Dr David Salisbury hosted a babyexpert webchat on swine flu as it relates to pregnancy, babies and children. Here is the advice he gave:
Q: Is the vaccine safe for children?
Dr Salisbury said: ‘We are still seeing that the under-fives are particularly affected by swine flu. They have no immunity to flu in general, and certainly not to this virus. As a consequence, we are seeing particularly high hospital admission rates in the under fives and a very high proportion of those children who are being admitted to intensive care were fully healthy without risk factors.
‘I am frequently asked is if the vaccine has been tested in children and the answer is yes. The vaccine offered has been tested in children as young as six months through the manufacturers’ own studies, and we have also been studying the vaccine through our researchers in this country. The safety profile is good and so for both sides of the equation I would say, yes, go ahead.’
Q: I heard Dr Hilary Jones on GMTV saying he wouldn’t advise pregnant ladies to have the vaccine. This left me very confused and I feel I am in an impossible situation. Why are some doctors advising against it?
Dr David Salisbury said: ‘Dr Hilary Jones phoned me after he had been on GMTV to ask about the scientific situation concerning the vaccine and pregnant women, and I think he went on TV the next day and said that he did not mean to cause any anxiety and that there were no concerns about the safety of the vaccine. I believe that the evidence that says that pregnant women should be vaccinated is good, and I don’t see reasons why they should not have the vaccine.’
Q: My daughter was treated for swine flu a few months ago and I really don’t know if I should have her vaccinated. What do you advise?
Dr David Salisbury said: ‘If your daughter had a laboratory test that confirms she had swine flu, then she does not need to be vaccinated. If it wasn’t confirmed, and she did actually have it, being vaccinated won’t do any harm. If she did not have it, then she will be protected by being vaccinated.’
Q: My 6 month old daughter was born with a medical condition called Left Isomerism. One of her symptoms is the lack of a spleen. Should she have the swine flu jab? Is it safe? She is due for an operation on her intestines next week, how long after this before we can safely give her the jab? And does it have to be a certain amount of time after the seasonal flu jab?
Dr David Salisbury said: ‘As your daughter does not have a spleen, we would recommend that she has the swine flu jab, as people without a spleen may be more prone to infections. The vaccine has been tested in children down to six months of age. The vaccine can be given at the same time as the seasonal flu jab and at any interval afterwards. She is due for an operation next week, so ask the paediatrician to sort out the vaccines as soon as she is over the operation.’
Q: I am concerned that the vaccine cannot be tested in pregnant women so the effects of the vaccine on unborn babies is ‘unknown’ at this time. On a personal note, I am 11 weeks pregnant, so would I be better to wait another week or two until I am over 12 weeks when the risk of miscarriage is lower before I get the vaccine?
Dr David Salisbury said: ‘No drugs are tested in pregnant women, but the vaccine has been fully tested in pregnant animals as drugs are routinely tested, without problem. We also know that about 90 women became pregnant shortly after having these vaccines, and 50 of them have already gone on to have normal pregnancies and babies.
The seasonal flu vaccine is routinely given every year to pregnant women who have risk factors for flu and the Pandremix vaccine has only one quarter of the amount of the vaccine that seasonal flu vaccine has.
It does have an adjuvant that improves the immune response and hence allows this tiny dose to be used. The adjuvant has got vitamin E in it, that we all have in our diet, and a fish oil (squalene) that again we have in our diet and squalene is normally present in our blood.
The problem with delaying until the risk of miscarriage is lower is that you remain vulnerable to swine flu whilst the virus is still circulating. I know this is a difficult choice, but I think protection is better than the risk of infection.’
Q: If I choose not to have the swine flu jab but my husband does (being asthmatic and therefore a high risk) am I more likely to get it? After he had his normal flu jab last year I came down with flu as well. So worried that I might get symptoms.
Dr David Salisbury said: ‘It was absolutely nothing but a coincidence last year. If your husband is immune after a swine flu or seasonal flu jab, he can’t give it to you. You can’t blame him – you caught the virus from someone else!’
Q: I have a 18mth old little girl and I am in two minds whether to give her the swine flu jab. Please can you tell me how long does the vaccine work, are there any serious side effects and does it stop swine flu or just make the symptoms less serious?
Dr David Salisbury said: ‘I can’t tell you for how long the vaccine will work, but this sort of vaccine should protect for years, not months, and may well protect if the swine flu virus drifts. We have not seen serious side effects in children in the clinical trials, and it does stop swine flu whereas Tamiful just makes the symptoms less serious. Protection is better than cure.’
