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October 27th, 2009:

H1N1 immunizations – just do it!

There are still a lot of misconceptions out there about the H1N1 vaccine. Confusion about the vaccine in general as well as more specific concerns about the adjuvanted vaccine versus the non-adjuvanted vaccine.

I’m not talking about the Jenny McCarthy lunatic fringe element. The Squid-dude and I have dealt with that in a past posting.

I’m referring to some sane and normal individuals asking some sane and normal questions about the vaccine.  After all, if you are going to put this stuff into your kids’ bodies, or your own, then you should understand a bit about what is in the vial, correct?

So – here are some realities and myths about the vaccine in general and the adjuvanted vaccine more specifically:

1. The H1N1 flu vaccine will give me the flu.


This is a common myth that doctors battle every year. And the H1N1 flu is being made the same way that seasonal flu is manufactured. The flu vaccine is created from killed virus, so there is no way to transmit flu from the vaccine.

Flu season coincides with the cold season so people frequently confuse the common cold with the flu. Also, in some cases, people who get a flu shot can still get the flu, but they may get a much less severe form of the illness and, most importantly, they’ll have a decreased risk of flu-related complications — especially pneumonia, heart attack, stroke and death — to which older adults are especially vulnerable.

2. Wearing a mask will protect me from flu.


Except in certain health care settings, the Centers for Disease Control and Prevention (CDC) does not recommend wearing a face mask. They have a lot of shortcomings for infection control. They’re only good for a short period of time and as soon as they get moist, they become ineffective. They also do not fit tightly enough around the face to prevent small infected droplets to get through. The best advice is that if you’re sick, stay home. Stay away from sick people and make sure to keep your hands clean and practice good cough etiquette by coughing into your sleeve. Still gross – as discussed by XUP, here.

3. Hand sanitizer is as effective as washing my hands.


They are an effective way of cleaning your hands of germs. Doctors use them and they’re commonplace in hospitals.

Ashton referenced the CDC, saying, the influenza virus is destroyed by heat. In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses, if used in proper concentration for a sufficient length of time. Wipes or gels with alcohol in them, for example, can be used to clean hands. The gels should be rubbed into hands until they are dry.

4. I am sneezing, have a sore throat and a cough, so I have H1N1 flu.


No, you need to also have a fever. Coughing and shortness of breath are common symptoms, but also vomiting, fatigue, muscle soreness and diarrhea.

Ashton cited the CDC saying the symptoms of novel H1N1 flu virus in people are similar to the symptoms of seasonal flu, although vomiting and diarrhea has been reported more commonly with H1N1 flu infection than is typical for seasonal flu.

The CDC studied the hospital records of 268 patients hospitalized with novel H1N1 flu early on during the outbreak. In this early subset of cases with significant clinical data, fever (93 percent) and cough (83 percent) were the two most reported symptoms. This is not surprising since cough and fever were part of the case definition. Other symptoms were shortness of breath (54 percent), fatigue/weakness (40 percent), chills (37 percent) and myalgias, also known as muscle soreness (36 percent).

5. If the rapid flu test comes back negative, that means I don’t have H1N1 flu.


The CDC reports that many of the rapid diagnostic tests may miss many cases of the H1N1 flu, Ashton said. The overall sensitivity ranged as low as 40 to 69 percent. So, she said, the first result may not be the most accurate. The CDC recommends that clinicians use their judgment based on the patient, and prescribe Tamiflu if necessary.

Q1. What is the difference between an adjuvanted and non-adjuvanted vaccine?

An adjuvanted vaccine is a vaccine that includes a substance that boosts an individual’s immune system and increases their response to a vaccine. An unadjuvanted vaccine has no “booster” element.

Adjuvanted vaccines are included in common vaccines such as tetanus and Hep B.  The adjuvant in Canada’s H1N1 flu vaccine is made up of natural ingredients such as water, squalene oil and vitamin E.

Q2. When was the last time Canada used an adjuvant in a vaccine?

Adjuvants are not new. They have been used for several decades to boost immune response to vaccines.  Many of the commonly used vaccines in Canada contain an adjuvant.  However, they have not previously been approved for use with influenza vaccines in Canada.

Q3. Are adjuvanted influenza vaccines safe for use?

The adjuvant used by GSK has been tested in approximately 45,000 people around the world and has been evaluated by Health Canada and other regulatory authorities as part of the review of the H5N1 vaccine in the pre-pandemic period.  No significant safety concerns regarding the use of the adjuvanted vaccine were detected.

In June 2009, the WHO held consultations on the safety of adjuvanted influenza vaccines to review and discuss known and theoretical safety concerns and prospective vaccine safety evaluation.  The outcome of the WHO consultation was that no significant safety concerns or barriers to evaluating or using adjuvanted vaccines for the current H1N1 virus were raised.

Clinical studies have been designed to study the risks and benefits of using both adjuvanted and unadjuvanted vaccine against the H1N1 flu virus, and Health Canada and the Public Health Agency of Canada are working closely with other national agencies to implement appropriate post-market monitoring.

Q4. Does an adjuvanted vaccine pose a risk to pregnant women?

All evidence suggests that adjuvanted vaccines are just as safe as unadjuvanted vaccines; however there is no safety data for the use of adjuvanted vaccine in pregnant women.  The WHO’s Strategic Advisory Group of Experts (SAGE) recommended in July that pregnant women should receive non-adjuvanted vaccine where possible, but that an adjuvanted vaccine could be used if necessary.

Q6. Is the Government ordering non-adjuvanted vaccine?  Who will it be recommended for and why?

The Government of Canada plans to purchase a small quantity of non-adjuvanted H1N1 flu vaccine (approx. 1.8 million doses) as part of its total order of 50.4 M doses.

The purchase of a small quantity of non-adjuvanted vaccine is a precautionary measure for pregnant women as no clinical data of the safety of adjuvanted vaccine in this group is available.

In these cases, should a non-adjuvanted vaccine prove to be effective, it may be the preferred option.  The WHO has indicated that it has no special concerns about the safety of adjuvanted H1N1 flu vaccines in general.  The WHO has also strongly recommended that pregnant women be immunized against the H1N1 flu virus, even if no non-adjuvanted vaccine is available.