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Sarah Thackoorie, holds her five year old son Samir as Jennifer Ally, right, administers an H1N1 flu shot at the International centre in Mississauga, October 29, 2009.

J.P. Moczulski for The Globe and Mail

Seasonal flu has reared its head early in parts of the country, and health officials warn that post-pandemic complacency about being vaccinated has the potential to make this influenza season worse than previous years.

Emergency departments at major Ontario hospitals are already inundated with patients showing influenza-like symptoms, a Montreal hospital has limited the number of visitors allowed because of the high number of flu cases, and 11 long-term care homes in Winnipeg have had outbreaks in recent weeks.

As public health officials battle H3N2, a seasonal flu that disproportionately affects the elderly, they worry that the fact that many people sailed through last year's much-hyped H1N1 pandemic virus will keep Canadians from getting a shot in the arm this year. Early signs reflect that fact: In Ontario, about 25 per cent of residents have received a flu shot, compared with 35 per cent in other seasonal flu years; and Toronto Public Health said vaccination rates are down 20 per cent compared with the two years before the pandemic.

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"There's been a certain reluctance on the part of the community-at-large to take up the vaccine this year, and I think that's most unfortunate," said Andrew Simor, head of microbiology and infectious diseases at Sunnybrook Health Sciences Centre in Toronto. "We're certainly at risk this year of having a more active and more severe outcome from our seasonal influenza." In an average year, about 5,000 deaths in Canada are associated with influenza.

Seasonal flu tends to spread from west to east, but this year, local activity appears to be increasing in parts of Alberta, Manitoba, Ontario, Quebec and Nova Scotia. While the H1N1 virus continues to circulate in small numbers, doctors say patients with seasonal flu, or H3N2, have clogged up hospitals. The Jewish General Hospital in Montreal, which has seen a large volume of influenza cases, said in a notice on Wednesday that it is limiting the number of visitors to one per patient in an attempt to prevent the spread of infection.

Health experts are hopeful that as more outbreaks surface and Canadians realize just how severe the flu can be, they will get the vaccine, especially the elderly, young children and pregnant women. The flu shot this year protects against H3N2 as well as H1N1.

Bunmi Fatoye, medical lead of communicable diseases at Manitoba Health, said the vaccination uptake is slightly lower in her province compared with other years. "There's always multiple factors that feed into why people decide to receive the vaccine or not," Dr. Fatoye said. "But I think the key message here is that we know that the vaccine is protective [and]it is effective, especially if the strain matches the strain in circulation."

But some say that mixed messages about the H1N1 vaccine may have turned people off the flu shot. Confusion reigned about who should be first to get the pandemic vaccine, and questions were raised about its safety. Public health officials failed to communicate the risks of the pandemic and the safety of the adjuvant (an ingredient added to boost a vaccine) effectively. In the end, less than half – 41 per cent of the adult population – received the vaccine. Although more than 400 people died and thousands more were hospitalized, the H1N1 pandemic was not as bad as predicted.

Allison McGeer, director of infection control at Toronto's Mount Sinai Hospital, said many people are just "flu-ed out" or say they don't have time to get another vaccine.

As a result, she said, "this is going to be a busier year than we've had for about a decade, 15 years maybe."

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