Summary
Wild rumors are flying about the newly developed vaccine for pandemic influenza H1N1, also known as "swine flu." We’ve seen e-mails stating that the vaccine is tainted with antifreeze or Agent Orange, causes Gulf War syndrome, or has killed U.S. Navy sailors. One says the vaccine is an "evil depopulation scheme." The claims are nearly pure bunk, with only trace amounts of fact.
If you are the sort who trusts anonymous e-mails more than you do doctors and experts from the U.S. Centers for Disease Control and the U.S. Food and Drug Administration, you may wish to stop reading now. For others, here are the facts as stated by the best authorities we can find:
- The vaccine does have some risks – the same risks as the seasonal flu vaccine. Except for the virus, it is functionally identical to the vaccine that’s given every year.
- The multidose formulation of the vaccine contains thimerosal, which prevents contamination. Some have accused thimerosal of causing developmental disorders in children, but scientific evidence doesn’t support this.
- The vaccine does not contain squalene, which has been accused – also without good evidence – of causing Gulf War syndrome.
- There’s no reason to believe that a vaccination would cause Guillain-Barre syndrome. GBS was associated with several hundred flu vaccinations in 1976, but there’s been no evidence of an association since then, despite close monitoring.
- While it’s true that a Navy vessel was prevented from deploying because of a flu outbreak, that had nothing to do with the vaccine, which hadn’t been developed at the time. And there were no deaths aboard the ship, as some e-mails claim.
- Vaccination is not mandatory for the public nationally or in any state, although New York requires that health care providers get vaccinated. Massachusetts legislation granting standby powers in case of health emergencies does not require vaccination or establish quarantine "camps."
Update, October 23: On October 22, New York State suspended the requirement for health care workers to be vaccinated. The governor’s office cited vaccine shortage concerns as the reason for the change.
Analysis
We’re starting to feel nostalgic for the early days of the swine flu pandemic, when the rumors centered around devastated villages and zombies in Cambodia. The crop of falsehoods about the H1N1 vaccine, though, are potentially much more dangerous, since they encourage the credulous to avoid vaccination at all costs. These myths fall into two loose categories: claims that the vaccine is tainted or dangerous, and claims that the government is going to make it mandatory anyway and punish anyone who doesn’t get vaccinated.
Same As It Ever Was. Really.
Click for e-mail excerpts claiming the vaccine is deadly
"Their EVIL DEPOPULATION plan is in full swing! Do the right thing…get this story out. The seasonal flu shot ALSO contains H1N! and H3N2 and one other deadly flu. DO NOT TAKE ANY VACCINE. NONE…NONE…NONE."
—
"I’ve seen a number of stories claiming that the upcoming swine flu vaccine is so dangerous that even the scientists who developed it refuse to get it and tell their families and friends not to get it. The claims seem to stem from fear that this is the same vaccine that was used in the 1976 swine flu outbreak that resulted in a nuerological disorder that caused paralysis and death."
The e-rumors claim generally that the vaccine is dangerous; one even claims it’s a government "depopulation" plot. We’ll say it straight out: There are some real risks to the H1N1 vaccine. There’s nothing shady or secretive about them, though – they’re exactly the same as the risks of the seasonal flu vaccines. They’re mentioned on the Department of Health and Human Services Flu.gov Web site, the Centers for Disease Control’s Web site and the package inserts for the vaccines. People who have previously contracted Guillain-Barre syndrome within six weeks of a vaccination shouldn’t get the vaccine. People who are hypersensitive to egg protein may want to avoid it because it is grown in eggs. Pregnant women should get the injection, which is made from killed virus, but should not get the nasal spray, which contains live but weakened virus. And, as with the regular seasonal flu vaccine, there’s some chance of side effects, ranging from redness around the injection site to allergic reactions. The CDC and the Food and Drug Administration are monitoring for other adverse effects.
In fact, everything about the vaccine is just like the seasonal flu shot, which has been administered to hundreds of millions of people. "It’s a new virus, but the vaccine is made the exact same way," Dr. Bruce Gellin, director of the National Vaccine Program Office at HHS, told us. The regular seasonal flu vaccine is a mix of the three viruses experts predict will be most likely to cause problems in a given year. But it’s only an accident of timing that H1N1 is not included in this year’s batches of regular flu vaccine. Had the H1N1 virus shown up several months earlier, Gellin told us, it’s "very likely" that it would have been a component of the seasonal vaccine. Instead, there’s a separate H1N1 vaccine, but it’s otherwise no different. And just like the seasonal flu vaccine, it’s been clinically tested and approved by the FDA.
