Health Rights.am

Two Flu Vaccines, Lots of Questions

October 18, 2009 - The annual ritual of fending off the flu is more complicated this fall as Americans weigh getting two vaccines.

The vaccine to fight seasonal flu is already widely available, although some areas have reported supply shortages or delays. But a new vaccine to protect against the H1N1 virus, commonly known as swine flu, is just starting to make its way to schools, public-health departments and doctors’ offices.

Because of an initial limited supply, the first doses of the swine-flu vaccine are earmarked for people with a high risk of getting serious complications from the swine flu and for those at risk of spreading the illness to them.

States have ordered about eight million doses of the H1N1 vaccine so far, with the potential for up to 250 million total doses, depending on demand, says Tom Skinner, spokesman for the federal Centers for Disease Control and Prevention in Atlanta.

Public-health officials say everyone who wants a swine-flu vaccine eventually will be able to get one free. But many people are still wondering if they need to get one or both of the vaccines.

About 88% of the U.S. population falls into a group that the CDC recommends receive the seasonal-flu vaccine. About half of the population fits into a category deemed a high priority for the swine-flu vaccine.

While some cases of the flu involve only several days of misery, others go on to become life-threatening or even fatal. Since the swine flu emerged in the U.S. in April, more than 800 people with symptoms have died, including 28 pregnant women and 86 children, according to the CDC. Most of those children had an underlying condition, but 20% to 30% of them were otherwise healthy. The seasonal flu sends an average of 200,000 Americans to the hospital each year, and 36,000 of them die, according to the CDC.

People who have had flu-like illness recently may think they had swine flu - and that they no longer need a vaccine to prevent it. But there are hundreds of other respiratory viruses circulating with symptoms that often overlap, and people with mild cases of suspected flu aren’t sent for laboratory confirmation of the H1N1 virus, making it impossible to know for sure if they’ve built up immunity, says Greg Poland, director of the vaccine research group at the Mayo Clinic in Rochester, Minn.

“Because there’s no harm in getting the vaccine even if you think you had [swine flu], we err on the side of caution and say you should get the vaccine,” Dr. Poland says.

While vaccination doesn’t confer 100% protection against the flu, it’s still the most effective way to prevent it or mitigate its harm to the body, the CDC says.

Clinical trials of the H1N1 vaccine show it has many of the same side effects as the seasonal-flu vaccine, chiefly a sore arm at the injection site.

The first-priority groups for the swine-flu vaccine are pregnant women, children six months to 24 years old, people who are around children too young to be immunized, health-care workers, and people age 25 to 64 who have underlying chronic medical conditions such as diabetes or asthma.

More people are recommended to be vaccinated against the seasonal flu since it tends to hit the elderly hard as well. About 82 million doses of that vaccine have shipped; manufacturers are expected to produce about 114 million doses total this year, according to the CDC.

People getting the seasonal-flu vaccine should ask about price and insurance coverage. Some employers and health insurers offer discounts or full reimbursement for the vaccine. Medicare recipients can receive it free after satisfying their Part B deductible. Uninsured children can get free vaccines through the federal government’s Vaccines for Children Program.

The swine-flu vaccine, meanwhile is free, though health-care providers may charge an administration fee.

Walgreens stores report a high demand for the seasonal-flu vaccine, says company spokesman Jim Cohn. Walgreens is offering seasonal-flu vaccines seven days a week either by appointment or on a walk-in basis, he says. The cost without insurance or Medicare is $24.99 for the shot and $29.99 for the nasal-spray version. Mr. Cohn suggests calling ahead to make sure a location has a supply and adds that a handful of sites are offering the swine-flu vaccine as well.

For people choosing to get either or both vaccines, the next questions often are: Should I get the shot or the nasal spray? And how far apart should the immunizations be for those getting both vaccines?

Only healthy people ages two to 49 can get the nasal-spray versions of both vaccines. People opting for both vaccines should wait four weeks between the two nasal-spray versions, says the CDC’s Mr. Skinner.

Children ages six months to nine years who have never received a flu vaccine before are recommended to receive two doses of both the H1N1 and seasonal-flu vaccine about a month apart, says Paul Offit, chief of infectious disease at the Children’s Hospital of Philadelphia.

By KRISTEN GERENCHER
WSJ