In This Issue
H1N1 is Here -
What Do We Know and What Can We Do?
Dr. Newmark Hits
the Bookstands!
WCW New Mom Update
Thansgiving Hours
November 2009 Newsletter

H1N1 is Here – What Do We Know and What Can We Do?

The Influenza A H1N1 flu season is in full swing, and we have been seeing many children with H1N1 infection. By the end of 2009, predictions are that approximately 60% of the US population will have been infected with the H1N1 virus. It is estimated that less than half of those infected will have symptoms, and fortunately, from what we’ve been seeing and what has been confirmed by the CDC, most people will have a relatively mild illness. While there are certainly children who are getting very sick and even dying, the vast majority will not have an illness anywhere severe enough to even consider hospitalization.

Symptoms can range anywhere from mild cold-like symptoms, to high fevers, chills, sore throat, runny nose and cough, headache, body aches, and vomiting/diarrhea. The CDC notes that about 12% of those who have H1N1 do not have fever, and many have vomiting and/or diarrhea as the predominant symptoms. Patients who are more likely to be hospitalized are children and adults who have associated risks, especially asthma, chronic lung or heart disease, diabetes, pregnancy, and immunosuppression for whatever reason. The death rate appears to be the highest in people 50-64 years of age, with the death rate 0.4% compared to a rate of 0.1% for seasonal flu. The following populations are considered at highest risk for influenza complications:
  • Children younger than 5 years and especially those younger than 2 years;
  • Adults older than 65 years;
  • Pregnant women;
  • Persons younger than 19 years who are receiving long-term aspirin therapy;
  • Persons with chronic lung, cardiovascular, neurologic, renal, hepatic, or metabolic disease, including diabetes;
  • Those with immunosuppression.
At the moment, virtually all of the Influenza A we are seeing is the novel H1N1 strain. While many clinics and hospitals are not testing for H1N1 infection, one advantage to getting tested is that if you or your child test positive, you will know that you are subsequently protected against future H1N1 infections this season. The symptoms we are seeing in our pediatric patients have ranged from a mild cold to more severe flu-like symptoms complicated by pneumonia. None of our kids has been ill enough to be hospitalized (fortunately!). While this is purely anecdotal, the children who seem to be doing better with the illness are those that are already on good immune supports – see below for our suggested immune supports for the flu season.

What about the H1N1 vaccine?
We have received our first shipment of H1N1 vaccine. Unfortunately, the vaccine we received does contain thimerosal (a mercury-containing preservative). Each 0.5ml dose (for kids > 3 years and adults) contains approximately 25 mcg of mercury, with each 0.25ml dose (for kids < 3 years) containing approximately half that amount. We have ordered the thimerosal-free vaccine from the health department; however, we have no idea when or if we will receive that shipment, and if it will even arrive in time to be of any use before kids are already infected.

We have received only a limited supply of H1N1 vaccine, and unfortunately do have to prioritize who will receive it first – our priorities will be children with asthma or underlying chronic illness/immunosuppression; children under 3 years of age; and parents of infants younger than 6 months of age. As we receive more shipments, we will be opening up vaccination to all of our patients.

Should your child get the H1N1 vaccine? This is an incredibly tough question to answer, and a decision that only you as a parent can decide for your own child. We do recommend that children with lung/heart disease or other chronic illnesses receive the vaccination. Apart from that, we have enough concerns that we feel the best thing we can do is to lay out the facts as well as we can tell, and hopefully make the decision easier for you as parents.

We are concerned with lack of safety data on the H1N1 vaccine, especially in children and pregnant women. It reassures us to know that none of the previously mentioned adjuvants about which we had major concerns, such as squalene, are in any of the H1N1 vaccines. Likewise, the H1N1 vaccine is manufactured using the same process as the seasonal flu vaccine, with the flu strains replaced by the novel Influenza A H1N1 strain. Therefore, we would anticipate that the H1N1 vaccine wouldn’t be any more or less safe than the seasonal flu vaccine. Adverse reactions to the H1N1 vaccine are not well-characterized given the limited studies performed, but can include headache, malaise, muscle aches, nausea, chills/shivering, fever, and vomiting. All significant adverse events that occur after vaccination, even if you are not sure whether the vaccine caused the adverse event, should be reported to the national Vaccine Adverse Event Reporting System by the parent or healthcare provider. This may be done online at

The H1N1 vaccine is contraindicated for patients with severe egg allergy or life-threatening reactions after previous flu vaccines. Precautions should be taken for those who have experienced Guillain-Barre syndrome after previous influenza vaccination.

