H1N1 (Swine Flu) spreads worldwide= Is declared a Pandemic

[Dionne]

I get the Fluview report from the CDC via e-mail. This weeks report will make you sit up and take notice. CDC is now advising we are at the "epidemic threshold". Suggest your Google CDC and read the entire report. The pediatric portion of the report is frightening.

[breeze]

Some good questions and answers about H1N1 from the New York Times "Health" section:

http://www.nytimes.com/2009/10/10/health/10primer.html?_r=1

[Stephanie]

I get the Fluview report from the CDC via e-mail. This weeks report will make you sit up and take notice. CDC is now advising we are at the "epidemic threshold". Suggest your Google CDC and read the entire report. The pediatric portion of the report is frightening.

Just the map alone is frightening enough. Not one state is reporting "no activity" and the majority is showing "widespread":

http://www.cdc.gov/h1n1flu/updates/us/

[RL3AO]

Almost at the same level now as the peak of the 2007/08 flu season.

[lurkey]

Study: Swine flu deadliest to young, healthy people


Eighteen-year-old Hayden Henshaw of Cibolo, Texas, recovers from swine flu last April. 'Our data suggest that severe disease and mortality in the current outbreak is concentrated in relatively healthy adolescents and adults between the ages of 10 and 60 years,' a new Canadian study finds. AP FILE

ftasker@MiamiHerald.com

Patients with the H1N1 swine flu virus who become severely ill and those who die tend to be relatively young adults without underlying medical conditions, according to a new Canadian study published in the Journal of the American Medical Association.

The average age of 168 patients studied in 38 Canadian adult and pediatric intensive care units was 32.3 years. Thirty-three of the patients died within 90 days of being admitted to the hospital.

The study, released Monday, suggests that H1N1 flu might be more complex than experts had believed. Many had said the virus was most dangerous to people with underlying medical conditions such as asthma, diabetes, chronic obstructive pulmonary disease (COPD) and immune system diseases. And experts say regular seasonal flu is most dangerous to the elderly.

``Our data suggest that severe disease and mortality in the current outbreak is concentrated in relatively healthy adolescents and adults between the ages of 10 and 60 years,'' the authors write.

But they go on to say that modern therapies, including breathing assistance from ventilators and antiviral medicines, can prevent most swine flu deaths.

``With such therapy, we found that most patients can be supported through their critical illness,'' the study says.

South Florida doctors agreed that the Canadian study suggests that H1N1 flu is not entirely understood.

``Most of the patients we've seen had underlying conditions or pregnancy,'' said Dr. Steven Katz, director of emergency services at Memorial Hospital West in Pembroke Pines.``But this is a new strain of flu. It's still early. Sometimes the facts change as diseases unfold.

``People die from the flu each year,'' he added. ``This one is no worse than other flus, at least so far.''

Most people with flu-like symptoms don't need to go to emergency rooms or even take antivirals such as Tamiflu, Katz said. Only people with severe shortness of breath or very rapid heartbeat should go to hospitals, he said.

The Canadian study, conducted between April and August, was authored by Dr. Anand Kumar of the Health Sciences Centre and St. Boniface Hospital in Winnipeg.

The fact that few of the severely ill patients in the Canadian study had underlying health conditions may be because the H1N1 virus primarily infects younger people, who tend to be healthier, the authors said. Older people -- especially those over 65, who are more likely to have underlying conditions -- appear to have some immunity because of long-previous exposure to similar viruses or to inoculations.

The study supported a statement Friday by the U.S. Centers for Disease Control and Prevention that swine flu is dangerous to children. The CDC said 76 children younger than 18 have died of swine flu so far this year, while regular seasonal flu typically kills between 46 and 88 children a year. In the Canadian study, 50 of the 168 seriously ill patients were under 18.

Patients who became critically ill suffered severely low levels of oxygen in the blood, fluid in the lungs and, in the most serious, multisystem organ failure, the study said.

In Florida, 808 patients have been hospitalized with swine flu since April and 110 have died. Of those deaths, 40 percent were patients 25 to 49 years of age -- although 65 percent of those who died had underlying health conditions.

These are the ages of Florida swine flu patients who have died:

• 4 percent were from birth to 4 years of age. • 15 percent were ages 5 to 24.

• 40 percent were ages 25-49.

• 35 percent were ages 50 to 64.

• 6 percent were 65 or older.

