1. 1
   Sandy Said:
   December:21:2009 - 13:53 
   

   Amoung the circles I hang in- the fears are the same that Europeans and Americans are having- about an insufficiently tested vaccine. Also, I heard a rumour- and it was probably just that – that the vaccine in the kingdom was rejected by both the EU and the US as somehow not up to standard,

2. 2
   Chiara Said:
   December:21:2009 - 23:39 
   

   This is a tragedy created by rumour mongers and uninformed conspiracy theorists. The vaccine was prepared the same way they prepare the seasonal flu every year, does not use a live virus, and was mass tested on humans before being made available. It is a tragedy because such low levels of vaccination rates don’t give “herd immunity” and make it likely that some children will have H1N1, which carries a low risk of death but a risk none the less.

   I just had both the H1N1 and Seasonal flu vaccines simultaneously (one in each arm). I did have a couple or 3 days of fatigue, low fever, and mild nausea, which is a lot better than seasonal flu which I have had in the past, or H1N1 flu which I am sure I had in June.

   Sad that people would rather believe charlatans than the WHO, the CDC, and their own highly respected Minister of Health.

3. 3
   Sandy Said:
   December:22:2009 - 04:51 
   

   Chiara- many medical people in Europe are refusing this vaccine. It gives me second thoughts. And unfortunately I do not believe the ministry of health (which earlier told us not to worry- there are no pigs in Saudi). Nor do I believe the CDC or WHO completely. I believe that it is in the best interest overall for this vaccine- but I may not be willing to take the same risks on a personal level that they are for an entire community. And some of the vaccines DO use live virus. I believe it is the nasel spray.

   The vaccine is also cheaper/easier than doing proper tracking of the virus- which is more costly. Most cases, are “presumed” swine flu. They seem not to be tracking very diligently at all.

   Also, it is my understanding that “herd immunity” happens with live vaccines.

   I have also spoken personally to medical people who are not completely sold on this vaccine. So it does not seem straightforward to me.

   I have to decide soon. Already in October there were massive outbreaks in Jeddah and in my childrens school.

4. 4
   Chiara Said:
   December:22:2009 - 11:24 
   

   Sandy–The new Minister of Health is an excellent and excellently qualified practitioner, and has been doing a good job and setting a good example. Not all in the Ministry he inherited are as capable I am sure.

   I am a medical person, and so many friends, medical and non, ask me about this that I know more about swine flu than I would normally care to, and way more about the pediatrics and geriatrics sides than I normally get involved in.

   “Herd immunity” is independent of whether a vaccine is live, or not, and merely refer to a high enough proportion of the group being vaccinated so that those who are ineligible or unable to get the vaccine in the community are protected as well, since others aren’t getting the virus and spreading it to them. Wiki actually does a decent job on this:
   http://en.wikipedia.org/wiki/Herd_immunity

   It also describes the problems of a failure of herd immunity for measles, mumps, and rubella in recent years because of undue fears about the MMR vaccine for children–more scare mongering about autism.

   Flumist (the nasal spray) does contain live ATTENUATED (ie weakened) vaccine as is a potentional danger to immunosuppressed individuals only, ie on immunosuppression because of a transplant, AIDS patients, etc, not just weaker people. The risk of infection is only about 2.5%. Infection with H1N1 is usually mild and self-limiting but would by definition pose a threat to these people who cannot mount an immune system.

   I got the vaccine because as a physician I am at higher risk of getting and spreading H1N1, but mostly because my father and mother are high risk of illness (underlying medical conditions) and one of my best friends is immunosuppressed.

   If I were your children’s mother they would have had the vaccine already, but I’m not and you have that decision-making power.

