Posted by: mindyourknitting | October 31, 2009

In Defence of Inoculation

I wasn’t going to write about this at all.  There are several sides to the vaccination debate, and the decision to vaccinate or not to vaccinate has devolved to become one of personal choice rather than public health.  Yet with the onset of H1N1 panic in Ottawa, and the good and bad information floating around out there, I feel like I need to say something about it.  And as it turns out, I have a lot to say.  First off, I will tell you that we are firmly in the pro-vaccination camp.  I did some research before Abigail was born on the safety of childhood vaccines, and aside from some concerns about the sheer number of vaccines she was scheduled to get before the age of 2 (which, upon further investigation, is a non-issue), I had little problem with the idea of inoculating her against various horrible diseases.

Our self-assured confidence in vaccinations hit a snag, though, when H1N1 reared its piggy head and we had to decide whether to get ourselves and our 15-month old the H1N1 shot.  The situation wasn’t helped by weeks of unclear information from Health Canada and the Public Health Agency of Canada about when the shots would be available, who should get it first, and what sort of safety testing it had undergone.  So we waited, unsure.  But the available information vastly improved (see the websites for Health Canada and the Public Health Agency  for general factoids –  most cities will have their own sites too, Ottawa’s is pretty good, and they also have a Twitter page to update people on the wait times etc. at city vaccination clinics), vaccine clinics opened their doors this week, and we are going to try to get Abigail vaccinated as she falls into one of the priority groups currently being given the shot.  From all accounts the clinics are a busy, disorganized mess, and I suspect that more than a few people who don’t fall into the priority groups are getting in line anyway, thus making the lines that much longer for the ill, the elderly, and those encumbered with small children.  But we’re going to do our best to stand in line for hours to provide our daughter with any protection she can get against this flu, which is killing young healthy people, something that seasonal flu tends not to do.  We have done our due diligence, are convinced the vaccine is safe, and we’ll all be getting it when it’s available to everyone.

There is a great deal of information out there, both from Canadian sources but also from excellent sites like the US Centre for Disease Control, which is a great resource for all things germy (the Canadian equivalent is a branch of the Public Health Agency)  I tended to trust information from government, scientific, and vetted/edited sources over anecdotal information from message boards, forums, and the like – that’s my bias.  Anecdote has its place, and science can be wrong, but when weighing evidence the latter was simply better researched and supported and we all know that “Dr. Google” is a bit of a quack.  And certainly don’t trust me – do your own homework.  But in any case here’s what I found.

The H1N1 vaccine being used in Canada is called Arepanrix.  It contains thimerosal (a mercury derivative) that acts as a preservative.  According to December 2005 information from the Public Health Agency’s National Advisory Committee on Immunization, “in Canada, some multidose preparations of influenza or hepatitis B vaccines are the only thimerosal-containing products that might be offered to children as part of the routine childhood immunization schedule. Thimerosal-free influenza and hepatitis B vaccines have also become available in recent years.”  In addressing specific concerns related to thimerosal, the National Advisory Committee on Immunization had this to say:

  • There is no legitimate safety reason to avoid the use of thimerosal-containing products for children or older individuals, including pregnant women.
  • The only absolute contraindication related to the thimerosal component of some vaccines is a previous episode of anaphylaxis attributed to thimerosal. While one such case has been described, the link to thimerosal was not proven.
  • If there is a documented history of a delayed hypersensitivity reaction to thimerosal (as manifest by a large local reaction with an eczematous rash) or a positive patch test reaction to thimerosal, immunization with thimerosal-containing vaccines can proceed, but individuals should be advised to report any reaction of concern following immunization so that it can be managed appropriately.
  • The long-term goal of removing thimerosal from vaccines, provided there are safe alternatives to ensure sterility in multidose vials, still applies, since this is one achievable way to reduce total environmental exposure to mercury.

I don’t have a very good understanding of virology and biology, but I like to think that the people on these sorts of advisory boards do.  I think Jenny McCarthy has done a world of damage by publicizing the idea that childhood vaccinations cause autism and other neurological disorders, and her organization has extended this assertion to include the flu shot, if the story on her website about the paralysis of an NFL cheerleader after getting the flu shot is any indication. There are always going to be those who believe that routine, scheduled vaccination, or public health vaccination campaigns like the one for H1N1, are scams cooked up by pharmaceutical companies and governments who want to make money and blatantly disregard people’s health.  I, for one, could care less if Big Pharma makes scads of money.  Good for them.  Maybe they’ll use some of it for further medical research and save some lives (and maybe they’ll use it for more Viagra commercials.  Whatever).  I have a hard time believing the government is party to a conspiracy when we’re not being charged for the vaccination and the various levels of government are paying to run the clinics.  What I want to know is whether the vaccine, or medication, or whatever, has gone through rigorous testing at corporate, governmental, and independent scientific levels.  If it has, then I have to trust that the experts, the doctors and scientists, know what they’re doing, more so than Ms. McCarthy does.

The other substance of concern in the H1N1 vaccine is the squalene-based adjuvant.  Non-adjuvant versions are available for pregnant women because no clinical data exists on the impact of adjuvants on pregnancy (presumably because scientists are reluctant to experiment on pregnant ladies), but the variety most people will get will contain this substance.  Adjuvants are not new and have been used in a wide spectrum of vaccines, although this is the first time they have been used in a flu vaccine.  Health Canada explains (better than I could) that : “an adjuvanted vaccine is a vaccine that includes a substance that boosts an individual’s immune system and increases their response to a vaccine. An unadjuvanted vaccine has no “booster” element.  Adjuvanted vaccines are included in common vaccines such as tetanus and Hep B.  The adjuvant in Canada’s H1N1 flu vaccine is made up of natural ingredients such as water, squalene oil and vitamin E.”  Thimerosal and the adjuvant (as well as formaldehyde, which acts as an antimicrobial agent and delivery medium) are the two components of the vaccine seem to generate the most chatter and concern.  Many of these elements (or the substances they are composed of) naturally occur in the human body. 

