Swine flu jab dilemma: Parents and pregnant women refuse it but experts insist it's safe... so who's right?
Swine flu jab dilemma: Parents and pregnant women refuse it but experts insist it's safe... so who's right?
By Steve Boggan
Last updated at 12:09 PM on 08th December 2009
Comments (55) Add to My Stories A few days before Christmas and health matters are farthest from your mind when, out of the blue, an invitation drops through the letterbox - but it isn't to a party and it isn't really for you.
It's a letter from your GP inviting your child to have the swine flu jab.
Only a few months ago, this might have led you to dance a little jig of relief; after all, medical evidence shows that unlike seasonal flu, where the elderly are usually most at risk, with swine flu it is the young who appear most vulnerable.
Caution: Doubts have crept up over the safety of the swine flu vaccine
Fast-forward a little and your reaction is less ecstatic. Over the past few weeks, doubts have cropped up about the safety of the vaccine and the need to have it.
No one knows how many parents will take advantage of the vaccination, but so far among the priority at-risk groups - pregnant women, those with heart disease, asthma, medical staff - the uptake has been alarmingly low.
Exact figures are hard to come by, but estimates suggest that of the 10 million or so entitled to the jab, around a fifth have had it.
Many pregnant women are turning their backs on it, citing fears over safety. And some health professionals seem reluctant to be vaccinated - sending out a worrying message to anyone else wondering what to do.
It is an astonishing state of affairs. You can see some of the thinking in this. On the one hand, health agencies around the world have been warning of a catastrophic pandemic since the first cases of novel H1N1 swine flu emerged in Mexico last April. On the other, most of us have either caught the disease or know people who have. And it has been just like a mild dose of flu.
But the fact remains, 270 people have died in the UK during the outbreak: 58 per cent children and adults up to the age of 49. For every 100,000 under-fives, around 140 are being hospitalised with swine flu compared with just over 30 per 100,000 in the rest of the population.
Because very young people have had little exposure to flu during their short lives, otherwise healthy children seem to be particularly susceptible to swine flu. For them, it can be a killer.
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So, why are people resistant to the idea of a vaccine? Are fears over dangers well-founded? And, the most important question of all: Should we all have the vaccination if offered it?
In trying to clear away the fog surrounding the vaccine, I've discovered there's been no single event, news story or public announcement that has caused this concern about the vaccine.
Instead, different groups of people seem to have been influenced by concerns emanating from a number of sources, not least the internet, where rumours spread faster than flu.
So, here are those concerns and the facts about them that matter to you and your family:
WAS THE JAB TESTED PROPERLY?
There are two swine flu vaccines, Pandemrix, produced by GlaxoSmithKline, and Celvapan, made by Baxter International. Of these, worries have focused on Pandemrix for two reasons - the apparent lack of testing before its approval, and the fact that it contains something called an adjuvant. Some reports claim adjuvants were responsible for Gulf War Syndrome.
Like most flu vaccines, Pandemrix started life being incubated in hens' eggs before being extracted, genetically manipulated and prepared for injection.
It contains inactivated - or dead - parts of a swine flu strain called A/California/7/2009 (H1N1) v-like strain (X-179A).
When injected into a human being, these inactivated parts, or antigens, provoke a response from our immune system that results in antibodies being produced to protect us against exposure to a live version of the strain.
But there is nothing alive in the vaccine - only inert bits and pieces that would normally be on the outside of a virus and which are recognised and targeted by our defences. So the vaccine doesn't give you a dose of flu.
Many people believe this vaccine has been produced so quickly that it cannot have been properly tested.
In fact, it is a modified version of a previous vaccine that was prepared, tested and approved to guard against a strain of bird flu called H5N1 - a particularly virulent and frightening form of the disease.
Scientists genetically removed the H5N1 strain and inserted the H1N1 strain. And remember, both vaccines contain only inert - dead - parts of the virus anyway. They cannot actually infect a recipient.