5. 5
   Michel Said:
   December:22:2009 - 11:41 
   

   Chiara, just a question (clearly from a non-physician); as you say you got the H1N1 flu last June, why did you need to get the H1N1 vaccine ? Weren’t you protected since you hag already got it ?
   Here in France people get the vaccine one after the other, I mean only once they get the official invitation from the MoH to go and get it; it goes without saying they have started with the most fragile as well as the most exposed people (doctors, nurses) now they are treating the other people, going up the age pyramid; I understand they want to have 12M people vaccinated, I guess to get what you call the herd immunity ?

6. 6
   Sandy Said:
   December:22:2009 - 13:51 
   

   Chair, you actually gave an exact example of what causes people to be cautious. First you say there is no “live” vaccine, and then when the nasal vaccine is brought up you elaborate with an explanation of “attenuated”. Which, I already know the meaning of. This creates a feeling of not being told the whole story from the outset. But mostly, your post read like you were instructing me- I merely was trying to illustrate that it is not mere rumour-mongering that is causing people to hesitate. And while you may be a member of the medical community, I know several others, including family members who are divided on this issue. And that is one thing proponents of the vaccine never address- why do members of the medical community have issue with it???

   And I would not at all say the concerns about the MMR vaccine were fear mongering. Appaparent correlations were there and it was reasonable to look into it. In fact, given a family history with autism in it, our doctor recommended some alternate to the way it was done at the time- I don’t remember the details. I also know someone personally who ended up a case study for the CDC because of a vaccine snafu. So everything isn’t people merely following charletons. And that attitude of acting as though peoples concerns are mere histrionics is part of why the medical authorities don’t have the credibility they think they deserve.

   Of course the ministers et al want everyone to have the vaccine. No doubt it is what is best for the community. What I have to decide is if it is what is best for my children. And if you were the parent of my children, it is highly unlikely you would have vaccinated these kids- as a vaccine has not been available to them. And you are absolutely right- it is not your decision to make.

   You were right about herd-immunity. I was mixing that up with the secondary immunity that can seep into the environment when a large percentage of the population has had a live vaccine .

7. 7
   Chiara Said:
   December:22:2009 - 21:07 
   

   Michel–I am 99% sure I had H1N1 in June, based on the fact there was no other flu strain around in June here, I was sicker with flu than I have ever been, and while I almost never get a fever, I had high fever (a classic symptom) for 5 days (typical duration). I rarely get flu, and when I do I usually just keep going and don’t bother with meds; this time I carefully dosed myself around the clock with the relevant night and daytime preparations. I didn’t get tested for it though, because by then they had stopped doing the testing as they (public health reporting to the CDC) had sufficient knowledge of the statistics and patterns to slow down on that aspect of knowledge gathering except for those who required hospitalization. So, this fall I followed the guidelines that if you didn’t have laboratory proof of H1N1 infection previously you should get the vaccine. There was also a recommendation to get it due to possible differences in strains.

   The French program sounds similar to the Canadian one, and well structured. You are right, someone must have calculated that there needed to be 12M people vaccinated to provide broader immunity to the group. I like the expression used in the wiki article of creating a “firewall” to dramatically slow or stop the spread of the disease. This protects those who didn’t receive the vaccine. It makes good sense. In the case of H1N1 there was excellent international collaboration among scientists, clinical epidemiologists, and governments to mount a quick response. Perhaps something was learned from the initial poor collaboration around SARS.

   Sandy–my apologies if my tone was overly didactic, or in any way offensive. I was typing fast while coordinating whether family needed/wanted me at my canine niece’s emergency cardiac consultation, or my father’s urgent “whatever it is he looks and feels like death warmed over, and he is too physically frail to handle it” consultation; and, having tricked him into seeing his family doctor, figuring out how to best persuade her nurse to actually give him a same day appointment. So again, my apologies.

   Starting with the first last, of course vaccinating your children or not is entirely your decision; I wouldn’t presume otherwise with anyone, patient or family member. This is one of the topics I deal with in the real world, as an academic, firmly on the decided of patient’s or their guardian’s decision making. The vaccine has been available to children here for some time, and like my sister did with my 10 year old nephew, I probably would have gotten my children vaccinated early with myself. My nephew also probably had swine flu in June (classic kid’s version, ie sypmptoms more severe and for longer), most likely from a kid in his class who was ill just prior (I was in a different city).

