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Tom Nolan on the swine flu vaccine

21 Oct, 09 | by julietwalker

The swine flu vaccine is officially here. The UK government announced on Friday that over 400,000 doses of the swine flu vaccine will be delivered to hospitals this week. The first to get the jab (from Wednesday) will be hospital inpatients belonging to at-risk groups and hospital staff. Next week GPs are due to start vaccinating patients according to their priority status, which are as follows (top priority first): people aged six months to 65 years with underlying health problems and the immuno-suppressed; pregnant women; household contacts of people with compromised immune systems; people aged over 65 with health problems. The Daily Mail are characteristically concerned about the vaccine, in particular its use in children.

“The Government’s Joint Committee on Vaccination and Immunisation (JCVI) decided that because the swine flu vaccine does not contain a ‘live’ virus, it can safely be given with other jabs.

“Campaigners have already voiced concerns that the recommended programme of more than 20 inoculations, including two doses of the MMR injection, by the age of four puts too much strain on children’s immune systems.

“GP Dr Richard Halvorsen, medical director of the Babyjabs clinic in Central London, said last night: ‘There is not a shred of evidence about the potential effects of combining all these childhood jabs with the swine flu vaccine. They simply have not had time to carry out tests.’”

However, judging by Dr Halvorsen’s Babyjabs website, he may not be the most representative doctor that the Daily Mail could have asked for a quote. Information on the MMR vaccine on the site includes statements such as “the [MMR] vaccine could be causing autism in up to 10% of autistic children in the UK – between 300 and 400 children a year.”

H1N1 + MRSA = bad news?

Elsewhere in the news, the MRSA Working Group and the Patients Association have written to all NHS hospitals to ask them to consider ways to avoid high bed occupancy rates that may increase MRSA infections. Suggestions include providing IV treatment at home and switching some patients to oral antibiotics. But when is the giving IV treatment at home really appropriate and shouldn’t we be doing the latter already?

In a fine example of quoting scary figures without backing them up, to the Daily Express reveal the following mortality rate for those co-infected with swine flu and MRSA:

“Swine flu patients who also contract MRSA would have a one in two chance of surviving. The superbug inflicts a form of pneumonia in those already weakened by viruses and kills half of its victims in 72 hours.”

A new marker of swine flu?

Is relative lymphopenia a marker of swine flu in adults? Correspondence in Clinical Infectious Diseases suggests that relative lymphopenia – a lymphocyte count of less than 21% of white blood cells – might be a useful marker of H1N1 infection in adults. Out of 25 adults who tested positive for influenza A in April and May, 23 had a relative lymphopenia . The authors suggest that relative lymphopenia may be useful if demand for virology testing exceeds capacity. However, without larger numbers and data that would provide specificity and sensitivity, it’s too soon to say.

Tom Nolan is a trainee GP in London.

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  • GH Hall

    How about answering Dr Halvorsen’s point about the absence of evidence on combining vaccines rather than making comments on side issues?

  • seshubabu

    Apart from lymphopenia, have you come across any other marker in lieu of virological testing to diagnose h1n1? There must be some clinical evidence which has not been recognised so far by clinicians treating h1n1 cases. I think clinicians right now are busy treating than documenting and planning to publish at a later date. By the time the epidemic declines, such data would n’t be of any use to the current episode. Through your blog columns you can motivate teams engaged in managing h1n1 cases to broadcast any shred of information as soon as possible, like the reported lymphopenia for the common good of all clinicians.

  • Mark Struthers

    I thoroughly recommend Richard Halvorsen’s book ‘The Truth about Vaccines’. It’s eye opening stuff and especially recommended for complacent doctors with their eyes wide shut.

  • Tom Nolan

    Seshubabu: i’m not aware of any other marker or more readily available test than (RT)PCR from a swab or other sample (see http://bestpractice.bmj.com/best-practice/monograph/1178/summary/overview.html). It would be interesting to look more closely at relative lymphopenia.

    A good place for sharing provisional findings quickly without peer review is PLOS Currents (discussed on a previous blog), but it’s not collaborative, more a means to publish results quickly. If anyone has read any other interesting research on swine flu please let me know any it can be featured on this blog too.

    GH Hall: The JCVI who announced that the vaccine could be given at the same time as other childhood vaccines because it is not a live vaccine according to the Mail. The minutes from their previous meeting are not available online yet (http://www.dh.gov.uk/ab/jcvi/index.htm) but if i can find more details about their reasoning I’ll let you know. However, isn’t it standard practise that this type of vaccine can be given with other non-live vaccines?

  • Anandan

    Did you find any use with methylprednisolone in H1N1 pneumonia? Some recommend it and they say the earlier the better.

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