Experts Answered Your Questions on the H1N1 Flu Vaccine

DR. WILLIAM SCHAFFNER: Well, the virus itself has been extraordinarily stable, genetically and this is somewhat different than regular seasonal influenza vaccine where when we create the vaccine, it's an educated inference about which strains actually will be circulating when we use the vaccine. But the H1N1 virus itself has been extraordinarily stable so we've made a vaccine that should be an absolute bulls-eye right on target with this virus that we're trying to prevent.

DR. CAROL BAKER: If I can just add, we do an amount of educated guessing each year in making our seasonal influenza vaccine and I think many of your listeners have heard about years where there's a good match, years when there's not as good a match. But here, that we know the virus; it's been stable as Dr. Schaffner says, so it's a perfect match. And in perfect match years, you should get at least 90 percent protection or better.

BETTY ANN BOWSER: Our next question comes from Karen in Gore, Va.: "My 6-year-old daughter had flu symptoms last week. I kept her at home and she recovered within a few days. My 10-month-old son then got sick and I took him to the doctor. He tested positive for the flu, so the doctor could not say for certain that it was H1N1. He, too, has recovered. Since both of them may have had H1N1, do I still need to get them vaccinated? And what about vaccinations for seasonal flu?"

DR. CAROL BAKER: So let me - I'll start with this one. Let's take the second part first. Seasonal influenza has - the epidemic has not begun and whether they've had H1N1 or not, that's certainly not going to protect them from seasonal viruses.

So the answer to the second part of the question is absolutely go and get both of your children immunized, especially the young one is in the group for seasonal influenza that has the highest rate of hospitalization among children. In fact, the rate of hospitalization is very similar to that of seasonal influenza hospitalization in the elderly.

So both children need to be vaccinated for seasonal influenza, if they haven't already been. And the little one, for sure, I know has not been vaccinated so that will require two doses, a minimum of four weeks apart. So you've got plenty of time to do that. Usually, seasonal flue doesn't come until about December and certainly lasts into the spring, so get that done.

A second thing to the listener, congratulations for keeping your children at home, which is advice that is very wise to limit the spread. Whether you go to an emergency room or a doctor's office, you certainly can spread the flu to susceptible - so now, I'm talking about the H1N1 virus. Even if you tested positive, most people are recommending, especially in your youngest child, that they go ahead and get immunization if they can.

It is possible that both of your children had H1N1 and are protected. But because this is so severe in the pediatric age group in terms of hospitalizations and even some deaths, it's recommended that they be immunized, both of them.

BETTY ANN BOWSER: What can you tell us about why this - the virus has - seems to have a knack for attacking young people?

DR. CAROL BAKER: Bill?

DR. WILLIAM SCHAFFNER: Yeah, thanks, Carol. What's occurred is on the seam, a new influenza virus has come along and that means that the substantial majority of the population is completely susceptible because this virus doesn't really resemble other influenza viruses that have been circulated.

And so the younger part of our population is completely vulnerable to this virus and that's why it's spreading so widely and can cause serious illness for some individuals. Now, older people seem to have a bit of protection, particularly those who about 60 and older. And that's because back in the 1950s, it's very likely that they encountered a virus that was genetically similar to this virus.

They became infected, developed some protection and that protection has maintained itself. So here, we have the flipside of what usually happens with regular seasonal influenza, which preferentially causes damage, if you will, serious illness among people who are older - 65 and older. This time, with the H1N1, this virus is spreading among the younger population.

DR. CAROL BAKER: Well, we're very fortunate that there are two ways of being vaccinated and I'm speaking in general. We have both the seasonal and H1N1 viruses that can be inhaled or be injected. So in general, children really love the inhaled - or the nasal spray because it's not a shot. By contrast, surveys have indicated that adults aren't too crazy about having something put in their nose.

Now, let's go back to the question of which are most effective. When you're talking about seasonal influenza, each of them are quite effective. But again, if you look at studies that compare children and adults with the seasonal nasal spray, the nasal spray seems to be a little more effective in children than it is in adults. And the answer to why that may be is very similar to Dr. Schaffner's previous answer.

Adults have seen many of the seasonal viruses in the past. Their immune system - they may have been infected, sick or not and their immune systems have made some immunity to the seasonal viruses. So the reason that it may be more effective in children - the nasal spray is more effective in children - is that children have never seen the seasonal viruses, certainly as much as adults.

