Tuesday, October 6, 2009

Flu: To vaccinate or not to vaccinate?

I am not an automatic nay-sayer on all vaccines. I think that there are people who are good candidates for vaccination, but others who are not. The decision to vaccinate is up to each person, with the guidance of their care provider.

This flu season I have an interesting dilemma. Should I be vaccinated? Should my daughter? These are separate, yet related questions.

Let's start with me. I'm a healthy woman in my 20s who has never had a flu shot. I'm not currently involved in patient care, but do work in a clinic, and in public venues where I can easily be exposed. So far, not very convincing that I need either shot, but there is a small concern.

The trick is entering my child into the equation. I'm a single mother. If either myself, or my child get sick, there will be missed work. If I get sick, who will watch my active preschooler? Now I'm starting to waiver, after all keeping my daughter healthy is very important to me. Hmmm...let's switch to thinking about my daughter now and see if there's more clarity.

My daughter is a highly active preschooler, who goes to daycare full time and is exposed to children of all age ranges. This puts her at an extremely high risk for contracting and spreading all sorts of illnesses. Some of the children there are under 6 months old and cannot be vaccinated. Their parents are relying on the other children to be immunized to protect their little ones. For the good of society it appears that my child should be vaccinated.

Here comes the problem, my child is immune compromised. She's at a high risk of catching respiratory and GI illnesses. You're thinking duh you should definitely do it. Problem being, immune compromised individuals should not receive flu mist because it contains live virus.

I prefer the live attenuated forms of vaccines. Flu mist provides exposure to the antigens, where the body would normally encounter them. It also provides a wider variety of antigens than the shot usually does, which makes it better able to protect people during antigenic drift. Since the virus is live, many of the questionable vaccine additives aren't used as they would inactivate the virus. Of course, live virus poses a very remote risk of reversion to the wild type, or infection with the weakened form (like has been seen with Polio.) I should avoid using the live form myself, to limit my chance of passing on the attenuated form of the virus to my daughter.

So my daughter could be vaccinated with both flu shots. She is 3 and has never had a flu shot, so she will require 2 shots for seasonal, and 2 shots for H1N1, flu coverage. See where this one is going? The shots contain a lot of the things that could possibly be dangerous. For instance, most of the flu shots are from multi-dose bottles. Since they are drawn from multiple times, they contain thimerosal as a preservative. So my child could be receiving 4 doses of thimerosal in less than 2 months time. After reading the research, I'm still not convinced whether thimerosal is safe, or harmful. To be prudent, I would rather avoid it.

There will be some single dose H1N1 shots available, which will be thimerosal free. When they will be available, and if they will be available in my county, is an unknown at this point. The other issue is that flu shots contain antibiotics. I avoid the use of antibiotics, and don't particularly want myself, or my daughter, to be exposed to them unless necessary.

I'm still facing my quandary. My daughter is the one who needs the most protection. She's the one who has the highest risk of exposure, and the greatest chance of infection. If I get vaccinated, she'll still have a major exposure at daycare, but I will hopefully stay healthy and able to care for her. Of course, its likely that I will remain healthy without vaccination.

I want to choose the option with the least harm. At this point, I'm favoring vaccinating my daughter, but waiting for thimerosal-free shots to be available. As for me, maybe I should just look into a back-up provider, like a family member, who can care for her if I get sick. After all, the flu isn't the only bug out there! I'll continue to keep us in the best of health by following basic wellness guidelines, no matter what my decision.


Robert said...

Thimerosol is a mercury solution. I had perfect health and no allergies until age 33 when a dentist put amalgam (approx 33% mercury) into my mouth for the first time, and it was a large amount (crown). My health then made a slow decline with multiple symtoms. After 6 or 8 GP doctors and referrals to an internal med specialist and an allergy doctor, and experiments with prescription anti-biotics, anti-histimines, and many psych drugs, I had no diagnosis and no relief. Long story short, after almost dying at times, and suffering with this for 10 years, I happened to read a newspaper article about the many problems that people can have from exposure to mercury. I then had a cognition that all my problems began to slowly manifest after the dentist put the mercury in my mouth. Against the dentist's advice, I got it taken out and then a very slow recovery began. Against my dentist's advice, I then had my childrens mercury removed from their teeth. Incidentally, all of the 3 family doctors I have had since then have all advised me not to allow amalgam in my mouth, and one of these docs has had her dental amalgams removed as well. So now I put it in writing at doctors and dentists on the admission form that there is to be no mercury used in any form on myself or my children. It is very difficult find a vaccine without thimerosol, but I won't get the shot unless I can find it. In La Grande, I have checked with Rite-Aid downtown, and the nurse asked the pharmacists, who said the label showed 2 ingredients, neither being thimerosol, so they thought it was probably ok, but the nurse offered that she could contact the manufacturer to be sure if I wanted. I wanted, and she called me back later that day to let me know that their vaccine does have thimerosol. The Union Co. health dept. told me on the phone that I would have to come in person to get the answer to the thimerosol question, and at check in the receptionist told me their vaccine has thimerosol. I will keep looking, but I don't hold out much hope of an affordable flu shot in La Grande. I expect that I might get it at a doctors office, but I dont want to go to that kind of expense. I will update this post if I have any success at finding thimerosol free flu vaccine in La Grande, OR.

Robert said...

I HERE IS WHAT THE CENTER FOR DISEASE CONTROL SAYS..."In July 1999 the Public Health Service (PHS) agencies, the American Academy of Pediatrics (AAP), and vaccine manufacturers agreed that thimerosal should be reduced or eliminated in vaccines as a precautionary measure.

Today, all routinely recommended licensed pediatric vaccines that are currently being manufactured for the U.S. market, WITH THE EXCEPTION of influenza vaccine, contain no thimerosal or only trace amounts. Thimerosal preservative-free influenza vaccines are available, but in limited quantities. The total amount of inactivated influenza vaccine available without thimerosal as a preservative will continue to increase as manufacturing capabilities are expanded. Link here for full report by the CDC http://www.cdc.gov/FLU/ABOUT/QA/thimerosal.htm

Doc Mock said...

People 2-49 can get Flu Mist which is thimerosal-free. Union County Public Health does have $15 flu mist. As you indicated, they don't have any seasonal vaccine in the shot form that is thimerosal-free for adults. They do have some for children.
Good luck with your search. I'll post an update if I hear of any other sources of thimerosal-free flu vaccine.

Doc Mock said...

Update- my daughter was able to get her first dose of the seasonal flu vaccine. Union County Public Health is now out of seasonal vaccine, but more will arrive in November. We're still waiting for the injectable H1N1 vaccine to arrive in Union Co.
More research is coming out, and it likes like the Mist is safe to use around the immunocompromised, expect those in hospital isolation rooms.

Doc Mock said...

CHD now has thimerosal-free H1N1 and seasonal flu injectable vaccines (single dose). They have H1N1 flu mist, which is also thimerosal free.

Anonymous said...

Interesting. I would have come to the opposite conclusion: you get the flu shot and avoid your daughter 4 shots. If she gets sick, you can take care of her, and have a someone (vaccinated!) to help.

Doc Mock said...

The issue is that my daughter has a compromised immune system. If she gets sick, she would likely be severely ill and need to be hospitalized.
On a positive note, she enjoys getting the shots! It doesn't hurt much and she gets a sticker. She was excited to go get her last one.

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