Take swine flu shot, doc says

By Malka Eisenberg

Issue of November 20, 2009/ 3 Cheshvan 5770

Rabbi Dr. Aaron Glatt made the case for taking the swine flu vaccine at a lecture in the Young Israel of Woodmere this past Sunday night, brushing aside all concerns and focusing on what he said are the facts.

“I’m proud to say I think I was the first person vaccinated in Nassau County,” he said. “The minute we got it I wanted to be vaccinated to show people how safe it was. I vaccinated my wife and kids with the intranasal. I would recommend strongly: do what I say, do what I do.”

In a talk that combined statistics, science and halacha, Dr. Glatt, a spokesman for the Infectious Diseases Society of America, president and CEO of New Island Hospital in Bethpage, LI, and assistant rabbi at the Young Israel of Woodmere, called current media coverage “aggressive” but “appropriate.”

He began with a quote from the Torah, that any plague that G-d put on biblical Egypt, He wouldn’t put on the Jews. Some consider this to be the first-ever reference to preventive medicine, Dr. Glatt noted. In a vaccine, the patient is given either parts of a dead virus, he explained, or live attenuated, or very weakened, virus in a non-dangerous form. This enables the body to learn to protect itself and attack the virus when it shows up. “Vaccination is the single most important medical advance that we’ve ever had,” he stressed.

He attempted to assuage fears and inform through slides, cartoons and anecdotes. One poignant cartoon brought home his point: the first frame showed a mother explaining why she couldn’t trust and thus give the vaccine. The second showed her standing over a tombstone saying, “I’ll visit again tomorrow.”

There are various types of influenza or flu, including avian (H5Nl) transmitted bird to bird generally, swine (H1N1) transmitted pig to pig generally, and seasonal flu dealt with yearly by scientists attempting to predict what will be the main strain that year. All flu vaccines are produced via the same process and same technology, he said. An epidemic means that there is “a lot around,” and that in a pandemic it’s in “a lot of countries, widespread, not more virulent.” For example, the common cold is pandemic but does not have a high mortality rate.

Tens of millions of people died in the flu pandemic of 1918; it was an extremely virulent strain, he explained. Strains mutate and when humans have contact with diseased birds or swine the virus can make the jump to humans. If it can be spread from human to human it can spread very rapidly if it’s a new strain and there is no immunity to it.

According to the latest statistics from the Centers for Disease Control and Prevention (CDC), there were 22 million cases of swine flu in the US since April 2009 — “a huge number of sick people,” Dr. Glatt said — about 1/13th of the population with 100,000 hospitalized, including 36,000 children. There have been 3,900 deaths; 540 were children. He noted that one in three cases of the disease is in a child under the age of 18, a higher percentage than in seasonal flu. It’s “not the worst epidemic to hit the world,” he said, “but people are dying from it.” It is appearing in a high percentage of healthy young kids, he said. “That’s why we have to know what to do to prevent this disease as much as possible. If we could give them something to prevent this illness you’re talking about preventing the most horrible, worst scenario, for a parent to bury a child.”

Glatt recommends the Swine flu vaccine either in its nasal form as flu mist (intranasal) with live attenuated virus, which offers gives slightly better protection, he said, or the injection with inactivated virus. The nasal version should not be given to pregnant patients, those with compromised immune systems, or those over age 49 (not studied); they should receive the injected form of the vaccine. Glatt also recommends getting the seasonal vaccine and noted that there should be a wait time of four weeks between nasal vaccines.  Injected vaccines can be given simultaneously.

Because of the vaccine’s limited availability there are levels of recommended population for vaccination starting with pregnant women, those taking care of children under six months, health care workers, including Hatzalah, then children age six months to age 24, and finally, adults 25 to 64 with underlying health issues.

“Simple actions” can prevent the spread of the disease: covering coughs and sneezes with your elbow, disposing of used tissues, washing hands properly with soap and water or using hand sanitizers and staying home when sick. Avoid visiting people who are sick with colds, but “phone, text, email.” He suggested limiting contact with a sick child to one parent; pregnant mothers should try to avoid caring for a sick child.

Health care workers are obligated to take care of people with infectious diseases, Glatt said.  He quoted a halachic decision to that effect by Rabbi Eliezer Waldenberg zt”l, the posek (halachic decisor) of Shaare Zedek Medical Center, known as the Tzitz Eliezer. “There is a tremendous benefit if we vaccinate health care workers since they could be a vector for transmission of disease, a ‘typhoid Mary.’ I’m a very firm believer that it’s the right thing to do, it’s a way to prevent the spread of disease.” The few reports of Guillain-Barré Syndrome, a rare autoimmune disorder, appear to be coincidental and unrelated to vaccination, he said.

“I think it’s pikuach nefashot,” lifesaving, said Dr. Glatt. “I think that anyone who says, ‘I don’t want to get vaccinated,’ they have to explain why and if they’re doing it for themselves and they say they don’t want to get vaccinated that’s fine, but when they come out on a public pulpit and they say it’s dangerous, I think they’re committing a serious avlah (halachic offense) by raising an issue without scientific support for it.”