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Patients' groups have expressed anger over this year's seasonal flu jab programme because people are unable to opt out of having the swine flu vaccine.Lump it or like it.
The H1N1 vaccine will be the dominant of three flu strains included in the shot, meaning millions of elderly and vulnerable patients will get it automatically.
Yet many people refused to have the swine flu vaccine when it was offered last year because of fears it may cause serious side effects.
The H1N1 'swine flu' vaccine will be included in this years seasonal flu jab meaning millions of elderly and vulnerable patients will get it automatically
The Mail on Sunday revealed last week that Government experts are examining a possible association between the H1N1 swine flu jab and the paralysing nerve disease Guillain-Barre Syndrome.
The vaccine has also been linked to fevers in young children, temporary paralysis and narcolepsy.
Katherine Murphy, chief executive of the Patients Association, said: 'We are very disappointed that patients are not being given the opportunity to choose for themselves whether they wish to take the swine flu vaccine as part of their winter flu vaccine.
'Some may not want the swine flu vaccine and this may mean they would also miss out on their winter flu jab. This seems to go completely against the new initiative from the Government which states that in the NHS there will be "No decision about me without me" for patients and that there will be a large emphasis on patient choice.
There does not seem to be any patient choice involved here – either patients have both vaccines or no vaccine.' Each year the World Health Organisation considers which strains of flu will be dominant in winter.
Katherine Murphy, chief executive of the Patients Association is disappointed that patients are not being given the opportunity to choose for themselves
This year they ruled H1N1 would be a dominant strain. The annual seasonal flu jab is being offered to about 12 million people. For the first time, pregnant women are included because of the dangers posed by the swine flu virus. However, some patients are fearful of having this year's jab.
Mary Harris, 64, from Plymouth, developed breathing problems and spent three days in hospital after having the swine flu vaccine last year. She said: 'I don't know whether to have the seasonal flu jab, even though I know I should. But I don't want a repeat of last year.
There really should be a choice.' The Medicines and Healthcare products Regulatory Agency received nearly 8,600 suspected adverse reactions to the swine flu jab during the pandemic last winter. Most involved pain or swelling at the site of the jab, vomiting and headaches.
The MHRA also received 15 reports of patients developing Guillain-Barre Syndrome. It is not known if the cases are linked to the vaccine, although a swine flu jab in the US in 1976 led to 25 deaths from the condition.
The British Medical Association agreed last month that patients should be told the seasonal jab contains the swine flu strain. Dr Peter Holden of the BMA said: 'This is not a Machiavellian plot to vaccinate everyone against swine flu.
There isn't enough capacity to produce an alternative vaccine for those worried about swine flu. 'The consequences of flu are a greater risk than any risk posed by the vaccine itself.'
Professor David Salisbury of the Department of Health said: 'Given that we expect the H1N1 virus to be the most common type this year, it would be negligent if we didn't protect people against it.
Every year people die in this country from complications caused by getting flu; these are deaths that could be prevented. 'I would encourage anyone who is offered the seasonal flu vaccine to accept it.'