Given that we know which H1N1 flu strain is prevalent, and this strain is in the H1N1 vaccine, we anticipate that the H1N1 vaccine should be effective in preventing H1N1 infection. However, it will only be effective if those people receiving the vaccine mount an appropriate immune response. While 97% of adults ages 18-64 years given the vaccine may show protective levels of antibody titers at 21 days after vaccination, the same isn’t necessarily true for children. At 10 days, the antibody response to the H1N1 vaccine in kids was found to be much lower (see table below). These results are similar to the response rate with the seasonal flu vaccine. The low response in children under 9 years of age accounts for the recommendation that children 6mos – 9 years receive 2 doses of the flu vaccine (both H1N1 and seasonal) approximately 1 month apart. After 2 doses, the antibody response has been found to be approximately 77%.

Antigenic Response to 2009 H1N1 Vaccine (Sanofi) by Age (10 days after 1st dose)
Age Group Response
10-17 years 76%
3-9 years 36%
6-35 months 25%

We do have concerns with the thimerosal in the vaccines. While most kids should do fine with this small amount of thimerosal at one time, we would exercise caution for those with underlying neurologic disorders such as autism. Governor Schwarzenegger has signed an emergency exemption allowing children younger than 3 years and pregnant women to receive thimerosal-containing H1N1 vaccine for the period between October 12, 2009 – November 30, 2009 to ensure that those who are at high-risk for H1N1 flu complications can receive the H1N1 vaccine even if preservative-free formulations are not available (which is currently the case).

One last consideration is that for many, by the time the H1N1 vaccine is available, it may already be too late. According to a study published by Purdue University on October 15, the greatest number of people was predicted to be infected with H1N1 during the last weeks of October. It likely takes 10-21 days to develop any significant immunity from the vaccine. Given that the H1N1 vaccines have only recently become available and are in much shorter supply than anticipated, it is likely that the H1N1 vaccine has arrived too late to benefit many patients.

So should you give your kids the H1N1 vaccine? It really depends on what risks you as parents are willing to take. While H1N1 infection tends to produce mild illness in most, it certainly can cause more serious and even life-threatening complications, especially for those populations considered at risk. On the other hand, while the H1N1 vaccine shouldn’t cause any more adverse events than the seasonal flu vaccine and should help to prevent the swine flu, the one that we have available right now does contain thimerosal, and the safety and efficacy data are limited at best. It’s not an easy choice. But we do urge that if you decide you would like your child to receive the H1N1 influenza vaccine, please call our office ASAP so that we may put you on our vaccination list and have your child vaccinated as soon as the vaccine is available. Please note that given the limited supply of H1N1 vaccine we have received so far, we will first be prioritizing those children under 3 years of age and those who have chronic medical conditions (i.e., asthma, diabetes, autoimmune illness, etc.).

Many parents have asked what I have done, and I feel that I should share with you my decision and my thought process. I did get the H1N1 vaccine just last week. My decision to do so was based on many different factors. The first was that as a pediatrician, I have been and will be exposed to many kids with H1N1 infections – my priority is to be available for all of my patients and not miss any days due to illness, and also to not transmit H1N1 infection to my patients unintentionally. The second was that, as many of you know, I am pregnant and therefore in a high risk category, and the thought of anything happening to my baby due to an H1N1 complication was not a risk I was willing to take. The third factor was that I do not have a major family history of neurologic illness including autism, autoimmune illness, or other chronic illness. And the final factor is that I have been rigorous about eating a diet rich in antioxidants and taking supplements that support my detoxification processes and immune system.

Are There Other Places For Me to Bring My Child for the H1N1 Vaccine?
If we are unable to provide your child with the H1N1 vaccine as soon as you would like, please note that Santa Clara county is holding several public vaccination clinics for those who are considered at high risk (pregnant women; care providers and household contacts of infants less than 6 months; children and young adults between 6 months and 24 years; adults 25-64 years with high-risk medical conditions; and healthcare and emergency medical services workers. These clinics will be held between Saturday, November 7 through Saturday, November 21, as follows:
Day Time Location
Saturday, November 7 9:30 a.m. – 3:30 p.m. Santa Clara County Fairgrounds
334 Tully Road
San Jose, CA 95111
View Map
Sunday, November 15 9:00 a.m. – 3:30 p.m.
Saturday, November 21 9:00 a.m. – 3:30 p.m.
Saturday, November 7 9:30 a.m. – 3:30 p.m. Valley Health Center Gilroy
7475 Camino Arroyo
Gilroy, CA 95020
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Saturday, November 7 9:30 a.m. – 3:30 p.m. Valley Health Center Moorpark
2400 Moorpark Avenue
San Jose, CA 95128
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Saturday, November 7 9:30 a.m. – 3:30 p.m. Valley Health Center Sunnyvale
660 S. Fair Oaks Avenue
Sunnyvale, CA 94086
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Saturday, November 7 9:30 a.m. – 3:30 p.m. CompreCare Health Center
3030 Alum Rock Avenue
San Jose, CA 95127
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Saturday, November 7 9:30 a.m. – 3:30 p.m. Gilroy Health Center
7526 Monterey Street
Gilroy, CA 95020
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Saturday, November 7 9:30 a.m. – 3:30 p.m. St. James Health Center
55 E. Julian Street
San Jose, CA 95112
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Updated information can be found at We are not currently aware of any similar clinics in San Mateo County, but it does not appear that you need to be a Santa Clara county resident to participate in their vaccine clinics. Please go to or for updates. We will post additional flu clinics we become aware of on our website.

