Shiloh
Editor, Senior Moderator
Source: http://www.thespec.com/News/Local/article/659693
H1N1 questions and answers
The basics
October 24, 2009
Compiled by Naomi Powell
The Hamilton Spectator
(Oct 24, 2009)
Who's vulnerable?
All of us, but especially people with compromised immune systems or underlying medical conditions such as heart and lung problems. Pregnant women, particularly in their second and third trimesters, have a higher risk of hospitalization and death than non-pregnant women. Health-care workers and people in isolated or remote communities are also at high risk.
The symptoms of H1N1 include coughing, sore throat, runny nose, body aches, headaches, chills and fever. Most people will get better with rest and fluids.
What about older people? Aren't they in the high-risk group?
People over the age of 60 have shown relative immunity to H1N1. Experts believe that those born before 1957 were exposed to H1N viruses that are similar to the one circulating now. That exposure likely gave them some immunity from the current flu.
"We had an outbreak in a long-term care home in Burlington but the strange thing was, it was the much younger staff, not the older residents, who were sick," said Dr. Bob Nosal, Halton's medical officer of health.
"It really is unusual. I've never seen anything like that in my 20 years here."
Great, I'm over 60. That means I don't need a flu shot, right?
Wrong. People over 60 appear less likely to catch the flu, but if they do catch it, they have a greater chance of severe illness and hospitalization.
Are women at higher risk?
In Hamilton, 32 people with H1N1 have been hospitalized. Two-thirds of those people were women. Still, no controlled studies have been done that prove women are more vulnerable to H1N1 than men.
And the higher number of infections among women may be circumstantial, because women typically have more contact with children, said Dr. Michael Gardam, director of infectious disease prevention and control at Ontario's Agency for Health Protection and Promotion.
Why are pregnant women at greater risk?
When women become pregnant, their immune system becomes somewhat suppressed. The extra burden of carrying a child can also make it harder for them to breathe and clear respiratory secretions. Both of those factors make them more vulnerable to H1N1.
The risk of hospitalization or death is four to six times higher if you are pregnant, Gardam said. Still, he cautions that the number of pregnant women who get seriously ill is very small.
How long will I be contagious if I come down with the flu?
People infected with the flu may be able to infect others from one day before getting sick, to five to seven days after, according to the U.S. Centers for Disease Control. The virus sticks around longer in children and people with compromised immune systems. The latter can sometimes shed the virus for months.
What happened to the seasonal flu? Do we still need to worry about it?
At the moment, the seasonal flu is on a "potentially permanent vacation," Gardam said. Most people who have tested positive for the flu have had the H1N1 virus. When a new flu strain appears -- as H1N1 did this year -- it tends to replace the old one, leading many to believe that H1N1 may be the new "seasonal flu." Still, no one knows for sure and it's still possible that the old flu strain will make a comeback later this year.
Are the symptoms of H1N1 different from those of seasonal flu?
Not really. The only difference, officials say, is that H1N1 seems to cause more nausea and vomiting in children.
When will flu season be over?
The flu typically hits an area in waves lasting eight to 12 weeks. Seasonal flu usually arrives around Christmas and sticks around until March.
But with H1N1, all bets are off. The virus has already broken with tradition by causing a wave of illness that started in the spring and continued to cause illness through the summer. Experts had expected a second wave to begin in September when kids returned to school and transmission rates increased. But the infection rate was much lower than expected.
"It's taken until now for the virus to really take off," Nosal said.
The vaccine
Which vaccine should I get?
Canada is currently rolling out the largest vaccination campaign in its history to deal with H1N1. Over the coming weeks, Hamilton public health officials hope to administer the H1N1 shot, called Arepanrix, to about 400,000 people. Canada has actually developed two versions of the vaccine: one with adjuvant and one without.
What's an adjuvant?
These are compounds that boost the body's immune response to the vaccine. Including them in the H1N1 shot allows practitioners to immunize people using smaller doses.The adjuvant in Canada's vaccine has two components: vitamin E and squalene, a natural fat that occurs in the liver and is "essentially a fish oil," Gardam said.