Also in Florida, 84 pregnant women have been hospitalized for H1N1 flu; 26 of them have needed treatment in intensive care units and five have died, according to the state Department of Health. CDC officials have said they believe pregnant women are more susceptible to swine flu because their bodies naturally suppress their immune systems to avoid rejecting the baby they are carrying.

In Miami-Dade, 323 people have been hospitalized with swine flu and 24 have died. In Broward, 70 have been hospitalized and nine have died.

[cycloneye]

11 more children die in U.S.,vaccine delayed

More sad news about this flu.

WASHINGTON - Even as swine flu infections are causing an unprecedented amount of illness for this time of year — and a growing number of deaths, particulary among children — supplies of vaccine to protect against it will be delayed, government health officials said Friday.

In the past week, 11 more children have died from H1N1 influenza infections, an official from the Centers for Disease Control and Prevention said, bringing the total to 86 children since April.

http://www.msnbc.msn.com/id/33345714/ns ... swine_flu/

[lurkey]

Found out today that a co-worker's son has been diagnosed with H1N1. . . and is that the co-worker is pregnant . .. so far she isn't sick. . .

[Stephanie]

Found out today that a co-worker's son has been diagnosed with H1N1. . . and is that the co-worker is pregnant . .. so far she isn't sick. . .

WOW! I hope that they both will be alright. Two of the most vulnerable types of individuals.

[lurkey]

Another co-worker's child sick . . both of his kids (one is better, the other one is now sick) and his wife (and she has asthma) are sick with H1N1.

The pregnant co-worker's son is better and she was back at work, so I guess she never got sick.

[lurkey]

H1N1 vaccine trials to start for people with asthma

by Vicky Eckenrode

People with asthma, who have been at higher risk to get seriously sick from the swine flu, are the focus of a new clinical trial to find out what the best vaccine dosage is to protect them from the H1N1 vaccine.

Wake Forest University is one of seven sites nationwide for the trial being launched by the National Institutes of Health.

Researchers are trying to figure out the best dose of H1N1 vaccine for asthma sufferers, who often take steroid hormones that can suppress their immune system and make them more susceptible to a serious infection if they get the H1N1 virus.

A federal Centers for Disease Control and Prevention review of hospital records earlier this year showed people with asthma were four times as likely to be hospitalized with the virus than others.

Health officials have targeted people with underlying health conditions like asthma to receive the already approved H1N1 vaccine when it starts being distributed in shot form. The nasal vaccine now available is not recommended for people with chronic conditions.

The NIH-sponsored study will cover 350 people with asthma ranging from mild to severe, to see which dose level produces an immune response to the virus.

[cycloneye]

Obama declares national emergency in U.S.

http://www.msnbc.msn.com/id/33459423/ns ... d_and_flu/

WASHINGTON - President Barack Obama has signed a proclamation declaring swine flu a national emergency, the White House said Saturday.

"In keeping with the administration's proactive approach to H1N1 Flu, President Obama last night signed a proclamation declaring 2009-H1N1 Influenza a national emergency," it said in a statement. "The proclamation enhances the ability of our nation's medical treatment facilities to handle a surge in H1N1 patients by allowing, as needed, the waiver of certain standard federal requirements on a case-by-case basis."

Officials described the move as similar to a declaration ahead of a hurricane making landfall.

[Stephanie]

Another co-worker's child sick . . both of his kids (one is better, the other one is now sick) and his wife (and she has asthma) are sick with H1N1.

The pregnant co-worker's son is better and she was back at work, so I guess she never got sick.

While I'm glad that your pregnant co-worker never got sick, I'm sorry to hear that others are sick with this as well.

[lurkey]

Another co-worker's child sick . . both of his kids (one is better, the other one is now sick) and his wife (and she has asthma) are sick with H1N1.

The pregnant co-worker's son is better and she was back at work, so I guess she never got sick.

While I'm glad that your pregnant co-worker never got sick, I'm sorry to hear that others are sick with this as well.

He is back at work as of Wednesday. Both kids are doing well and I think back at school. His wife is doing better, but recovering more slowing.

Another co-worker is sick (been out a week) and I think I heard that both she and her daughter have the flu.

So it is slowing making its way through the office. . . :/

[Stephanie]

I hope that you don't catch it.

