But if you insist, will you be able to get non-adjuvanted vaccine for your child? Currently, the answer is: Probably not. Most vaccinations are being done in clinics and, after a series of queue-jumping scandals, the recommendations are being followed to the letter. Individual physicians have more freedom to provide non-adjuvanted vaccine to patients but they have been supplied with very little of that product.
Q: Our three girls (ages 2, 2, and 4) have been vaccinated. We were told at the clinic a half-dose was provided and to return in three weeks for the other half-dose. But then I heard on that radio that a second shot was no longer required. Can you help clear up this confusion?
A: The current recommendation is that children aged six months to nine years should receive the adjuvanted vaccine in two half-doses, administered 21 days apart. But the World Health Organization said last week that one half-dose provides a sufficient immune response to protect children from H1N1. The Canadian policy is currently being reviewed. Practically, the focus now is getting all children vaccinated once and, within the next couple of weeks, it will likely be announced that young children don't need a second shot - a rare bit of good flu news for parents. For the seasonal flu, it is still recommended that children aged six months to nine years get the vaccine in two shots, at least 28 days apart.
Everyone 10 and over requires only one shot of H1N1 vaccine and one shot of seasonal flu vaccine.
Q: How will we know when the pandemic is over?
A: Influenza spreads in a well-established and predictable manner: The number of cases increases in an accelerating manner until it reaches a peak, and then the number of new cases gradually falls off. Public health officials will know that peak has been reached when they start to see a decrease in the number of new cases. In Canada, the peak of H1N1 influenza was reached the week of Nov. 24.
Q: There have been two waves of H1N1. Will there be a third wave?
A: The "third wave" theory is a point of much debate among public health officials. While it is possible that there could be a resurgence of H1N1 flu in the New Year - after all the flu usually peaks in January - it is unlikely. Why? Because, to date, about 40 per cent of Canadians have been vaccinated and another 10-15 per cent of the population has likely been infected. That means only about one-third of the population is at risk of contracting H1N1, so large outbreaks are not likely. However, one can expect to see a fair bit of seasonal flu early in 2010.
Q: In the end, how many people actually died of H1N1?
A: As of Dec. 19, there were 401 confirmed deaths from H1N1. A total of 1,404 Canadian were admitted to intensive care units for treatment of the swine flu; some of them will have life-long disabilities as a result. There were also 8,436 people whose flu symptoms were so severe that they required hospitalization. The most noteworthy characteristic of H1N1 was how it disproportionately affected younger people. For example, while influenza usually affects seniors, the median age of those hospitalized with H1N1 was only 28 and the median age of those who died was 53.
Q: When you look back were the people in the priority groups for vaccination more at risk?
A: According to the latest data - mid-December - those with underlying medical conditions like asthma and cystic fibrosis suffered the brunt of the H1N1 epidemic. More than half of people who were hospitalized and three-quarters of the deaths occurred among those with underlying conditions that placed them at high-risk. Similarly, one in five hospitalizations and one in 12 deaths occurred among pregnant women. Finally, about seven per cent of hospitalizations and deaths were in aboriginal people while they make up only about one per cent of the population.
Q: How much is the "largest immunization campaign in Canadian history" costing us, the taxpayers?
A: The vaccine costs about $8 a dose, so the total cost is about $400-million. Far more costly though is the cost of administering and publicizing the vaccine in the hundreds of clinic sites around the country; as of mid-November, that cost had reached about $1.5-billion. So, when all is said and done, the H1N1 campaign will cost well in excess of $2-billion. The federal government is picking up 60 per cent of the tab and the provinces are on the hook for the other 40 per cent.
Q: Who can I call if I have more questions?
A: The Public Health Agency of Canada has a H1N1 hotline 1-800454-8302. Most provinces and health regions also have telehealth lines that you can call for information, including where to get a flu shot.