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Ask the Doc: Q & A with Edward Kasarskis, MD, PhD 

Dr Kasarskis

Dr. Kasarskis

Edward Kasarskis, MD, PhD is Director of the University of Kentucky ALS Multidisciplinary Clinic at Cardinal Hill Rehabilitation Hospital 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: I'm wondering if people with ALS should get the seasonal flu and the H1N1 vaccines this year?

Dr. Kasarskis:  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 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 instead of an injection.  The nasal spray contains a live but weakened virus, unlike the injection, which is made of inactivated pieces of the virus.  The Centers for Disease Control (CDC) recommends that patients who receive the live nasal sprays for seasonal flu and H1N1 separate the two vaccines by four weeks. So get the seasonal flu immunization as soon as you can since it’s widely available now. The H1N1 should be available in mid-October to people in high risk groups, such as people with ALS. 

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 get the vaccine).

No shortage of 2009 H1N1 vaccine is expected, but vaccine availability and demand can be unpredictable and there is some possibility that initially, the vaccine will be 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 bacterium. There are more than 80 different types of pneumococcus bacteria, and 23 of these are covered in the current vaccination. 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.

Each issue we feature a leading neurologist specializing in ALS responding to a question. If you would like to submit questions for a future Q & A, please send your questions to Amber Walters. Please understand that we won’t be able to address all questions and we won’t be able to respond to individuals personally.

 

 



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