[southerngale]

A 5 year old little boy in the Beaumont area has died of complications from the H1N1 virus.
This is the first death in Jefferson County. My prayers go out to his family during this very difficult time. So young, so tragic. It breaks my heart.

Health Department says 5-year-old is county's first H1N1 death

October 27, 2009 5:19 PM
Scott Lawrence

BEAUMONT - From Beaumont Health Department - The Beaumont Health Department confirmed today that a 5-year-old Jefferson County child has died of complications from the H1N1 virus. The child died in a Houston hospital after being ill for about a month. This is the first reported death of a county resident from H1N1.

“We are saddened to learn about the death of this young child,” said Ingrid Holmes, Public Health Director for the City of Beaumont. “Most people who have gotten this strain of flu have had only mild symptoms, but it is our sincere hope that every family is taking precautions against both seasonal and H1N1 flu, so that we can keep infections to a bare minimum this season.”

The manufacturer of the H1N1 vaccine, in cooperation with the state of Texas, determines the timing and number of vaccines released to each city’s health department, based on the production speed of the drug and the population of the respective cities, Holmes said. The city’s health department has received a negligible number of H1N1 vaccines to-date, and has a plan in place to administer doses according to patient risk levels once the vaccine arrives in sufficient amounts.

“Once we receive enough vaccines, the city is ready to distribute them,” said Holmes. “In the meantime, if you or your child show symptoms of H1N1, such as fever, cough, sore throat, aches or other symptoms, it is important that you seek medical attention as soon as possible.”

For more information on seasonal and H1N1 flu, visit the Texas Department of State Health Services at http://www.dshs.state.tx.us/txflu/default.shtm.

[southerngale]

More on the little boy mentioned above...



snippets from the story:

Colten "Cole" Paul Davis died Monday at Texas Children's Hospital in Houston. He was a kindergarten student at Langham Elementary in Nederland.

The relative told us Cole had no pre-existing health problems.

"It started as an ear infection, then bronchitis and fever."



Beyond heartbreaking.

[vbhoutex]

The way some of these cases are happening is scary. I just had an overnight stay in a hospital and I asked a nurse if they were getting the H1N1 shots. She said "I ain't gettn' that!!! No way!". This is a supposedly educated person who didn't even tell me the right way to do something I had to do for a couple of days. Back on topic though. This is sounding like a very virile and changing virus. Don't know enough to say much, since I am not a medical doctor. I do realize that in most cases it is a mild illness, but try telling that to those that have lost or almost lost loved ones to it. I hope they get a better handle on the "weirdness(my word)" we are seeing with this soon.

[RL3AO]

Its amazing how this "fear" for the lack of a better word has happened over the vaccine. The only reason there is a separate vaccine is because they couldn't create it fast enough to be added to the seasonal flu vaccine.

[SaskatchewanScreamer]

96 have died so far in Canada
Carmen Chai, Julianna Cummins and Erin DeCost, National Post Wednesday, October 28, 2009

While the H1N1 virus has claimed as many as 96 victims across Canada, nearly 90% had pre-existing health conditions. Here are some of the victims:


Nova Scotia (one flu-related death reported):

- 51-year-old nursing home worker, Annette Sampson, with underlying health problems, Halifax, July.


Quebec (27 flu-related deaths reported):

- Elderly woman, Quebec City, June.

- 23-year-old Montreal woman, Fatihal Idrissa Kaitouni, died weeks after giving birth. She never regained consciousness after a C-section; her son was born healthy.

- 27-year-old pregnant woman, Montreal area.

- Woman, 50s, with underlying health conditions, Montreal, June.

- Man, 40s, with underlying health conditions. Montreal, June.

- Woman, 50s, with underlying health conditions, Montreal, June.

- Woman, 60s, Quebec City, June.

- Elderly woman, Monteregie area, with underlying health conditions, June.

- Teenager, with chronic health problems, Laurentian area.

- 87-year-old woman, Chaudiere-Appalaches region, October.


Ontario (28 deaths reported):

- Ravinjan Paramsothy, 44, Scarborough, late May.

- Unidentified person with underlying medical conditions, May 31.

- Rubjit Thindal, Brampton, 6, mid-June. .

- Male, 78, visiting from U.S., Orangeville, June 17.

- 17-year-old man, Ottawa region, with underlying health condition, June.

- 52-year-old woman, eastern Ontario, with underlying health condition, June.

- 68-year-old man, Durham Region, with underlying health condition, June.

