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.
Last week's questions:
Friday, Nov. 13
Today, Globe readers have a number of questions related to blood donation and transfusion.
Q: I'm a long-time blood donor. Yesterday, I got the flu shot. Can I still give blood?
Q: I'm getting heart surgery next week. I'm wondering if can get swine flu from a transfusion?
Q: If you get the flu, does it stay in your blood? If you give blood will it endanger others?
Q: If I get blood from someone who had the vaccine, will I get the antibodies? I mean, can avoid getting the vaccine myself that way?
A: Yes, you can donate blood after getting flu shot, but Canadian Blood Services recommends that you wait 48 hours before doing so. This is simply an extension of normal policy, where blood donors are asked to flag if they feel unwell after a donation - an indication they may have been infected by a bacterium or a virus. That blood is discarded. Because minor reactions like fever are common after the flu shot, the wait period is a way of ensuring that blood donations are not wasted.
There is no wait period for getting a flu shot after a blood donation and no impact on the efficacy of the vaccine.
You cannot get the flu (H1N1 or seasonal) by giving or receiving blood or blood products. Influenza is a virus spread through the respiratory route; it is not blood-borne.
If you get a blood transfusion from someone who has had the H1N1 vaccine or who has had the flu, you will get some antibodies but it is very unlikely you will get enough to protect you. Besides, getting a vaccine is a lot less trouble than getting a transfusion.
So far, pandemic influenza has not had an appreciable effect on blood donation. But, with the flu becoming more widespread, the plan is to "ramp up" collection and bolster inventory to seven days' worth from the normal five days' supply. To do so, CBS needs 120,000 blood donations over the next six weeks.
Getting a needle in your arm is in vogue these days so consider getting a second needle and giving the Gift of Life.
Thursday, Nov. 12
Q: There's a lot of talk about queue-jumping so I would like to know if the Prime Minister and other senior officials received priority access to the H1N1 shot?
A: Stephen Harper has said he will get the shot. The PM has asthma and was eligible to get the vaccine on a priority basis but he has opted to wait and get it at the same time as others in his lower-priority age group.
Federal Health Minister Leona Aglukkaq said her one-year-old baby, who is in a high-risk group, has been vaccinated but she is waiting her turn.
Dr. David Butler-Jones, the man who, in a $3.5-million ad campaign, has been relentlessly urging Canadians to get vaccinated and wash their hands, has not yet been vaccinated either. The chief public health officer of Canada, who suffers from both asthma and an immune condition, was going to get his H1N1 vaccine early on to set an example but, because of media reports of shortages, long waits and queue-jumping, he too opted to wait.
Q: My husband and I are heading to Florida in a couple of days, where we plan to spend the winter. I'm wondering if Snowbirds can get vaccinated before going south?
Q: I'm a frequent flyer. It seems that every day I'm on a plane with someone who is hacking and coughing. I really don't want to get the flu and spread it to others. Public health says I can't get the vaccine for a couple of more weeks. Doesn't it make sense to vaccinate people like me sooner?
A: Being trapped on a plane for several hours with the modern-day version of Typhoid Mary is certainly no fun. But there are no special provisions to provide early vaccination to Snowbirds and frequent flyers. Remember, those given high priority are those most likely to suffer serious complications if they are infected with H1N1 influenza, not those who are most likely to actually catch the bug.
Public health officials are urging those who are sick to avoid mass transit, and calling on carriers to be flexible (read: no punitive charges) in allowing them to delay their travel.
The good news is that some jurisdictions - particularly those outside large urban centres - are vaccinating priority groups more quickly than they had anticipated so the shot will soon be available to everyone. So check with your local public health authorities before heading south.
Wednesday, Nov. 11
Today, we have several questions related to pregnancy and babies:
Q: I am eight months pregnant and I have been vaccinated against H1N1. What I want to know is: Will my baby have antibodies when she is born?
A: Flu studies done in the past show that when pregnant women get flu shots before giving birth, they pass on immunity to their child. The baby may not have 100 per cent immunity but even partial protection can be helpful during the infants first few months of life.
Q: My baby is two months old and can't be vaccinated. But I'm breastfeeding - will that protect him? (I got the adjuvanted vaccine myself because my doctor said it was safe to get while breastfeeding.)
A: Breastfeeding has many advantages. Breastfed children are generally healthier, which offers some protection against infection with pathogens like the H1N1 virus. Moms can also pass on some immunity to the baby in their breast milk. Finally, breastfeeding mothers themselves tend to have stronger immune systems; this reduces the chance of a contracting the flu and passing it on to her infant. And, you are correct, the vaccine is recommended for breastfeeding Moms, and if they have very young babies they are at the top of the priority list.
Q: We have a newborn. My husband, my other children and myself have all been vaccinated. But lots of people aren't vaccinated so should we keep the baby out of public places just to be safe?
A: A key message that public health officials have tried to convey is that while H1N1 poses a risk, that risk should be kept in context and life must go on. The large majority of people - including babies - will not get sick from the flu and only a tiny minority will get gravely ill or die. While you should not deliberately put your baby in harm's way, trying to hide away (or quarantine) the baby will not substantially reduce risk and will probably be a huge inconvenience to the family.
Q: I am not pregnant, but I'm trying to get pregnant. Should I get the non-adjuvanted vaccine just to be safe?
