That’s incredibly helpful, those four points. We’re vaccinating because the husband and the kid are both asthmatic. The answer to (1) is unthinkable and more likely than the unthinkable answer to (2).

I didn’t read comments from yesterday’s posts, but just in case no one mentioned this: I think it’s no coincidence that the health industry is making such a huge deal about H1N1 during a time when their industry has so much at stake in the health care overhaul debate. It works in the private HC industry’s favor to keep the public scared shitless about this flu. It works in their favor to rush a vaccine through so they can look like heroes, without regard to the long term effects of a drug so little tested. I don’t have kids, but I wouldn’t go near that vaccine at this point. The socio-economic conditions surrounding health care at this particular time are perfect to foster greed-driven negligence on the part of the vaccine makers.

Wow, Katherine – great comment! Word!

I love Karoline’s 4 questions. They can be used for all sorts of things in life.

I’m terrified of the vaccine. I’m also terrified of the H1N1. I’m thinking I’m just going to hermit us all up in the house for the winter like bears.

I just wanted to point out that the pregnant women are not necessarily getting the shots for the unborn babies who wont be born yet…. they are getting them because due to the pregnancy their immune system fights things differently… A mother just died in my town yesterday who contracted the H1N1 just before delivering her baby, the baby was born, put in isolation and was FINE, the mom was put in a medically induced coma (for 30 days) and never came back. She died after a month and never got to hold her baby. I realize this is an isolated case, but its the same reason my ob/gyn always pushed me when pregnant, if no other time, to get the regular flu shot.

I don’t think the H1N1 vaccine is being tested for safety reasons since they already consider the flu shot safe. It’s being tested for dosage amounts. They found from the trials that adults only need 1 shot and kids 2 shots. They probably are testing pregnany women separately since their immunity is different. This really is a safe vaccine, much safer than the flu. I planned on getting my whole family vaccinated, unfortunately my 3 year old is sick with a fever and a cough today and I’ll find out in 30 minutes if it’s the flu. If it is, the choice has been taken out of my hands. Consider yourselves lucky that you have the choice.

This is such a gut-wrenching topic on so many levels. My kids will not be getting the vaccine for a myriad of reasons, but I respect every parent’s decision to make the choice they feel most comfortable with.

Have you seen this doctor who, in an interview with Fox (a network I normally hate), says he wouldn’t give his own children the H1N1 vaccine? It’s really interesting. Scary, too. (He talks about it starting at 1:42)

http://www.youtube.com/watch?v=E1z7KSEnyxw

another useful tip for making either/or decisions: live your life for one day as though you made one decision – how does it feel, what regrets do you have, etc. Then live the next 24 hr as though you made the other. The “right” answer will likely be clearer after this exercise. Good luck (PS I’m vaccinating for both this year. I work in healthcare and see oodles of kids and oldies die from the flu each year. Just my bias.)

If no one posted it before (coming in late and didn’t check yesterday’s comments) – two thoughts, from my coworkers who are in the medical/virology arena.
1) this flu shot is being assembled the same way as the “seasonal” flu shot, and is thus as safe as the seasonal (I find that reassuring. Take it as you wish.)
2) http://www.cdc.gov/flu/weekly/ is a good quick update. The key thought for us, which I’m still considering – my whole house, work, already had the flu a couple of weeks ago – and the odds are overwhelming that it was H1N1, because that’s what’s out there, if you look at that data. Now whether to get a vaccine for which we already have the immunity? Not sure. Will be getting the seasonal, though!

A great quote I use in situations like this: if you’re going to hang your hat on a statistic, you have to look at the statistic from both sides. By choosing to NOT vaccinate, you are accepting the very large risks that come from the flu, and your kids, as you said, attend a petri dish for day care/preschool, increasing their odds that they will get it. By choosing TO vaccinate, you are accepting the risks that from from the vaccine. Which is the larger risk, and how bad is it?

I am vaccinating this year, as every year. I work in a hospital, and I have a responsibility to protect not only myself, but other people around me, the sick, weak people here in the hospital. The risks from this flu strain are too great compared to the relatively minor risks of the vaccine itself.

And remember, other than the thimerosol, this vaccine formulation is exactly the same as a regular flu vaccine. It just has a different strain of flu. The differences are the same as those from the 2007 flu vaccine to the 2008 flu vaccine.

