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FAQ: Swine Flu Vaccines Arrive In Mass., But Not Cases

Swine flu vaccinations are underway in Massachusetts, but so far there aren’t nearly as many suspected H1N1 cases this fall as there were in the spring. Still, public health officials aren’t letting their guards down. The state will continue getting vaccine shipments through the winter. And in communities statewide, plans to set up clinics are in the works.

Asia Johnson, 6, of Boston, receives an intranasal H1N1 vaccine at the primary care clinic at Children's Hospital on Friday. (Lisa Poole/AP)

Asia Johnson, 6, of Boston, receives an intranasal H1N1 vaccine at the primary care clinic at Children's Hospital on Friday. (Lisa Poole/AP)

How widespread is H1N1 in Massachusetts as of mid-October?

Not widespread at all, actually. In other parts of the U.S., the number of suspected H1N1 cases is higher than in New England. But the Boston area has been largely spared so far this fall. For example, in the first week of October, the city of Boston had a total of only eight new flu cases. Those are suspected — not confirmed — H1N1 cases, because the state is no longer testing for the type of flu. But doctors assume that most cases occurring now are H1N1.

“What we’re seeing are very small numbers of influenza cases in Boston at this point. None of them are hospitalized. We track visits at university health centers; they’re not at a very high level. We track visits at the school nurses’ offices; they’re not at a very high level.”

–Dr. Anita Barry, Boston Public Health Commission’s Infectious Disease Bureau

Why are there so many fewer H1N1 cases this fall, especially considering that last spring some schools had 20 percent absenteeism rates because of swine flu?

The medical community doesn’t know for sure, since there’s still a lot of mystery surrounding H1N1. But there are two prevailing theories. One is that this is the calm before the storm. The other is that so many people in the Boston area were infected with H1N1 last spring that there’s now widespread immunity in the region. That’s because once someone has been infected with a particular strain of flu, they develop a resistance to that strain and won’t get sick from it again.

“It could be that the virus just hasn’t hit our area yet. I think an explanation that people are hoping for is that there was so much illness in the community last year that we have a lot of immunity in the population to the 2009 H1N1 virus.”

–Dr. Anita Barry, Boston Public Health Commission

If swine flu hasn’t hit our area yet, then when will the H1N1 season get into high gear?

The typical flu season really kicks in in December, or sometimes in late November. But the flu doesn’t follow a fixed schedule, so public health professionals can’t be sure when H1N1 might start spreading more widely — if that even ends up happening. That’s why the medical community recommends that people get vaccinated for both seasonal flu and H1N1.

“Some years in Boston we’ve seen peak right around Christmastime just to ruin people’s holidays, I think. Sometimes we haven’t seen the peak until February. You really can’t predict with influenza viruses. They are totally unpredictable.”

–Dr. Anita Barry, Boston Public Health Commission

The intranasal H1N1 vaccine is displayed at the primary care clinic at Children's Hospital Boston. (Lisa Poole/AP)

The intranasal H1N1 vaccine is displayed at the primary care clinic at Children's Hospital Boston. (Lisa Poole/AP)

Can anyone in Massachusetts get the H1N1 vaccine right away?

No. So far, only clinical settings such as hospitals are getting the vaccine, and they’re vaccinating priority groups, including health workers, pregnant women, and anyone between six months old and 24 years old. The general public’s turn will come after those higher-risk groups have been widely vaccinated.

When will Massachusetts begin holding large H1N1 vaccination clinics?

Most likely in mid-November, since that’s when local boards of health and other public health care providers should have enough of the H1N1 vaccine to hold big, free clinics.

Are clinic organizers worried that turnout will be low because of concerns some people have about the safety of the H1N1 vaccine?

Hard to say, since clinics aren’t being held yet. But most public health professionals say the H1N1 vaccine is safe because it’s being manufactured the same way that past vaccines have been made. And if Cambridge is any guide, a seasonal flu clinic recently held there had a 50 percent increase in attendance over last year, which seems to indicate a high interest in the flu vaccine this fall.

“What I explain to people is every year the seasonal flu vaccine is made up of three different new strains of influenza that have been circulating in the world, and we didn’t have time to put this new H1N1 into this year’s seasonal flu. So now we’re rolling it out as separate shot. But it’s really no different from the seasonal flu vaccine.”

–Louise Rice, senior director of public health nursing, Cambridge Public Health Department

Should I get a flu vaccine even if I don’t usually get the flu?

Health care workers are urging even people who usually don’t get the flu to be vaccinated, because the resulting immunity will safeguard not only the individuals who were vaccinated, but also other people by limiting the spread of the virus.

