by Adrienne Randolph, MD, MSc, Division of Critical Care Medicine
Tilmo, my taxi driver, was there as promised to take me to the Atlanta airport when I left the Centers for Disease Control and Prevention (CDC). He had dropped me off that morning so I could meet with six different influenza researchers and give a talk on life-threatening influenza in children.
“A letter has been sent home from my child’s school,” he said as we drove away. “I must decide whether or not he will get the swine flu shot. Doctor, what would you advise?”
I am an attending physician in the Medical-Surgical Intensive Care Unit (ICU) at Children’s Hospital Boston. In June and July of this year, we had an upsurge of admissions of children with influenza pneumonia who had profound hypoxia (oxygen deprivation) that wasn’t responding to treatment. I immediately said, “Get him vaccinated as soon as it is available. My three children will get the vaccine.”
He asked, “Are there any risks?”
The answer is not completely clear. Testing hasn’t yet been performed in an enormous number of children, and longer-term risks can’t be assessed. “There is a very small risk of developing neurologic side effects from the vaccine, but this virus causes a very severe pneumonia that can kill otherwise healthy children,” I told him. “The risks of not getting vaccinated are higher than the risks of getting vaccinated.”
I had weighed these risks carefully. In 1976-77, with the last swine flu vaccine, as many as 1 in 85,000 people vaccinated came down with Guillain-Barré syndrome — a neurologic condition that paralyzes the muscles, causing respiratory failure. In contrast, there were very few confirmed deaths from swine flu that year.
But it is clear that the 2009 swine flu is more severe. According to the CDC Web site, from August 30 to September 12 alone there were 4,569 hospitalizations and 364 deaths among U.S. adults and children from any type of influenza – and the only flu strain going around at the moment is the novel H1N1 influenza A swine-origin strain. Of the 114 children who died from influenza in the last year, from September 28, 2008 to September 12, 2009, 46 had influenza A H1N1 — the strain that started to infect people in April.
Because I was funded by the CDC in January to investigate why some children get sicker with influenza infection, I knew of severe flu cases in my study network, consisting of 30 pediatric ICUs. We’ve seen cases of encephalitis, an infection in the brain, and cases of influenza myocarditis, an infection of the cardiac muscle causing the heart to have severely depressed function.
We were almost back at the airport. Tilmo had one more question. “Is the vaccine made from swine? I have a problem because swine are considered unclean in my country.” Tilmo is from Ethiopia and is a Muslim. It took me a moment to reply: “The novel H1N1 strain of flu is called swine flu because part of the virus is of the same type that infects swine. It is not actually made of swine.”
I then realized that it is important for Muslim leaders to be educated about this. Despite the attempts of public health experts in many nations, the nickname “swine flu” just won’t go away, and it would be very worrisome if Muslims did not get vaccinated.
Four days after leaving the CDC, I learned that my research network was funded by the NIH to perform surveillance for life-threatening and fatal cases of swine flu in U.S. children. We are also in the final contest for CDC funding to study the effectiveness of the H1N1 vaccine in preventing life-threatening illness. Our government has quickly released millions of dollars to combat H1N1, and I hope that those who are able to get their children vaccinated will take advantage of the opportunity.