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Why Some Need Two Swine Flu Vaccines

by Sue Hubbard, M.D.

The title of this should be first…before second. What do I mean by that? It seems easy enough, first always comes before second right? But this year, in the face of shortages and backorders of both seasonal and novel H1N1 (swine) flu vaccines, we are getting a lot of phone calls from parents who are requesting that their child getting their second flu vaccine. Many are not happy to hear that they will have to wait while others get their first doses.

The recommendations are a little different for seasonal flu vaccine, than those for H1N1 (swine flu) vaccine. For all children six months to nine years of age, who are receiving seasonal flu vaccine for the first time, need to receive two doses of vaccine, given a month apart.

The first dose of the vaccine primes the immune system in a child, while the second dose provides the longer immunity. After a child has received two doses of seasonal flu vaccine during one season, they will be protected by a single shot/mist during the subsequent flu seasons.

That being said, things are not always as clear as they may seem and yes, sometimes things change. So…this year with the emergence of novel H1N1 (swine flu) in spring of 2009, and the need for a separate flu vaccine to protect against novel H1N1, children between six months and 10 years (different than seasonal flu recommendations) and will have to have two immunizations this season for novel H1N1 (swine flu). This is necessary to provide adequate immunity against this new virus.

With the shortages at hand children ages six months to 24 years are being prioritized for vaccination along with other high-risk groups. Again, the vaccine is available as both an injection (killed virus) for children ages six months to two years, and also as a nasal mist (live attenuated virus) for children two and up that do not have any underlying health issues.

As our office is now receiving regular shipments of novel H1N1 vaccine, we are giving first doses to all who fulfill high-risk criteria. We are not going to be giving second doses to any children until we have provided first doses of swine flu vaccine to all eligible children.

This is not a perfect answer, but it will provide the protection to the greatest number of people, and that is what public health is all about. We are all hopeful that as the weeks go by we will see a slow down in cases of “swine flu” and an increase in the production of both seasonal and H1N1 vaccines. There are only four vaccine makers to make vaccine for all of us, and they can only work so fast, while providing safe, effective vaccine. You can’t rush the egg to grow the virus needed to make vaccine (kind of like you can’t rush a pregnancy) there is just time and patience involved.

If you have not gotten your children their flu vaccines, now is the time to be checking about the availability of both vaccines from your pediatrician or health department. Put a reminder on your calendar if your children require a second vaccine, which must be at least four weeks from the first vaccine. If the vaccine is not available at that time, be vigilant about keeping up with the news on vaccine availability and checking in with your doctors. It may be 2010 before there is enough vaccine to begin second doses for children who require the two dose series. But at the same time, remember flu season does not usually end until March so vaccinations will be continuing.

Here’s hoping flu season next year will be easier for all. Stay healthy and wash the hands!

That’s your daily dose, we’ll chat again tomorrow.

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