Confusion may hurt flu vaccine rollout, health officials fear

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Noor Javed

FACTS ABOUT H1N1 AND IMMUNIZATION

Q: What is H1N1 flu virus?

A: H1N1 flu virus is a respiratory illness that causes fever, chills, cough, sore throat, headache, muscle aches, fatigue, and possibly nausea, vomiting or diarrhea.

Q: Who is most at risk from H1N1 flu virus?

A: Younger children, pregnant women, individuals with pre-existing chronic disease.

Q: When do vaccination clinics begin in Toronto?

A: Clinics for seasonal flu shots for people 65 and older will begin Oct. 22 at civic centres and long term care facilities and at homeless shelters. When the H1N1 vaccine becomes available in mid-November, shots will be available at hospitals and public clinics at 10 TTC-accessible sites across the city.

The non-adjuvanted H1N1 vaccine is being recommended for pregnant women, and young children.

The adjuvanted vaccine will be available to everyone, and will start with those who will benefit the most from the vaccine, including health care workers and those with underlying chronic illnesses.

Q: Will there be a flu vaccine clinic at my work place?

A: Likely not this year. The province has a new information tracking system to be set up in all public health units to record information on numbers immunized and any adverse reactions.

Q: What is the province's immunization plan?

A: Although there are a variety of approaches being taken, the most common plan is to offer seasonal shots in October only to people 65 and older who are at low risk of catching swine flu, and residents of long-term care facilities. Pandemic vaccine will be offered when it becomes available in November and then seasonal flu vaccine will be offered to people under age 65 when the pandemic vaccine program is completed.

Q: How does the virus spread?

A: Coughs and sneezes release the flu virus into the air. The virus can be picked up from counters and door knobs and transmitted when a person touches their mouth or nose.

Compiled by: Noor Javed

Source: Toronto Department of Public Health; Public Health Agency of Canada

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There is much ado about the flu. Or to be more exact, about how not to get the flu.

The good news is that the province has a three-pronged immunization plan ready to roll out during the fall flu season for both the H1N1 and the seasonal flu virus.

But the plan – seasonal shots to seniors, then rolling out swine flu vaccine for everyone in mid-November and then resuming seasonal flu shots in December or January – is already marred by doubt and uncertainty.

"I think there is a lot of confusion," said Dr. Allison McGeer, an infection disease expert with Mount Sinai Hospital in Toronto.

And that has many experts concerned that people are fearing the vaccines more than the actual flu.

"This is a major concern. Any time there is confusion about what you ought to do, it has a tendency to make people less likely to get vaccinated," she said.

The uncertainty, McGeer says, is due the complex nature of influenza, and little knowledge of what the rest of this influenza and pandemic season is going to look like. But it also has much to do with conflicting scientific data released last week that suggests those who received the flu shot last year have double the risk of catching swine flu compared to unvaccinated people. Ontario appeared to be influenced by the controversial Canadian study, scaling back its vaccination rollout plans.

The Public Health Agency of Canada said a preliminary analysis of that study shows no link between having the flu shot and developing a severe case of swine flu. And that similar results have not been seen anywhere else in the world.

"Public health wants to be cautious, but I think the message was just not clear," said Andrew Simor, head of microbiology at Sunnybrook Hospital. "With a little bit of foresight we could have been able to come out with much clearer advice for the public who are now completely unsure of what to do," he said.

"I have talked to a lot of people who say, maybe I shouldn't get seasonal influenza vaccine ever again," said Simor. "But that does not make sense. The vaccine has proven its benefits."

Experts say the public's confusion is understandable. They too are finding it challenging to keep up to date with daily new information about the H1N1 virus.

"We are learning something new about H1N1 every day," said David Jensen, a spokesman with the ministry of health.

This is what experts know for sure: This year's flu season will be primarily made up of the H1N1 virus. The so-called pandemic that will hit the province will be a mild one. And according to the science out there, the benefits of getting the flu vaccine far outweigh the harm.

Experts almost unanimously suggest those older than 65 get the seasonal flu shot, even though the seasonal flu strain will likely not be seen during the season. And they suggest otherwise healthy people get the H1N1 vaccine when it is released in November. Despite the province's advice on also getting the second seasonal flu shot when it is available in December/January, many physicians say there is "no rush" to get it.

Says Dr. Barbara Yaffe, director of communicable disease control for Toronto Public Health:

"People have to think: Where am I? Am I pregnant? Do I have young children? Do I have underlying conditions? Where do I fit in this whole thing? What are the risks and benefits to me?" said Yaffe. "People have to get their own information and make their own decision," she said.

In the meantime, many experts are trying to determine how the situation became so confusing in the first place.

"The problem is between facts and expectations," said Dr. Richard Schabas, Ontario's former chief medical officer of health.

"H1N1 wasn't what most public health officials were expecting; it wasn't what they planned for and I think they have had trouble adjusting to it. And now they don't know where they really stand. I think that is the root of the confusion."

"It's a big step down to move from calling the pandemic flu a threat to humanity to now saying it isn't any worse than a regular flu year," he said.

Toronto Star

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