By Terri Hansen

Environment Science & Health Reporter (NFIC) 10/19/2009

Vaccine for the 2009 H1N1/A (swine flu) virus began arriving at Indian Health Service clinics this week. It works with a single dose and quickly takes effect.

Clinic patients should not delay calling to learn what clinic vaccination plans are, said IHS epidemiologist John Redd M.D.  “We want people to get their seasonal vaccination as quickly as they can, and once the H1N1 vaccine arrives, get that quickly.” Patients can get both vaccines at the same time.

Many clinics plan mass vaccination days. The IHS also offers the pneumococcal vaccine, and Redd encourages those who haven’t received it to ask for that vaccination, too. 

Influenza is increasing in all 50 states, and 98 percent of it is the H1N1 strain. Most cases are occurring in children and young adults, Dr. Anne Schuchat of the Centers for Disease Control and Prevention said at a briefing. She said 76 children have died so far this year from complications of the flu. Most cases are responding to the antiviral drugs oseltamivir and zanamivir.  

President Obama’s science advisory council reported earlier this year that Native American populations are at elevated risk of severe outcomes from 2009 H1N1 infection due to their populations being “historically at high risk for severe respiratory infections,” and, “A cluster of severe H1N1 disease among First Nation people in remote Manitoba, Canada suggests these groups may be at high risk. Cases of H1N1 virus infection in these clusters have had rapidly progressive, diffuse, lower airway disease … resulting in development of acute respiratory distress syndrome and prolonged ICU admission.” 

“We don’t think that American Indian and Alaska Native people strictly by virtue of being AI/AN are individually at higher risk for H1N1 disease,” said Redd. “But risk factors such as diabetes and obesity are known to be more common in American Indians and Alaska Natives, so the population may be at higher risk because of the risk factors.” 

The CDC says pregnant women, health care workers, people 6 months to 24 years of age, those who care for infants and those with chronic health conditions are priorities for the H1N1 vaccination. Redd said IHS efforts regarding H1N1 have been vigorous.

“We started the first weekend of the outbreak,” he said. “We’ve issued guidance involving use of the Strategic National Stockpile. We’ve spent a lot of time communicating with states to consider those tribal populations within their borders. We’ve done a lot of outreach to providers including community health representatives and public health nurses on getting the system ready to receive the vaccine.” The SNS is a large stockpile of medicines and supplies that support public health agencies during a public health emergency. It is deployed per guidance issued by the federal government, as a joint effort among state, local, territorial, tribal and federal officials if the health of a community is threatened. 

As far as the antiviral medications, those intended for the general population are distributed through the SNS by the states, said Redd. “In the Arizona outbreaks, we received the antivirals we needed from the state.” 

Redd said a big goal of the IHS is what they call mitigation – minimizing the impact of sick patients who might overwhelm a health facility. “A small hospital could deal pretty well with taking two intensive care patients for 10 days, whereas it might be very difficult for them to take 20 ICU patients in one day,” he said. “So one of our goals is to minimize spread and slow the flu down.” 

Schuchat said that although there is a very strong safety record for H1N1 vaccine, she knows, “this doesn’t satisfy everybody.” She herself is very comfortable in getting the H1N1 vaccine, but said that everybody has to make the best decision for the health of his or her family. “The CDC is committed to giving the information needed to make those decisions.” CDC experts say this year’s flu vaccine “is made as flu vaccine is made each year, by the same companies, in the same production facilities with the same procedures, with the same safety safeguards.”

“There is no reason to think that the H1N1 vaccine will be any different from the seasonal flu vaccine that AI/AN people have been receiving for many years,” echoed IHS epidemiologist John Redd M.D. “It’s manufactured using the same process as the seasonal flu vaccine.” First, the CDC identifies and tests a viral strain, then it’s distributed to vaccine manufacturers who inject it into millions of eggs to multiply, after which it is harvested, purified and developed into vaccine.

“We’re hearing everyone should get it but for healthy people it’s not a bad thing to get sick now and then, the immune system has gotten it’s tune up for the year,” said Portland, Ore. naturopathic physician Wendy Hodsdon. “But if you’re going the western medicine route, vaccine is what they offer. If you’ve already gotten the seasonal flu shot you may be more at risk for H1N1, so then it’s better to get that vaccine, too.”

Redd wanted to clear up a misconception making the Internet rounds: that the 2009 H1N1 flu vaccine contains adjuvants, substances sometimes added to other vaccinations to make them more effective. “There are no adjuvants in either the 2009 H1N1 vaccine, nor any flu vaccine used in the U.S.”

There are two versions, a nasal spray that uses a live attenuated or weakened virus, and the injectable vaccine made from a killed influenza virus that cannot recombine in the body to produce flu but can still stimulate the body to evoke a protective response. Redd warned that people with a severe allergy to chicken eggs should not use either method.

People with asthma should not use the nasal spray, also called FluMist, said Redd. But it’s particularly important that asthmatics get the H1N1 vaccine injection. He urged anyone with questions about pre-existing chronic conditions to consult their medical provider.

Hodsdon said most people clear the mercury, or thimersal that’s used as a preservative in the multi-dose vials, from their body without problems, “but some cannot.” She said while we want to keep our heavy metal load down we “must make choices based on what’s available, who we are and where we’re at.”

Redd said that a single dose, thimersal-free version is available at Indian Health Service, Tribal and Urban clinics.

The 2009 H1N1 flu vaccine is the cornerstone of U.S. flu strategy. U.S. officials have reassured the public they do not intend to force vaccinations but warn it could endanger public health if a substantial portion opt out of the $3 billion vaccination program.

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