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Nurses prepare influenza vaccine injections during a flu shot clinic in Boston on Jan. 12, 2013.Brian Snyder/Reuters

Karen Baillie has been in the residential care business for 35 years, and she says this is a first for her.

Ms. Baillie, executive director of Laurel Place in Surrey, was referring to a rare, public-health edict requiring all visitors and staff at 125 long-term care facilities throughout the Fraser Health Authority to wear a mask, if they have not had a flu shot.

The order was imposed this week by the authority's chief medical health officer, Paul Van Buynder, to combat what he calls "a perfect storm" of winter influenza viruses sweeping through the province's largest health-care district.

Ms. Baillie said extra staff have been posted to the reception area at Laurel Place to intercept visitors and find out their vaccination status.

About a third report not being immunized against influenza, and they are then asked to don a surgical mask, before being allowed in.

So far, all have complied, Ms. Baillie said. "No one's giving us grief, no one's given us any static, at all."

At the George Derby Centre in Burnaby, executive director Janice Mitchell said visitors are being asked to sign in and told of the new requirement. Some opt to be vaccinated on the spot, she added, noting, however, that they must still wait two weeks for the vaccine to take effect, and wear a mask in the interval.

"Some are surprised, but it's been absolutely no issue. They are happy to comply," said Ms. Mitchell.

She said George Derby, with its 300 residents, is in the midst of its second influenza outbreak this season.

"Unfortunately, it comes in from the community, and this is really one more step to reduce the risk of it being spread to our frail, elderly residents."

Dr. Van Buynder said he opted for his unusual order, after more than 20 of the authority's long-term care institutions reported flu outbreaks, compared with the average annual total of six to eight. Death and hospitalization rates among residents have zoomed, he said.

At the same time, the norovirus, which is not technically a flu bug, has also been strongly prevalent in the region, Dr. Van Buynder added.

"It's a double whammy this year, a perfect storm. If you're in the community, you'll almost certainly know someone who has had one or both by now."

Immunization rates are higher than ever among health-care staff this year, thanks to an earlier announced, province-wide policy – subsequently rescinded – that all employees had to be vaccinated or wear a mask. But Dr. Van Buynder said his order under the Public Health Act was nonetheless needed as an extra measure to head off what could be 50 to 60 outbreaks among the elderly at care facilities "if this trend continues."

For the moment, it applies only to these institutions because the elderly are most at risk from influenza, as a result of their weakened condition, he said.

Health-care unions resisted the short-lived stipulation that their members be required to have a flu shot, but unvaccinated members working in Fraser Health's long-term care residences are now wearing masks to comply with Dr. Van Buydner's declaration.

"What we're saying is: let's stop letting these viruses in and bumping off our old people. Everybody put a mask on, and see if we can reduce the number of outbreaks, and save lives."

The situation is a serious reminder of the health havoc that influenza can wreak, he said. "People have become very blasé about it, because we've had several very mild years. … This outbreak is widespread, it's serious, it's impacting on our most vulnerable, and we need people to do all of the right things to try and protect them."

As it is, even the flu vaccine, itself, is far from 100-per-cent effective, according to provincial health officer, Perry Kendall.

This year's vaccine is 50-per-cent effective against one of the current flu strains, and 70-per-cent effective against the second strain. "However, it's also true that if you do get the flu, and you have been vaccinated, it will likely be less severe," Dr. Kendall said.