What Can I Do to Keep My Kids Healthy?
Whether or not you decide to vaccinate your child (and even if you do get the vaccine, the vaccine is not 100% effective), we believe it is of utmost importance to do as much as you can to keep you and your kids as healthy as possible. Many of my patients want to know what I do to stay healthy. And as I mentioned before, the kids who seem to be doing the best with H1N1 infection are those that are already taking good immune supports. There are commonsense measures, such as washing hands frequently and before eating or touching your face, avoiding close contact with people who are sick, staying well-hydrated, eating lots of colorful fruits and vegetables, avoiding refined sugar and processed/junk food, getting fresh air and daily exercise, getting adequate sleep, and minimizing stress.

Apart from these measures, I also take and recommend the following supplements. The dosages that I mention are only intended as general guides, and may vary according to each child’s unique needs. Please contact your pediatrician for specific dosage recommendations:
  • Fish oil.
  • Probiotics – I have been using Metagenics Ultra Flora Plus at a dosage of Ό tsp or 1 capsule 2x/day. A study found this particular probiotics blend to be effective in significantly reducing the rates of fever and upper respiratory symptoms when taken daily throughout the cold/flu season.
  • Vitamin C – I have been using Metagenics Ultra-Potent C because it has added ingredients such as lysine and glutathione which assist in fighting viruses. In general, I recommend Vitamin C 500mg 2x/day.
  • Vitamin D3 – there is speculation that the rates of illness increase over the winter because of the widespread deficiency of Vit D. In general, I recommend 1000IU daily for children, but some kids who are very deficient may require higher dosages.
  • Arabinogalactan – this is a natural sugar derived from the bark of the larch tree that enhances “natural killer cell” activity – these cells are part of our first line of defense against any invading organism. We carry the Vital Nutrients arabinogalactan powder, and generally recommend ½-1 tsp 2x/day.
  • Oscillococcinum and/or SyImmune – these are homeopathic medicines that may help to prevent influenza infection.
  • Xlear nasal spray – I am religious about irrigating my nasal passages with Xlear nasal spray at the end of every day, and after any potential exposure (work, school, playgroups, plane travel, etc.). This is a saline nasal spray with xylitol and grapefruit seed extract, both of which have antimicrobial properties. You cannot overdo it, and will not get “addicted” to it. Other options for nasal irrigation are a regular saline spray or neti pot. Apart from regular hand washing, I believe that daily and frequent nasal irrigation is one of the MOST important things that we can do to prevent influenza and other viral infections. This is because after exposure to a virus, the virus tries to invade and multiply in your nasal passages for at least 1-2 days before you develop any symptoms. Nasal irrigation can wash away viral particles before they have the opportunity to take hold, and thereby prevent many infections from happening in the first place!
What If My Child Gets the Swine Flu?
I have found that starting various homeopathic and herbal medicines at the very beginning of my cold/flu symptoms can often shorten the duration and severity of illness and knock it out of my system within a day or two. This is what I take and recommend for my whole family at the start of a cold/flu:
  • Windbreaker – this is a Chinese herbal formula by Kan Herbs. It works GREAT! I will add Chest Relief if there is a cough or other formulas depending on the specific symptoms.
  • Oscillococcinum – this is a homeopathic flu remedy, general dosage is 1 vial 3x/day.
  • SyImmune or SyInfect – these are also homeopathic flu remedies, general dosage is 1 tablet every 2-3 hours during the first 1-2 days of illness.
  • Elderberry syrup – a recent study found that elderberry has the ability to inhibit H1N1 infection in vitro. The authors of the study note that “the H1N1 inhibition activities of the elderberry flavonoids compare favorably to the known anti-influenza activities of Oseltamivir (Tamiflu).”
  • Increased Vitamin C.
  • Increased nasal irrigation with Xlear nasal spray.

