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What to Know About the Vaccine

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Attenuated versus inactivated? In the arm or up the nose? What’s an H1N1 virgin to do? Here are a few vaccine guidelines, based on suggestions from federal and city health officials.

The first batches of H1N1 vaccine to reach New York this week are expected to be FluMist—made from live but weakened H1N1 flu virus and administered as a nasal spray.

This is the vaccine that will go primarily to children (kids 10 and up should achieve immunity with one dose; children age 2 to 9 will need two). Clinical testing indicates that it provokes a protective antibody response in about eight to ten days.

Some experts argue that a live vaccine like FluMist may be better than flu shots because it may induce local immunity in the nasal passages, which is where the flu virus strikes. However, a live vaccine like FluMist cannot be given to pregnant women, children under 2, adults over 50, and adults with chronic conditions like heart disease.

The other type of swine-flu vaccine, which should arrive soon in injectable form, uses killed virus to stimulate the immune system. (Its response time: also eight to ten days).

Seasonal-flu vaccines, which are different from those for swine flu, are already widely available in the city, and public- health officials recommend receiving both. Either vaccine can be taken first, they say, or simultaneously. “The only thing not recommended,” says Health Commissioner Thomas A. Farley, “is getting nasal spray for both vaccines at the same time. One will block the uptake of the other.”

The American Academy of Pediatrics recommends the H1N1 vaccine for everyone between the ages of 6 months and 24 years. At a time when initial supplies are still limited, the CDC recommends that several groups receive priority vaccination: pregnant women, people who live with or care for children younger than 6 months, health-care and emergency workers in direct contact with patients, children between 6 months and 4 years old, and children 5 to 18 years old with chronic medical conditions.

Health officials stress that the new vaccines are safe. But as I mentioned to Commissioner Farley, even my own family’s pediatrician did not yet recommend the new vaccine for our children. “I understand that there are always questions about vaccine safety,” Farley responded. “We’ve had decades of experience with essentially this vaccine, and although it’s very frequent for people to have side effects”—primarily soreness at the site of injection—“serious adverse reactions are very, very rare.”


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