“People used to say, ‘Oh, I never get the flu, so I’m not at risk or I don’t need it.’ But the message that we send out is that you’re not necessarily getting the shot for yourself — you’re getting it to protect the people around you. And I think that message has begun to resonate.”

–Louise Rice, Cambridge Public Health Department

If I want the flu vaccine, do I have to get a shot?

Possibly. The early shipments of the H1N1 vaccine were mostly a nasal spray called FluMist, but that isn’t approved for everyone, including pregnant women, people with respiratory problems such as asthma, and people with underlying medical problems such as heart disease or diabetes. So an injectable version of the vaccine is arriving in the state, too.

Do I need two doses of the H1N1 vaccine to be fully vaccinated?

Not necessarily. Public health officials initially said the H1N1 vaccine would require two doses, but officials now say full vaccination is possible with a single dose. Children age 9 and under need two doses, however. And infants under six months old should not be vaccinated because they are at higher risk of flu-related complications.

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  • karen ancas

    This photo (of the young African American girl getting a nasal vaccine) scares me since there is much controversy among credible sources to say that the vaccine is dangerous.

  • Anjanika Walker

    My daughter recently recovered from Influenza A. The nurses, doctors and lab seem to believe it was H1N1. Since, it was not tested for H1N1, I don’t know conclusively that it was H1N1. In this kind of circumstance should I still get my daughter vaccinated against H1N1?

  • Birol Bircan

    are you recommending a trip to bangkok (thailand) at the end of december 2009 under swine flu circumstances

  • Jessie Bennett

    Karen– If you could link to the “credible sources,” your statement would be more helpful. As it is, if only Dr. Sears and his ilk are scared of the vaccine, I’ll certainly be getting it for myself and my son. I am pregnant and asthmatic, and the risks of the illness are real, whereas the general discomfort people have with vaccines is often amorphous and based on fear rather than fact.

  • http://www.wbur.org Sacha Pfeiffer

    Hi — Sacha Pfeiffer here from WBUR, logging in to answer your various questions about the H1N1 swine flu. Thanks for all the feedback. It’s important to remember that your first source of information about H1N1 should be your primary care physician. You can also go the CDC’s Web site, which has a wide-ranging Q&A section on H1N1 at http://www.cdc.gov/h1n1flu/.

    To briefly address the individual questions posted here so far:

    Karen, regarding your concerns about the safety of the H1N1 vaccine, I can only reiterate that most health care professionals say the H1N1 vaccine is as safe as seasonal flu vaccines. In addition, the CDC and FDA will be closely monitoring vaccinations for any problems.

    Anjanika, regarding your question about whether to get your daughter vaccinated for H1N1 even though you suspect she may already have had swine flu in the spring: a specific test is required to know if a person has already been infected with H1N1, and that type of testing is rarely happening now. So if you choose to err on the side of caution and get your daughter vaccinated, the vaccine should not be harmful, according to the CDC.

    Birol, regarding whether traveling to Bangkok is advisable given the H1N1 situation, I recommend you check out the “H1N1 Flu and Travel” section on the CDC’s Web site at http://wwwnc.cdc.gov/travel/content/novel-h1n1-flu.aspx.

  • Marc

    On point had a show in August http://www.onpointradio.org/2009/08/swine-flus-big-return about H1N1 . I called in asking about traveling and a doctor on the show said I should take my trips (Mexico and Spain) and that I was no more likely to get it there than here. In a curious twist, Bill Frist was arguing in favor of the vaccine and Bill Maher was arguing against it on Friday’s Real Time. I believe it is safe and intend to get it.

  • novaccine4me

    A friend’s son was recently in the hospital in a major metropolitan city with appendicitis, and asked the nurse how many cases of swine flu had been seen at the hospital, and was shocked to hear “none.” Over the next several days she asked the different nurses how many cases and each nurse confirmed that there had been no cases. Since all we have heard over the past few months has been that there is a raging epidemic and that it is having a more serious effect on children, she was very interested to hear there had been no hospitalizations. On her last day at the hospital, the nurse seemed in a hurry to get them out of the room, and when asked why, the nurse said there were a lot of very sick children. When asked what they were sick with, the nurse replied “asthma.”

    I recalled reading about two studies that were never written about in any major newspaper in the US, but which were very significant. One, “Childhood asthma is reduced by half when the first dose of diphtheria, pertussis, and tetanus (DPT) is delayed by more than 2 months vs given during the recommended period, according to the results of a retrospective longitudinal study reported in the March issue of the Journal of Allergy & Clinical Immunology.” This is an extremely important study in light of the chronic, life threatening and expensive nature of asthma. Second, from “ScienceDaily:
    Children Who Get Flu Vaccine Have Three Times Risk Of Hospitalization For Flu, Study Suggests.” Not only is the flu vaccine not preventing cases of flu in asthma patients, it is associated with vaccinated asthmatics being more likely to be hospitalized than asthmatics who did not receive the flu vaccine. Reporters, please let this be a call to you to end this propaganda campaign and report all the facts having to do with vaccination. These two studies paint a very clear picture about the relationship between vaccination and chronic illness, and there are many other studies, which can be easily found with a few strokes of a keyboard.

