Sunday, October 25, 2009
News, Health + Fitness

Where's the swine flu shot?

Suspicions, slow manufacturing methods tangle vaccination efforts

By Stephanie Ramage

The DeKalb County Board of Health has been disappointed with the demand for its H1N1 flu vaccine.

“We’ve seen a slow but steady trickle,” says Spokeswoman Vickie Elisa. “We think that it’s probably a matter of awareness.”
 
One problem is that DeKalb has the H1N1, or "swine flu," vaccine in nasal spray form, but not in shot form. The nasal spray can’t be used by people who have chronic illnesses of any kind.

“Anything,” says Elisa. “Diabetes, epilepsy, anything. If you’re uncertain of whether you or your child should get the nasal vaccine, you should ask your doctor or pediatrician.”

Another problem, she says, is public worry over the tiny risk of a serious side effect. When a different vaccine was used in 1976 to combat that year's version of the swine flu, a small number of people who got the vaccine developed Guillain-Barré Syndrome. Though the number was small, people in DeKalb County, she says, have expressed concerns.

“When you already have some sort of communications barrier, something like that only adds to the resistance,” she says. “Guillain-Barré is rare, but it comes up when people ask about the vaccine.”

Alex Isakov, executive director of the Office of Critical Event Preparedness and Response at Emory University, says the chance of developing the syndrome is small. Only about one out of 100,000 of those vaccinated in the ’70s developed it, and scientists still aren’t sure it was in reaction to the vaccine.

“I am far more worried about people who are at risk getting the flu and becoming seriously ill," he says. "I think this is as safe a vaccine as a vaccine can be. As far as I am concerned and my family is concerned, it’s safe and we’re getting it.”

According to the National Institute of Neurological Disorders and Stroke, “Guillain-Barré usually occurs a few days or weeks after the patient has had symptoms of a respiratory or gastrointestinal viral infection. Occasionally, surgery or vaccinations will trigger the syndrome. The disorder can develop over the course of hours or days, or it may take up to three to four weeks. No one yet knows why Guillain-Barré strikes some people and not others or what sets the disease in motion. What scientists do know is that the body's immune system begins to attack the body itself, causing what is known as an autoimmune disease. Guillain-Barré is called a syndrome rather than a disease because it is not clear that a specific disease-causing agent is involved.”

Bruce Ribner says there’s some conflicting data on whether there is even a one-in-a-million chance of developing Guillain-Barré in association with H1N1 vaccination.
 
“It should be about the same as it would be for any seasonal flu shot,” he says, adding that if manufacturers had H1N1 vaccine ready when they whipped up this year’s regular seasonal flu vaccines, he believes the public would not have been so suspicious about the vaccine. They would have merely gotten their usual flu shots without so much concern.

“But this is a separate shot,” he says.

“Shot” being the operative word. The nasal spray, he says, was designed for healthy kids under 4 who are afraid of needles. (But DeKalb is making it available to every healthy person between ages 2 and 49.) Ribner doesn’t know why DeKalb hasn’t received the vaccine in shot form yet. Emory—which saw at least 500 cases of H1N1 among the university’s undergraduates in August and September—got some of its batches of the shot in mid-October.

Ribner blames manufacturers and the common method of producing the vaccine. The H1N1 vaccine testing missed its target dates by weeks, he says, explaining that most vaccine manufacturers still use the egg-inoculation method, but the development cycle for this year’s H1N1 vaccine was plagued by a low yield of vaccine from each egg.

“We probably will be moving to a cell-lined base [method] soon,” he says.
 
Ravae Graham, spokeswoman for the Georgia Department of Community Health, says the state has no control over how quickly county health departments get the vaccine, period. Georgia basically puts in a request for an allocation, and then the Centers for Disease Control and Prevention decides how much of the vaccine Georgia gets, based on population, and in what form.

However, says Graham, the state does offer a Web tool called the “H1N1 Influenza Vaccine Provider Locator” that can help residents find places that offer the vaccine. She says people should contact the providers to be sure they still have the vaccine, and in what form.

“The allocations the state has received thus far have been small in comparison to the number of providers registered to administer the vaccine,” Graham writes in an e-mail. “This is why it is so important for anyone wishing to receive the vaccine to contact his or her family doctor’s office or health care provider before making an appointment or traveling to the provider’s office.” SP

UPDATE 11:44 A.M. OCT. 26: The Fulton County Department of Health and Wellness has the nasal spray version of the vaccine. "We are anxiously awaiting the injectible version," says Spokeswoman April Majors, adding that she does not have a time frame for its arrival.

WHERE TO FIND THE VACCINE

According to the Georgia Department of Community Health, health care providers listed on its “H1N1 Influenza Vaccine Provider Locator” have signed written agreements to provide H1N1 vaccine as it becomes available and to be included in the listing. The following should also be noted:

•           Participating county health departments are also included in the listing. 
•           At this time, small amounts of the H1N1 vaccine are being allocated by the CDC.
•           Additional supply is anticipated over the next weeks and months.
•           Health care providers receive their vaccine supply directly from the CDC's distributor, McKesson. 

The Vaccine Provider Locator can be found at 
http://sendss.state.ga.us/sendss/!immuprov_track.h1n1_prov_locator

Or to find vaccines in the City of Atlanta, DeKalb or Fulton, call the DeKalb County Board of Health at 404-294-3700, or the Fulton County Department of Health and Wellness at 404-730-1211.