Thimerosal
Click for e-mail excerpts about thimerosal.
"I keep hearing the swine flu vaccine has a lot of bad stuff in it such as mercury and anti-freeze to name a few."
—
"Flu shots contain formaldehyde, a known carcinogen, and all multi-dose flu shot vials have thimerosal, (mercury), a controversial ingredient linked to autism."
—
"Please help in calling the US Food and Drug Administration to discontinue the distribution of the multi-dose H1N1 vaccine with Thimerosal until further evaluation of the current scientific data on the toxicity of Thimerosal additive. This compound is an organo-mercury compound that had been discontinued as vaccine additive in Europe because of its association to Autism and other neurological disorders.”
A common theme in the scare stories is that the vaccine contains harmful ingredients. The "tainted vaccine" rumors aren’t new to swine flu vaccine – they’re old suspicions about vaccinations writ large, pinned to the most recent public health concern. Most of the problems posited with the H1N1 vaccine originated with other vaccines and date back as much as 30 years.
For instance, we’ve heard from people concerned about the vaccine containing thimerosal, a preservative that contains mercury and that has long been the subject of suspicion without a lot of scientific support. FDA regulations prevent adding thimerosal to primarily pediatric vaccines. The H1N1 vaccine is not specifically formulated for children, and the multidose version – but not the single-dose version – does contain thimerosal. However, the CDC stresses that even flu vaccines with thimerosal should pose no danger to children.
The thimerosal anxiety stems from the fact that it contains ethyl mercury, which is related to the type of mercury (methyl mercury) that can be harmful in food. Thimerosal was removed from pediatric vaccines mainly as a precautionary measure – a 1999 FDA review found that most children’s mercury exposure from thimerosal-containing vaccines would be well within the guidelines for methyl mercury, and ethyl mercury may be less likely to affect the brain, especially in the dosage one would get from a vaccine. But the move to phase out thimerosal piqued concern from some parents and activists, who posited a link between mercury in vaccines and developmental disorders like autism.
A 2001 report by the Institute of Medicine found that the idea that thimerosal exposure could lead to developmental disorders was "biologically plausible" but "is not established and rests on incomplete and indirect information." A 2004 report went a step further and recommended rejecting the hypothesis that thimerosal caused autism. The biological mechanism that would account for the causal connection is theoretically possible, IOM said – but only theoretically. Numerous other studies also find no link between thimerosal and developmental disorders. Ironically, thimerosal is added to vaccines to keep them from being tainted. Multidose vaccines require repeated needle insertions, which can push bacteria into the vial. Thimerosal prevents bacterial contamination of vaccines, which can cause illness and toxic shock.
As for formaldehyde and antifreeze, we’ll deal with those claims further down.
Squalene
Click for e-mail excerpts about squalene.
"No one should take this vaccine—it is one of the most dangerous vaccines ever devised. It contains an immune adjuvant called squalene (MF-59) which has been shown to cause severe autoimmune disorders such as MS, rheumatoid arthritis and Lupus. This is the vaccine adjuvant that is strongly linked to the Gulf War syndrome, which killed over 10,000 soldiers and caused a 200% increase in the fatal disease ALS (Lou Gehreg disease)."
—
"The vaccine / adjuvant combination being referred to as the "swine flu vaccine" has apparently never been safety tested or approved by the FDA."
—
"What is terrifying is that these pandemic vaccines contain ingredients, called immune adjuvants that a number of studies have shown cause devastating autoimmune disorders, including rheumatoid arthritis, multiple sclerosis and lupus."
—
“This vaccine has 1 million times more Squalene than the original Gulf War vaccine… 1 million times more Squalene than the Anthrax vaccination that caused Gulf War Syndrome; remember that all 146,00 soldiers that got this vaccine became very ill.
PLEASE do NOT get this vaccine. Swine Flu is a MILD flu. The vaccine however may just change your life dramatically for the worse!!!”
Some of the messages make a false claim that the vaccine contains an ingredient linked to Gulf War syndrome and, in the words of one e-mail, "is one of the most dangerous vaccines ever devised." But unlike thimerosal, squalene is not an ingredient of the vaccine. The claim is simply wrong.