But I want to say in general, both are effective whether you're talking seasonal of H1N1. Now, with the H1N1, as Dr. Schaffner said earlier, the entire population is susceptible with the possible exception of those over 60 years of age. So again, I think given the delay in vaccine delivery and the fact that the nasal spray went out first.

Certainly, if I was judging for myself, I would take - I don't like anything put in my nose either so I'm a typical adult, but I certainly would take protection by either route and take the vaccine that is available first.

BETTY ANN BOWSER: Our next question is from Nancy in Pittsburgh, Pa., and she wants to know how long is it from the time the vaccine is given until it becomes effective and provides immunity?

DR. WILLIAM SCHAFFNER: Well, what we usually stay is 10 days to two weeks for the body to develop the protection that is initiated once you get the vaccine. Now, young children under the age of nine will require two doses, so it'll take - separated by four weeks - so it'll take them a little bit longer - all the more reason to get them vaccinated promptly, both against seasonal influenza and H1N1.

BETTY ANN BOWSER: And let me ask you a question. This is not from a viewer; this is from me. Why do children require two vaccinations?

DR. CAROL BAKER: Well, the first vaccine dose is to get the immune system ready to be protected. We call that priming. It's sort of like you need one kind of fuel to launch the first part of the rocket and a second kind of fuel to get it into the atmosphere. So it's to get the immune system in children who've never seen the vaccine proteins before ready to respond with the second dose. The first dose won't do it.

BETTY ANN BOWSER: Do you think a lot of parents know this?

DR. CAROL BAKER: I hope so. I hope - if there's any question in their mind about their children, they certainly should contact their health-care provider to understand. But if you've only received one dose in the past and you're under 9 years of age or if you're someone who has received no doses in the past and again, you're under 9 years of age, you need two doses to be protected. One dose won't do it. But the H1N1 in children in that young group, it's very easy. No one's ever been immunized before so they all need two doses. Fortunately, the adults only need one.

BETTY ANN BOWSER: Do you worry that because it's so hard to get Americans just to get vaccinated for seasonal flu and now you're talking seasonal flue and H1N1 and with H1N1, kids require two doses?

DR. WILLIAM SCHAFFNER: Well, what's happened according to surveys is that the population seems to be divided into two groups, perhaps almost equally. There are the folks who've paid a lot of attention and they're largely the early acceptors. They're very ready to go the extra mile and get themselves and their children vaccinated.

And then there's the other part of the population that's a bit more skeptical or hasn't paid that much attention to the details so we're still having to do Vaccination 101, as it were. And so we need to give them more information and reassurance to bring them along.

DR. CAROL BAKER: But in the group that wants more information and will not accept vaccination, they're really gambling with their children's lives. I say that as a pediatrician. We don't know why those normal healthy children who have already died - we don't know why they had such severe disease. Yes, the H1N1 virus has been pretty mild, when you're talking about a pandemic virus. But it's still killing people.

DR. WILLIAM SCHAFFNER: You know, my friend Carol has been so eloquent at - excuse me - in a number of meetings talking about how a child, a healthy child, can be symptomatic with the influenza virus illness early in the morning and by the evening, already be so - in such dire straits that they have to be admitted to an intensive care unit and receive - and receive support for their grieving.

We just - about three weeks ago, had a healthy 5-year-old come to our pediatric emergency room and I'm afraid died in the emergency room. Vaccination is the only way to really prevent this.

DR. CAROL BAKER: And I think that's a really good question because many parents think if their child is healthy, that they are not going to have severe influenza disease. While there's no question that the risk is greater in children who have underlying health conditions such as asthma, but even with seasonal flu, we have somewhere between 70 and 80 deaths every year from seasonal influenza. And if it's your child, it's everyone.

And I've had children every year - I practice in a large pediatric hospital - die of seasonal influenza. And now we're having children who are perfectly healthy dying of H1N1 influenza. And the parents always say, well, why? And I don't know the answer to the question, why this particular healthy child was afflicted so severely, but I do know the answer to prevention: Vaccination is the best way to protect all of our children against seasonal and H1N1 virus.

DR. WILLIAM SCHAFFNER: Betty Ann, let's make it very clear: You asked what are parents aware of. I think many are not aware that for at least 5 years the CDC's advisory committee on immunization practices and the American Academy of Pediatrics and other groups have recommended that all children, all of them from age six months up to 18 years of age be vaccinated annually against influenza. Very comprehensive recommendation.

