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(NICKY LOH)
(NICKY LOH)

Earlier questions

The daily H1N1 question: Nov. 3 to 6 Add to ...

Despite a huge amount of information about the H1N1 virus, Canadians still have questions about diagnosis, treatment and how to best respond.

Join André Picard, The Globe and Mail's public health reporter, as he answers a question a day from readers about the pandemic.

Come back daily for all the answers and leave your questions here using the Globe's comment function.

More Related to this Story

For more answers, see the Globe's previous Q&A's on the virus , the vaccine and parents' questions .



Questions from Nov. 3 to Nov. 6:



Friday, Nov. 6:

Q: My three-year-old daughter got the flu two weeks ago. The doctor said it was H1N1 but it was not confirmed because the region doesn't do routine testing. My husband and I did not get sick. How can this be? We took no special precautions. Now we're wondering: Should we get the vaccine or are we immune to this flu?

A: You have raised several interesting issues related to H1N1 and vaccination. First, about 90 per cent of all the flu cases in Canada today are caused H1N1. There is very little seasonal flu so far. That's why doctors assume that cases of the flu are H1N1. Testing everyone is not considered a good use of resources.

Second, there is a common assumption that everyone exposed to the H1N1 virus will get the flu. In fact, the large majority of people exposed to the virus will not get sick.

Even though you were in close contact with someone sick with swine flu, healthy young adults like yourselves have powerful immune systems that fight off a constant barrage of pathogens. When you are exposed to a virus, your body will produce antigens and develop immune resistance. In some people, this happens with very few disease symptoms; others will get quite sick. A vaccine does the same thing by tricking the body into thinking it is being exposed the virus.

Many people argue that there is no need to be vaccinated, that we should depend on our immune systems and bolster them with good nutrition. That is a bit of a gamble.

With H1N1, a new strain, it is anticipated that about one-third of the population will get sick. To date, it is estimated that about five per cent of Canadians have fallen ill with H1N1, so a lot more sick people are expected in the coming months.

While it is true that most cases of the flu are "self-limiting" - meaning you get better with rest and fluids, in rare instances people can get gravely ill and die. Again, the risk of complications is greatest in those with weaker immune systems - babies, children, people with chronic health conditions - but some healthy people will get severe illness.

So far in Canada, 1,779 people have been hospitalized with H1N1, including 351 who ended up in intensive care and required ventilators. There have been 92 confirmed deaths.

That is why public health officials recommend that everyone by vaccinated unless they had a laboratory-confirmed case of H1N1. That would include you and your daughter. Even if you have immunity to H1N1, the vaccine will do no harm.

Q: In the online posts, many comments suggest that journalists like yourself are queue-jumpers who use their insider knowledge to get the vaccine. Are you brave enough to answer honestly?

A: I am in the risk category healthy adults aged 18-65. I live in Montreal. I am eligible to receive the H1N1 vaccine after Dec. 7, and so I will get my shot some time after that date. Then I will get my seasonal flu vaccine.

Thursday, Nov. 5:

Q: Why aren't teachers and daycare workers considered "high-priority" for the H1N1 vaccine? Teachers are in daily contact with children (and sick children). Also, many teachers are in their childbearing years and lots of them get pregnant. I don't understand why teachers aren't at the front of the line for vaccination.

A: When outbreaks of infectious disease occur, schools and daycare centres are invariably among the places hit first and hardest. Children are virtual microbe-spreading machines and teachers know this well - they tend to get every bug out there. By virtue of being in contact with large groups of children, teachers at relatively high risk of contracting H1N1.

However, the priority groups for vaccination are not those at highest risk of contracting the disease, but those at highest risk of suffering complications and dying if they are infected. This in an important distinction.

The priority groups are:

- People under 65 with chronic health conditions;

- Pregnant women;

- Children aged six months to five years of age;

- People living in remote and isolated communities, particularly First Nations;

- Front-line health workers;

- Care providers to those at high-risk.

As you can see, pregnant women (including teachers) are a high priority for the vaccine. Some jurisdictions, like Quebec, are also urging all pregnant teachers, daycare workers and health professionals to take "preventive early maternity leave" to lessen their risk of contracting H1N1 influenza.

Daycare workers who care for children under the age of six months are a high-priority group and should be vaccinated. Daycare workers and teachers of children aged six months to five years, as well as those care for or teach children with chronic health conditions like cystic fibrosis are also considered a high-priority group in most jurisdictions though there are varying interpretations of what the term "care provider to those at high-risk" means.

So, while not all teachers and daycare workers are at the front of the line for vaccination, some of them should be.

Many have wondered why front-line health-care workers are considered high priority and teachers are not. After all, nurses and doctors are not at higher risk of complications and dying if they are infected. There are two reasons: 1) Front-line health-care workers treat a lot of high-risk patients and could put those patients at grave risk if they passed on the flu bug; 2) They are needed to treat people who are sick with the flu (and other conditions), particularly if there is a pandemic that causes widespread illness. Put crudely, a sick nurse would cause a lot more sickness and social disruption than a sick teacher.

Wednesday, Nov. 4:

Q: There is a lot of talk of the risk of H1N1 to children. Can you tell me how many children have actually died? And were they all healthy? Also, how does that compare to a regular flu season?

A: As of Oct. 24, there have been 100 deaths from H1N1 in Canada, including six deaths in children 15 and under (that is seven per cent of the total). Only one of the children who died had an underlying health condition. By comparison, among adults, 63 per cent of the fatalities have occurred in people with an underlying condition.

In a 'normal' flu season, there are roughly 5,000 deaths, most of them seniors. Between three and five children die of seasonal influenza annually (less than 0.1 per cent), and they are usually babies with underdeveloped immune system. Deaths in the six months to 15 age category are very rare.

While every death of a child is tragic, it is also important to keep them in context. The greatest risk to children, by far, is unintentional injuries - motor vehicle crashes, falls, accidental poisoning - which result in almost 400 deaths a year. Another 170 children each year die of cancer. So one of the best ways to keep your child safe is to drive carefully when you head to the vaccination clinic.

Tuesday, Nov. 3:

Q: There are six priority groups for vaccination, including people under 65 with chronic medical conditions. My wife and I are both over 65; she suffers from COPD and requires oxygen. She gets the flu shot every year because she is considered high-risk. Can you tell my why she is being sent to the back of the line this time? This seems, at best, arbitrary and bureaucratic and, at worst, flagrant discrimination against seniors.

A: In regular flu seasons, seniors (particularly those with lung diseases like COPD) are the high-risk group. However, there is strong evidence that older people (meaning over 50) have full or partial immunity to swine flu. That is because, between 1918 and 1957, H1N1 viruses circulated commonly so most people developed antibodies that seem to protect them against the current strain of H1N1. In other words, seniors are well down the priority list because they stand to get a lot less benefit from the shot than younger people. It should be noted though that some physicians and public health officials believe that all people with respiratory conditions like COPD and asthma should be vaccinated in priority fashion, regardless of age. This is an area of some controversy. While seniors have a lower risk of contracting H1N1, if they do get infected, disease can be very severe. In fact, despite all the attention paid to the deaths of young people, the over-65 group has the highest mortality rate from H1N1 and virtually all seniors who died had underlying health conditions. Finally, don't forget that, even if they are being told to wait for the H1N1 vaccine, it is recommended that seniors get the seasonal flu vaccine.



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