- Woman, 81, June.

- Unspecified gender, late 50s, Niagara Region, early July.

- Man, 37, Toronto, July.

- Ottawa-area patient, underlying health conditions, August.

- 65-year-old man, Ottawa, Sept 17.

- 15-year-old boy, Timmins, with significant underlying medical conditions, Oct. 14.

- 10-year-old girl, Vanetia Warner, Cornwall, no health conditions, October.

- 13-year-old Evan Frustaglio, previously healthy, Oct. 26


Manitoba (seven deaths reported):

- Perry Chernesky, 42, no health conditions, June.

- 45-year-old Lorraine Wilson, underlying health conditions, June.

- Child, underlying medical conditions, June.


Saskatchewan (eight deaths reported):

- Woman, 40s, underlying health conditions, June.

- Man, 70s, underlying health conditions, June.

- Child less than 10-years-old, underlying health conditions, July.

- Woman, 50s, underlying health conditions, July.

- 16-year-old male, underlying health conditions, October.


Alberta (nine deaths reported):

- Tina L'Hirondelle, 39-year-old woman, Gift Lake Metis Settlement, underlying health conditions, April 28.

Compiled by Carmen Chai, Julianna Cummins and Erin DeCost, National Post
http://www.nationalpost.com/story-print ... id=2152939

[SaskatchewanScreamer]

http://www.theglobeandmail.com/life/hea ... le1340101/

Discussion
H1N1 myth busters

Dr. Michael Gardam of the Ontario Agency of Health Protection and Promotion answers your questions and debunks common misconceptions on the swine flu vaccine
Globe and Mail Update Published on Tuesday, Oct. 27, 2009 11:40AM EDT Last updated on Tuesday, Oct. 27, 2009 12:42PM EDT

The following discussion was originally published on Oct. 23, 2009 and was conducted live from 1-2 p.m. ET. It has been edited for clarity and to better help answer your questions on swine flu/H1N1. Read the transcript from the original discussion here.

Caroline Alphonso: Welcome everyone to our H1N1 discussion with Dr. Michael Gardam of the Ontario Agency of Health Protection and Promotion. Health Canada approved the vaccine on Wednesday, and local public health authorities are embarking on mass vaccination clinics starting the week of Oct. 25 across the country. This is the country's largest immunization campaign.

The following questions were posed to Dr. Gardam from readers.

Q: Do you as a doctor feel safe taking the H1N1 flu shot? I mean the Canadian studies aren't even done yet! I for one won't be taking the shot!

A: I actually had planned to get my shot this morning but our hospital hasn't received it yet--hopefully I can get it Monday. This vaccine is like any other vaccine or drug -- we don't need Canadian studies to say that they are safe and effective. The data for this vaccine come from Europe. The Canadian studies are more about fine tuning the vaccination process...

Q: My son is 3 1/2, recently had an asthma attack for first time, should he get the vaccine with or without the adjuvant?

A: I think your son should get the adjuvanted vaccine. Here is why: He is in the age group that is likely to get infected; he has asthma which is a risk factor for more severe flu; the adjuvanted vaccine gives a better immune response than the unadjuvanted vaccine (it works better); and it is available now, whereas the unadjuvanted vaccine won't be available for awhile.

Q: My son has epilepsy and everything that I read leads me to agree that he needs the vaccine. I am nervous, however, as you hear so many conflicting reports regarding the safety of the vaccine. I have always believed in vaccination, but this time I am very worried. What are your take on the safety of this vaccine?

A: The reality is that there really are not any credible reports about any safety issues with the vaccine. we have been giving flu shots for decades ... this is just another flu shot. The only difference is the adjuvant, which has been used in millions of people around the world. The adjuvant is made up of two natural fats: vitamin E and squalene which is a molecule your body makes (the squalene in the vaccine comes from fish oil). I'm giving it to my kids without any worries.

Q: I have just received innoculation for the seasonal flu. ... when should I receive the HiNI flu shot ? I am over 65 years of age?

A: There is no reason why you can't get the H1N1 vaccine as well. The good news is you are more likely than someone under-65 to already have protective immunity to H1N1 (so you are less likely to get infected), but if you do get infected, you have a higher risk than someone younger of ending up really sick. So bottom line, I would get it.