The other by-product of this H1N1 campaign seems to be a general increase in the scepticism related to vaccination in general, and routine childhood vaccinations in particular.  Perhaps a combination of relative affluence, first-world health care, and, ironically, a decline in life-threatening childhood diseases has resulted in what I perceive to be an increasing complacency about vaccinations.  When it comes down to it, I want people to get vaccinated so they don’t make me and my family sick.  As a public health measure vaccination only works if a critical mass of people does it, because there are individuals who can’t be vaccinated and are therefore vulnerable, and sometimes immunities from vaccination don’t stick.  If most people are vaccinated, that extends protection to those who can’t or don’t have immunity to that particular disease.  As a superb Wired article on the subject of vaccination stated, “[n]obody in the pro-vaccine camp asserts that vaccines are risk-free, but the risks are minute in comparison to the alternative.”  Most of the risks of vaccination for an overwhelming percentage of the population are minor (ex. soreness at injection site).  That alternative is the resurgence of nearly-defeated diseases, and the emergence of the so-called “superbugs” among our population, which will kill far more people than the vaccines will.  When you consider that most vaccinations can’t be given to babies under 6 months of age (as is the case with the H1N1 vaccine), a decision not to vaccinate yourself and take your chances with the flu becomes one with much, much wider implications for others.  And if that extends to a refusal to vaccinate children against things like pertussis (whooping cough) and measles, the results can be deadly for our littlest, most vulnerable population. 

The concerns about preservatives and adjuvants in vaccinations, among other issues, should be taken seriously and studies should be undertaken to further investigate their effects on bodies, big and little.  Like most things, every vaccine has a risk, but the choice I’ve made is that I’d rather take that very minimal risk than the one that involves exposing my unprotected child to every germ and bug out there, and hope she can survive them, not infect others, and come out the other side unscathed.   This post may not win me many fans (next in this series: posts about bottlefeeding, co-sleeping, and peanuts!), but I’ve made academic and professional careers out of doing research, and supporting arguments with facts.  Everyone is entitled to their opinion, but it’s difficult for me to swallow when that opinion is based on flawed research, celebrity endorsements, and anecdote, particularly when that decision could have a devastating impact on me and mine.

*We braved the lines yesterday, so I took the afternoon off work and spent two hours outside in the rain to get bracelets for myself and Abigail (I fall into the priority group because of heart condition, which had not occurred to me earlier since I was so focused on getting Abigail the shot, duh), which from other stories I’ve heard was a “short” wait.  We returned to the clinic at 6pm as instructed, then waited another three hours to get the shot.  Abigail was a miserable mess because she was up two hours past bedtime and terribly bored, so I walked her around and tried to distract her (like every other parent there).  The City of Ottawa security guards in the building where the clinic was held mainly treated people lined up like cattle needing to be herded into the appropriate area, so there were frequent verbal spars over keeping children in line etc.  The overall organization is getting better, but is still extremely flawed and confusing. 

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Responses

  1. Well I initially wavered on the shot but after the deaths of local kids who were healthy I looked at my own high-risk self and promptly decided to err on the side of caution. I have severe chronic asthma which means I was one of the few single thirty somethings standing in line this week at the outdoor daycare centers…er vaccination clinics.

    In my entire life I’ve never had a flu shot, not from fear but because up until the age of 12’ish my severe allergy to eggs prevented me from getting one and for many years afterwords I wasn’t keen on stabbing egg into my arm. I have at age 32 grown out of the egg thing and eat them regularly these days.

    When I’ve had the flu or even a cold for that matter in the past it has led to most nasty asthma complications so I figured if I got H1N1 I would likely have my life expectancy drop a big notch.

    As anecdotes to vaccination side effects go I had severe muscle pain in the arm I was shot in for 3 days and the first night after I had some shivers/sweats in my sleep and had a crappy next day at work. Having done similar research to Trista, I found that all of these symptoms are on par with the Adjuvant component but I feel fine now.

    The vaccination still takes 10 days to become effective so here’s to not get the flu by next weekend.

    Mark

  2. I’ve had muscle soreness too in the area of the vaccination…almost like I got a shot in the arm :0

  3. This is a really good and comprehensive piece of work, Trista. Nicely done!
    Rita

  4. Nice post–and based on actual RESEARCH, and not the hysterical forwards being sent around the web. Honestly, as wonderful as the Internet is, it’s sad that suddenly so many people consider themselves experts. Doctors spend nearly ten years learning about the human body, but we listen to Jenny McCarthy? An ACTRESS? Very, very strange to me.

    I will always consider those who choose not to vaccinate their children selfish. Not popular to call people on their shit, but that’s the honest truth. Because they are relying on the rest of the world to take the risk–and sure, there is a risk–for them. There is no immunity without herd immunity, period. We all take the risk, we all reap the benefit. We none of us take the risk, we none of us benefit. But some taking it and others refusing, and still reaping the benefit? Not cool.

    My father is an Infectious Disease doctor, and I can’t tell you how frustrated it makes him when people think they know better. He’s not being a stuck up asshole, he actually JUST KNOWS MORE. And he is 100% behind the swine flu vaccine, even for us, his family, the most important people in the world to him. Does it make me nervous? Sure. All medicine makes me nervous to some degree. It’s like magic in a way, in that I have to trust someone else to have the knowledge for me. But I do trust.

    Wow, this is getting very long and wordy. Maybe it’s the cider and Soco? TRY IT. You won’t regret it. Seriously.


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