    According to the Asthma and Allergy Foundation of America:
    * Asthma accounts for one-quarter of all emergency room visits in the U.S. each year, with 2 million emergency room visits. [7] (This epidemic dwarfs the swine flu epidemic)
    * Each year, asthma accounts for more than 10 million outpatient visits and 500,000 hospitalizations. [8]
    * The average length of stay (LOS) for asthma hospitalizations is 3 days. [9]
    * Nearly half (44%) of all asthma hospitalizations are for children. [10]
    * Asthma is the third-ranking cause of hospitalization children. [11]
    * Asthma is the #1 cause of school absenteeism among children accounting for more than 14 million total missed days of school. [12]
    * African Americans are three times more likely to be hospitalized from asthma. [13]

    * Each day 11 Americans die from asthma. There are more than 4,000 deaths due to asthma each year, many of which are avoidable with proper treatment and care. In addition, asthma is indicated as “contributing factor” for nearly 7,000 other deaths each year. [14]
    * Since 1980 asthma death rates overall have increased more than 50% among all genders, age groups and ethnic groups. The death rate for children under 19 years old has increased by nearly 80% percent since 1980. [15] (22 doses of childhood vaccines recommended from birth to age 6 in 1983 – 48 doses of childhood vaccines by the age of 6 recommended in 2009 – not including swine flu vaccine)
    * More females die of asthma than males, and women account for nearly 65% of asthma deaths overall. [16]
    * African Americans are three times more likely to die from asthma. African American Women have the highest asthma mortality rate of all groups, more than 2.5 times higher than Caucasian women. [17]

    There is no action without an equal and opposite reaction. In the effort to prevent all experience with infectious disease, children are becoming immunologically and neurologically poisoned and have developed high rates of chronic illness and disability. Reporters, you owe it to this and future generations, to report the facts, not the hype.

  • Diane

    Hi! I am wondering what are we doing to our child’s immune systems by constantly giving all of these vaccines. I understand vaccines have been very positive to decrease diseases and deaths across the US, but for things like the Chicken Pox and the Flu that all of us used to get and the healthy majority would recover from, I have to wonder are we doing more harm than good? Are we breaking down our own immune systems and making these “germs” stronger much like too many antibiotics or antibacterial soaps have been proven to do? Thank you in advance, I look forward to your response!

  • Carly Vernon

    Do you know if any or all of the vaccines contain thimerasol?

  • Diane

    Why are they not testing for the type of Flu any longer?

  • Melissa

    An interesting article in the new Atlantic Monthly questioning the effectiveness of flu vaccines:

    http://www.theatlantic.com/doc/200911/brownlee-h1n1

  • http://www.wbur.org/news/wbur/people/spfeiffer Sacha Pfeiffer

    Hi — Sacha Pfeiffer of WBUR here, back to answer more of your online questions about H1N1. Again, I encourage anyone with questions to go to the H1N1 section of the CDC’s Web site at http://www.cdc.gov/h1n1flu/.

    Carly, you ask about thimerosal, which is a vaccine preservative that contains a small amount of mercury. Most vaccine vials that contain more than one dose do contain thimerosal. Vaccines in single-dose packages contain only trace amounts of thimerosal. You can find more information about thimerosal on the CDC’s website here: http://www.cdc.gov/h1n1flu/vaccination/thimerosal_qa.htm.

    Diane, regarding your question about why flu testing is not happening: the CDC recommends that testing the general public is unnecessary because most flu symptoms are treated the same way, so an H1N1 diagnosis would probably not change how a patient is treated. In Massachusetts, the decision to stop testing was also driven by the presumption that most flu cases cropping up are H1N1, so testing would only confirm the obvious — and would risk overwhelming health care providers.

    However, certain patients should be tested, including pregnant women and people with weakened immune systems, since an H1N1 diagnosis could help their doctors make decisions about their care.