Specific homeopathic medicines, such as homeopathic Belladonna, Gelsemium, Bryonia, and Nux vomica have also been useful, depending on the specific symptoms that are being experienced. Please call your pediatrician for more specific advice to help your child with his/her specific flu symptoms.

As noted in our previous newsletter, Tamiflu is a prescription antiviral medication that may be effective in preventing influenza-related complications when started within the first 1-2 days of illness, and may also be effective when used to prevent illness in high-risk populations. Virtually all of the current H1N1 infections have been found to be susceptible to Tamiflu. Tamiflu has been associated with significant adverse side effects, but may be of considerable benefit for children older than 1 year of age and adults who are considered at higher risk for influenza-related complications.

When Should My Child See the Doctor?
In general, if you or your child has come down with the swine flu, it is best to stay at home and rest, and avoid contact with others. You should, however, seek medical attention for your child if he/she has:
  • Fever for more than 3-4 days;
  • Confusion, excessive drowsiness;
  • Inconsolability, excessive irritability;
  • Difficulty breathing;
  • Severe or persistent vomiting;
  • Dehydration (no urine for more than 6-8 hours);
  • Or if your child falls in a high-risk category and he/she may benefit from Tamiflu administration.
We wish everyone a healthy winter season. Eat your fruits and veggies, get plenty of rest and exercise, and most of all – stay well!

Dr. Song and all of us at Whole Child Wellness

Dr. Newmark Hits the Bookstands!

Dr. Newmark has published a chapter in a new textbook called Integrative Pediatrics, part of the Weil Integrative Medicine Library series. He wrote the chapter on Developmental behavior Pediatrics, which includes autism, ADHD, and sleep disorders. It is mainly aimed at physicians and other health professionals and is available on here.

Dr. Newmark was also one of a group of authors who published 2 articles in a journal called BMC Clinical Pharmacology. These both stemmed from a research study he helped perform in Arizona concerning the safety and effectiveness of DMSA chelation therapy for autism. 65 children were given 1 dose of DMSA, and toxic metal (mercury and others) excretion was measured. Those children who had high toxic metals went on to a “placebo-controlled trial” in which half were given DMSA chelation for 3 months and half were given a placebo or “fake” medicine. They hoped to show that the ones given the real thing showed more improvement than the ones given the placebo.

What they found was very interesting. Both groups improved, but there wasn’t much difference between the groups. However, the initial round of DMSA appeared to normalize glutathione levels and help significantly with heavy metal excretion. This may have accounted for the improvement in both groups. They also monitored carefully for lab abnormalities and side-effects and both were quite minimal. Clearly, this is an area that needs a lot more research.

Here are links to the full articles and references for those who are interested:

Safety and Efficacy of Oral DMSA Therapy for Children with Autism Spectrum Disorders: Part A - Medical Results
J. B. Adams, M. Baral, E. Geis, J. Mitchell, J. Ingram, A. Hensley, I. Zappia, S. Newmark, E. Gehn, R.A. Rubin, K. Mitchell, J. Bradstreet, J.M. El-Dahr Safety and Efficacy of Oral DMSA Therapy for Children with Autism Spectrum Disorders: Part A - Medical Results BMC Clinical Pharmacology 2009, 9:16

Safety and efficacy of oral DMSA therapy for children with autism spectrum disorders: Part B - Behavioral results
J. B. Adams, M. Baral, E. Geis, J. Mitchell, J. Ingram, A. Hensley, I. Zappia, S. Newmark, E. Gehn, R.A. Rubin, K. Mitchell, J. Bradstreet, J.M. El-Dahr Safety and Efficacy of Oral DMSA Therapy for Children with Autism Spectrum Disorders: Part B - Behavioral Results BMC Clinical Pharmacology 2009, 9:17

WCW New Mom Update

Kandice Stellmon is back November 2!
Kandice's maternity leave is over and Kandice is taking appoinments starting November 2. For now, she will be available on Tuesdays and possibly by request on other days.

Dr. Song on maternity leave from December 7 to March 1, 2010.
Dr. Song and Peter Johnson will soon celebrate the arrival of their first child! Their daughter is expected to arrive on January 1st. Of course, not knowing exactly when she might decide to come, Dr. Song will only see sick visits starting December 7, 2009. She will return from maternity leave on March 1, 2010. In the meantime, Dr. Sandy Newmark and Dr. Ann Wolf will be available for any well and sick visits that are needed. Dr. Song will look forward to seeing everyone in the New Year!

Thanksgiving Hours

Our office will be closed on Thursday and Friday, November 26 & 27 for Thanksgiving. We wish all our families a happy holiday!


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