 6 months old should get the vaccine, except:
- People who have had a previous anaphylactic (severe allergic reaction) to any element of the vaccine, OR
- People with a hypersensitivity to eggs ( e.g. hives, swelling of mouth and/or throat, breathing difficulty); OR
- People experiencing a high fever, OR
- People who have previously experienced Guillan-Barré Syndrome within 8 weeks of receiving a seasonal flu vaccine.
Yes, if you're not in a high risk group, you should wait a couple of weeks so all of the high risk people can get vaccinated first. But in general, everyone should be vaccinated, not just for their own health, but for the health of the people around them. Vaccines do fail. They do not give 100% immunity. Therefore, it's important for everyone to get vaccinated, to reduce the amount of the disease circulating in any given community. That's why, for instance, there's such an emphasis on trying to get workers in old age homes to get vaccinated for the regular flu: it adds an extra layer of protection on top of vaccinating the older people themselves. See, for example, this article in The Lancet.
There's mercury in the vaccine. That's dangerous.Well, yes, there is a small amount of thimerosal in the H1N1 vaccines prepared for Canadian use (both adjuvanted and unadjuvanted). But it's well within the recommended daily safe maximum. In fact, there is less mercury in a dose of H1N1 vaccine than in a single can of tuna (see Q4 in this link).
Seriously, the risks of not getting the vaccine are way worse than the risks of taking it.
Of course, it's your health and your decision. Deciding whether to get vaccinated is a personal choice. But if you bloody well don't get vaccinated[1] and then you die, I am going to be seriously pissed off.
I like you, and I want to keep you around.
[1] Assuming you're not contraindicated.