Q: I am over 65 and am a doctor. Should I get the H1N1 shot first, wait for a while and then get the regular flu shot? Or the other way round? or both together? Is it necessary to wait a specified period of time between the two flu shots?

A: You can get both shots at the same time, one in each arm.

Q: Myself and two of my children have already had the flu this season (we're in Vancouver and our school has been hit hard). We don't know for sure if it was H1N1, but it likely was. Do we still need to be vacinated?

A: Eventhough we had a peak of flu last spring going into the summer, the reality is that the majority of people who had symptoms during that time did not have H1N1 - there were other viruses circulating in the community at that time. Certainly if you had a positive test for H1N1 I don't think you need to run out and get vaccinated, but otherwise, the odds are you didn't have H1N1.

Q: There is so much controversy about the vaccine - in fact, several friends' doctors advised them not to get the vaccine for themselves or their young children. I am surprised at this but don't know why their doctors are advising that. It makes me even more nervous to hear that and even though my own doctor advised me to get the vaccine, I am confused. What are people afraid of?

A: As sad as it is for me to type this, not all doctors know what they are talking about. Much of our education has actually been aimed at doctors to make sure that they have the facts straight. There is almost no reason why somebody shouldn't get vaccinated ... it all comes down to whether you want to prevent yourself from getting the flu.

Q: I'm running the New York marathon on Nov. 1st. What, if any, are the possible down sides of getting the vaccine so close to race day? Should I just wait until I return to get my vaccination?

A: I love the marathon question, being crazy enough to do that kind of running myself. I definitely would get the vaccine. You don't want to be coughing up a lung on race day. You are going to be miserable enough as it is. Hope you get a PR.

Q: Have clinical studies showed any negative effects to getting the H1N1 vaccine?

A: There are studies and lots and lots of experience with components of this vaccine in millions of people that all say this vaccine is safe. There are no data saying it isn't safe.

Q: I'm concerned about the adjuvant squaline that is being added to the vaccine. This is the same substance that was added to the anthrax vaccine and was implicated in causing Gulf War Syndrome in American soldiers. I've heard people say this theory has been debunked, but I continue to hear evidence to the contrary.

A: I am glad you brought this up. If squalene is a problem, then we are all in trouble as we are all making it in our livers right now. It is a natural compound produced by your body. And the anthrax vaccine story is wrong. There was no squalene in that vaccine and it has never been scientifically linked to Gulf War syndrome. When people get sick they look for something to blame and vaccines seem to make a nice, easy target.

Q: Could you please talk about pregnant women? I understand the numbers in terms of risk of contracting the illness, but not in terms of getting seriously ill. Scary news stories have covered women dying/losing their babies who have underlying conditions/are smokers, etc. (mostly glossing over those facts), but what are the risks of getting really sick as a regular, healthy pregnant woman? And what are those risks vs the risks of getting the vaccine?

A: The risk of a pregnant woman contracting flu is the same as a non-pregnant woman. The risk of a pregnant woman getting really sick and potentially dying from flu is about 4-5 fold higher though. This has been shown consistently throughout this pandemic in multiple countries. The absolute risk of getting really sick though is still very small even if you are pregnant. I can't give you an exact numbers because that kind of data is not yet available.

Think of it this way: There is a small but documented risk of serious disease if you are pregnant, and serious disease is definitely a risk to your fetus. On the other hand, there is no evidence that any component of this vaccine is harmful to your fetus.

Q: My family has been sick but we were not tested. I realize testing everyone is time consuming and expensive but if I knew that I have already had, and survived, the swine flu I could then stop worrying for the rest of the winter (I worry about my kids as one has asthma and I have emphsyma) and my vaccine could go to some other person or country that may be short vaccines so in that sense why is testing not done on all people that show all the signs?

A: Lots of people want to know if they have had this already. The problem is there is no good routine lab test to figure that out. We can look for antibodies but this is only done in a small number of research labs and the test is not that good...and this is not unique to Canada; all labs are having the same issue.

Q: Dr. Gardam, I have a question that isn't related to vaccinations. I understand that complications from H1N1 is highest in certain vulnerable groups (e.g. immunocompromised) but there was recently a story about the young and healthy woman from B.C. who died from H1N1. Are you able to comment on this?

A: Yes a fair percentage of people who have died from H1N1 around the world have had no identifiable risk factors.

