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Is the swine flu vaccine safe?
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US and Australia, vaccination has already begun. Can we be sure that safety hasn't been compromised in the race to test and produce the vaccine? Didn't vaccination hurt people during the last big swine flu scare? And do the benefits of vaccination outweigh the risks? In this excerpt from our in-depth feature Swine flu: fact versus fantasy - to be published in full next week - New Scientist sorts the myths from reality.
This flu isn't always mild and unlike ordinary flu it mostly kills young people, including the healthy (see diagram). You might be one of the unlucky few. And even if you only get the mild version yourself, you might infect a family member or friend who then becomes severely ill. So doing nothing is risky, even if the odds are low.
What about the vaccines? People's nervousness about swine flu vaccines is understandable. In 1976, after the death of a US army recruit triggered fears of a repeat of the deadly 1918 pandemic, around 48 million Americans were given a swine flu vaccine. Of these, 532 developed Guillain-Barr
Fears from the 1970s
The 1976 vaccine caused around 10 cases per million vaccinated. Even ordinary flu vaccines, however, are thought to cause one extra case of Guillain-Barr
Does this mean it is safer not getting vaccinated? Absolutely not. First, there is the risk of swine flu killing you. Second, what few people know is that US have fallen 20 per cent since 1996, and cases reported after flu vaccination have fallen by 60 per cent. Intriguingly, this coincides with a fall in infections by the food poisoning bacterium Campylobacter , thanks to improved meat hygiene. Guillain-Barr Campylobacter is the main cause. It is also endemic among chickens, and flu vaccines are grown in chicken eggs. So the occasional contamination of flu vaccines with Campylobacter proteins might explain the link with Guillain-Barr
The new vaccines
That is reassuring, if true. If the problem in 1976 was contamination rather than some property of the virus, there is no reason to expect a repeat. There has never been a similar problem with any other vaccine. And almost all the pandemic vaccines now being given in the US Australia are being made in the same plants and in the same way as ordinary flu vaccines. Only two proteins on the vaccine virus have been changed, to match the 2009 H1N1 virus, and these proteins are similar to those of seasonal H1N1 flu, which have been in vaccines since 1977.
The exception is Celvapan. It contains the whole, killed pandemic virus, not a vaccine virus with pandemic proteins, and the virus is grown in cells rather than eggs - making it safe for people with egg allergy. While it and a similar bird flu vaccine have undergone safety testing, no seasonal flu vaccine has yet been made this way.
Another potential worry are the immune-stimulating chemicals called adjuvants that are added to some vaccines. The World Health Organization asked countries to make pandemic vaccines with adjuvants because much less of the key ingredient, dead flu virus, is needed per dose - meaning far more doses can be produced. The US could not do this because no seasonal flu vaccines with adjuvants had already been tested and approved there. In Europe they have been, so the main pandemic vaccines being given in Europe - Focetria - do contain adjuvants.
All the pandemic vaccines have had their own safety tests, and almost all are based on seasonal flu vaccines used for years. But very rare side effects can only be detected when millions take them. The seasonal flu vaccines with adjuvants have mostly been given to older people, so we cannot yet be sure that these vaccines do not have very rare side effects in younger people. Celvapan has had no large-scale monitoring. But here are some odds we do know about to consider.
The odds
The risk of getting Guillain-Barr Swine flu is estimated to have killed 800 people in the US already, or more than 2 in every million so far. And during the first wave of swine flu this summer, 1 out of every 20,000 children aged 4 or under in the US ended up in hospital.
Still think it's safer not to get vaccinated?
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Not long ago we were all going to die from bird flu. Whatever happened to that threat? Somebody must be making a bunch of money from these flu scares.
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