   In some of my reading I also had the impression that there was an effort to mislead, or at least add in information at the end that changed the beginning. However, that was never from reputable medical sites, like the CDC, WHO, Canadian Ministry of Health. For a physician, the first classification is live or killed virus used in the vaccine; then, if live, attenuated or unattenuated, which is why I gave the information in that order. I wrote “Flumist (the nasal spray) does contain live ATTENUATED (ie weakened) vaccine”, and don’t see where I claimed that the nasal vaccine is not live and then said that it is. The injectable is the killed vaccine, which is what I had myself.

   All the members of the medical community that I know are in agreement on vaccination, but may disagree on who exactly should get it, ie on what they would recommend based on individual risk factors (that is basic to all medical decision making). Last week an older friend asked me whether he and his kids should get it. He thought his children in their late 40′s should get it, but was afraid to get it himself, as he is 70 and was afraid of an allergic reaction. We reviewed all his risk factors, including that as he works from home, and lives only with his wife he was less likely than others to be in contact with or spread the virus. We also discussed that at his age he probably had some natural immunity from exposure to previous flu seasons in the 40′s and mother who as a nurse brought home everything. Given his medical history it was probably best he didn’t get it. He raised the issue of herd immunity because although he didn’t want the vaccine, his social conscience was plaguing him. I told him that herd immunity is important, but he personally didn’t have to help provide it, and that I had just done my part for him. He was very relieved and much happier with the decision he had already made. He is a recently retired criminal defense lawyer, drafter of aboriginal rights legislation, and wouldn’t have agreed to anything he didn’t want to do anyway.

   The autism debate is a very emotional one, but the scientific evidence has been clear for a long time that vaccination is not the cause, but the timing coincides with or precedes the usual timing of the noticeable symptoms (about age 2). As a precaution, and because many children with autism also seem to have hypersensitivity whether gastric or allergic, some physicians space the timing of the vaccines, instead of giving a bunch at once. I am of the “if you broaden the criteria for the diagnosis, you diagnose more people” school of thought, having seen it happen in the course of my training let alone my career. eg. anorexia–if you require a loss of 25% of normal body weight to make the diagnosis, you diagnose fewer cases; if you broaden that (as was done between DSM-IIIR and DSM-IV) to a loss of only 15% of normal body weight, and the diagnosis applies, it then applies to a lot more women/men, which results in a dramatic increase in “anorexics”. If you go looking for something you find it: ADD, being a prime example of a broadened diagnosis, and an awareness campaign among physicians and the public.

   Alas, the people I have had the most challenging discussions with are very bright professionals who are following charlatans. They never seem to clue in that the Dr of chiropody from unheard of island writing on the latest and greatest illness in the news always follows the same pattern: new disease! a few medical facts that sound good with enough science to fool the non-professional health care provider; big pharma, big governement, big money, evil or misguided physicians; miracle plant cure, that the same dr is selling; order form. One of my best friends, and worst offenders on this, is a specialist (doctoral level) in the genetics of cell biology and plant hormones. Just enough overlapping science to totally mislead herself, especially when her persuasive, hypochondriachal (meets all DSM-IVTR criteria)husband gets in on the act.

   To return to the question of swine flu in Saudi, I do hope all who need/want the vaccine get it, and provide herd immunity for the rest. Most often swine flu is just very unpleasant as flus go, sometimes it is fatal (more often than the vaccine).