Q: Is it true the H1N1 flu vaccine is still being tested on the public? Is it true that tests do not mean the future side effect are known? Would it be better for a person over 65 to just have the regular flu shot than take a gamble on future problems from the H1N1 flu vaccine?? Lots of people do not trust this vaccine!

A: This vaccine is being treated like any other vaccine. One cannot do studies of millions of people before licensing so there is what we call post licensing surveillance where people report in very rare side effects.

Q: I am breastfeeding a three month old and considering getting the vaccine so that I don't get H1N1 and pass it to my baby and toddler (or be too sick to properly take care of them). However, I'm concerned that in the few days after I get the vaccine, my breastmilk will contain too much of the vaccine for my baby. I'm also concerned about the adjuvant. I know they have no clinical results for adjuvants in pregnant women but do they have clinical results to show it is safe in breastfeeding women? Should I dump my breastmilk for a few days after the vaccine or avoid getting the vaccine altogether since I will be breastfeeding?

A: No significant amounts of the vaccine will get into breast milk. And again, the adjuvant is vitamin E and squalene - your child is already producing squalene naturally. It is definitely a good idea for you to do as you say - get vaccinated to protect your baby.

Q: What is the age cut off for needing 2 shots of H1N1 instead of just one in children?

A: Kids six months to nine years old should get two half dose shots. This dosing schedule may be modified as additional trial information becomes available.

Q: "There is almost no reason why somebody shouldn't get vaccinated, it all comes down to whether you want to prevent yourself from getting the flu." Don't mind getting the flu - what I'd like to avoid is two weeks in a heart/lung machine and/or death. I think that's the issue for many. Getting sick occasionally isn't a big deal. Dying or killing someone else IS.

A: Yes you are right, nobody wants to get really sick from this. It is important for people to be aware that the risk of serious illness if you are otherwise healthy is small, but not zero.

Q: Why does the Globe continue to call this the Swine Flu instead of H1N1... continuing to use this term. only further damages our pork industry.

A: The term swine flu is common parlance. It was originally called swine flu by the World Health Organization. We make sure we refer to it as H1N1 as well. It is important that are stories be readable and accessible to the public, not overloaded with jargon.

Q: If a 65+ person has been vaccinated as early as this month with the seasonal flu vaccine. Do they need to be re-vaccinated again in the spring as their immunity tends to wears out after a few months?

A: You will likely be OK if you got your shot recently, you shouldn't need to be revaccinated this spring. Keep tuned to the public health advice this spring in case something changes

Q: What's the preservative that they're using in the vaccine?

A: The preservative in the vaccine is thimerosol. This is another one of those molecules that people get worried about, because it contains mercury. The amount of mercury in a typical vaccine is the same as in less than in a can of tuna. Thimerosol has NEVER been credibly linked to any health problems, including autism, this is despite researchers trying very very hard to find a link.

Q: Is the nasal spray safer for children and is it available in Ontario?

A: The nasal spray is not available in Canada.

Q: Should I be concerned about GBS? Also why can children under 6 months not get the vaccine for H1N1?

A: Six month olds aren't vaccinated because it doesn't work, their immune system is too young to respond to the vaccine. That is why we recommend those around them get vaccinated.

GBS (Guillan Barre syndrome) was associated with the swine flu vaccine in 1976 and never since. An association does not mean that it was caused by the vaccine, only that they were associated (like saying that umbrellas are associated with rain, doesn't mean they cause rain). The association that year was a possible increase of 1 case per 100 000 people vaccinated. Please note:

1. that is pretty small;
2. the risk of getting GBS from having natural flu infection is greater than that;
3. the risk of serious complications from the flu is much greater than that; and
4. Most cases of GBS are actually caused by infections including food poisoning. So GBS, like the adjuvant and thimerosol, are red herrings.

Q: There is a lot of criticism that the media is scare-mongering and confusing the public about H1N1. As a senior public health offiicial what do you think about what you read in the paper and see on TV. Is it confusing?

A: In general, I don't think there has been scare-mongering. Most of the coverage I have seen has been just fine. I think the biggest problem we have all faced is that flu is very very confusing, shows up in different ways and different places, and we are always looking for more information to better understand what might happen. This uncertainty means that you will see some variation in reports and that can be confusing.

Q: My wife is pregnant, and we're confused about the H1N1 vaccine. Would you recommend she get the vaccine available in Toronto next week, or should she wait for the adjuvant-free version? (We were surprised when her midwife suggested she go ahead and get the version available next week.) Also, which one should our two-year-old son get?

