The Truth About H1N1 Vaccinations - Shot, Nasal Spray, or Neither? Parents Uncertain.

A recent Associated Press-GfK Poll found that one-third of parents will not have their children vaccinated with the H1N1 flu vaccine. While 59 percent of parents were willing to give permission to schools to administer the H1N1 vaccine to their children when available, 38 percent refused.

Sounds like a lot, doesn't it?

But it's not. News reports failed to highlight another fact in the same survey. Two-thirds of parents (66 percent) planned on having their children vaccinated against the traditional seasonal flu and one-third (32 percent) did not.

In other words, the number of parents opposing the H1N1 vaccine is about the same as the seasonal flu vaccine. As a whole, a significant number of parents oppose flu vaccinations whether for the seasonal or H1N1 virus, which was commonly referred as the swine flu in the spring.

Yet, reports from CDC show that the flu outbreak is widespread in 37 states with the vast majority being H1N1. The number of pediatric deaths for the 2008 to 2009 flu season (starting September 28, 2008) stands at 147 with 76 deaths due to the 2009 H1N1 virus. Twenty-nine of the H1N1 deaths occurred since August 30, 2009. What is concerning is that the number of pediatric deaths is higher than in years past. Since the H1N1 virus started in the spring, it is very possible the number of pediatric deaths will only increase for the 2009 to 2010 flu season.














The H1N1 virus is particularly harmful in children and young adults aged 25 years and younger. CDC reported in the spring that the number of H1N1 cases was 23 to 26 times higher in individuals 24 years and younger than people 65 years and older. The older cohort had some natural immunity while the younger group had none.

Given all of this information, why aren't parents acting?

Psychology may explain this. People tend to have more regret when they actively make a decision that results in a bad outcome than if they passively had it happen.

For example, some research suggests that changing answers on a test on average benefit the test taker. Yet, most of us are quite reluctant to do so even if it is in our best interest. Why? Feelings of regret are far more powerful if did something to result in a bad outcome than if the bad outcome occurred due to no action on our part. In the case of test takers, they felt better if they left a wrong answer (inaction) than if they actively changed an answer and then got it wrong (action). Even though having a wrong answer, the bad outcome, was the same in both cases the latter group felt far worse.

Actively scheduling and then taking a child to get the flu shot and potentially needing to deal with side effects are not very likely, but still a real possibility. Should the child suffer an adverse reaction, then naturally the parent would feel terribly responsible. If the child instead developed H1N1 and had not gotten vaccinated earlier, the parent would feel not feel as guilty.

Yet as for the threat of H1N1, I suspect many parents see what they want to see. If their child isn't ill and they don't know others who are ill, inaction is preferred.

This inaction is just a sign of a disturbing trend. Increasingly more parents are concerned about vaccinations in general than the illnesses they protect against because people don't have personal experience with individuals suffering from illnesses like polio, mumps, or measles. They don't recall the scare sixty years ago when polio outbreaks closed public pools, paralyzed otherwise healthy individuals, and prominently impacted the life of a sitting American president, FDR. Despite all of the medical advances in the 21st century, new cases of polio still occur throughout the world despite the availability of effective polio vaccines. Children still suffer from devastating life altering complications from polio because their parents refused get them immunized. Vaccinations work.

Given a choice between the inactivated flu shot, which uses a killed virus, versus a nasal spray vaccine, which uses a live but weakened flu virus, I would suggest parents who are concerned about safety to opt for the former. I feel better about receiving a dead virus to train the immune system rather than subjecting the body to a weakened one. I would note, however, that both vaccines are approved for usage.

Although the inactivated H1N1 flu shot must be given on two separate occasions for children 9 years old and younger (up to 6 months old), this is not different than when children get the seasonal flu vaccine for the first time. Read more about the inactivated H1N1 flu shot via the vaccination information statement. Research has shown that children 10 years old and up only need one H1N1 flu shot.

The nasal spray uses a live, but weakened virus which can only be administered to children ages 2 years and older. Therefore, children age 6 months to 2 years desiring a H1N1 immunization will need to get the shot. More about this nasal spray H1N1 vaccination via its vaccination information statement. It only needs to be given once.

In the end, I hope these parents that choose not to vaccinate their children against H1N1 are right. I hope their assessment of risk to their children is correct. I hope that they aren't wrong, because if they are wrong, they could be deadly wrong.

A vaccine exists and has the real potential to save lives. It's safe. Instead many parents are walking away partly due to psychology, some fear, and often due to lack of experience with formerly common debilitating illnesses. Often what troubles me as a doctor is knowing something could have been done to save lives, decrease suffering, and improve health, only to discover that the opportunity is missed and it never happens. I hope that the concerns parents have about H1N1 or the seasonal flu and their subsequent inaction do not become one of these tragic missed opportunities.

More information about the H1N1 vaccine can be found at the CDC website.