Squalene is an organic compound produced naturally by humans (and some of the things we eat). It’s commonly found in cosmetics, but emulsions of squalene can be used in vaccines as an adjuvant – a substance that makes a vaccine work better. Chain e-mails claim that this flu vaccine contains squalene as an adjuvant, that the adjuvant has never been tested, and that squalene will cause severe autoimmune disorders. In fact, flu shots in Europe have used squalene emulsions as an adjuvant since 1997 – according to the World Health Organization, 22 million doses have been administered without ill effects. But no vaccines with a squalene adjuvant have been approved in the U.S. So far, the only approved vaccines that contain adjuvants use aluminum salts.
The idea that vaccines containing squalene were responsible for autoimmune symptoms came from a 2000 article on Gulf War syndrome published in the journal Experimental and Molecular Pathology. The researchers found that of 38 veterans with Gulf War syndrome, 95 percent had squalene antibodies (“anti-squalene”) in their blood, and blamed the anthrax vaccines that soldiers received before being deployed. Of 12 veterans without Gulf War syndrome, the researchers said, none had anti-squalene. A letter to the editor in the journal’s next issue criticized this study for failing to give enough evidence that the test could detect squalene antibodies in the first place. The critics wrote: “[T]he conclusions… purporting to relate anti-squalene with Gulf War illnesses, in our opinion, rely on circular logic. Positive results with an assay not validated to detect antibodies cannot be used as scientific proof that antibodies to the antigen exist in samples of unknowns.”
Since then, the U.S. military has revealed that the vaccines these soldiers received didn’t even contain squalene – they used alum, the only adjuvant approved for use in the United States. According to the Institute of Medicine, the Department of Defense requested a study on the squalene content of their vaccines and found that most had no squalene and some had negligible amounts: “The study report, dated August 14, 2001, found that 1 lot of over 30 lots tested contained measurable levels of squalene. Three samples from that lot contained squalene at 7, 9, and approximately 1 parts per billion, respectively. Use of vaccine from that lot has not been associated with elevated rates of adverse events.” A later study, published in 2004 in the Journal of Immunological Methods, found that all study participants – veterans who’d gotten the anthrax vaccine and regular joes – had squalene antibodies, and that there wasn’t much variation between the groups. They did find evidence that women had higher amounts of anti-squalene, and that the antibodies increased with age.
In any event, the H1N1 vaccine being administered in the U.S. could not contain a squalene emulsion, because there are no approved U.S. vaccines with a squalene adjuvant. And as it turns out, this vaccine, like the seasonal flu vaccine, has no adjuvant at all. The FDA has released the ingredients of the approved vaccines, and none contain squalene.
Other False Vaccine Dangers
Click for e-mail excerpts about catching flu or Guillain-Barre from the vaccine, and other vaccine dangers.
"Of the 347 man crew that were vaccinated, 333 contracted the H1N1 flu FROM THE VACCINE. Two died, as mentioned above, and 331 survived. Only 14 of the 347 vaccinated sailors did not show any ill effects from the vaccine…The truth is that the swine flu epidemic will be created BY THE VACCINE. If we don’t take it, there will be no epidemic. From this one test it’s apparent that the vaccine as tested on that ship’s crew in April is 96% effective at infecting the recipient with swine flu. Such an infection rate is impossible to achieve by any natural means. Though it only killed 1% immediately, there is no telling what the long term effects on those injected with the vaccine will be."
—
"Today I heard a that the H1N1 Virus Shot contains one (or more) of the same chemicals as contained in Agent Orange. Is there any semblance of truth to this rumor??"
—
"It all harkens back to 1976 when a previous formulation of the swine flu vaccine paralyzed and killed thousands of Americans. Turner was one of the attorneys instrumental in halting that vaccine, and he fears a repeat situation could potentially recur today. He told NaturalNews, ‘[In 1976] they were intending to inoculate 200 million people. We stopped them… and somewhere between 40 and 50 million people were vaccinated. What ultimately brought it down is that a substantial number of people got "French Polio" [Guillain-Barre syndrome], a paralysis that goes… through the body, and if it goes far enough you die.’"
