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Then there's the glare of the Internet -- where someone merely declaring on Facebook that he's sure the shot did harm could cause a wave of similar reports. Health authorities will have to tell quickly if there really do seem to be more cases of a particular health problem than usual.
So the CDC is racing to compile a list of what's normal: 25,000 heart attacks every week; 14,000 to 19,000 miscarriages every week; 300 severe allergic reactions called anaphylaxis every week.
Any spike would mean fast checking to see if the vaccine really seems to increase risk and by how much, so health officials could issue appropriate warnings.
Very rare side effects by definition could come to light only after large-scale inoculations begin -- making this the year scientists may finally learn if flu vaccine truly is linked to Guillain-Barre, an often reversible but sometimes fatal paralysis. It's believed to strike between 1 and 2 of every 100,000 people. It often occurs right after another infection, such as food poisoning or even influenza.
But the vaccine concern stems from 1976, when 500 cases were reported among the 45 million people vaccinated against that year's swine flu. Scientists never could prove if the vaccine really caused the extra risk. The CDC maintains that if the regular winter flu vaccine is related, the risk is no more than a single case per million vaccinated.
So the question becomes, Is the risk of disease greater than that?
Mayo's Poland cites a study in Chicago that found the rate of preschoolers being hospitalized for the new H1N1 flu last spring was 2 1/2 times higher than that possible Guillain-Barre risk.
However the flu season turns out, the extra vaccine tracking promises a lasting impact.
"Part of what we hope is that it will teach us something about how to monitor the safety of all medical products quickly," said Harvard's Platt.
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