These are the CDC's current Swine Flu Vaccination recommendations (updated 28 Aug 09):
CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended that certain groups of the population receive the 2009 H1N1 vaccine when it first becomes available. These target groups include pregnant women, people who live with or care for children younger than 6 months of age, healthcare and emergency medical services personnel, persons between the ages of 6 months and 24 years old, and people ages of 25 through 64 years of age who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems.
We do not expect that there will be a shortage of 2009 H1N1 vaccine, but availability and demand can be unpredictable. There is some possibility that initially the vaccine will be available in limited quantities. In this setting, the committee recommended that the following groups receive the vaccine before others: pregnant women, people who live with or care for children younger than 6 months of age, health care and emergency medical services personnel with direct patient contact, children 6 months through 4 years of age, and children 5 through 18 years of age who have chronic medical conditions.
My personal recommendations are based upon the following factors:
1. CDC recommendations
2. My general philosophical belief in the beneficence of vaccination for major communicable diseases
3. My general bias against new medical treatments (i.e. less than one year's worth of data from widespread use in the general population) except in deadly diseases such as advanced AIDS - think recalls of cars in the first year of almost any new or redesigned Detroit auto model
4. The similarity of this Flu strain to that of the 1976-77, 1957, and 1918-19 strains, and the potential of full or partial immunity for those people old enough to have been exposed in any or all of those years
5. The increased incidence of Guillain-Barre Syndrome (GBS), a potentially fatal autoimmune disease that causes paralysis, associated with the 1976 H1N1 vaccine (as a consequence the vaccine was withdrawn from use) (nb link to UK article below)
6. The susceptibility of this year's H1N1 strain to Oseltamivir (Tamiflu) and presumably to Zanamivir (Relenza) (although laboratory resistance has been seen, this has not yet manifested as human resistance (nb link to promedmail below)
7. The resistance of last year's seasonal influenza strain to Tamiflu, but susceptibility to Relenza (along with Amantadine and Rimantidine, 2 older flu meds that are not considered effective against influenza A
8. This year's upcoming seasonal flu vaccine, the 2009--10 trivalent vaccine, contains the virus strains A/Brisbane/59/2007 (H1N1)-like, A/Brisbane/10/2007 (H3N2)-like, and B/Brisbane 60/2008-like antigens.
9. Most seasonal influenza A (H1N1) virus strains tested from the United States and other countries are now resistant to oseltamivir (Tamiflu) (per the CDC)
10. The unproven theory that dietary gluten (a protein found in grains such as wheat, rye, barley and oats) may be a contributing factor in the rise in autoimmune diseases in western cultures
11. Both Relenza and LAIV (one of the two seasonal flu vaccine options, the other being the TIV flu shot) are nasal sprays and should not be used by those with asthma or reactive airway disease, nor should pregnant women receive LAIV
12. My prediction based on past seasonal flu resistance patterns is that we'll be seeing a drift (small change from past years' strains) rather than a shift (major strain change), and thus I think the seasonal flu vaccine will be very effective (around 80-85%)
Given all of the above considerations, here are my recommendations regarding seasonal flu and swine flu (H1N1):
A. Follow the CDC guidelines for the seasonal flu (nb CDC link below) - get vaccinated and take your usual seasonal flu precautions
B. Ask your doctor if there is a "Flu Entrance" to the office/clinic/ER to decrease exposures
C. Sign up at cdc.gov for weekly email updates on swine flu, but remember that no government in human history has ever run a website, economy or healthcare system in a timely, efficient fashion. The government can't keep you healthy or safe -it's your responsibility
D. Viz. C. above, a Washington State biosurveillance firm warned the CDC about the current swine flu outbreak in Mexico 18 days before the World Health Organization (WHO) alert was issued. You will get better real-time info from private sites such as google.org/flutrends
E. Re: swine flu vaccination, the risk/benefit ratio is not so easy. If you have only one of the risk factors mentioned by the CDC at the top of this post, I wouldn't recommend vaccination this year. But if you are a 20-something healthcare worker with asthma or an autoimmune disease (i.e. 3 risk factors), get vaccinated
F. If you are either exposed to or exhibit Flu-Like-Symptoms (FLS) which include fever >101 degrees, headache, dry cough, joint or muscle aches like you've been run over by a truck, do the following:
1. If it's not during standard seasonal flu season (i.e. Dec-Mar with the peak usually beginning in mid-late Jan), assume it's swine flu and ask your doctor for Relenza (non-asthmatics only) or Tamiflu. Remember, treatment is only useful if your symptoms are < 48 hours old - get treated quickly. After 48 hours of symptoms, don't go to your doctor's office - it's either supportive care at home (fluids, naproxen or ibuprofen and tylenol), or go to the ER if you're really sick
2. If it's during flu season, it could be either swine or seasonal flu. Ask your doctor for Relenza (non-asthmatics only) and either Amantidine or Rimantidine (as an optional boost against last year's Tamiflu-resistant seasonal influenza B). If you are asthmatic, ask for Tamiflu for swine flu protection and either Amantidine or Rimantidine for Seasonal influenza B protection
G. Pregnant women: get the TIV (seasonal flu shot), not the LAIV (flu-mist nasal vaccine). Follow the E. recommendation above.
H. Children:. I'm not a pediatrician - follow the recommendations of the CDC and your pediatrician
I. Whether or not you have Celiac Sprue, start eating a gluten-free diet now. Your immune system will thank you for it.
What will I personally be doing? I'll get the seasonal flu shot as soon as it's available, but I will not get the swine flu vaccine this year, as I have only one CDC risk factor. I will be wearing a mask while seeing patients during outbreaks to prevent transmission of subclinical flu (i.e. early infection before symptoms show). I'll recommend the same for my wife. For my 11 month old daughter, 2 seasonal flu shots and no swine flu shot. For my 27 month old daughter, 1 seasonal flu shot (she got 2 last year per the CDC recommendations) and no swine flu shot
Worst case scenario:
1. Relenza- and Tamiflu-resistant swine flu emerges
2. Relenza-resistant seasonal flu emerges
3. Seasonal flu shifts instead of drifts, with ineffective seasonal flu vaccine
Result: 300-500,000 US deaths (i.e. 10 times worse than an average flu season)
More likely: 50-100,000 deaths (i.e. 1.5 - 3 times worse than average)
I will update this as the situation changes