Another claim is that the vaccine causes Guillain-Barre syndrome, a paralytic illness. It’s true that in 1976, adults in New Jersey who received a different swine flu vaccine were found to have an elevated risk of GBS – about 10 extra cases per million people vaccinated. "Thousands of Americans" did not die or become paralyzed due to the vaccine, as one e-mail asserts. According to one study, 532 people developed Guillain-Barre syndrome after having recently been vaccinated. Subsequent monitoring found either a much smaller increased risk or none. The CDC concluded: “Available evidence indicates that any risk of GBS from influenza vaccine appears to be far lower than the risks associated with influenza among persons for whom the vaccine is indicated.” The CDC does recommend that people who have already contracted GBS not get the H1N1 vaccine.
One anonymous e-mail claims that the crew of a Navy vessel got H1N1 from the vaccine, and that two crew members died. This, one e-mail author claims, is proof that "their EVIL DEPOPULATION plan is in full swing!" It’s true that in May the Navy canceled the deployment of the U.S.S. Dubuque because of a swine flu outbreak combined with what a Navy spokesman called "an abundance of caution." There were no deaths or hospitalizations among the Dubuque crew, who had not been vaccinated, since the vaccine was not yet developed. It’s not possible to get H1N1 from the injected vaccine, which does not contain live viruses. The nasal spray contains live but weakened viruses, and also should not be able to cause the flu, though the CDC reports that there is a minor chance of catching the flu from someone who’s had the vaccine.
One of the wackiest variations on this claim we’ve heard is that the vaccine contains the same chemicals as Agent Orange. Agent Orange, which was used to defoliate trees during the Vietnam War, is made of a mixture of herbicides. Some of the vaccine ingredients might sound alarming – for instance, one of the FDA-approved vaccines, made by Sanofi Pasteur, may contain residual amounts of formaldehyde, though not more than 100 micrograms in a dose. But none are herbicides. Most are either salts – the injected vaccine is essentially killed virus in a saline solution – or antibiotics to prevent contamination. The Sanofi Pasteur vaccine and another approved vaccine made by Medimmune also contain gelatin and sucrose, and the Medimmune vaccine has small amounts of arginine, an amino acid. As for antifreeze, the Sanofi Pasteur vaccine has a tiny amount of polyethylene glycol. Ethylene glycol is an antifreeze, but polyethylene glycol has many clinical uses – some research indicates it may even help prevent cancer.
Damned If You Don’t, Too
Click for e-mail excerpts about mandatory vaccinations.
"Is the state of Massachusetts (or any other states) passing a bill that makes the H1N1 vaccine mandatory and allows for the internment of persons that refuse to get the vaccine? I’ve been hearing that they will take your children away if you refuse to give them the shot."
—
"I received an email saying the police and the military are training right now to stop people to check if they have had the swine flu h1n1 vaccine and if they have will be fitted with tracking wrist band and if they dont and refuse will be hauled off to some kind of camp."
—
"The United States of America is devolving into medical fascism and Massachusetts is leading the way with the passage of a new bill, the ‘Pandemic Response Bill’ 2028, reportedly just passed by the MA state Senate and now awaiting approval in the House. This bill suspends virtually all Constitutional rights of Massachusetts citizens and forces anyone ‘suspected’ of being infected to submit to interrogations, ‘decontaminations’ and vaccines."
—
"The Massachusetts law about the flu vaccine has generated hundreds of questions and allegations about the vaccine and martial law. Does the Massachusetts law require people to be immunized or quarantined? Does the vaccine contain Mercury? What testing has been done on the vaccine?"
—
"It took corporate media swine flu hysteria to ram through a martial law bill in Massachusetts. S18 gives the Governor the power to authorize the deployment and use of force to distribute supplies and materials and local authorities will be allowed to enter private residences for investigation and to quarantine individuals."
—
"The Centers for Disease and Prevention (CDC) website, you would find that less than 1,000 people actually die each year from the flu, the 30,000 deaths robotically reported by the media."
In addition to misinformation about what the vaccine contains, we’ve seen rumors that it is being forced on the population despite H1N1 being a made-up pandemic. The latter claim relies on a semantic misunderstanding we’ve addressed before – a “pandemic” flu doesn’t need to be unusually deadly, just unusually widespread. As it happens, the World Health Organization lists the severity of H1N1 as "moderate," meaning that most people recover without hospitalization and most health care systems are equipped to handle the number of cases. But calling it a pandemic is not scare-mongering. It’s an accurate reflection of the disease’s international spread.