Thank you so much for these last 2 posts. I’ve been worrying about giving my 12 month old and 3 year old the swine flu vaccination . To do? Or not to do? You have helped me to sort things out. Again, thank you!

Reading the comments yesterday made me feel much better about my decision to vaccinate my son (and myself, if H1N1 is available for me) for both. Thanks for starting the discussion.

Wow, you just re-invented the method used by a famous jurist, Learned Hand, to evalute the duty of care required in any act:

[degree of harm] X [likelihood of harm] = [duty of care].

This formula is often used by lawyers and judges in tort cases to determine whether someone was using the proper level of care.

Also, I’m deathly allergic to thimeresol, which used to be used as a preservative in some contact lens solutions. I would have TERRIBLE reactions if I used a solution containing thimeresol.

Nonetheless, even iwth this allergy, I routinely have flu shots that contain thimeresol (I’m too lazy to seek out the thimeresol-free shots), and I have zero adverse reactions. No swelling, no redness, no itching, nothing to indicate that my body reacts negatively to the preservative.

So, FWIW, I wouldn’t worry about the thimeresol.

There was an interesting part of “The Conversation” today on H1N1 Vaccines.

http://www.kuow.org/program.php?current=TC

They are saying that mercury free shots will be available for pregnant women and small children, but not as readily available.

Also, exactly what Kathleen said above, the H1N1 would have just been incorporated into the regular seasonal flu shot for this year had it been widely discovered before April. The H1N1 is like an additional season flu shot. Not using any different procedure or materials than the regular seasonal flu shot which is changed each year.

That said, it is still a tough decision.

It’s a tough decision. At my last staff meeting at work, our staff physician reported that our population outnumbers the amount of vaccines that have been ordered and the most at risk groups will be getting it first. I kinda zoned out and don’t remember who goes first, it was a long presentation. So it might be a while before we can get it.

I don’t think I will be getting it for my kids or myself. I work in a hospital but do not have direct patient contact. While it’s worrisome, I think there are worse things to worry about. That’s motherhood, right. Constant worry.

Thimerosol = mercury. We don’t EAT mercury. Why would it be safe to inject it, especially in pregnant women and infants? The Canadian study is right on, by the way. The worst that could happen? You die. Or your kid dies. Either way. But I’ll take my chances with the flu, because the OTHER worst that could happen is neurological damage. As it already has, in the case of MY kid. Who makes weird noises in class, even though he is smarter than most kids in his class. Who acts “weird.” The other kids will call him “RETARD.” He’s beautiful and bright and brilliant, and the stupid flu shot stole my beautiful bright brilliant baby and took his potential away from him, and from us. I’d rather have the flu. I have asthma, allergies. I’ve had pneumonia several times. And I think it’s BECAUSE vaccines got my immune sytem going, and it doesn’t know, now, how to turn itself off. Research “excitotoxins.” And ask yourself, why is it that no vaccine manufacturers or board members of the American Association of Pediatrics will take Jock Doubleday up on his monetary offer, up to $215,000 now, if vaccine ingredients are so safe. http://www.spontaneouscreation.org/SC/VaccineOffer.htm

I would just like to say that if you’ve had a tuna fish sandwich lately (or any fish, really) you have indeed eaten mercury.

OMG, just reading this made me PANIC! My 10 mo. old has her well baby appt. on Thursday and I was planning on having her get the seasonal flu shot until I just read Linda’s last comment…EFF!

The trouble with these sorts of decision is that there’s no right answer. It’s not like other parenting decisions. We know we shouldn’t beat our children because that’s wrong, so we don’t.

But the vaccine thing. Is it the right decision? Maybe. Is it the wrong decision? Could be.

Motherhood really just means “Second-guessing yourself on every single freaking decision, even after it’s been made. For the REST OF YOUR LIFE. The end.”

First, my thoughts about the Canadian study you referenced: considering that’s only one study, a study that has yet to be published or peer reviewed, I’m not ready to put too much stock in it just yet.

As for the vaccine, I worry about side effects for it the same way I do about all vaccines. But worry or not, I give my kids the regular seasonal flu vaccine every year. Considering that the H1N1 flu is presenting more complications for kids than seasonal flu typically does, how can I not vaccinate for it if I believe that the vaccine is as safe as the seasonal one?

