Australia’s chief medical officer, Jim Bishop has announced that children under five years old should not receive the flu vaccine. Apparently at least 60 children under the age of 5 have had high fevers and 23 have had convulsions shortly after receiving the vaccine. I have not heard any advisory from the New Zealand authorities yet, although Stuff says that doctors have been warned not to use Fluvax, the alleged culprit in Australia. Child and youth health chief advisor, Pat Tuohy, rambles on about how 4% of children with high temperatures have seizures, but that does rather seem to miss the point that we do not normally see this number of febrile convulsions (fever fits) after a vaccine.
It is possible that the swine flu component is causing this problem. We did not see febrile convulsions after the original, emergency swine flu vaccine, but that was a whole-virus vaccine. The current vaccines all contain broken-apart viruses to increase their antigenicity (the amount of immune system response that is made). It may be that this has exposed an antigen that causes an extreme immune response. This makes sense when you consider that the deadliness of the swine flu was that it occasionally causes massive immune responses in its victims. Otherwise, it was a fairly innocuous form of flu. The fact that this seems to be a problem mostly with Fluvax, suggests that CSL’s manufacturing process might be the one that specifically exposes this antigen. Interesting. And very scary for the parents whose children suddenly became ill.
Contrary to the entertaining frenzying of the anti-vaccine lobbies, this is no reason for anyone over the age of five not to get the vaccine. There does not appear to be any safety issue here (though I know of a number of people who swear they developed flu symptoms within 24 hours of receiving the vaccine). The very fact that the authorities have picked up this problem (of febrile convulsions in under fives), means that the systems are working fine. Note that, unlike long-term vaccines like Gardasil and MeNZB, it is not reasonable to expect the seasonal flu vaccine to undergo extensive safety trial each year. We would simply have no seasonal flu vaccine if this were the case as these trials would be prohibitively expensive and too lengthy to allow the vaccine to be produced every year. Therefore, the flu vaccine is monitored more stringently than other vaccines.
There has been some criticism of the response time of Western Australia’s public health system. Two weeks elapsed from the first case of febrile convulsions associated with the vaccine to the current warning. In fairness, however, there are many other causes of febrile convulsions and it takes time to investigate each case to determine the likelihood of the convulsions being caused by the vaccine. This is not to say that the current surveillance system is perfect – far from it. For a start, a decent monitoring system would actively contact recipients of the vaccine and check for reactions, rather than waiting for the patient to see a GP and for the GP to actually notify CARM (Centre for Adverse Reaction Monitoring). Only the most severe reactions, such as a febrile convulsion, make it through this process. If we knew the prevalence of minor reactions, we could be more alert for severe reactions, if there was a sudden jump in minor ones.
Flu vaccination saves a number of lives every year and reduces the flu burden on society and the associated costs to the economy. It is certainly still worth considering. But I will not be recommending preschoolers have the vaccine, regardless of the manufacturer or the indications.
There is still some dispute as to whether the death of the toddler in Western Australia was vaccine related. I would be surprised if they can say definitively it was not related (and provide evidence). I have less surprise that the GP did not notify this as a possible vaccine death. The combination of the firm belief that vaccines are safe, plus the disincentive of the likely can of worms one is opening, reporting the case, makes most GPs very reluctant to report such things. It is therefore unsurprising that vaccine reactions are very underreported.
Our practice received a fax from vaccination control last night warning us not to use the flu vaccines in the under 5s. I am wondering why it took FOUR DAYS for them to make up their mind after Australia issues a warning. Surely it should take no more than a few hours?