Colorado mom ponders H1N1 flu shot
October 25, 2009
ASPEN – If you had asked me a month ago if was going to vaccinate my children against H1N1, I would have said no.
Two weeks later, I would have said yes.
Today, I would tell you that the decision on whether to vaccinate is far more complicated than a simple yes or no.
I am not alone in my feelings. Just listen to the moms on the playground, the teachers at the schools, the people lined up at the local health fairs. Even the experts can be found talking circles around the issue.
“I cannot make a blanket recommendation, because it’s a personal decision … a decision you should talk to your physician about,” said Dr. William Mitchell, of Aspen Valley Pediatrics. “But what I can tell you is that I am very scared of the disease.”
Perhaps we should all be scared. We’ve all read the headlines, and you have to admit they’re a bit frightening. As of Oct. 17, H1N1 had hospitalized 1,058 people in Colorado and killed 20 – six of them under the age of 18. Nationally, 41 states were reporting widespread cases of the disease as of Oct. 17, and some 86 children had died from the virus, according to the Centers for Disease Control.
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And while people die from the flu every year, this strain is different. For one, it’s an unknown. H1N1 first appeared in spring 2009 and has since assumed pandemic proportions; nobody can predict exactly what it will do next.
But more important, perhaps, is that the swine flu seems to hit children harder than anyone else – and this has struck a nerve across the nation, and in our valley.
The black, white and gray
So why, if H1N1 is indeed deadly, is there a debate over whether or not to vaccinate our children against the disease? When I look at the statistics, I wonder why I hesitate. But I do.
For Sarah Shaw, mother of 9-year-old Spencer, deciding not vaccinate her family against H1N1 is part and parcel of her generally philosophy on health.
“I tend to err on the side of less is more, and I don’t like taking medicine or shots if I don’t have to,” she said. “I feel like a bit of exposure to all of this is natural, and its part of our bodies’ abilities to build immunities and stay strong.”
It’s a belief that many in the Roaring Fork Valley share. But it’s one that gives pause to others, including Liz Stark, director of community health for Pitkin County.
“The flu is the flu, no matter what variety. And the flu can be very serious,” she said. “With H1N1, the increased challenge is that we have no immunity because it is a new strain. We believe you can reduce your chances of getting this flu through vaccination.
“And I feel perfectly comfortable promoting this vaccine even though it is brand new.”
Indeed, the H1N1 vaccine was created only this year. It was not used before this flu season, nor was there time for extensive testing. And this raises questions about its safety and its effectiveness. But it was made using the same techniques as the seasonal flu vaccine, and had H1N1 been identified in early 2009, when this year’s flu vaccine cocktail was being concocted, it likely would have been included in the seasonal flu shot.
“If all of this had come about six weeks earlier, we might not be having this conversation,” said Dr. Mitchell. “I am comfortable with the seasonal flu vaccine; we have a history with it. But I don’t have a crystal ball, so we’ll have to wait until next year to know more about this H1N1 vaccine.
“Again, it’s a personal decision.”
Regardless, there are many in the community who believe the time to vaccinate is now, including Lynn Bayko.
Bayko said the decision to vaccinate her 5-year-old daughter Sadie against H1N1 was simple: “I was told by everyone in health care to vaccinate her for both types of flu, as well as myself and (husband) Ben. Sadie’s never had any problems with vaccinations, so I decided to give it to her.”
For others, though, the question of whether or not to vaccinate is more convoluted than “I don’t believe in vaccinations” or “I follow what the CDC recommends.”
And this is the gray area where I reside. My 9-year-old daughter is perfectly healthy; it has never crossed my mind that I need to vaccinate her against the flu. My 6-year-old son, on the other hand, is more at risk; he has a complicated medical history and getting the flu – perhaps even more so the swine flu – is a road we don’t want to travel.
So I vaccinate him, right? The benefits of the vaccine – tested or not – outweigh the risks of him getting the flu. Not so fast, I have learned.
Limited supply, varying risks
Currently, there isn’t enough H1N1 vaccine to go around. There isn’t even enough to immunize those considered high-risk – health-care providers, households with children under 6 months, pregnant women, children 6 months to 4 years, and those between 5 and 18 with certain underlying health conditions.
“With the little bit we’ve been given, we can’t vaccinate everyone. We can’t even vaccinate all of those at high risk,” said Stark, explaining that Pitkin County, like all local governments, receives its allotment of the vaccine from the state health department, which receives its allotment from the Centers for Disease Control.
“No one is hoarding the vaccine. No office in town has a stash. These vaccines are being given out as quickly as they are coming in,” she continued.
The numbers back Stark’s story. Pitkin County has received three shipments of H1N1 vaccine since it was first made available. The most recent shipment included just 200 doses. In a county with more than 15,000 residents, it’s easy to see why there is a shortage of vaccines for the general public.
“Our doctors are in a tough position right now,” said Stark. “We need to be patient and understand what a complicated situation this is.”
The issue of a limited vaccine supply is even further complicated by the types of vaccines currently available – mist, single-dose injectible and multiple-dose injectible. The reason? Even if there is an ample supply of a certain type of vaccine, it may not be the type a person can take, or wants to take.
Pregnant women, for example, cannot take the flu mist as it contains the live virus; they must get the flu shot. Conversely, the flu shot currently available in the Roaring Fork Valley contains thimerosal, an organic mercury-based preservative that some studies have linked to autism and other disorders.
“This is troubling,” said Dr. Mitchell, whose pediatric practice removed thimerosal from its shelves nearly a decade ago. “It’s not ideal for young children, so it makes for tough decisions.”
For Kim Estock, whose 4-year-old son Turner falls into the high-risk category because of his age, it’s black and white.
“I won’t do thimerosal. We never have and we won’t now,” she said. “It’s just not worth that risk to us.”
My husband and I are leaning in the same direction. Until Pitkin County receives more H1N1 flu mist, or injectible vaccine without the thimerosal, our children will likely remain unvaccinated. While our son is at a higher risk for flu than many kids, he is not that high-risk. But this is a personal decision, and we could change our minds as we learn more.
Sarah Shaw, who has never received a flu shot nor chosen to vaccinate her son, appreciates the logic in this.
“We don’t vaccinate, but I would certainly do the right thing by my family if the need arises,” she said. “We are very fortunate to all be healthy. If one of us had a health issue, I would reconsider the vaccination issue.”
And that’s a logical way to approach this complicated issue, according to one local child-care provider who asked not to be identified.
“I truly believe it is a parent’s obligation to be educated, be informed and make the best possible decision they can for their child in regards to the H1N1 vaccine,” she said.
“But I feel there are many pro-active practices that we can all adopt to help children through this flu season,” she continued. ” Good rest, hand washing, staying home when sick, good nutrition, etc., are so important.”
Stark couldn’t agree more.
“These are the things those of us in health care and community health have been preaching for years,” she said. “It’s basic stuff, but it works. And right now, it might be the only defense we have against H1N1.”