8. 8
   Sandy Said:
   December:23:2009 - 15:55 
   

   Well I had written a more gracious response earlier but my touchpad decided to click me elsewhere and erase everything- so I was in a mood and a rush to type as well, It was you’re letter number 2 that gave the impression it was all dead vaccine- but in either case it is the jab that I believe is becoming available in Saudi. Thus far they were vaccinating high risk, and the Mecca/Medina regions. I know many people that have had swine flu- thankfully only one with complications,but a lot of underlying health issues there as well. It swept through my kids school in Oct. None of them got it which does make me wonder if we had a mild case when we all got sick in Sept. though most people Iknow who had it had nasty cases of the full set of flu symptoms. (Excpet the brother of one friend, who had NO symptoms. Had himself tested because eveyone in his household had it- he was positive)

   I agree that there appears to be no link with vaccines and autism. But the way the issue was explored didn’t leave people with a feeling of confidence at the time. And the lack of good will created leaves a residue.

9. 9
   Chiara Said:
   December:23:2009 - 18:37 
   

   Sandy–thanks I just re-read my comment #2 which indeed refers to dead vaccine. The nasal mist is almost unheard of, and so I was just thinking jab (also still have the needle mark).

   Contact without symptoms could still give a positive response, so maybe that is what happened to your friend’s brother. Hopefully whatever you had in September gave you some immunity. Some have very mild cases, though most have a distinct flu feeling. Some have no fever, like my friend’s husband, who had other upper respiratory symptoms.

   Unfortunately the media jumped on a preliminary scientific study about vaccines and autism, which has now been disproven, and renounced even by the scientists who did it. Most scientists are extremely cautious even about their own findings, whereas journalists are less so. The MMR scare has caused a problem in the UK especially, where the study was done, with there being too few getting the vaccine to provide herd immunity, and severe cases of MMR. People forget that measles kills, and currently kills far more people in Africa than AIDS does.

10. 10
    Malik Said:
    December:28:2009 - 00:16 
    

    I am hearing at my mosque that they are putting pieces of swine into vaccine from a special herd of swine, to create a herd immunity within people. They are recommending not to take an unclean vaccine in this way.

11. 11
    John Burgess Said:
    December:28:2009 - 15:12 
    

    I think there’s a great deal of ignorance about how vaccines are made. But the ulema across the Muslim world have, for the past 20 years, authorized the use of pig parts in human transplants when the alternative was death. Heart valves taken from swine are regularly used in heart surgery, for instance. Perhaps ignorance is bliss, but a little knowledge can clearly be a dangerous thing.

12. 12
    Chiara Said:
    December:29:2009 - 01:47 
    

    Malik–I am sorry to read that this type of false belief is being spread at your mosque. H1N1 is a type of flu virus that affects both humans and swine. In fact the swine had “swine flu” and humans and animals, and birds often pass flu viruses back and forth the way that humans spread viruses back and forth, eg by coughing and sneezing and the other person breathing the virus in, or touching something with the virus on it, and then touching their face, nose, mouth.

    “Swine flu” is just a name, like “Mexican flu” or “Asian flu” or “Bird flu”. The virus itself doesn’t contain any swine, it infects swine and humans. The vaccine is made from the virus affecting humans not the one affecting pigs. There are no pig parts in the vaccine, the same way that there are no bits of Mexican, or Asian, or Bird in the vaccines for those flus.

    “Herd immunity” has nothing to do with animal herds. It refers to a group of people as a herd, and is based on the idea that if you vaccinate a certain number of people the rest will become immune too.

    Every year a new vaccine is made for the “seasonal flu” out of the types of strains scientists observed in humans in the winter previous. Those of us who live in the north are used to having flu every winter, or trying not to have it and getting a vaccine for it.

    Scientists made finding the genetics of the type of H1N1 affecting humans a priority so that they could make that vaccine ready in time for the winter months when flu viruses are happiest because they like cold weather. The only thing unusual about H1N1 over other types of flu is that they jumped on it so quickly and that it was still active in the summer.

    I hope you will help the people at your mosque learn more about H1N1 and the vaccine from reliable sites like the Center for Disease Control, the World Health Organization, and so on.

RSS feed for comments on this post.

Sorry, the comment form is closed at this time.