Marcela Astralaga's 7-year-old daughter, Daniella, just got over swine flu. But she still doesn't intend to get the H1N1 flu vaccine for her 3 1/2 -year-old daughter, Andrea, or for herself.
"I mistrust new shots," says Astralaga, a Miami bank sales manager. "I think we just have to get sick once in a while."
To the frustration of public health officials struggling to speed delivery of swine flu vaccine, polls indicate 30 to 40 percent of Americans agree with Astralaga -- they don't want the vaccine.
Their two biggest reasons: Some think swine flu is just another childhood virus, no more serious than the regular seasonal flu. Or they mistrust it; they think it's too new and untested, or they've seen Internet sites about toxic ingredients or scary side effects.
Vaccines are also catching flak from such commentators as Rush Limbaugh on the right and Bill Maher on the left, ironically for the same reason: Mistrust of government.
"I would never get a swine flu vaccine or any vaccine," Maher said on his HBO show. "I don't trust the government, especially with my health."
On his radio show, Limbaugh said, "Screw you, Ms. Sebelius. I am not going to take it." Kathleen Sebelius is secretary of Health and Human Services.
Dr. Howard Koh, an assistant secretary at the U.S. Department of Health and Human Services, calls reluctance to get the vaccine "tragic."
"Young people are dying before they reach the prime of life," he said.
In South Florida, health officials, in the early stages of their vaccination campaigns, are still trying to figure out how many want the vaccine and how many don't.
In Miami-Dade, a county check of 19 elementary schools in a vaccination program showed an acceptance rate of only 12 percent.
Parents aren't saying they don't want their children vaccinated, says Lillian Rivera, director of the Miami-Dade Health Department: "They just aren't turning in the forms."
She has assigned her staff to find out why.
A one-time mass clinic at the Youth Fair grounds brought out 2,500 seeking vaccinations. But most clinics have not seen long lines.
Broward, too, is still measuring early response to its school vaccination program.
"Some are choosing to have their children vaccinated, some are not," says Dr. Paula Thaqi, director of the Broward Health Department, who didn't have details about the percentage of students who have returned permission slips.
A major reason the polls say some people aren't getting the swine flu vaccination is a feeling that the H1N1 virus is not very serious.
Dr. Judy Schaechter, a University of Miami pediatrician, disagrees strongly. "I've been on the pediatric wards and seen strapping adolescent high school athletes who have never been sick with anything now sick enough to come into the hospital," she says.
About 3,900 Americans have died of the H1N1 flu or its complications since it surfaced in April, according to the U.S. Centers for Disease Control and Prevention.
In most people, H1N1 is about as serious as regular seasonal flu, says CDC director Dr. Thomas Frieden. Rarely, it turns deadly, particularly in three groups: healthy people from birth through age 24, the pregnant, and adults 25 to 64 who have underlying medical conditions, the CDC says.
In those it kills, the virus somehow gets deeper into the lungs, creating secondary bacterial pneumonia and other infections that can be fatal, CDC experts say. They don't know why.
Another main reason people are avoiding the vaccine is fear of its safety.
A national survey in September by the Harvard School of Public Health found that only 40 percent of adults were certain they would get vaccinated. A national Associated Press poll in October found 38 percent of parents said they probably won't let their children be vaccinated at school. And 72 percent were worried about possible side effects.
Dr. Gary Snyder, head of Alternative Medicine Center in Fort Lauderdale, articulates much of the fear of the vaccine -- though the CDC disputes his assertions.
Snyder says his main concern is "additives to the vaccine -- formaldehyde, a preservative used for corpses; Thimerosol; mercury, a deadly toxin; and oil-based MF-59 that includes squalene, which has been strongly linked to the Gulf War Syndrome."
CDC experts say no current vaccine for either regular seasonal flu or swine flu containes squalene. And while Thimerosol, a preservative that contains traces of mercury, has been cleared of negative effects by several studies, the CDC has responded to continuing fears by making both vaccines available without it to anyone who asks.
Snyder said he wasn't sure where he got the information about squalene, and hadn't been aware the vaccines are available without Thimerosol. Even so, he says, "too few people will be aware" they can get the vaccines without the preservative.
The FDA says formaldehyde is routinely used in vaccines -- for example, to kill the virus used in making some swine flu vaccine -- but in very small amounts that are considered safe.
Another source of vaccine fear is the flawed national influenza vaccine campaign of 1976. A flu epidemic seemed to be starting, and the federal government launched an aggressive vaccination campaign that included a photo of President Gerald Ford getting his shot. The epidemic fizzled but about 25 deaths were blamed on the vaccine, and 500 people came down with a severe paralytic illness called Guillain-Barre Syndrome.
Dr. Anne Schuchat of the CDC says her agency at that time lacked the sophisticated vaccine production and testing methods that today would stop such problems more quickly.
The CDC says that, in 1976, the disease developed in about 1 case per 100,000 persons vaccinated. Today the CDC website says: "Some studies done since 1976 have shown a small risk of GBS in persons who received the seasonal influenza vaccine. This risk is estimated to be no more than 1 case per 1 million persons vaccinated."
Replying to general fears about swine flu vaccines, Frieden says H1N1 flu vaccine is made the same way by the same manufacturers as regular seasonal flu vaccines that Americans have taken for years.
He says preliminary results of clinical trials of swine flu vaccine in 3,000 people in five top U.S. hospitals have found no serious side effects.
Still, testifying before Congress, Dr. Jesse Goodman, the FDA's acting chief scientist, did not claim infallibility. "Although we expect potential side effects to be similar to seasonal vaccine, unexpected rare adverse events are a potential risk of any medical product."
Says Frieden: "The risk of H1N1 influenza is a lot greater than the risk of getting the vaccination." To see more of The Miami Herald or to subscribe to the newspaper, go to http://www.herald.com. Copyright (c) 2009, The Miami Herald Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
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