The CDC estimates that seasonal flu is normally associated with about 36,000 deaths per year in the United States, although flu isn’t the primary cause of death in all cases. H1N1 caused about 593 deaths before the CDC stopped requiring lab confirmation of flu deaths on Aug. 30, 2009, and there have been 2,029 total flu-related deaths and 292 lab-confirmed flu-related deaths since then. The CDC has recorded a total of 83 H1N1-related deaths in children. The CDC’s recommendations for the seasonal flu vaccine are similar to its recommendations for who should get the H1N1 vaccine.
And they are just that – recommendations. There’s no national or state requirement that everyone get vaccinated, though New York state and some hospitals do require flu vaccination for health care workers. (Update, Oct. 23: New York’s requirement was suspended on Oct. 22.) The vaccine does not contain an RFID chip that will track your compliance, nor will tracking bracelets be issued. One computing company, who happens to manufacture RFID technology, did suggest that hospitals – not the government – might issue RFID bracelets to patients and visitors, which could be used to track people’s contact with infected patients and thus help stem the spread of the disease.
Some of the e-mails mention a Massachusetts bill that the anonymous authors claim would force vaccinations and force people into quarantine camps. There is a real pandemic preparedness bill, which passed the state Senate as bill number 2028 (a new draft of bill 18), and the House as bill number 4275 (there’s no conference agreement yet), but it’s being mischaracterized. For starters, the Senate bill is explicit that vaccination will not be required:
Massachusetts Senate Bill 2028: An individual who is unable or unwilling to submit to vaccination or treatment shall not be required to submit to such procedures but may be isolated or quarantined pursuant to section 96 of chapter 111 if his or her refusal poses a serious danger to public health or results in uncertainty whether he or she has been exposed to or is infected with a disease or condition that poses a serious danger to public health, as determined by the commissioner, or a local public health authority operating within its jurisdiction.
In other words, the bills allow for isolation (of sick people) or quarantine (of healthy people who have been exposed to illness) in part so that vaccinations can remain voluntary without endangering public health. Both bills require that isolation and quarantine measures use "the least restrictive means necessary to prevent a serious danger to public health," which may include confining people to their homes or preventing them from going to work. And the House bill allows people to appeal a quarantine or isolation order.
Far from establishing "camps" for flu sufferers, the Massachusetts legislation actually repeals sections of Massachusetts law that established dedicated facilities to isolate disease sufferers and explicitly permitted them to be confined there non-voluntarily. In the House bill, the discussion of quarantine and isolation replaces Massachusetts general law chapter 111, section 96, which allows a magistrate to "issue a warrant directed to the sheriff of the county or his deputy, or to any constable or police officer, requiring him, under the direction of the board of health, to remove any person infected with a disease dangerous to the public health or who is a carrier of the causative agent thereof, or to take control of convenient houses and lodgings." (That’s "remove" to a hospital, not "remove" in the organized crime sense.) The quarantine and isolation language in the House bill replaces section 95, which also allows for establishment of and removal to disease hospitals, and section 96 is repealed. (In the Senate bill, section 95 is replaced by language that would allow the state commissioner to require that properties be decontaminated.) Both bills also repeal sections 92 and 93, which deal with the establishment and regulation of isolation hospitals.
Jared Caine, director of communications for the senator who spearheaded the bill, explained in an e-mail: "S. 2028 modernizes the statutes dealing with isolation and quarantine, which date from 1701." The old statutes didn’t contain due process regulations, and the new ones do. The same is true of allowing law enforcement to take necessary action to maintain public health, including arresting people who refuse to comply with orders – they are already empowered to do so, but the new legislation would make sure citizens were protected by due process.
What the bills do is allow the governor to declare an emergency (not, as some have said, "martial law") in the case of a pandemic. During an emergency, the commissioner or a local public health authority would have some new powers. For instance, they would be able to close or require the decontamination of public facilities; control movement of people in stricken public areas; get, store and distribute vaccines, antibiotics or medical supplies; and waive state licensing requirements for qualified health care professionals. None of this would apply unless a public health emergency was declared.