Q: I work as a neonatal nurse so have been offered the vaccine at work. I am also an asthmatic so qualify for the vaccine through my GP. Am I right in saying that it is not a live vaccine? Am I therefore OK to have it prior to a shift at work without posing as a risk to my patients?
Dr David Salisbury said: ‘No, it is not live; the viruses are inactivated and you can’t pass the vaccine viruses on to anyone else.’
Q: I note that babies under 6 months are not being vaccinated. Will this change in the near future? Should my baby have the jab as she was born early?
Dr David Salisbury said: ‘At this stage, we are not offering vaccine to children under six months and I don’t think that situation will change. When your daughter reaches six months of age, please talk to someone at your doctor’s surgery.’
Q: I am 28 weeks pregnant and also have a 16-month-old. I can’t decide whether to have the vaccination and all the experts I speak to will only advise that it’s personal choice. Also, why is it OK to have it when your baby is unborn but it’s not OK for babies under 6 months?
Dr David Salisbury said: ‘Of course it is a personal choice, but I actually advise that pregnant women should be vaccinated, and so should young children. If you are vaccinated whilst you are pregnant, you protect yourself and your baby.
We don’t give swine flu vaccine to babies under six months because there is insufficient evidence about the immune responses and studies are complicated because they are having so many other of their vaccines just at that time.’
Q: Are there any side effects for children who have the swine flu jab?
Dr David Salisbury said: ‘Children can get swelling and some soreness where the injection is given, but the studies from the manufacturers and from our researchers here in the UK, showed very few children got reactions like temperatures. The safety profile in children looks very good.’
Q: ‘I’m asthmatic and 17 weeks pregnant but I’ve not been called for the vaccine yet – when should all the high risk groups be vaccinated by?
Dr David Salisbury said: ‘All the high risk groups should be vaccinated by mid-December.’
Q: On another website, people seemed overly concerned about something called GBS and a Swine Flu vaccine that was given in the 1970s. Is it the actual vaccine that they are offering that has been tested or the H5N1 vaccine that I was reading about? I am also extremely worried about the long-term effects of having the vaccine as it has only been tested recently and long term effects are not known. Also how many pregnant women and kids under 5 have officially has Swine Flu so far and how many have been unfortunate enough to have lost their lives?
Dr David Salisbury said: ‘Ten pregnant women in this country have died and the World Health Organisation estimates that up to 10% of deaths worldwide are in pregnant women. I don’t have the number of cases in under fives to hand, but they continue to have pretty much the highest hospital admission rates in this country.
You also ask about GBS. In 1976, when there was swine flu in the US, there was an increase in cases of GBS in people who were vaccinated. The increase was about one extra case per hundred thousand vaccinated people. GBS is a pretty rare condition involving paralysis – a bit like polio – but most people make a full recovery. It is thought to be some sort of immune response against, usually, an infection. It can be linked to a food poisoning bug and has also been linked to flu disease, itself.
Since the 1976 US problem, there have been many studies trying to see if there is a link with seasonal flu vaccine, including H1N1 virus and it has not been seen. So far, around 4 million doses of Pandremix (the vaccine being used here) have been used and everybody is looking at very carefully for GBS cases but no increase over background has been found.’
Q: I’ve heard there are two types of Swine Flu jab – the one they currently have is the one which includes the drug which they advise pregnant women not to have. Is this true? And if so, why are we being offered this rather than waiting for the ‘safe’ dose to become available?
Dr David Salisbury said: ‘Pandremix protects almost 100% of individuals after the first dose, whilst Celvapan protects only 70%, and so two doses are needed to get the same impact as Pandremix. For that reason, we strongly recommend that pregnant women do have Pandremix because you get protected much more quickly at a time when the virus is circulating.
Pandremix has a lower dose of the swine flu antigen (the bit that gives you immunity) than Celvapan and achieves its effects through the adjuvant that is included in the vaccine. Pandremix does have thiomersal in it to keep the vaccine sterile after the contents have been mixed up.
Study after study has shown that there is no harm from thiomersal in childhood vaccines. Moreover, the benefits from the rapid protection from Pandremix need to be taken seriously against unfounded fears, for which there is no evidence base at all.
PCT’s do have stocks of Celvapan that were provided for people with serious egg allergies who cannot have Pandremix. In my opinion, Pandremix is the right product because protection is so important whilst the virus is still in our communities.’