The bird flu version was approved by the European Committee for Medicinal Products for Human Use (CHMP) in May last year following clinical trials involving 12,000 patients. This organisation and the World Health Organisation have approved the H1N1 version.
GlaxoSmithKline says that ongoing trials among a further 10,000 patients have produced positive results and thrown up no concerns for safety.
Of course, it would say that, wouldn't it? However, independent and respected scientists such as Professor Hugh Pennington, emeritus professor of bacteriology at the University of Aberdeen, are satisfied the vaccine is safe.
'Flu vaccines have been used perfectly safely since the Forties and this one is no different,' Professor Pennington says. 'Billions of doses have been given over the years and I would advise anyone who is offered this one to take it. There are usually no side-effects, but even where there are, the most common is a sore arm.'
Many people may have confused the swine flu jab with Tamiflu, which has well-known side-effects. Tamiflu is a treatment for swine flu once you have it, it's not a vaccine.
I'VE HEARD IT CONTAINS AN ADJUVANT WHICH CAUSES GULF WAR SYNDROME
From the Latin adjuvare, meaning to aid, an adjuvant increases the efficiency of the antigens - the inactivated parts of the swine flu virus - in the vaccine. This means fewer antigens are needed to promote the production of antibodies in humans.
The adjuvant used in Pandemrix is a fatty substance which causes our immune system to react more vigorously - the adjuvant is called squalene and is extracted from fish oil.
Professor David Salisbury, director of immunisation at the Department of Health, says: 'An adjuvant is simply something that improves the efficiency of the antigens in the vaccine. For example, the normal seasonal flu vaccine, without an adjuvant, contains three strains of flu, each containing 15 micrograms of antigen per strain.
'But when you want to produce a vaccine to tackle a potential pandemic, having an adjuvant means you need fewer antigens to make it work just as well, so you can divide them up and produce more doses. So, in a dose of Pandremix, there are only 3.75 micrograms of antigen, but the adjuvant makes it even more effective than 15 micrograms without the adjuvant.'
There have been claims in the U.S. that squalene was in a cocktail of drugs linked to Gulf War Syndrome, a wide-ranging set of conditions including muscle pain, skin problems, fatigue, headaches and memory loss.
However, John Oxford, professor of virology at St Bartholomew's and the Royal London Hospital, says: 'No, they were not in any of the Gulf War vaccines. If anything caused Gulf War Syndrome, my money would be on the vaccines themselves, not least an unlicensed Anthrax vaccine.
'If anyone needed proof the adjuvant in the swine flu vaccine is harmless, you only have to consider that 80 million doses have been given throughout Europe and no one has died, no one has become seriously ill and no one's arm has fallen off.'
ISN'T THERE MERCURY IN IT?
There are tiny traces of mercury in thimerosal, the preservative used in the H1N1 vaccine. Some U.S. websites have suggested this can lead to autism in children.
However, this has been dismissed through lack of evidence by the World Health Organisation.
After use of mercury-based preservatives was halted in the U.S., studies showed rates of autism went up, not down.
COULD THE JAB PARALYSE ME?
There's been lots of talk about the swine flu jab causing Guillain-Barre Syndrome (GBS), a potentially paralysing neuromuscular disease. This goes back to 1976, when there was an outbreak of a different kind of swine flu on a U.S. military base. Subsequently, President Gerald Ford ordered the entire U.S. population to be vaccinated against it.
By the time the scare was over, 24 per cent of Americans had had the jab, but reports came in of a slight increase in the prevalence of Guillain-Barre among those who had been vaccinated. Could this happen here, too?
According to Professor Pennington, nobody has ever been able to figure out why the increase in Guillain-Barre occurred, but it is a phenomenon that has never been repeated.
He points out that people suffering from flu are eight times more likely to contract GBS - so statistically it is safer to have the jab.
I'M PREGNANT, IS IT RISKY?
Reassured: Pregnant woman need not worry about the swine flu vaccine, says the Government's main advisor
If pregnant women were worried about being given a dose of swine flu, they shouldn't be, as the vaccine contains no live virus. Should they be worried about the adjuvant? Again, according to Professor Salisbury, the Government's main adviser on such matters, no.
