A registered nurse injects a dose of the H1N1 flu vaccine at a Toronto health clinic on Thursday, October 29, 2009.Darren Calabrese
Public health officials have been pleading with Canadians for weeks not to jump the pandemic vaccination queue, but by Christmas they may be faced with an even bigger challenge: persuading people to get shots when the worst is likely over.
Most Canadians aren't eligible until the end of this month or early December for the H1N1 flu shot, which takes about 10 days to be fully effective. By that time, the second wave of the flu will be on the wane or coming to an end in parts of the country, leading to fears that some won't feel vaccination is required.
If that's the case, the Public Health Agency of Canada may find itself sitting on a mountain of vaccine - it ordered 50 million doses when it thought two shots were required - but so far, about six million doses have been delivered to the provinces and territories.
"What our mathematical model suggests is that there is the possibility for the peak [in Vancouver]to occur between the end of November and early December," said Babak Pourbohloul, director of the division of mathematical modelling at the British Columbia Centre for Disease Control. "But there are a lot of uncertainties involved in this estimation because this is a new virus."
The Globe on H1N1
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Experts generally agree it is a good idea to get vaccinated. Some are suggesting a potential third flu wave may come in the spring, though not every one agrees that will happen.
While there could be a third wave, "there's no reason to think there will be," said Richard Schabas, Medical Officer of Health for Ontario's Hastings and Prince Edward Counties Health Unit.
With the second peak coming to an end and most of the general public still not vaccinated, Dr. Schabas estimated - using death rates in Australia where the pandemic is over - that a healthy person in Ontario is about "20 times more likely to be killed by a car than by an H1N1 virus this year."
"With each passing day," Dr. Schabas says, "the cars look worse."
This second wave of the flu has been milder than the first, which ended on Aug. 29. From Aug. 30 to Oct. 31, 948 people were sent to hospital, including 147 placed in intensive care and 24 who died, according to Public Health Agency of Canada figures.
In the first wave, from April 12 to Aug. 29, 1,492 people were sent to hospital, including 296 to the ICU and 76 who died.
"Is it too late?" asked Michael Gardam, director of infectious diseases prevention and control at the Ontario Agency for Health Protection and Promotion. "It kind of depends where you live. This virus is going to be around for a while, so I don't think it is too late per se."
British Columbia's Lower Mainland and Southern Ontario are coming to the end of the peak. Other provinces with large numbers of hospitalizations include Quebec and Alberta.
The Public Health Agency of Canada can't say for certain whether a peak has been reached or if there will be additional waves of outbreaks, said spokeswoman Caroline Grondin, because "influenza is an unpredictable virus."
Donald Low, chief microbiologist at Mount Sinai Hospital in Toronto, said he thinks it is worth getting vaccinated. "We're going to see it come back again, he said. "Whether it's next spring or whether it's next fall, it's not over.
"Why not get protected when you have the vaccine available? If we get enough people vaccinated, the third wave may either never happen or it may be very minor."
It remains unknown why a tiny minority of otherwise healthy young Canadians have been gravely ill or died from the flu, in contrast to seasonal flu that is typically fatal only to the old and ailing. What doctors do know is that most people have no natural immunity to the virus, which is why it has spread.
Andrew Simor, head of microbiology and infectious diseases at Sunnybrook Health Sciences Centre in Toronto, said vaccination is a good idea, particularly since the flu will not peak at the same time everywhere in the country, and further waves can be expected.
"Pandemics actually come not in one or two waves, but typically there's even a third wave and we may well see a third wave of H1N1 later next spring," said Dr. Simor. "Getting vaccinated now should provide a level of protection even for that third wave."
Scott Halperin, director of the Canadian Centre for Vaccinology in Halifax, said Canada is such a large country geographically, he expects the flu to be a "Canadian problem for a while.
"Why would one want to play roulette for the sake of a sore arm?"
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H1N1: WHAT CANADA IS DOING
A single dose shot of H1N1 vaccine creates enough antibodies to provide protection in about 10 days. However, most Canadians will have to wait two or three weeks to obtain the vaccination.
Quebec City is expected to start vaccinating the general public on Nov. 30 and Montreal on Dec. 7. Prince Edward Island says it plans to start vaccinating the general public on Nov. 30, pending vaccine availability.
Alberta has no date yet for the general public to be vaccinated, but will be expanding its priority group tomorrow, to add two new groups: both parents or one parent and one caregiver of infants under six months of age; children under age 10 as of Nov. 1 with chronic health conditions. Winnipeg has no date yet for the general public and is not vaccinating its priority groups again until Thursday and Friday.
While British Columbia has not announced when the H1N1 vaccine is available to the general public, they expect it to be some time in late November or early December, depending on vaccine supply.
Ontario also has not announced when it will be available to the general public, but it is expected in late November.
Lisa Priest, Ingrid Peritz, Robert Matas and Caroline Alphonso