Category Archives: Prevention

Why So Afraid of H1N1 Vaccine?

h1n1The H1N1 virus is full into its second wave all over the world. There has been a large increase over the last 2-3 weeks, including in China. There are some disturbing signs that this H1N1 virus is more dangerous to pregnant women and children than previously thought. With pregnant women, the risk of death from H1N1 is six times higher than the population, and health authorities are stressing that pregnant women get the vaccine. And as for children, already in the US 86 children have died from H1N1, again already a higher total number than we would usually see during the entire seasonal flu season.

And yet there are widespread reports of uncertainty about the H1N1 vaccine. Is there any data to support such fears? The quick answer is no, but let’s talk more about it…

Where’s The Data?

No vaccine is ever 100% safe, but so far this H1N1 vaccine is proving to be as safe as expected — which is to say, very safe. And why wouldn’t it? It is not a completely “new” vaccine, in the sense that it is made the same way as the seasonal flu vaccine, using a similar non-active fragment of the virus. So you would expect the same adverse effect profile.

As for chronic worries by some regarding thimerosal and adjuvants, those issues are moot here, as there are no adjuvants in the H1N1 vaccine nor is there any thimerosal in the single-use vaccines (there is thimerosal in some multi-use vials). Moreover, there continues to be no good evidence linking either thimerosal or adjuvants to increased illnesses.

As for real data on safety, within China, of the 300,000+ initial vaccine group, there are about 100 reported side effects, none serious. That’s considered an even lower side effect profile than the usual seasonal flu vaccine. An earlier report had stated that of the first 39,000 recipients, only 4 had side effects, all mild (muscle cramps and headaches, usually).

There are a lot of websites providing poor information, or latching on to alluring but clinically irrelevant case reports, so it’s best to stick with the most reliable news sources such as WebMD. You can also follow the most reliable tracking of adverse effects from the US CDC and the WHO websites; they have frequent H1N1 updates.

Does the Seasonal Flu Vaccine Help or Hurt H1N1?

You may have read some conflicting news sources over the last couple weeks regarding the seasonal flu vaccine and how it affects H1N1. First, there had been news from an as-yet unpublished Canadian study suggesting that persons vaccinated against seasonal flu were twice as likely to get swine flu. But then a study in Mexico reported the exact opposite finding — that the seasonal flu vaccine actually offers partial protection against H1N1 (here is that original article, published in BMJ). So, who to believe? Well, as this WebMD article discusses, both studies have their flaws, and the overall numbers from other countries still show that there is no cross-over protection to H1N1. And the recommendation remains for those at highest risk to get both seasonal and H1N1 vaccines this year.

Still Not Available in China…Except Schoolkids

Most parents know that the government is offering the H1N1 vaccine to all students over 3, including the expat schools. I personally think this is a great idea, and I hope that parents can assess the real data and say “yes” to vaccination. Unfortunately for us adults, there is as yet still no word as to when the local expat clinics in Beijing will receive the H1N1 vaccine, as the government is allocating these initial stocks. There will be very limited supply for months; even by December there may be enough for only 5% of China’s population. So, China is doing what every country is doing — prioritizing limited supplies for those most at risk. So, stay tuned, and as usual, always practice good prevention. And don’t forget that the seasonal flu vaccine is available now.

Meanwhile, the CDC has updated Q&A about H1N1 vaccine, as well as specific information for pregnant women. The WHO also has their latest update, which specifically mentions concerns that many younger healthy people are ending up in critical care; also, the highest risk patients remain children under 1 and pregnant women.

Summary…

There is no evidence so far that this H1N1 vaccine is causing any more adverse effects than the regular seasonal flu vaccine. Moreover, the flu season is heating up, and there are some disturbing trends that pregnant women and children under 1 are having more serious illnesses than expected — including death. So, please consider vaccinating your children this week in school, and as the rest of us wait for the H1N1 vaccine, it’s a good idea for those at highest risk to get the available seasonal flu vaccine now. And as we wait, keep up with your best preventive medicine habits!

