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By DONALD G. McNEIL Jr.
Published: September 27, 2009

As soon as swine flu vaccinations start next month, some people getting them will drop dead of heart
attacks or strokes, some children will have seizures and some pregnant women will miscarry.

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Enlarge This Image But those events will not necessarily have anything to do with the
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vaccine. That poses a public relations challenge for federal What’s your score? »

officials, who remember how sensational reports of deaths and

illnesses derailed the large-scale flu vaccine drive of 1976.

This time they are making plans to respond rapidly to such events What you can do to
and to try to reassure a nervous public and headline-hunting prevent osteoporosis
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The first day of vaccination in New York in

1976. Forty-five million Americans got the Every year, there are 1.1 million heart attacks in the United States,
medicine. 795,000 strokes and 876,000 miscarriages, and 200,000 MOST POPULAR - HEALTH

Americans have their first seizure. Inevitably, officials say, some of ● E-Mailed ● Blogged

these will happen within hours or days of a flu shot.

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The government “is right to expect coincident deaths, since people
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women to be among the first to be vaccinated. Pregnant women are usually advised to get flu shots,
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“There are about 2,400 miscarriages a day in the U.S.,” said Dr. Jay C. Butler, chief of the swine flu 10. Essay: Pregnancy Is No Time to Refuse a Flu Shot

vaccine task force at the federal Centers for Disease Control and Prevention. “You’ll see things that
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would have happened anyway. But the vaccine doesn’t cause miscarriages. It also doesn’t cause auto
accidents, but they happen.”

In the opening days of the 1976 vaccination campaign, which eventually vaccinated 45 million
Americans, three elderly Pittsburgh residents died soon after receiving their shots at the same clinic.
Though scientists believe it was just a freakish coincidence, some news reports suggested the vaccine
had killed them.

“Press frenzy was so intense it drew a televised rebuke from Walter Cronkite for sensationalizing
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coincidental happenings,” Dr. David J. Sencer, who was then the director of the C.D.C., wrote in 2006
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Two months later, reports emerged of vaccine recipients suffering from Guillain-Barré syndrome, in
which the body’s immune system attacks the nerves, leading to temporary or permanent paralysis
and, in a few cases, death. That effectively ended the campaign, as officials suspended it to
investigate. Experts still disagree over whether the vaccine caused cases to increase that year, and the Advertisements
C.D.C. will be on high alert for reports of it this year.

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Don’t Blame Flu Shots for All Ills, Officials Say - NYTimes.com

Guillain-Barré’s cause is unknown, though different studies have suggested it more often affects
people who have had a flu shot, the flu itself, some bacterial infections or even, according to Dr.
Sencer’s paper, people who have been struck by lightning.

In any case, after the suspension, there was no reason to restart because the predicted swine flu
epidemic never emerged.

That, experts emphasize, is the great difference between 1976 and 2009. The earlier virus apparently
burned out the previous winter inside Fort Dix, N.J., before any vaccine was even made, while this
pandemic H1N1 virus has already infected millions and, unchecked, will probably reach over two
billion, according to the World Health Organization.

In 1976, getting flu shots into 45 million Americans was unprecedented. Now about 100 million get
annual shots, and the government has ordered twice that many doses of swine flu vaccine.

Other changes since 1976 worry officials. The 24-hour cycle of news on television and the Internet did
not then exist; public health officials now must be ready to respond to rumors instantly. In 1976, the
C.D.C. did not hold news conferences, and it took it five days to respond to the Pittsburgh deaths, Dr.
Fineberg said.

“Back then, it was a neat thing to have a fax machine and get out four pages a minute,” said Joe
Quimby, a press officer for the disease centers. “Now, communications have to be multimodal.
Turning on the three broadcast news outlets is not going to reach everybody any more.”

The agency now has a “war room” in its Atlanta headquarters and, since the pandemic began in April,
has held news conferences, sometimes even daily, at which reporters from around the world ask
questions by phone. They can be seen live on the agency’s Web site, and it has another Web site, flu.
gov, devoted to the pandemic, as well as a constantly updated Facebook page and Twitter feed.

Complicating the challenge for officials, some experts argue, is that health news coverage has suffered
since 1976.

“I’ve seen the rise and fall of experienced medical reporters,” said Dr. Michael T. Osterholm, director
of the Center for Infectious Disease Research and Policy at the University of Minnesota. “I can’t tell
you how many reporters have come to me since last spring who don’t really know what flu is.”

Also, antivaccine activists are far more powerful now. Thirty-three years ago, vaccines were
enthusiastically welcomed; many parents or grandparents still remembered children dead of
smallpox, measles or polio. The minority opposing them were often followers of natural healing or
traditional chiropractic beliefs.

In 1976, autism was not on the public’s mind, and the problem was still attributed to indifferent
mothering. Vietnam veterans with chronic illnesses usually blamed Agent Orange, a defoliant.

Today, many parents blame vaccines for their children’s autism and some ill Gulf War veterans blame
their anthrax shots.

Some antivaccine groups are raising fears of thimerosal, a preservative used in some brands of flu
vaccine. Others issue dire warnings about squalene, an immune booster used in military vaccines and
in some European flu vaccines but not in any American ones.

And, in the rancor over health insurance reform, unfounded rumors are spreading that the Obama
administration will make swine flu shots mandatory. Administration officials have emphatically
denied that. But a recent decision by New York State to make them mandatory for all hospital
employees has reinvigorated those rumors on the Internet.

To defend itself, Dr. Butler said, the C.D.C, has compiled data on how many problems like heart
attacks, strokes, miscarriages, seizures and sudden infant deaths normally occur. And it has broken
those figures down for various high-priority vaccine groups, like pregnant women or children with
asthma. When vaccinations begin, it plans to gather reports from vaccine providers, hospitals and
doctors, looking for signs of adverse events, so it can detect problems before rumors grow.

“Then we’ll try to verify the signal, see if it’s real,” Dr. Butler said. “Then we’ll try to see if it’s
associated with the vaccine. If it is, we’ll say so. The process will be as transparent as we can make it.”

Next Article in Health (11 of 42) »

http://www.nytimes.com/2009/09/28/health/policy/28vaccine.html?_r=2 (2 sur 3) [2009-09-29 02:10:19]
Don’t Blame Flu Shots for All Ills, Officials Say - NYTimes.com

A version of this article appeared in print on September 28, 2009, on page A1

of the New York edition.

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Past Coverage
● 'Bumpy' Start Seen for Swine Flu Vaccine Plan (September 26, 2009)
● NATIONAL BRIEFING | SCIENCE; Swine Flu Doses Will Be Double the Number Expected (September 25, 2009)
● WORLD BRIEFING | ASIA; China: Swine Flu Campaign, First in World, Begins in Beijing (September 22, 2009)
● Benefit and Doubt in Vaccine Additive (September 22, 2009)

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