Monday, March 1, 2010

THIMEROSAL - Guide for Kids 0 to 6 years of age

THIMEROSAL:  A GUIDE TO PARENTS in Canada and the US who have children 0-6 years of age
Added April 28, 2010 Error in  Canada section
Added April 30, 2010 link to letter on expiry dates 
Added June 22, 2010  information on trace amounts of thimerosal.
Added June 28, 2010  label is more accurate than product insert
Corrected September 23, 2010 Fluvirin in US in single dose has trace thimerosal.
Corrected  January 24, 2011  1999 recommendation excluded influenza because it excluded influenza.

In the past, some routine childhood vaccines contain thimerosal, a preservative In November 1999, ACIP recommende­d to the CDC all vaccines that were on the kid vaccination schedule be preservative free. At the time, the only influenza vaccine approved was in 10 dose vials and therefore used thimerosal as a preservative.  Influenza vaccine was not on the schedule, but was given to kids in high risk groups. The recommendations explicitly excluded influenza vaccine.
Evidence suggests that children with certain medical conditions (e.g., cardiopulm­onary disease, including asthma) are at substantia­lly increased risk for complicati­ons of influenza (7,8). During the influenza season, rates of cardiopulm­onary hospitaliz­ations for otherwise healthy women in their second or third trimester of pregnancy conditions­....ACIP concluded that the benefits of influenza vaccine outweigh the potential risks for thimerosal­."Recommendations Regarding the Use of Vaccines That Contain Thimerosal as a Preservative November 5, 1999
The last lots of vaccine routinely given to kids that used thimerosal as a preservative had expiry dates in 2001.  Influenza vaccine, excluded from the 1999 recommendation still used thimerosal as a preservative.

In 2006, it was recommende­d that all infants from 6 to 23 months routinely receive flu vaccinatio­n, but "persons for whom inactivated influenza vaccine is recommended may receive vaccine with or without thimerosal, depending on availability."
The U.S. vaccine supply for infants and pregnant women is in a period of transition; the availability of thimerosal-reduced or thimerosal-free vaccine intended for these groups is being expanded by manufacturers as a feasible means of reducing an infant's total exposure to mercury, because other environmental sources of exposure are more difficult or impossible to eliminate. Reductions in thimerosal in other vaccines have been achieved already and have resulted in substantially lowered cumulative exposure to thimerosal from vaccination among infants and children. For all of those reasons, persons for whom inactivated influenza vaccine is recommended may receive vaccine with or without thimerosal, depending on availability.
Prevention and Control of Influenza July 28 2006" 

There is no need to be concerned about the thimerosal in vaccines. But let us say that, for whatever reasons, you are concerned. Here is what you do.

For US residents,  go here, print off the table and take it to the doctor. You see that thimerosal has been removed from routine childhood vaccines except the flu vaccine -- where much of it is supplied in 10 dose vials. Single doses and the nasal spray do not contain thimerosal.  Corrected September 23, 2010.  Fluvirin in single dose syringes has a trace amount, less than 1mcg/dose.  It is only approved for those 4 years of age and over.
So all US flu vaccine, in single doses, for infants, has zero thimerosal.

  There are trace amounts in one of the DTaP vaccinesTripedia (Sanofi Pasteur, Inc) Trace(≤0.3 µg Hg/0.5mL dose).
Added June 21, 2010
Some vaccination opponents don't seem to understand what trace amounts mean *** The table linked to above states: The term "trace" has been taken in this context to mean 1 microgram of mercury per dose or less." As the standard amount of ethyl mercury in multi-dose vaccines was 25mcg, this was an enormous decrease.  The Omnibus Autism Proceedings thimerosal had the three special masters individually agreeing that the amount of  organic mercury from vaccines, even when there was much, much exposure to thimerosal was inconsequential.  If you reduce the amount of exposure, especially in a short period of time and especially for a young infant to either zero or twenty-five times less, that's truly, truly inconsequential.
Added April 30, 2010   
Some vaccination opponents argue that thimerosal containing vaccines were still being used for years after the time when they should no longer have been used. In June 2003, the FDA wrote a letter detailing expiry dates for all vaccines containing thimerosal.  In June 2003 the FDA set out the information it had


Added June 28, 2010
I'm trying to understand where the claim that vaccines containing thimerosal (beyond a trace) had expiry dates after 2002 came from.  The only possibility is that they relied on product inserts which were not updated.  The FDA letter at page 2, paragraph 2 makes clear that it is the label on the package that accurately indicates how much preservative is used in the vaccine.

There's also a CDC document last updated in 2010 that list trace amounts of thimerosal in vaccines that according to the FDA are thimerosal free.  The FDA document is to be preferred because the FDA's document was written specifically to answer questions on thimerosal.
----end added June 28---
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For Canadian residents,  see here  and here (Question 33).  Canadian flu vaccine currently is only supplied in 10 dose units. Because it is a better vaccine, the Canadian H1N1 vaccine with thimerosal contains much, much less thimerosal than the US vaccine with thimerosal.  Most likely, this unnecessary advantage will continue in the years to come as Canada isn't likely to switch back to a less effective vaccine.  Considering that the concern was too much thimerosal in too many vaccinations given in a short period of time, a single dose (two spaced out the first time) once a year is not a concern.

Added April 28, 2010 
There are  two additional seasonal (trivalent)  flu vaccines approved for use in Canada.  Multi-doseVaxigrip with 2 mcg of thimerosal  (breaks down to 1 mcg of ethyl mercury) Single dose Vaxigrip, of course, has no thimerosal.    There is a trade-off with the lower level of thimerosal. The  multi-dose vial has to be used within 7 days, GSK's Fluvirin has to be used in 30 days.

Influvac available in limited quantities for 2009-2010 is only available in single doses, so there is no thimerosal Solvay, maker of Influvac, did not produce a 2009 H1N1 vaccine.

For the 2010-2011 flu season, the seasonal flu vaccine will contain the same strain of 2009 H1N1 vaccine used in the fall of 2009 to combat the pandemic.   

If you are still concerned, then drive your kid across the border into the US and get a thimerosal-free vaccination there.  Most Canadian live within 150 miles of the border.
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Now you know.  So go back to looking after your kids.
Next.

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