Article: As Flu Vaccines Are Given, Myths Are Debunked – NYTimes.com.

Do Cell Phones Cause Brain Cancer?

Every so often, I hear people mention the dangers of cell phones, and I usually dismissed that idea. But now there does seem to be growing evidence that long term use of cell phones may indeed increase the risk of some brain cancers, especially in children. The article below discusses this latest information, especially from an August publication which reviews the literature. Some of the publication’s findings:

Cell phones can be made safer, and the technology to do so exists right now. For example, said Mr. Morgan, “you can get a 10,000-fold reduction in exposure simply by keeping the phone 6 inches away from the head.”

There are also steps that can be taken right now to make cell phones safer to use, he said. These include using a wired headset (not a wireless headset such as a Bluetooth), using speaker-phone mode, or sending text messages; keeping the phone away from the body when not in use; avoiding use in a moving car, train, or bus, or in rural areas at some distance from a cell tower, because any of these uses will increase the power of the cell phone’s radiation; and keeping the cell phone turned off until you need to use it.

The authors also recommend using a corded land-line phone whenever possible, instead of a wireless phone, and to avoid cell phones when inside buildings, particularly with steel structures. Since children face a greater health risk, they should not be allowed to sleep with a cell phone under their pillows or at the bedside, said Mr. Morgan. Ideally, those younger than 18 years should not use a cell phone at all, except for emergencies.

Again, there is definitely no medical or scientific consensus of a threat, and other studies are pending which may help settle this. But given some of this more recent information, perhaps it is a good idea for hard-core mobile users to think about simple things like always using a headset, or restricting use for children. Some countries, including the UK and France, are already starting to impose such restrictions. Very provocative reading…

Article: Cell Phones and Brain Cancer — Jury Still Out .

Good Health Practices: Slide Show Series

Over the last months I’ve created a few online slide shows based on Powerpoint presentations I’ve given in Beijing, and I wanted to review them here. They focus on the most common illnesses, and they review symptoms as well as prevention and treatment. With the magic of the internet, you can instantly view them online with no downloading (full screen available as well, very cool!)

  • H1N1 Flu: The Basics
  • How To Prevent Heart Attacks & Strokes
  • The Common Cold
  • Gastroenteritis
  • Food Poisoning
  • STDs
  • Hayfever
  • Is Soy Milk Better Than Cow Milk?

    Soy milk has been popular in Asia for thousands of years, and is much more common than cow milk. Are there different health effects? There is a lot of differing information out there, but some recent scholarly reviews help to find some answers.

    There’s a terrific 2006 review from the American Heart Association — here is the free PDF file. Unfortunately, the main conclusion shows that earlier 1990’s reports of soy’s cardiovascular health have not been well confirmed by follow up studies, and the average cholesterol improvement was only 3%. The abstract sums it up well:

    …In the majority of 22 randomized trials, isolated soy protein with isoflavones, as compared with milk or other proteins, decreased LDL cholesterol concentrations; the average effect was 3%. This reduction is very small relative to the large amount of soy protein tested in these studies, averaging 50 g, about half the usual total daily protein intake. No significant effects on HDL cholesterol, triglycerides, ipoprotein(a), or blood pressure were evident. Among 19 studies of soy isoflavones, the average effect on LDL cholesterol and other lipid risk factors was nil. Soy protein and isoflavones have not been shown to lessen vasomotor symptoms of menopause, and results are mixed with regard to soy’s ability to slow postmenopausal bone loss. The efficacy and safety of soy isoflavones for preventing or treating cancer of the breast, endometrium, and prostate are not established; evidence from clinical trials is meager and cautionary with regard to a possible adverse effect. For this reason, use of isoflavone supplements in food or pills is not recommended. Thus, earlier research indicating that soy protein has clinically important favorable effects as compared with other proteins has not been confirmed…

    But, as the article mentions, if you have a high risk diet, then switching your protein intake to soy products (tofu, etc) from cow proteins may be a good idea due to secondary effects of lower saturated fat and higher fiber, vitamins, and minerals. You can read more about the American Heart Association’s most recent (2006) general diet and lifestyle recommendations here (a PDF file)

    What About Soy Formula?