  • Diane

    Hi! I am sending this again in case you missed it or maybe I needed to focus it on the swine flu specifically. I am wondering what are we doing to our child’s immune systems by constantly giving all of these vaccines. I understand vaccines have been very positive to decrease diseases and deaths across the US, but for things like the Flu that require vaccination each year and we used to get the flu and recover, I have to wonder are we doing more harm than good? As I understand it, the swine flu is just another variety of the flu and older individuals may not be getting it from getting exposed at another point in their lives. So, again, are we doing more harm than good by breaking down our own immune systems and making these “germs” stronger by not having our immune system fight it off naturally. Thank you in advance, I look forward to your response!

  • Renee Masiello

    I am trying to find out how people on the priority list can get the H1N1 vacc. I am pregnant and primary care doc’s office knows nothing, keep calling back they say, and then they can not even tell me, if they are getting a supply of Thimerisol- free vaccs. In addition, at my son’s pedi office, which did just today get 100 shots of the vacc, told me to come down, only to run out. There was seemingly no priority given, questions asked about health status etc. so presumably some of those 100 shots went to non-priority cases.

    Any info on how a pregnant lady can get bumped to the front of the line, somewhere, anywhere, would be helpful.

    Thank you

  • Rachel

    Hello, I currently work at a hospital in hospice palliative care and anticipate having a lot of exposure to the swine flu. Therefore, I plan to get vaccinated. However, I have a severely immune compromised husband (due to being on Remicade for Crohn’s Disease) and I have a two year old at home. My question is this: my husband was told by his PCP that people who get the vaccine through a spray form emit a live form of the virus out of their nostrils for a period of time after being vaccinated. So, even tough the recipient may not come down with the flu, others who are immune compromised around them might. Can anyone advise on how long I should be separated from my husband and son and/or wear a mask until I will no longer be at risk of transmitting a live form of the virus to them? We called the CDC tis evening and they did not know, nor were they able to direct us to someone who could answer this question.

  • K. Dziewisz

    It is important to note that there is a possibility that ten million Americans are carrying a latent version of VMRV virus, now known to be the cause or at least be associated with Chronic Fatigue Syndrome

    See Science Magazine, October 8, 2009.

    Any flu like H1N1 can possibly trigger the latent XMRV and throw you into what I have experienced, the end of my career, and the loss of my entire adult life of 19 years because of CFS. You don’t want to fool around with saying no to your vaccines. They are our way for the time being of dealing with our increasing knowledge of the human immune system.

    CFS affects mostly women. And a minorrity of men. Women who already have CFS should get vaccinated for H1N1 and XMRV. Women who test positive for XMRV in the upcoming weeks and months need to be especially careful since it is not known if it can be transmitted via breast milk.

    I’m not a doctor. But ask yours about this.

    I plan to get my vaccines, even if there are five or six a year, because I am really ill now from CFS.

    Eventually we will wipe out all these viruses and live healthier lives. For those who plan on skipping the H1N1 shots, good luck and stay far away from me.

  • Richard Mandell

    Although the news reports are stating that there have been few new cases of H1N1 Flu, my sense is that new cases have been severely underreported. I believe that both my son and I had the H1N1 flu, but neither of us was ever tested. Even when my son went to the pediatrician, he was never tested, even when he was also finally diagnosed with pneumonia. When doctors are telling us to stay out of circulation when we exhibit flu symptoms, these cases are never reported.

  • Lissa Harris

    I have a 14-month old daughter and am very anxious to get her vaccinated. So far I’ve called two hospitals and the clinic I take her to for regular pediatrician visits. Nobody seems to have any H1N1 vaccine available; nobody knows when they’ll get it. How are these priority groups getting the vaccine?

  • Aaron

    Sacha Pfeiffer – I would not refer people to the CDC website, not long ago they said it was OK to send children who had h1n1 back to school within 24 hours of when the symptoms reside. There are several studies out there that state that people can be contagious for weeks! I know first hand h1n1 is here in MA, I know of a mother and son who are recovering from viral pneumonia from h1n1 (this seems to be a common, see comment from a man above). The doctor said they probably had bronchitis which is a laugh. They had all the symptoms of swine flu!! So, what we have here are lots of people getting sick and doctors misdiagnosing h1n1 for bronchitis and strep throat. h1n1 is here in a big way, if they no longer test and report you just believe that people are not getting sick?

    Read what Richard Mandell commented above, it exactly what I am seeing out here in western MA with friends and neighbors in the last couple weeks:

    “Although the news reports are stating that there have been few new cases of H1N1 Flu, my sense is that new cases have been severely underreported. I believe that both my son and I had the H1N1 flu, but neither of us was ever tested. Even when my son went to the pediatrician, he was never tested, even when he was also finally diagnosed with pneumonia. When doctors are telling us to stay out of circulation when we exhibit flu symptoms, these cases are never reported.”
    Posted by Richard Mandell

    BTW, I called my doctor today, she admitted to this.

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