Sunday, August 30, 2009

Two ends of the spectrum on vaccination

Spokane's Spokesman-Review reported on a local meeting held by CDC on Aug. 29 (one of ten held throughout the US) to elicit comments on the upcoming swine flu vaccination program.  
The campaign to immunize children and other vulnerable people against the fast-spreading H1N1 influenza virus should be moderate – perhaps even passive – a panel of 71 people specially chosen to represent Spokane told federal health officials. Spokane was among 10 cities selected by the CDC for “public engagement meetings” to help the agency determine how best to distribute the vaccines, which should be ready by mid-October...  Only 11 percent of those polled Saturday believe the vaccination program should be a full-scale effort, including such actions as mass vaccination clinics at local schools.
Meanwhile, the Associated Press reports that West Virginia's largest hospital (CAMC) is requiring all its employees to get a seasonal flu vaccine, or find another job. 

And in the same vein, 
"a New York state law takes effect this month requiring hospitals to provide records showing all their workers have seasonal flu vaccinations or face fines..."  Yet "hospitals where employees must get flu vaccines as a condition of employment are so rare an American Hospital Association expert couldn't name another besides CAMC..."

"Virginia Mason Medical Center in Seattle is cited by many, including CAMC's Lee, as a national model in vaccination policies for its workers. In 2004, it decided to require seasonal flu vaccinations, but that policy was successfully challenged [in court] by the union representing nurses at the hospital."

"A vaccine for swine flu won't be available until this fall, though, and making it mandatory would mean addressing the concerns of many that it could be unsafe. Even hospitals encouraging the seasonal flu vaccine have to address fears that it will make recipients sick, or that it's not necessary for young, healthy people..."

"Those objections, along with religious or philosophical concerns, have made many health care facilities wary of instituting a mandatory policy, the AHA's Bentley said."

I decided to see what the PDR said about safety and seasonal flu shots.  Glaxo makes 2 different seasonal flu vaccines.  The information is not clear-cut:

Flulaval contains 25 micrograms mercury per dose.  The label suggests "careful consideration of the potential benefits and risk" if you have ever had Guillain Barrre Syndrome within six weeks of a flu vaccine  Two safety studies were conducted in a total of 1,049 adults.  However, the control subjects received another flu vaccine, and side effects occurred at comparable rates.  "Safety and effectiveness of Flulaval have not been established in pregnant women and children... Animal reproduction studies have not been conducted with Flulaval... Flulaval should be given to a pregnant woman only if clearly needed."

Fluarix has had over 95% of its mercury removed during manufacture, leaving less than 1 microgram.  Yet it contains up to 50 micrograms of formaldehyde, and several other chemicals.  It has not been evaluated for carcinogenicity [formaldehyde is a known carcinogen--Nass], for fetal harm, for effects on fertility and is not to be used in children.  Its clinical trial used control subjects who received a vaccine placebo, allowing for a more useful comparison.  Fluarix recipients reported muscle aches in 23%, twice the rate in subjects who received placebo.

Overall, the vaccines appear relatively safe, but not so safe (and not so effective) that I would support mandating them for health professionals or others.  The results of postmarketing surveillance, in much larger populations, would help to confirm their safety and efficacy.

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