However, some governments, including Canada's and Switzerland's, have decided not to give Pandemrix to women amid public concern over a lack of testing (although they have produced no evidence of any dangers).
At the time, a spokesman for the German Medical Association said: 'We know the effects of the various ingredients in adjuvant vaccines, but not the combined effect. It's understandable that people are wary of getting jabs of drug cocktails.'
Professor Salisbury says he does not know why there are international differences, but he finds it frustrating. 'They have exactly the same evidence as we have, and we are satisfied the vaccine is safe for pregnant women,' he said. 'It is a shame that governments are sending out such mixed messages, because it simply confuses people.'
As for testing the vaccine on pregnant women, this is difficult. Usually, drug companies have only a few months to produce the annual flu vaccine - they cannot inject women and then wait nine months. However, GSK estimates that as many as 90,000 pregnant women worldwide have received its swine flu vaccine without any obvious concerns.
Professors Pennington, Salisbury and Oxford point out that thousands of pregnant women are given the flu jab every year without problems. Statistics show that pregnant women catching any kind of flu are ten times more likely to be admitted to hospital than ordinary flu patients and five times more likely to develop complications from it.
'Having the jab is the much safer option,' says Professor Pennington. Women can ask for Celvapan, which does not have an adjuvant, if they wish, but the Department of Health recommends they have Pandemrix, as they need only one dose; Celvapan requires two doses over three weeks, so does not offer instant protection.
INFECTION RATES ARE LOW, SO WHY HAVE THE JAB?
Last summer, Health Secretary Andy Burnham was predicting that 100,000 people would be coming down with the virus every day, while the Chief Medical Officer predicted the death toll could be as high as 65,000.
However, these predictions have been revised downwards as the infection rate has been decreasing. There were 22,000 new cases in England last week, compared with 46,000 the week before, and 53,000 the week before that.
But Professor Oxford warns: 'Don't be lulled into a false sense of security - rates might be plummeting now, but what about next week, or Christmas, when flu always seems to reach peak numbers, or January, or February? The situation is very unpredictable and I won't be breathing easily until we are into March.
'This is a virus that can put you in hospital or the mortuary. And there aren't many viruses around like that. The sensible advice is to have the vaccination if you are offered it.'
WHY AREN'T DOCTORS BEING VACCINATED?
The uptake among doctors and nurses is likely to be below 50 per cent, according to surveys for a number of healthcare magazines. In fact, this is an improvement on uptake of the seasonal flu vaccine programmes aimed at NHS staff, which has been as low as 30 per cent.
Professor Salisbury says he is puzzled by the reluctance to have the swine flu jab, as it not only puts the health workers at risk, but also their patients and, back at home, their families.
And their actions fly in the face of advice from the British Medical Association, Royal College Of General Practitioners, Royal College Of Midwives, Royal College Of Nursing and the health workers' union Unison, who all believe the vaccine is safe and that their members should have it.
Dr Dean Marshall, a GP and the BMA's swine flu spokesman, says: 'I think that most doctors and nurses simply assess their situation and if they don't think they're personally at risk, then they don't bother with it. It is just people avoiding the inconvenience of queueing up and getting a sore arm.'
Up and down the country, some hospitals are reporting an increase in uptake of the virus. Already, 275,000 doses of the swine flu vaccine have gone to healthcare workers, more than double the entire take-up of the seasonal flu vaccine by this group last year.
SHOULD MY FAMILY HAVE THE JAB?
Which simply leaves us with the all-important question: If you and your family are offered the vaccine, should you have it?
The experts and professionals I spoke to all said 'Yes'.
'Put simply,' says Professor Pennington, 'if the people who have been killed by swine flu had had the vaccine, they would probably be alive today.'
Read more: http://www.dailymail.co.uk/health/article-1233989/Swine-flu-jab-dilemma-Parents-pregnant-women-refuse-experts-insist-safe--whos-right.html#ixzz0Z8iY9eQB