A: I understand your confusion Re: which vaccine for your wife. The current recommendation is that if she is less than 20 weeks and otherwise healthy, she can probably wait if she wants to get the non-adjuvanted vaccine - this is because the first trimester of pregnancy is not at increased risk of severe disease - not because of safety concerns with the adjuvanted vaccine.

If she is more than 20 weeks or less than 20 weeks with underlying medical problems I think it makes the most sense to get the adjuvanted vaccine now so that she is protected as soon as possible as the country is just heading into its fall wave of flu right now.

Q: I would really like to know about masks -- why aren't Canadians wearing them on a daily basis in public?

A: Katie, surprisingly we have no data on how well masks work when worn by the general public. I think it makes sense if you are sick and coughing, and have to go out, that you wear a mask.....but nobody knows how much others wearing masks around you will protect them. We wear them (or respirators) in healthcare but also stress hand washing and may wear glowns, gloves and eye protection as well.

Bottom line, I have no problem with people doing that if they want, I just don't know how much it will help. I personally don't wear a mask on the subway but I definitely wash my hands a lot.

Q: With three family members who have died from three different autoimmune diseases, and many living with other autoimmune diseases, I'm concerned the adjuvant may trigger an underlying autoimmune disease. Can you comment on this?

A: This is a very tricky question that is currently being discussed and I suggest that people with serious autoimmune diseases such as lupus should talk to their immunologists about it. Again, one would have to weigh that theoretical risk versus the real risk that someone with severe autoimmune diseases is going to be at increased risk for getting bad disease from the flu.

Q: It was rather difficult to get the death rate attributed to influenza. Would you know it. This is for people worrying about neurological complication of 1 in a million. However hard to argue when you dont' t know the complication rate and death rate for influenza.

A: We don't know the actual risk of death per people infected because we don't have a good handle on the number of people infected. This is a problem all over the world because you just can't test everybody. Many people with flu won't even seek healthcare.

The estimates I have seen of the risk of serious disease, especially in people with underlying illnesses is certainly greater than the risk of serious adverse events from the flu shot.

Q: I'm a nurse and required to get a flu shot every year and I'm wondering what the cumulative effect that thimerosol will have if I'm taking one, or in this case, two flu shots per year.

A: There isn't a lot of thimerosol in the vaccine as I mentioned before, you are exposed to many many fold more mercury just by living in a industrialized country. Also, if your previous flu shots were given from single preloaded syringes, there was no thimerosol in the vaccine (it is only put in multidose vials). I've had at least 15 seasonal flu shots so I am right there with you.

Q: Can you clarify the situation with egg allergy as an absolute contraindication for the H1N1 vaccine? If you have a positive response to egg antigen with skin testing, but no symptoms at all when you eat eggs, can you have the vaccine?

A: The only time we worry about egg allergies is if someone has had true anaphylaxis to eggs (difficulty breathing, asthma, facial swelling etc.).

Q: How long does it take for the vaccine to provide immunity/to reach full effectiveness?

A: It takes about 10-14 days to develop immunity post vaccine. It may be a bit quicker with the adjuvanted vaccine because it works so well.

Q: I'm generally healthy and getting by the flu season fine without any flu shots in the past. But my boyfriend and I will go to Mexico for a week in mid November. Would that be an added motive for us to get the shot, or this virus has no particular correlation with Mexico any more? We are both in our early 30s.

A: There really isn't a link to Mexico anymore. I would just get it in the off chance you get flu while down there and it screws up your holiday. Nothing worse than sitting on the beach hacking up a lung.

Q: I have heard that in our Ontario hospitals, few people have died because of the vaccine, so everyone is pretty freaked out. Have you heard any of that?

A: Nobody has died because of the vaccine. But many people have died from H1N1 before the vaccine was available.

Q: Some people believe that taking the flu shot every year for the "run of the mill flu" defeats the purpose of building up the body's natural immunity. This year maybe people like that are thinking "I don't want to die from the big one, so I better get a shot this year". Is it fair to say this kind of thinking misses the fact that getting a shot every year has the same affect of building up immunity?

A: Yes you are correct. Getting a shot is the same thing as getting the flu in terms of developing immunity, only with the shot, you don't have to go through actually getting sick. which is one of the main reasons why I get it every year.