ASK A TOP DOC: Should I get the H1N1 vaccine this fall?

There’s no escaping the headlines: H1N1, also known as swine flu, could double the death toll of our normal flu season. Even more alarming: The virus tends to take down healthy young adults and children, and the CDC’s vaccine set to debut early this fall is being rushed to market, leaving many concerned that it may not undergo proper safety testing. (The CDC has yet to give an exact date as to when the H1N1 shot will be available.)

To help you decide whether or not it’s smart to take the shot, we spoke with Top Doctor Michael D. Cirigliano, M.D., associate professor of medicine at the University of Pennsylvania School of Medicine. Check out his answers to our most pressing questions below, including whether or not he’ll be immunizing his own family come fall.

H1N1 has been in the headlines since April. Although there have been deaths, there hasn’t been anywhere near the pandemic the CDC is concerned about occurring this fall. Why does the CDC expect the numbers of cases to go up so drastically?
“Because it’s going to get cold, and when it’s cold, everybody stays inside and has more contact with each other, which can spread the virus. People will be crammed into schools and indoors more during the winter months than the spring and summer.

How bad could it get?
Let me put it to you this way: If I had a hotline to God, it would make it a lot easier. But we don’t know how bad it will be. Does it have the potential to be really ugly? Sure, and therein lies the problem. The CDC is quoting a worst-case scenario of 90,000 deaths.

Will the vaccine really protect you from coming down with the virus?
It depends on whether the virus mutates. If it mutates and it’s not in the vaccine, then it’s not going to help you. But from what I understand, there will be a number of antigens in the vaccine that will help you develop immunity and even if it mutates it will give you a better shot at fighting it off.

Some people are nervous because the vaccine is coming to market so quickly because it doesn’t leave much time for proper safety testing. Do you think there’s a reason to be concerned?
From my information, the safety profile thus far has been equivalent to other immunizations. It has to come to market quickly if it’s going to help anyone. There will be two shots, spaced three weeks apart, so if you were to get the first shot at the beginning of October, you wouldn’t have full immunity until around Thanksgiving. It takes time for the body to build immunity from the antigens in the vaccine.

There was an outbreak of swine flu in the US in 1976 and the CDC rushed a vaccine to market. Though the outbreak never fully materialized, after 10 weeks of the national campaign to vaccinate the public, many people who received the vaccination began to develop side effects. Is there a reason to be concerned that the same thing could happen with this vaccine?
During the 1976 debacle with swine flu, those immunized developed Guillain-Barré syndrome [a paralyzing neuromuscular disorder] at a higher rate than with other vaccines. But comparing a 1976 vaccine to the vaccines we have today is like comparing a ’76 Chevy to a Chevy now. The technology has improved and the quality has gotten better. There are air bags now, anti-lock breaks. If you say ‘I’m not going to get any immunizations,’ then tell me: Where did polio go? Where did small pox go? We are spoiled in a way because we don’t remember them, but vaccines save millions of people. Polio and small pox were major killers.

Do you think people should be vaccinated for H1N1?
The key to life—no matter if it’s taking a baby aspirin or getting in a car—is asking if the benefit outweighs the risk. If you’re part of the high-risk population [anyone ages 6 months to 24, pregnant women, health-care professionals and anyone with a compromised immune system], it’s an easier decision to take the vaccination. Where it gets tricky is with the healthy, general population.  

Will you be vaccinated? Will you give the vaccination to your son?
I don’t think I’m going to have a choice as a health-care provider. I imagine it will be mandatory at Penn, but that is up to Penn and I would do it if that’s the case. I don’t want to infect my patients so I feel I would need to get the shot. Am I going to give it to my son? I will discuss it with his pediatrician.