DR. WILLIAM SCHAFFNER: Well, I think there are a couple of things that Jane can do. The first is practice very good hygiene: Hand-washing, repeatedly, is very useful in helping to reduce the risk of acquiring influenza, whether seasonal or H1N1. Another thing that she might consider doing is what we call, quote, quote, "social distancing," namely trying to avoid crowds as much as possible. As I like to quip, this may be the time to rent the movie rather than going to the movie. Jane will have to decide whether she wants to go to religious services, whether she wants to go to the football game, go to a concert and things of that nature or whether she ought to be a little bit more distant.

Another thing she can do is have a very tight relationship with her health-care provider such that if she is knowingly exposed to someone with H1N1 or seasonal influenza to call that health-care provider who might suggest that, given her circumstances, she receive some antiviral medication as a preventive or, at the very least, the moment she gets sick, to call the health-care provider so that appropriate treatment can be provided.

BETTY ANN BOWSER: The next question is from Rebecca in Walnut Creek, Calif. This is a really good one. She is pregnant and she has asthma: "I want an H1N1 vaccine, but am only able to find one containing mercury. Doctors in my area have ordered the mercury-free shots, but have no idea when they will or if they will come in. I also have a 2-year-old and would like one for him. How safe is the mercury shot for second-trimester pregnancy and for 26-month-old toddler?

DR. CAROL BAKER: So let me take this one, Bill, because we get this question a lot from - not pregnant women, but certainly mothers. Let's talk about the toddler first. If she is unable to get the preservative-free vaccine, the pediatric preservative-free vaccine than definitely the risk of H1N1 - because the epidemic is here right now - is greater than any potential risk from mercury. Scientific studies have excluded mercury as a harmful product for young children. I know some people are still concerned about it. When we have plenty of mercury-free vaccine, great, but the preservative is a completely different thing than the mercury that we all eat - well, at least fish-eaters eat. It should be of no risk to that child.

If you can get preservative-free vaccine, great, but don't hesitate when we're in a situation where we don't have enough H1N1 vaccine. If you've got something that has got the preservative in it, go ahead and get your child protected. Again, you don't want to gamble with your own child's life.

With regard to pregnant women, same thing: The studies have - scientific studies, more than 20 of them have shown that the preservative in the flu vaccine is not harmful to anyone. So I would use the same rationale. If you're in the second trimester of pregnancy, you're getting towards the time when your lung function is abnormal. And that's why pregnant women are so vulnerable. Six percent of our deaths so far have been in pregnant women. So I would worry a lot more about H1N1 virus than I would about the preservative in the vaccine.

So I hope you heed my advice. Actually, what I hope for you is that you don't get seasonal or H1N1 influenza. But don't gamble; don't take a chance with your own life or with your child's life. Some of the pregnant women that have contracted the H1N1 virus, actually their lives have been saved with intensive care, but they have lost their babies.

BETTY ANN BOWSER: What can you tell us - again, this is my question - about when vaccine is going to be available? I was at a clinic in Rockville, Maryland, last week. There were 2,000 people, a lot of pregnant women. They had 249 doses of the injectable. It was gone in the first hour-and-a-half after they opened. And people were just kind of frantic about what are they going to do if they can't get more vaccine?

DR. CAROL BAKER: I'll let Dr. Schaffner answer the question. But I'm excited that people were there trying to get it. I know it's frustrating, but I'm excited that so many people turned out.

DR. WILLIAM SCHAFFNER: As am I. I'm very pleased with that. And we're all eager to receive the vaccine and a little bit frustrated that more hasn't yet arrived. I don't think we need to go into why that is. It has been a lethargic virus growing in eggs, largely. But, nonetheless, more H1N1 vaccine will be shipped to state health departments and from those locations to the providers in every state over time, continuing well into November and into December and maybe even beyond.

It is true; all of us will have to pay a little bit more attention, make a few more efforts in order to be aware when the vaccine is available. And I dare say the local media - newspaper and television stations - will make announcements when new vaccine shipments have arrived in your neck of the woods.

BETTY ANN BOWSER: Is it possible that the H1N1 could have run its course before enough vaccine is available?

DR. WILLIAM SCHAFFNER: Personally I think that that's unlikely. We have such an extraordinarily susceptible population. And throughout the United States, this virus has not been equally active in every community; it's in every community, virtually, now, and it's spreading more or less rapidly. Even in our own community here in Nashville in the Southeast, we were hit early and hard with H1N1 once the fall began. I know it hasn't gotten into some populations.

For example, it's been in our children a lot, but we have several colleges in town and they have been only minimally affected. They are susceptible young adults. I view that as tinder waiting for a spark. So I hope the vaccine gets here in time to protect them.