    This is also a running debate, but there is a recent 2008 review from the American Academy of Pediatrics which helps shed some light. Here is the summary:

    1. In term infants, although isolated soy protein-based formulas may be used to provide nutrition for normal growth and development, there are few indications for their use in place of cow milk-based formula. These indications include (a) for infants with galactosemia and hereditary lactase deficiency (rare) and (b) in situations in which a vegetarian diet is preferred.

    2. For infants with documented cow milk protein allergy, extensively hydrolyzed protein formula should be considered, because 10% to 14% of these infants will also have a soy protein allergy.

    3. Most previously well infants with acute gastroenteritis can be managed after rehydration with continued use of human milk or standard dilutions of cow milkbased formulas. Isolated soy protein-based formulas may be indicated when secondary lactose intolerance occurs.

    4. Isolated soy protein-based formula has no advantage over cow milk protein-based formula as a supplement for the breastfed infant, unless the infant has 1 of the indications noted previously.

    5. Soy protein-based formulas are not designed for or recommended for preterm infants.

    6. The routine use of isolated soy protein-based formula has no proven value in the prevention or management of infantile colic or fussiness.

    7. Infants with documented cow milk protein-induced enteropathy or enterocolitis frequently are as sensitive to soy protein and should not be given isolated soy protein-based formula. They should be provided formula derived from hydrolyzed protein or synthetic amino acids.

    8. The routine use of isolated soy protein-based formula has no proven value in the prevention of atopic disease in healthy or high-risk infants.

    Make Your Own Soy Milk!

    There are many very simple machines that allow you to make your own soy milk. I’ve been doing it for a couple years now and I love it. In America, this machine isn’t too common to find in stores, so maybe your best bet is first check the store websites

    Preparation is super easy; you simply pour in a tiny cup of soy beans and let soak overnight, then press the button in the morning, and the machine grinds and cooks the beans. Presto, within 10-15 minutes you and your family have fresh milk!

    Vaccines: New Study Again Confirms MMR Safety

    There has been a lot of controversy since 1999 regarding the MMR vaccine and an alleged link to autism. Fortunately, the best studies have shown no relation, and now again there is a new study to corroborate this. It’s a UK NHS study which found the same rate of autism among adults as in children. If the MMR vaccine were to cause autism, then the study would expect a higher rate among children, but this was not found.

    “The findings do not support suggestions of a link between the MMR vaccine and the development of this condition.”

    A Department of Health spokesperson said: “There is no credible evidence to support the link between the MMR vaccine and autism.

    “MMR vaccine has been used extensively and safely around the world for over 30 years and is the best way of protecting your child against measles, mumps and rubella.”

    Article: BBC NEWS | Health | Autism rates back MMR jab safety.

    More Resources on MMR and Vaccine Safety:


    Pain Relief in Children: Ibuprofen Wins Again

    I discussed in an earlier post that parents may want to consider ibuprofen (Motrin) as the first line medicine over acetaminophen (Tylenol) for their child’s pains and fevers. Now, there’s a new study comparing ibuprofen to a Tylenol-codeine combo for pain, and ibuprofen was just as effective. Here’s the comment from JournalWatch:

    These findings should encourage the use of ibuprofen to treat acute traumatic extremity pain in children. This study also serves as a reminder that codeine is a poor analgesic and that an effective opioid, such as hydrocodone or oxycodone, should be considered for children with moderate-to-severe pain that is not effectively relieved by ibuprofen or acetaminophen.

    Review: Analgesia in Children: Ibuprofen as Effective as Acetaminophen-Codeine – Emergency Medicine.