And none of it is unexpected for an emergency plan. The Department of Homeland Security provides a list of best practices for a pandemic preparedness plan, which includes having law enforcement "encourage voluntary compliance from public for quarantine/isolation orders issued by public health officials" and "implement isolation perimeters in areas with high infection rate." The National Governors Association best practices list also mentions quarantine and other social isolation tactics (like closing public facilities) as a possible means of containing the spread of disease, though the NGA warns about the potential psychological effects of quarantine and adds that it loses effectiveness over the course of an outbreak. So adding quarantine provisions into a piece of emergency public health legislation is by no means unusual; on the contrary, it’s widely recommended.
–by Jess Henig
Clarification, Nov. 2: We changed one sentence in this story after a conversation with the CDC. Previously, we had said that the CDC stopped differentiating H1N1-related deaths from seasonal flu-related deaths on August 30, 2009. In fact, the CDC says that as many as 98 percent of the flu samples it has seen have been H1N1, so all, or nearly all, of the more than 2,000 flu-related deaths after August have been due to H1N1. During the initial months of the pandemic, the CDC was requiring lab confirmation for all flu deaths in order to assess the prevalence of the disease. After August 30, it returned to the usual method of reporting, which counts all deaths from influenza or pneumonia-related symptoms and does not require lab confirmation. As of the publication date for this story, the CDC had reported 2,029 flu-related deaths and 292 lab-confirmed flu-related deaths. As of the most recent CDC report, for the week ending October 24, flu-related deaths totaled 2,916 and lab-confirmed deaths totaled 530.
Sources
U.S. Department of Health and Human Services. "Vaccination." Flu.gov. Accessed 16 Oct. 2009.
Interview with Dr. Bruce Gellin, director, National Vaccine Program Office, U.S. Department of Health and Human Services. 13 Oct. 2009.
Centers for Disease Control and Prevention. "Key Facts About 2009 H1N1 Flu Vaccine." 7 Oct. 2009. Accessed 16 Oct. 2009.
U.S. Food and Drug Administration. "Influenza A (H1N1) 2009 Monovalent Vaccines Descriptions and Ingredients." 13 Oct. 2009. Accessed 16 Oct. 2009.
CSL Limited. "Package Insert – CSL Limited Influenza A (H1N1) 2009 Monovalent Vaccine." Accessed 16 Oct. 2009.
Novartis Vaccines and Diagnostics Limited. "Package Insert – Novartis Vaccines and Diagnostics Limited Influenza A (H1N1) 2009 Monovalent Vaccine." Accessed 16 Oct. 2009.
Sanofi-Pasteur, Inc. "Package Insert – Sanofi Pasteur, Inc Influenza A (H1N1) 2009 Monovalent Vaccine." Accessed 16 Oct. 2009.
MedImmune LLC. "Package Insert – MedImmune LLC Influenza A (H1N1) 2009 Monovalent Vaccine Live, Intranasal." Accessed 16 Oct. 2009.
U.S. Department of Health and Human Services. "Flu Myths and Realities." Flu.gov. Accessed 16 Oct. 2009.
World Health Organization. "Squalene-based adjuvants in vaccines." 21 Jul. 2006. Accessed 16 Oct. 2009.
National Institute of Allergy and Infectious Diseases. "Adjuvants and Other Vaccine Ingredients." Accessed 16 Oct. 2009.
National Network for Immunization Information. "Vaccine Components: Aluminum Adjuvants in Vaccines." 7 Nov. 2008. Accessed 16 Oct. 2009.
Joellenbeck, Lois M. et al. "The Anthrax Vaccine: Is It Safe? Does It Work?" National Academies Press, 2002.
Asa, Pamela B. et al. "Antibodies to Squalene in Gulf War Syndrome." Experimental and Molecular Pathology 68: 55-64 (2000).
Alving, Carl R. and Josh D. Grabenstein. "Letter to the Editor." Experimental and Molecular Pathology 68: 196-198 (2000).
Asa, Pamela B. et al. "Antibodies to Squalene in Recipients of Anthrax Vaccine." Experimental and Molecular Pathology 73: 19-27 (2002).
Matyas, Gary R. et al. "Detection of antibodies to squalene III. Naturally occurring antibodies to squalene in humans and mice." Journal of Immunological Methods 286: 47-67 (2004).
Centers for Disease Control and Prevention. "2009 H1N1 Influenza Vaccine and Pregnant Women: Information for Healthcare Providers." 2 Oct. 2009. Accessed 16 Oct. 2009.