I think it should be noted that the Canadian study is still under review, and the results haven’t even been formally published. Though the results are definitely of the “holyshit” variety, it seems that there might only be a correlation between getting the seasonal flu shot and contracting H1N1 and no actual causation. There’s definitely a likelihood for study bias, in that the folks seeking out the seasonal flu shot were a more predisposed population (lower immune systems, etc…) to begin with.

You know, just offering more information to further muddy the decision-making waters.

Linda, please let us know, not that it’s any of our business, but we will worry with you…

Callie, as a reference, the H1N1 vaccine has 25,000 times the amount of mercury in your tuna sandwich.

as a pediatric nurse practitioner, i feel like i should weigh in on this subject a little bit.

first off, i commend you guys on being such responsible parents and educating yourselves to make the best decisions for you and your families. [thats not the case with most of my patients, so i always appreciate this and feel you should all be commended.]

as an adult providing direct, hands on care in a children’s hospital where it is required, i will personally get vaccinated. ive already received this years flu shot (didnt get sick!) and will receive the h1n1 when it is available. like most health care professionals, its my responsibility to provide the safest care to my patients possible and me being vaccinated requires that.

as for my patients, i am especially recommending both flu vaccinations for high risk patients (ex-preemies/nicu babies, asthmatics, etc). those are truly the patients at risk of negative outcomes from having the flu and in my eyes, the risks of vaccination far outweigh the benefits. all of the children i have seen get REALLY sick (and yes, die) from the flu are the ones that werent healthy to begin with.

im recommending all adults get vaccinated, as the negative effects of the vaccination are much less of an issue, and by vaccinating adults kids are therefore much less likely to get the illness.

with non-high-risk kids, its a bit more tricky. in general, i recommend parents go with their gut. the cdc website, as listed above, is a great source of information. (i use it all the time!) everything has pros and cons, and those 4 questions listed by linda are an excellent decision making tool. (i might even use that with some of my families!)

i also feel i should make this disclosure: as a medical professional, i am generally pro-vaccination. i understand the concerns and issues surrounding vaccinations, and i feel it is important to understand all sides of the issue. i hope each of you is able to work with a care provider who listens and addresses your concerns in a competent and caring manner.

********************

and on a totally unrelated note: linda, have you seen “californication,” with david duchovny? check it out. i think you might love it. its filled with excellent writing, brilliant acting by duchovny (who is also HOT), absurd sex scenes and loads of potty humor, all while still maintaining a heart of gold. worth the add to the netflix queue.

Oh, man, the BC suspension is premature. The “study” in question is not only unpublished but unreviewed! That’s not good public health praxis. Gah.

I don’t usually have myself or anyone in my family get the flu shot, but this year is a little different. I’ve recommended to my husband that he get the regular flu shot when it becomes available because he rides the commuter train twice a day — not everyone who rides makes a habit of personal cleanliness, let alone take steps to keep from spreading germs. Since the H1N1 virus is known to be more deadly for children, I plan on vaccinating them both (they are 7 and 4) when it becomes available, as one is in elementary school and the other attends preschool, and there have been local cases of H1N1 already. The link between vaccines and autism is scientifically rather thin — the chance that a vaccine will cause neurological problems is considerably less than the chance one or both of my children will be exposed to H1N1, so it’s a chance I’ve decided is worth the risk. I will probably not be vaccinated myself as actually I am a SAHM with a very, very, VERY boring life consisting mostly of preschool pickups and attempting to find the bottom of my laundry basket (I’ve determined that it may actually be bottomless). My main risk of infection comes from my husband and children.

Wait, wait, WAIT: the Brontosaurus is actually an Apatosaurus?? When did that happen?

And then there are stories like this that make one go “holy shit!”
http://tinyurl.com/yd2bw6v

“Callie, as a reference, the H1N1 vaccine has 25,000 times the amount of mercury in your tuna sandwich.”

This is all sorts of wrong. An average can of tuna contains 20.4 mcg of mercury while an average dose of flu vaccine with thimersol contains 25 mcg of mercury. Very similar amounts. The pediatric dose only contains 0.5 mcg of mercury.

I know what you mean about that gut feeling. I had it with one of my daughters, not the other one. It’s been proven that some kids have a higher susceptibility to neurological problems caused by vaccine ingredients. (And this is mainstream research, not some wacko weirdo source.) I had a feeling my daughter was “on the line” neurologically and I shouldn’t do anything that might push her over that line. It would suck to find out the hard way that my gut was right. So I postponed all vaccines and then only got the most important ones – no flu shots.