A: The recommendation is that pregnant women receive the non-adjuvanted vaccine. Currently, there are no provisions to provide the non-adjuvanted vaccine to others. However, by week's end, more than one million doses of non-adjuvanted vaccine will be available - far more than there are pregnant women, so there may be some latitude. (After the queue-jumping scandals though, don't expect clinics to stray at all from the rules. Try and raise your specific situation with an individual physician.) Public health officials, for their part, say that it is vaccination that it is important, regardless of whether you receive the adjuvanted or non-adjuvanted version. This is particularly true for pregnant women - and those trying to get pregnant - because flu symptoms (especially fever) can trigger miscarriages and injure the fetus.
Q: Why is the vaccine not considered safe for children under 6 months and what magically happens at 6 months to make it safe?
A: The issue is not safety, it is efficiency. Children under the age of six months do not have fully developed immune systems so they do not produce a good immune response to the vaccine. That is why it is recommended that caregivers and close contacts of young babies - parents, siblings, daycare workers - be vaccinated.
Swine flu snippets:
Readers have reacted strongly to news that Taliban prisoners-of-war in Afghanistan received the H1N1 vaccine from their Canadian captors:
- "This is a credit to the Canadian Forces and those men and women who don its uniform. The provision of medical aid to prisoners-of-war is not to be discriminated against on the basis of nationality or status."
- "Are Canadians that apathetic that we put the well-being of enemy combatants ahead of our own children?"
Tuesday, Nov. 10
Today, we a number of related questions:
Q: Is it true that I can't sue if the swine flu vaccine makes me sick or kills me?
Q: I've read some pretty frightening things about vaccines on the Internet. How many people do they actually kill?
Q: I read that in the U.S. vaccine makers can't be sued. Is that true in Canada too?
Q: Why have the vaccine producers been given blanket immunity shielding them from any adverse reaction lawsuits?
Q: When I got the H1N1 vaccine, I had to sign a waiver that said I couldn't sue. Is that valid?
A: In the U.S., federal legislation has, since the 1980s, protected vaccine makers against lawsuits related to childhood vaccines. In July, that protection was extended to makers of H1N1 vaccine. This was done because, in the litigious U.S., drug companies had essentially threatened to stop producing childhood vaccines, which are not particularly profitable and there were fears that production of the flu vaccine would be delayed by legal concerns.
The inability to sue manufacturers does not mean those who are vaccine-damaged cannot receive compensation. The U.S. has a "vaccine court" that hears cases and awards compensation.
In Canada, vaccine manufacturers do not have blanket protection from lawsuits and suits related to harm caused by vaccine are usually settled out-of-court. One province, Quebec, has a no-fault insurance program that operates in a manner similar to the U.S. vaccine court. Over two decades, there have been about 100 claims and a couple of dozen substantial awards.
The Canadian Paediatric Society estimates that about five children a year will potentially suffer a serious adverse event from vaccination. Bear in mind that there are almost 400,000 children born a year and they get approximately two dozen shots by the time they hit kindergarten.
Health officials describe the number of severe adverse reactions to influenza vaccines as "very rare." The biggest danger is a life-threatening allergic reaction to a component of the vaccine such as egg proteins. In rare instances - again, numbers are hard to come by - a person can suffer from Guillain-Barré syndrome after vaccination. The autoimmune condition, which is characterized by paralysis that can be reversed, is related to fever. The disastrous 1976 swine flu vaccination campaign was derailed by reports of numerous cases of Guillain-Barré. But infectious disease experts note that the flu itself triggers far more cases of Guillain-Barré than the vaccine.
On the question of "immunity" from H1N1 vaccine lawsuits (a clever play on words), the reality is a bit more complex. In the contract between the government of Canada and GlaxoSmithKline, Ottawa promises to "indemnify" anyone harmed by the vaccine. Practically, what this means is that, if you suffer harm from the vaccine, you can sue and the government, not GSK, will be responsible for paying the settlement.
Many have argued that this is an unnecessary gift to a big, wealthy pharmaceutical company. But the underlying philosophy - as articulated in a landmark 1985 Supreme Court judgment - is that people exposed to a potential harm while undergoing an intervention that is in the greater public good, particularly at the urging of the state, should be compensated by the state if they are harmed in the process.
Finally, when you get a H1N1 vaccine you will be asked to sign a waiver. The wording of these waivers varies a lot across the country but most say that you waive the right to sue those administering the vaccine - principally nurses. Lawyers consulted said that these waivers would in no way limit your ability to sue the vaccine maker of the government.
Daily, we will also be posting comments taken from readers' postings. Today's swine flu snippet:
"I understand that from now on, when a clinic runs out of vaccine, a Public Health official will don a Porky Pig costume and run along the line of people shouting "eeba-deeba-deeba that's all folks!"
Monday, Nov. 9, 2009
Q: Is the non-adjuvanted vaccine available now for pregnant women? And can we get non-adjuvanted vaccine for our kids too?
A: By week's end one million doses of non-adjuvanted vaccine have been distributed to the provinces and territories. However, the vaccine, called Panvax, has not yet been approved by Health Canada. Approval is imminent so the vaccine should be available to any pregnant woman who asks by week's end.
The formal recommendation is that only pregnant women get the non-adjuvanted form of the vaccine. But some parents have safety concerns because there has been limited testing of the adjuvant, particularly in younger children.
So the question becomes: Should you demand the non-adjuvanted vaccine?
The vast majority of pediatricians and public health officials will tell you that the adjuvanted vaccine is safe and that it actually works better than the non-adjuvanted vaccine - meaning it generates a better immune response, including in children and pregnant women.
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.
Sunday, Nov. 8:
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.
Check here for last week's questions
More questions answered:
- A guide to H1N1 for parents
- Your H1N1 vaccine questions answered
- Send questions to The Globe's André Picard
- Visit the Globe's H1N1 page