Experts Answer H1N1 Questions Online

By Samantha L. Quigley
American Forces Press Service

Nov. 12, 2009 - Experts did their best to answer questions and allay fears over H1N1 flu and the associated vaccine during a Nov. 10 online town-hall meeting hosted by the Military Health System. Questions -- submitted via a special Web site -- included concerns such as whether it's possible to distinguish between seasonal or H1N1 flu based on symptoms. The answer, provided by Army Col. (Dr.) Ted Cieslak, the Defense Department's liaison to the Centers for Disease Control and Prevention, was simple.

"You cannot differentiate seasonal flu from H1N1 based on symptoms," he said. He later emphasized that it's tough to make a claim that one version of the flu is more dangerous than another.

"'Dangerous' can be defined in many different ways," Cieslak said. "This particular strain does not appear to produce more severe disease in most people, but it does affect certain subgroups [such as pregnant women and people with some underlying medical conditions] disproportionately.

"Moreover," he continued, "susceptibility to the H1N1 strain is almost universal in persons under 50 years of age, which is not always the case with seasonal flu."

The topic of alcohol-based hand sanitizer versus good old soap and water as a way to keep from preventing the spread of H1N1 was broached, as well. Soap and water wins out, one doctor said, because that method removes and kills organisms.

"Alcohol-based hand gel can and should be used when soap and water are not available," said Navy Capt. (Dr.) Tanis Batsel Stewart, director of Emergency Preparedness and Contingency Support for the Bureau of Medicine and Surgery. "Use enough to fully wet your hands, and rub them together."

Some participants were concerned with the content of the H1N1 vaccine and its safety overall, especially for children.

Navy Lt. Cmdr. (Dr.) Tom Shimabukuro offered assurances that the vaccine is safe, contains no squalene, and was licensed in the same way that seasonal flu vaccines are licensed every year. Squalene, a substance found in some vaccines, has been the subject of some controversy, with opponents to its use claiming a link between the substance and Gulf War Syndrome.

"The H1N1 vaccines were licensed as a strain change to an existing biologic license application with the [Food and Drug Administration]," he said. "There was no fast track or waiver provided to the vaccine manufacturers, and the vaccine is not experimental. H1N1 vaccines are licensed flu vaccines, and [people should] expect them to have a safety profile similar to regular flu vaccines."

Shimabukuro is the pandemic influenza vaccine coordinator for the immunization services division of the CDC's National Center for Immunization and Respiratory Diseases.

Army Col. (Dr.) Wayne E. Hachey addressed the effects the H1N1 vaccination might have on small children in response to a participant's question about the controversy over childhood vaccinations and links to autism.

Hachey, director of preventive medicine and surveillance in the Military Health Affairs force health protection and readiness division, said no evidence exists that the H1N1 vaccine -- in either its injectable or mist forms -- poses a threat to the neurodevelopment of children.

The experts also provided guidance on the spacing of vaccinations for the seasonal flu and H1N1, and age restrictions for the mist version of the vaccine.

A person can receive two injectable flu vaccines or one nasal-spray vaccine and one injectable vaccine at the same time, Shimabukuro said. But someone who gets nasal spray vaccines for both strains should separate those vaccines by at least 28 days, he added.

The nasal vaccine is available only to people age 2 to 49, said Air Force Lt. Col. (Dr.) Philip Gould, chief of preventive medicine operations for the Air Force Medical Support Agency. "There are three injectable vaccines," he added, each with different ... age limits: one from 6 months and older, one from 4 years and older, and one from 18 years and older."

Those over the age of 49 must get the injectable vaccine, he added.

A replay of the town-hall session is available on the Military Health System's Web site. The Military Health System is a worldwide partnership of medical educators and researchers, health-care providers and support personnel, including Defense Department and military officials, combatant command surgeons and Tricare providers.