Flu, swine or otherwise, is only very rarely “serious.” But neurological problems – I’ve seen them literally destroy lives, and also create a need for lifelong intensive therapy just to get to basic functioning. No thanks. I’ll risk the flu.

I hate to mention this, but given the information shown on this chart at the CDC – http://cdc.gov/h1n1flu/updates/international/map.htm – getting the seasonal flu shot seems pretty much worthless, since 99% of all flu being diagnosed in the U.S. is H1N1, not the seasonal flu.

And to get an idea of how much flu is going around – this guy’s hospital is running out of pediatric liquid Tamiflu (http://twitter.com/setonh1n1) and they had 353 patients show up at the ER today, 70% of whom had H1N1; this pediatric intensive care doc says 1/4 of his PICU patients are H1N1 cases (http://twitter.com/Jalbietz); and this chart shows how fast the influenza-like illnesses are growing this year compared to the previous two years (http://cdc.gov/h1n1flu/updates/us/#iligraph). That spike you see at the far right? It normally happens in January, not September.

I’m guessing that what my girl has isn’t H1N1, so we will be getting the H1N1 shot…

no advice. just hugs.

I hesitated to comment yesterday because this is an issue that makes the blood boil. But I actually work on this issue. H1N1 response and vaccination. I feel the need to make one comment. The H1N1 vaccine is no different than the seasonal flu shot you give your kids every year. It just incorporates a different virus. Every year’s flu vaccine incorporates 3 strains of virus scientist think will cause the most illness in the next flu season. This virus only includes one virus – H1N1. Otherwise the vaccine is made the exact same way using the exact same materials and processes. Nothing new was added to this vaccine to make is different or special. That’s why we know this vaccine is safe … because we have been giving for decades.

I’m so glad you posted these two posts… it’s been something that I’ve had nagging at the back of my brain. A hard decision for sure. I’ve been going here: http://www.who.int/csr/disease/swineflu/notes/pandemic_influenza_vaccines_20090924/en/index.html for further reading. I feel like the WHO has a slightly different angle than the US.

I have not read all the comments and I’m not sure this one will be particularly useful, but my kids’ doctor, who is extremely conservative, pro-vaccine, etc. is very much on the fence with regard to the H1N1. His take is he can’t make a firm recommendation either way yet and what they are seeing from the H1N1 is incredibly mild – not even treating many cases with Tamiflu. I was all set to give it to my kids based on the guidelines from Sebilius and the conversation with him has definitely made me pause. Our kids have gotten the “regular” flu vaccine, as they do every year but his hesitancy has strongly affected my family’s decision making process on this one and I think that they way we are leaning is towards not getting the vaccine. Hopefully we will make the “right” decision, whatever that is. FWIW, he specifically expressed concern over the fact that this vaccine was so new.

Oh, and I love your writing. Thanks!

My husband works in the field of public health and pandemic preparedness for governments, colleges, and hospitals (he used to work for the state health department, and is now a private consultant, but he is not medical professional so this is a layman’s view). We are getting the seasonal flu vaccine this year and will get the H1N1 vaccine when/if it becomes available for those of us that aren’t high-risk. His (and my) view is that since we are not high-risk, if getting the vaccine may prevent us from coming down with it and potentially spreading it to potentially high-risk people we come into contact with, that is a risk we are definitely prepared to take.

Of course, the vaccine isn’t a magic bullet. He always stresses to his clients the things that seem all “duh” but tend to get lost in the shuffle of the vaccine debate — frequent hand-washing, taking care when sneezing and coughing (elbow!), keeping up with vitamin C, etc. — all promote generally being healthier and being able to fight off virus and infection more easily anyway. And he also recommends a bit of planning ahead — not to go all building a bunker or anything, but to try to keep a good stock of pantry and household staples on hand if you can so that you don’t *have* to be out and about as much interacting with the masses if there’s an outbreak in your area.

We don’t have kids, so we aren’t having to make the decision *for* someone and I know that’s got to be hard. I hesitate to even say this because ultimately I *can* see both sides; my gut feeling is that it’s more socially responsible to be vaccinated, but that is simply my personal opinion, we don’t face compromised immunity anyway, and again, I have no frame of reference for how I’d feel if I were faced with having to make the decision for my kids — I could very well feel differently about it.

Best of luck — there’s certainly a lot of information out there. I’m just glad to see people discussing it calmly and intelligently!

