Kids' flu shots can be ordered free of mercury

Many Ozarks-area health care providers are currently placing orders for flu vaccine. The flu virus killed 142 children last year, and the Centers for Disease Control and Prevention wants the youngest children possible to be protected this year.

While the preservative-containing doses are OK for anyone 6 months and older, some doctors are also ordering doses free of thimerosal so parents don't skip the vaccine over concerns about possible health risks.

Some parent activists and researchers believe thimerosal causes neurodevelopmental problems such as autism.

Doctors warn parents, however, that supplies of thimerosal-free vaccine may be limited, and it's likely to cost more — a minimum of $24 for two pediatric half-doses compared with about $10 for a standard flu-vaccine dose.

Costly production

Vaccine manufacturer Aventis Pasteur Inc., with the only government-approved preservative-free flu vaccine for children 6 months to 3 years old, will make more this year if doctors order it by mid-May, spokesman Len Lavenda told the News-Leader.

Production gears up after that, and Lavenda said he's not sure doctors will be able to order more. The company usually makes an extra 20 percent to allow for late orders, he added.

Aventis can't promise that all orders for thimerosal-free vaccine will be met since it's more expensive to make and single-dose packaging takes up more space, Lavenda said.

The preservative is added during production to prevent bacteria and fungi, then it's removed — along with some of the vaccine. That adds to cost and waste, he said.

Without a preservative, it must be stored in single-dose vials as opposed to space- and cost-saving 10-dose vials, he said. Aventis produced 43 million doses of flu vaccine last year and packaged it in 4 million vials instead of 43 million separate vials, he said.

"Whether people want preservative-containing or preservative-free vaccine, people should let their doctor know now that they'll be coming in so physicians can order during the pre-booking period," Lavenda said.

There are two more thimerosal-free options: Vaccine maker Chiron Corp. sells a single-dose injectable flu vaccine for older children and adults. FluMist by a Wyeth-MedImmune collaboration is a nasal spray vaccine for healthy people ages 5 through 49. It costs $60 to $70 per dose.

"Parents will just have to call the doctor's office," said Atlanta-based Lyn Redwood, president of parent activist group Safe Minds. "They have to be informed consumers and let pediatricians' offices know now," so vaccine manufacturers will make more. "... We will have to control production through the back door — through consumer demand."

Safety precaution

Parent advocates, researchers and the CDC are locked in a debate over whether the mercury-laced thimerosal causes problems such as autism. Mercury is a neurotoxin known to cause brain, kidney damage and possibly cancer.

The Missouri and Iowa legislatures and the U.S. Congress are also debating bills to ban thimerosal from all vaccines mandatory for children. Missouri's bill, sponsored by Springfield Rep. Roy Holand, has passed the House and a Senate committee and awaits Senate debate.

Vaccine makers have removed thimerosal from all required childhood immunizations — except those for tetanus and flu — at the request of the American Academy of Pediatrics. It says there is no link to autism, but it wants to eliminate any possible risk and encourage continued immunizations of children to protect them from deadly diseases.

Offering a choice

That's why many physicians like Springfield pediatrician Fred Hamburg will give parents a choice of flu vaccine in his office this fall.

"I think parents will be a lot happier with thimerosal-free vaccine because it's such a big issue," he said. "I believe it's better to have the most pure product, but I also think this is not the answer that people say it is."

Environmental toxins like the mercury that fetuses are exposed to is a more likely problem, Hamburg said.

Springfield pediatrician Tamara Fusco, whose child was diagnosed with an autism spectrum disorder, feels stronger about the issue.

"I fully intend to offer thimerosal-free vaccine, regardless," Dr. Fusco said. "It's the safest route to vaccinate our children from influenza. As the controversy on thimerosal being used as a preservative continues to be researched, in the best interest of children's health, we want to use the safest route."

Here's what others are doing to meet what they expect will be greater overall demand this fall:

• St. John's Health System increased its pharmacy and physician orders for both flu vaccines by 20 percent, to more than 76,000 doses. All pediatric clinics and most family-practice clinics ordered some of the thimerosal-free pediatric doses.

• CoxHealth Regional Services ordered only thimerosal-containing flu vaccine — 42,280 doses — for doctors and pharmacies. Preservative-free would have doubled patients' cost, according to Cox, and officials feared that would deter parents from getting the vaccine.

• The Springfield-Greene County Health Department ordered both kinds, but non-thimerosal pediatric doses are mainly for kids in a federal vaccine program.

Director Kevin Gipson echoes his counterparts at county health departments statewide.

"I'm a firm believer that if we have the ability to get thimerosal out of vaccines, we should try to do it," Gipson said.

But he doesn't believe scientific studies support a link between thimerosal and autism.

Neither does Springfield pediatric neurologist Bernardo Flasterstein, who thinks neurodevelopmental problems coincidentally appear after children are immunized. He also cites a study showing that the incidence of autism actually increased when thimerosal-containing vaccines were discontinued in 1992 in Denmark.

Springfield pediatrician Robert Steele is chairman of the state Advisory Committee on Childhood Immunizations: "Our feeling, and the feeling of the health department, is that the issue is still at best just on the table. There's not enough science to suggest there is a problem with thimerosal itself, but there certainly is a problem with children getting influenza."

His pediatric office ordered both vaccines because some parents won't immunize their children if they can't get thimerosal-free, he said.

Parents with affected children are equally passionate.

Trisha Montez of Joplin saw her daughter lose developmental skills at 18 months old after her immunizations. Fearing the mercury-based preservative in flu vaccine, "I wouldn't let them near her at this point," Montez said.

Protecting babies

CDC spokesman Curtis Allen said people should realize how serious influenza is: It kills 36,000 people a year and hospitalizes 114,000.

"We know the consequences of not vaccinating and we know the health risk that influenza can cause," Allen told the News-Leader. "What is unknown is the danger of thimerosal. But the danger of influenza far outweighs any hypothetical risk of influenza vaccination, as we saw last year in the 142 children who died from influenza."

Knowing some parents' concerns about thimerosal, the CDC encourages them to talk to their doctors, Allen said.

"And if they're still concerned, ask for thimerosal-free vaccine."

Contact reporter Kathleen O'Dell at kodell@News-Leader.com.