Information about the Seasonal and H1N1 (Swine Flu) Vaccines, and the Pneumonia Vaccine

by Edward Kasarskis, M.D., Ph.D,  Director of the University of Kentucky Neuroscience Center ALS Association Multidisciplinary Center in Lexington, Kentucky, professor in the Department of Neurology at the University of Kentucky, and Chief of Neurology at the VA Medical Center in Lexington KY.

Q: Should people with ALS – and their families and caregivers -- get the seasonal flu and H1N1 vaccines this year?

A: The short answer is yes.

People with ALS are already at increased risk for respiratory problems associated with viral and bacterial infection, and the flu can deliver a harsh blow. I’m already seeing some people in my community with H1N1 and it causes a decreased appetite and a severe cough, both of which are significant problems for people with ALS.

The H1N1 vaccine and the seasonal flu vaccine are two separate vaccines against different viruses. The H1N1 vaccine protects only against the new H1N1 influenza virus, which is the cause of swine flu.  It does not protect against other strains of seasonal flu.  The seasonal flu shot, which is offered every year, provides protection against an additional three common strains of influenza viruses.  Both vaccines are expected to reduce illness, limit hospitalizations, and potentially save lives.

Both these vaccines can be given as a nasal spray and an injection. The nasal spray contains a live but weakened virus, unlike the injection, which is made of inactivated (killed) pieces of the virus. I have talked with some people who have had the nasal spray and they found it uncomfortable; they feel like they get a clogged-up nose. As you are aware, many of our ALS patients experience thick secretions and have difficulty handling them in their mouth and throat.  I can imagine that the nasal route of administration might be troublesome for them. I think that the injection would be safer and less stressful for ALS patients. However, if the nasal spray is the only available route at this time in your community, talk with your physician to decide what is best for you.

For the H1N1, the CDC recommends that people aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza get the vaccine. That includes everyone with ALS (since they’re also recommending people 6 months of age to 24 years get the vaccine).

No shortage of 2009 H1N1 vaccine is expected, but vaccine availability and demand can be unpredictable and the vaccine is now only available in limited quantities. 

Anyone with an allergy to eggs should not receive the H1N1 vaccine, since chicken eggs are used in the manufacturing process.  If you have a weakened immune system, you should not receive the live virus nasal spray; get the injection with the killed virus instead.

The side effects of the H1N1 vaccine are similar to those associated with seasonal flu vaccine: pain at the injection site, muscle aches, headaches, and malaise (feeling run down).  Rarely, patients suffer severe allergic reactions to the vaccine.

Some people wonder about the downside of getting the H1N1 vaccine. Since this is a new vaccine, there are no data yet from large numbers of vaccinated people, and there is a statistical risk of adverse events that is as yet unknown. But the clear and present danger is contracting something serious that would have been preventable.

Two studies recently published in the New England Journal of Medicine involved several hundred adult patients who received the vaccine who have been followed for months. Initial data was published several weeks after vaccination.  No serious short-term side effects were found in any of those patients.

I also recommend you get the pneumonia (Pneumococcal) vaccine to help prevent pneumococcal pneumonia, caused by the pneumoccus bacteria. There are more than 80 different types of pneumococcus bacteria, and 23 of these are covered in the currently available vaccine. But of the 80 different types, the vast majority of infections are caused by the 23 serotypes contained in the vaccine. You may be able to get the pneumonia vaccine at the same time you get your seasonal flu vaccine. It’s a valuable vaccine, but the seasonal flu vaccination and H1N1 should be your first priorities.

For more information on the H1N1 vaccine, visit the CDC website: http://tinyurl.com/lst74s 

Revised October 29, 2009

Disclaimer: The material contained herein is provided for informational purposes only, and should not be construed as medical or legal advice on any subject matter.

No recipients of content from The ALS Association should act or refrain from acting on the basis of any content provided without seeking the appropriate medical or legal professional advice on the particular facts and circumstances at issue from a physician, attorney, or other licensed professional in the recipient’s state.

The information contained on this web site is protected by copyright and may not be published, broadcast or otherwise distributed without the prior written authorization of The ALS Association.

©2009 by The ALS Association