Kudos to Australia's public health system and chief medical officer for a perfect response:
- acknowledging the problem,
- halting vaccinations pending results of its investigation,
- enhancing surveillance for adverse events (even asking parents to report adverse events),
- consulting with colleagues internationally, and
- conducting its own investigation.
An healthy two year old girl died in Queensland 12 hours after receiving her seasonal flu vaccine, on April 9.
Professor Collignon says health authorities need to better weigh up whether rolling out a vaccination to millions of people around the country will cause more harm than good.
"If you're in a risk group everybody agrees you need to be vaccinated," he said. "But the majority of the population don't have risk factors, including children, and before we roll out a vaccine to millions of people, in my view, we need to do studies of thousands of people over a period of time to make sure we are always going to do more good than harm with the vaccine."
Professor Collignon says about 20 per cent of Australian children who received the swine flu vaccine had moderate to severe side effects in the form of a fever of more than 38.5 degrees Celsius and severe muscle aches and pains.
But he says last winter, the risk of someone under the age of 40 getting swine flu and dying from it was less than one in a million.
"You have to start weighing this up because you may actually produce as much influenza-like illness with a vaccine as you prevent with people not getting influenza," he said... [When I had a private practice, it was my impression that about 20% of elderly flu vaccine recipients told me that they developed a flu-like illness shortly after receiving the vaccine--Nass]
Professor Collignon says an effective surveillance system should monitor thousands of people for one or two weeks after vaccination before rolling out the vaccine to the entire population... [This is absolutely what is needed for all vaccines. But surveillance should be carried out over longer periods as well, since a different set of adverse reactions may occur later.--Nass]UPDATE April 26: Vaccinating small children against influenza is a new idea, and in the US was based on the (unproven) theory that vaccinating children will prevent their grandparents from getting flu. The 2009-10 swine flu epidemic was the first to provide policymakers with a better rationale for vaccinating children: to protect children. However, even for swine flu, the number of deaths in otherwise healthy children was quite small. (To estimate total US child deaths, CDC quadrupled the number of known child deaths. This strategy assumed that public health officials missed counting 75% of children who died. However, virtually all child deaths occur in hospitals and were therefore counted, making the CDC strategy specious.)
Last October, Rino Rappuoli, MD (the head of Novartis Vaccines in Siena, Italy) wrote in Science magazine that, "At present, only the United States, Finland, and Mexico recommend vaccination of children, and implementation is low." [Public health. Rethinking influenza. Rappuoli R, Del Giudice G, Nabel GJ, Osterhaus AD, Robinson R, Salisbury D, Stöhr K, Treanor JJ. Science. 2009 Oct 2;326(5949):50.] Thus there was little experience with mass flu vaccination of young children before now.
IMHO, the world's public health policymakers have jumped on the flu vaccines for children bandwagon with very little data on the risks and benefits, taking their cue from swine flu. But influenza vaccines are made up differently each year, in a rush to be available before the winter flu season, and are therefore not tested in humans prior to use. Whether children actually get more benefit than harm from such vaccines remains to be seen. For flu seasons 2005-6 through 2008-9, less than 100 children died per season in the US from influenza. Most had chronic health problems, and would have been in a high-risk group for whom vaccination is appropriate. But is it appropriate for the rest of our children?