Centers for Disease Control and Prevention. "General Questions and Answers on Thimerosal." 14 Sep. 2009. Accessed 16 Oct. 2009.
Centers for Disease Control and Prevention. "Thimerosal in Seasonal Influenza Vaccine." 8 Jul. 2009. Accessed 16 Oct. 2009.
U.S. Food and Drug Administration. "Thimerosal in Vaccines Questions and Answers." Accessed 16 Oct. 2009.
Stratton, Kathleen et al. "Immunization Safety Review: Thimerosal-Containing Vaccines and Neurodevelopmental Disorders." National Academies Press, 2001.
National Institute of Allergy and Infectious Diseases. "Vaccines." Accessed 16 Oct. 2009.
Immunization Safety Review Committee. "Immunization Safety Review: Vaccines and Autism." National Academies Press, 2004.
Heron, Jon et al. "Thimerosal Exposure in Infants and Developmental Disorders: A Prospective Cohort Study in the United Kingdom Does Not Support a Causal Association." Pediatrics 114: 577-583 (Sep. 2004).
Madsen, Kreesen M. et al. "Thimerosal and the Occurrence of Autism: Negative Ecological Evidence From Danish Population-Based Data." Pediatrics 113: 604-606 (Sep. 2003).
Centers for Disease Control and Prevention. "Recommendation of the Immunization Practices Advisory Committee (ACIP) Influenza Vaccines, 1983-1984." Morbidity and Mortality Weekly Report. 8 Jul. 1983.
Scutro, Andrew. "50 amphib sailors have flu symptoms." Navy Times. 6 May 2009.
Centers for Disease Control and Prevention. "2009 H1N1 Flu Shot: Vaccine Information Statement." 2 Oct. 2009.
Centers for Disease Control and Prevention. "2009 H1N1 Nasal Spray: Vaccine Information Statement." 2 Oct. 2009.
Centers for Disease Control and Prevention. "Questions & Answers: 2009 H1N1 Nasal Spray Vaccine." 7 Oct. 2009. Accessed 16 Oct. 2009.
CBC News. "Deadly defoliants." 14 Jun. 2005.
World Health Organization. "What is phase 6?" 11 Jun. 2009. Accessed 16 Oct. 2009.
Centers for Disease Control and Prevention. "Seasonal Influenza Weekly Report: 2009-2010 Influenza Season Week 40 ending October 10, 2009." 16 Oct. 2009. Accessed 19 Oct. 2009.
Centers for Disease Control and Prevention. "2009 H1N1 U.S. Situation Update, October 19, 2009." 16 Oct. 2009. Accessed 19 Oct. 2009.
Centers for Disease Control and Prevention. "2009 H1N1 U.S. Situation Update, September 4, 2009." 4 Sept. 2009. Accessed 19 Oct. 2009.
Centers for Disease Control and Prevention. "Seasonal Flu Vaccine: Questions and Answers." 8 Sep. 2008. Accessed 16 Oct. 2009.
Centers for Disease Control and Prevention. "2009 H1N1 Vaccination Recommendations." 15 Oct. 2009. Accessed 16 Oct. 2009.
McNeil, Donald G. and Karen Zraick. "New York Health Care Workers Resist Flu Vaccine Rule." New York Times. 20 Sep. 2009.
Srikanth RP. "RFID can help in containing Swine Flu." Network Computing. 29 Sep. 2009.
Massachusetts Senate. "An Act Relative to Pandemic and Disaster Preparation and Response in the Commonwealth." (as introduced 6 Apr. 2009.)
Massachusetts House of Representatives. "House document numbered 4271, as reported from the committee on Ways and Means, as a recommended new text for the Senate Bill relative to pandemic and disaster preparation and response (Senate, No. 2028, amended), as changed by the committee on Bills in the Third Reading, and as amended by the House." (as introduced 8 Oct. 2009.)
General Laws of Massachusetts. Chapter 111: Public Health. Accessed 16 Oct. 2009.
U.S. Department of Homeland Security. "Pandemic Influenza: Best Practices and Model Protocols." Apr. 2007.
National Governors Association, Office of Best Practices. "Preparing for a Pandemic Influenza: A Primer for Governors and Senior State Officials." Jun. 2006.