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An H1N1 Vaccine Primer
At 5 a.m. on Sept. 30, the Centers for Disease Control and Prevention (CDC) will launch its largest vaccine giveaway in decades. Lining up for this invitation-only event will be the health departments of each of the 50 U.S. states, which are responsible for dispensing at least 251 million doses of the 2009 H1N1 pandemic-flu vaccine to health providers across the nation. The vaccines have been purchased by the Federal Government and will be given to states — and patients — gratis. It's not the usual way influenza immunizations are distributed, but nothing about this flu season is normal — from the dominance of a novel strain to the high number of cases emerging so early in fall to the creation and testing of an additional vaccine. So before you line up for your shot, here's the latest on the vaccine rollout.
When will I be able to get the 2009 H1N1 flu vaccines?
The CDC expects 3.4 million doses of the 2009 H1N1 vaccine to begin shipping on Oct. 1. Most of this first wave of vaccines will consist of the nasal-spray variety, which contains the weakened live H1N1 flu virus and is recommended for healthy people ages 2 to 49. Pregnant women, the elderly and those with chronic health conditions should get the injectable vaccine, which contains the inactive virus and is expected to be widely available within the first two weeks of October.
As the flu season progresses, five vaccinemakers will churn out 20 million additional doses each week until the government's goal of 251 million doses is reached. Every day, state health officials will collect additional vaccine requests from doctors, hospitals, retail pharmacies and other providers — 90,000 in all — and forward them to the CDC, which will distribute vaccines through McKesson, a San Francisco-based medical and pharmaceutical distribution company. McKesson has dedicated six new facilities — two in Ohio and one each in California, Tennessee, Georgia and Texas — to handling the receipt and shipment of the H1N1 vaccine, along with additional supplies such as syringes, needles and sharps-disposal kits, also provided free by the government.
Are the 2009 H1N1 vaccines safe?
Yes. On Sept. 15, the U.S. FDA approved four H1N1 vaccines — three injectable versions and one nasal spray — on the basis of early results from clinical trials involving hundreds of healthy adult volunteers that showed that the immunization was both safe and effective in activating a good immune response to H1N1. Studies with children and pregnant women are still under way, but so far both groups show no serious reactions to the vaccine.
The pandemic-flu vaccine is made the same way as the seasonal-flu shot, except with a different influenza-virus strain, so the clinical trials were not actually required for licensure — the seasonal-flu shot is not tested this way each year but is considered safe. Yet health officials wanted to be cautious; the last time the government ordered a vaccine against an H1N1 virus, in 1976, 40 million Americans received the shot, and soon after, several hundred contracted Guillain-Barré syndrome, a rare but paralyzing neurological condition.
The new vaccine has no such problems so far, and nearly 80% of all inoculated people produce enough antibodies to protect them from getting sick.
Why won't the seasonal-flu vaccine protect me against 2009 H1N1?
The regular flu vaccine does not contain the 2009 H1N1 flu strain. If the first cases of H1N1 had emerged earlier — in January or February instead of in March — then the novel flu strain might have been part of this fall's yearly flu vaccine. But because the World Health Organization (WHO) decides in February which three influenza strains to include in the next season's vaccine, it was too late to fold in H1N1.
Health officials also chose not to interrupt production of the seasonal-flu vaccine to make room for H1N1; that would have left us with no immunizations at all for the start of the flu season. This way, the seasonal vaccine was delivered on time, with the 2009 H1N1 vaccine close behind. If 2009 H1N1 continues to circulate as one of the main influenza strains this fall and winter, the WHO may decide to include it in the annual vaccine next year.
How many H1N1 flu shots will I need?
That depends on how old you are. Early trials suggest that a single dose of the H1N1 vaccine will be sufficient to protect adults and children ages 10 and older. That's good news, since health officials initially thought most people would need two doses. Now twice as many people can be vaccinated with the same number of doses purchased by the government, and people won't have to keep track of their vaccination schedules.
Children under 10, however, will need two doses of the new vaccine, 21 days apart. That's in line with current immunization practices for this age group; all children up to age 10 who are getting vaccinated for the first time against seasonal flu also receive two doses. That's because young immune systems cannot mount as strong a response against influenza as more mature ones can, and since youngsters are less likely than adults to have been previously exposed to influenza, they don't benefit from residual immunity against the virus.
This means some children will need four doses of influenza vaccine this year — two for seasonal flu and two for H1N1.
There are two types of the H1N1 and seasonal vaccines. Can I mix and match?
Both the seasonal and the H1N1 vaccines come in two varieties — an injectable form and a nasal spray, FluMist. Ideally, anyone needing two doses of either the seasonal or the H1N1 vaccine should stick to the same form of inoculation — the shot or the spray.
But if that's not possible, it's O.K. to mix and match. Children younger than 10, for example — who need two doses of the 2009 H1N1 vaccine — can get one FluMist and one injectable dose.
Only one combination is not recommended. If you need to get the seasonal and 2009 H1N1 vaccines at the same time, don't get FluMist for both. "It's a question of how the immune system deals with a live virus," says Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases. "It's better not to push two live-virus vaccines at the same time."
Again, pregnant women, anyone under 2 or over 49 and those with an underlying condition like heart disease, asthma or a compromised immune system should not get the spray vaccine. But the injectable version, made from the killed influenza virus, is approved for everyone 6 months old and up.
Where can I get the 2009 H1N1 vaccine?
The new vaccine should be available wherever the seasonal vaccine is traditionally administered — doctors' offices, hospitals, public-health clinics, workplaces and retail clinics.
In addition, the H1N1 vaccine will be available at some unconventional locations, including pharmacies (pharmacists in 49 states are allowed to administer flu shots) and schools. That's because health officials not only want to immunize as many people in as short a period as possible but also want to target school-age children first. (Other priority groups for vaccination include health-care workers, pregnant women and caretakers of children under 6 months.) In New York City, for example, which had one of the country's highest rates of 2009 H1N1 last spring, each public and private elementary school will serve as a vaccination center and will hold two rounds of immunizations, spaced four weeks apart, to ensure that children needing two doses of vaccine receive their complete schedule of shots — with parental consent.
What You Need To Know About The H1N1 Vaccine
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