Who gets the swine flu vaccine?
Photo: © 2009 Jupiterimages
In June 2009, World Health Organization officials declared the H1N1 influenza virus—commonly known as swine flu—a global pandemic. It is the first time they have taken this measure in 40 years. Some projections have warned there will be between 30,000 to 90,000 deaths in America caused by swine flu—compared with 36,000 deaths from flu complications in a typical year.

Flash back three years ago to when the world braced for the dangerous spread of a different strain of influenza called H5N1—commonly known as bird flu. While the United States ended up escaping a full-on outbreak of H5N1, it killed nearly 200 people worldwide. How did we escape? The H5N1 virus never mutated into a form communicable by human-to-human contact (everyone who died caught the virus from birds, not other humans). But swine flu can be spread from human-to-human contact.

As the winter flu season dawns in the Northern hemisphere—coinciding with the start of the school year—questions about a swine flu vaccine are becoming more urgent.

What are the symptoms of swine flu?
Dr. Michael Osterholm—who answered questions about bird flu on The Oprah Winfrey Show in 2006—says in most cases, you won't be able to tell the difference between regular seasonal flu and swine flu. Both result in muscle aches, fever and chills.

According to Dr. Julie Morita, medical director of the Chicago Department of Public Health's immunization program, the only way to be sure that a person has seasonal flu or swine flu is by taking a laboratory test. This test, she says, is only recommended for those who are sick enough to be hospitalized or whose health conditions increase their risk for dangerous complications from flu.

Who should get the swine flu vaccine?
Dr. Morita says the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices released a priority list to outline who is most in need of the vaccine. That list includes: pregnant women, caregivers for children younger than 6 months old, healthcare and emergency medical personnel, anyone between 6 months old and 24 years old and anyone between ages 25 and 65 who has a medical condition that increases the risk of complications.

Does the swine flu vaccine protect against regular seasonal flu?
"The seasonal influenza vaccine will protect against three different nonpandemic influenza strains that caused the majority of influenza infections in recent years," Dr. Morita says. "However, it will not prevent pandemic influenza infections. Likewise, the pandemic influenza vaccine will only prevent infections caused by the pandemic influenza strain, not infections caused by seasonal influenza viruses."

So if you are eligible to get the swine flu vaccine, be prepared for a total of three shots. "One for seasonal flu and two doses for the nominal H1N1," Dr. Osterholm says. Studies have shown that the swine flu vaccine must be given in two doses to be effective.

UPDATESeptember 16: On Tuesday, September 15, the FDA approved a swine flu vaccine that may require just one dose. Final testing on number of doses is still pending.

When will the swine flu vaccine be available?
No date has been set for delivery. "We hope in mid-October the first doses will start," Dr. Osterholm says.

If you aren't on the high-priority list, will it be possible to get vaccinated?
"No, because it won't exist," Dr. Osterholm says. "There are only 190 million doses for the country. If it takes two doses, [that's only 85 million people who can be vaccinated] right there."

There's no need to panic if you aren't able to get the swine flu vaccine. Doctors will be able to treat severely affected patients with antiviral medications like Tamiflu and Relenza, Dr. Morita says. But even that type of intervention won't be commonly necessary. "Most people do not need antiviral drugs to fully recover from the seasonal or pandemic influenza infections," she says.

Are there any risks from the vaccine itself?
"The pandemic influenza vaccines are being produced using the same manufacturing process as seasonal influenza vaccines," Dr. Morita says. "When seasonal influenza vaccines are administered according to licensed indication and usage information, they are safe. However, vaccines, like any medical product, carry some risks."

Dr. Osterholm agrees. "It is the seasonal flu vaccine, just a different antigen in it," he says. "We've been giving that successfully for the past 25 years without any problems at all."

If you think you or your children have contracted swine flu, what should you do?
Dr. Osterholm says the first thing you should do is pick up the phone and call your physician. "Don't go in," he says. "Call them."

Dr. Morita says it's important for infected people to stay away from others as much as possible. "Do not go to work or school while ill," she says. Her other recommendations for recovery from pandemic flu are what you'd do to recover from seasonal flu: Get plenty of rest, drink clear liquids, cover coughs and sneezes and wash your hands regularly.

Worsening influenza symptoms include: difficulty breathing, purple or blue discoloration of the lips, vomiting, signs of dehydration like dizziness or absence of urination, seizures or convulsions and confusion. If you see any of these, Dr. Morita says to get emergency medical care right away.

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