Coming from someone who just got back to work today after being out with the swine flu for two weeks, DO IT. I would hate to see a child have a fever that bounces from 100.5 to 102.8 for 13 days. NO FUN!

I just wanted to thank you for providing a forum (that I can relate to) for this discussion, for carefully reading all the comments you got yesterday and for summing ’em up today. For me, the pendulum is still swinging, but it may come down to my own laziness. Our God damned pediatricians office is to fucking far away to go to for my two kids to get two shots each. Now, if it were Black Plague vaccine or leprosy cure, well that’s another story…

I didn’t have time to comment on yesterday’s post, and don’t have time to read the comments now.

Just to provide you with a reliable source of information I am giving you this link,
http://csuplibrary.wordpress.com/2009/09/30/free-evidence-based-influenza-information-from-ebsco/ which is to a post I just wrote on my library’s blog to give our campus community a reliable source of information about H1N1. I hope you find it useful.

Julie

The story you just cited about the girl dying after the HPV vaccine almost perfectly illustrates how effed up the media is when it comes to covering science/medical issues. And it ties into what I said the other day about people’s flawed, post hoc reasoning about alleged “effects” of vaccinations — just because the media reports that something happened after someone got a vaccine doesn’t mean that the vaccine caused whatever happened. Rarely does the lede include pertinent information such as the person’s underlying condition or anything at all, really, other than SCARY ASS SHIT.

The release of the unpublished, unreviewed Canadian study by the media is equally irresponsible. The study doesn’t prove anything at all, least of all causation between the seasonal flu shot and contracting H1N1.

I think to the extent possible, people should rely on information provided by the CDC (and their own doctors), because clearly the media isn’t going to do much but inflame fears and misinform the public. Grah!

OMG. This is making me so stressed out. Information overload! Please figure it out for all of us and we will just follow your lead. ;-)

i’m not getting my daughter vaccinated for the H1N1 virus, for the same reasons that I may not get her vaccinated for HPV. it’s too new, and because of that i don’t trust it.

i have friends that are nurses who refuse to get the H1N1 shot basically for the same reason. the research isn’t there yet to show just how well it will work.

i think my favorite quote that i’ve heard concerning swine flu is this.

“90 people get swine flu, everyone wants to wear a mask. millions of people have HIV and no one wants to wear a condom”.

it kinda goes to show just how much the media has built up the whole thing.

I had a lengthy discussion with my father (an anesthesiologist) about H1N1, and here’s the thing… statistically the people who have died from H1N1 have been otherwise healthy children and adults, because it is not the virus itself that kills, it is the body’s immuno-response to the virus, i.e., people who are otherwise healthy, might have an immune system that kicks into overdrive, causing H1N1 symptoms that can result in death (like having your lungs fill with mucous, congestive heart failure, seizure inducing fever, among other things).

I’ll take my chances with a vaccine, over that virus any day of the week. I know several people who have had H1N1 with no complications, but I’d rather not be one of the people who does!

Oh, and I don’t know if it has been mentioned in the comments yet, but the Flumist nasal spray seasonal flu vaccine does not contain Thimerosal. It is available in limited quantities, but many doctors offer it at this time of year on a first-come first-served basis. There is also a Thimerosal-free injected flu vaccine available that is reserved for children under the age of 2 and also pregnant women (although I had no luck finding it last winter when I was pregnant!)

I’m happy you posted about this. I am SO torn about what I will do (I’m 12.5 weeks pregnant) and it helps to hear so many stories from people in my position. Although it also makes it harder because the stories are so conflicting.

Like you my gut tells me to just be careful, wash my hands, consume vitamin C – but what if I’m one of the unlucky ones who contracts the virus and has a worst case scenario? I was pregnant last year and had a regular flu shot at 6 weeks. It is most likely a coincidence, but my baby stopped growing at 6 weeks. Whether or not the two were linked I will never know for certain.

I wish there was an option C) Crawl into a hole and emerge in April when my baby is due.

Anna, I am so sorry. I hope you have a really wonderful doctor right now who can help you decide.

I’ve never gotten a flu shot and won’t now. A friend of my mother’s died from a flu shot years ago – it’s terrified me ever since. She was young, healthy, with 2 young kids. It took her and her family by surprise – at least with the flu you have time to say good-bye (so morbid, I know!). I just can’t get over the story from a personal standpoint – so I’m anti-vaccine…