Are adjuvants dangerous?
The 2009 H1N1 vaccine is the first licensed flu vaccine containing adjuvant in Canada, though they have been used in other Canadian vaccines in the past. Adjuvant has also been part of flu vaccines in Europe for many years.
There is no data on the use of adjuvanted flu vaccine on children and pregnant women. Pregnant women in Canada can choose to wait for the unadjuvanted vaccine, though it likely won't be available for two weeks. Because the body usually takes two weeks to build antibodies against the vaccine, Nosal recommends women in the latter half of their pregnancy get the adjuvanted vaccine now rather than risk catching the flu. Given the rising infection rates in the area, it is better to do this than wait, he said.
Which version will I get?
Everyone 10 years of age or older should receive one dose of adjuvanted vaccine. Children between six months and 10 years should receive the adjuvanted vaccine in two half-doses, administered at least 21 days apart. Pregnant women are advised to get one dose of unadjuvanted vaccine, though if they are 20 weeks or more into their pregnancy and the unadjuvanted vaccine isn't available, they are advised to get the adjuvanted shot. Infants younger than six months old aren't vaccinated for influenza.
Why do kids up to 10 have to get two shots?
Children's immune systems are different from adults' and the vaccine appears to be less effective in kids, said Dr. Chris Mackie, Hamilton's medical officer of health.
How does it work?
The vaccine injects an antigen, or small dead part of the virus, into your muscle. When your body recognizes the antigen as foreign, it begins developing an immune response to it. When your body is hit with the real thing, it will already have a defence.
Is there enough vaccine for everyone?
There's plenty. Canada contracted GlaxoSmithKline in Ste-Foy, Que., to provide 50.4 million doses of the vaccine. Health Canada initially thought two doses of the vaccine would be necessary for everyone, but the agency now says one is enough.
What about the seasonal flu?
A seasonal flu vaccine has also been produced, though not in large quantities. Given the dominance of the H1N1 virus, the government is recommending the shot only for people over 65 or who are in chronic care homes.
If I do get sick, will my doctor give me Tamiflu?
Tamiflu is an antiviral pill that prevents the flu from replicating. In order to be effective, it must be administered within the first 48 hours of illness. Officials are urging that it only be given to those who are seriously ill or hospitalized. The more people receive Tamiflu, the greater the chances that a Tamiflu-resistant strain of the flu will proliferate.
I've already been sick with what I suspect was H1N1. Do I still have to get the vaccine?
Yes, because unless you were tested, you can't be sure you had H1N1.
My kids were sick with H1N1 and I was exposed to the bug while caring for them. Do I still have to get the vaccine?
Yes. The "clinical attack rate" (the rate of transmission in special circumstances such as a home setting) in families runs between 10 and 20 per cent, Gardam said. If someone living with you has the flu, the odds are you're still not going to catch it from them. "Get your vaccine," he said.
I've heard H1N1 is travelling from the western to eastern provinces. Is that true?
Yes. British Columbia and the Northwest Territories experienced waves of H1N1 activity that began four weeks ago. Just this week, B.C. had 17 outbreaks of the bug, while the Northwest Territories had eight outbreaks.
Why is it taking this route?
No one knows. Viruses often travel in unpredictable patterns, Gardam said. For example, no one is quite sure why both B.C. and the Northwest Territories have had a significant increase in cases while Alberta has not.
The H1N1 toll so far
Canada
Number of hospitalizations due to H1N1: 1,541
Number of deaths due to H1N1: 80
Ontario
Number of hospitalizations due to H1N1: 439
Number of deaths due to H1N1: 28
Hamilton
Number of hospitalizations due to H1N1: 32
Number of deaths due to H1N1: 4
Halton
Number of hospitalizations due to H1N1: 7
Number of deaths due to H1N1: 0
H1N1 questions and answers
The basics
October 24, 2009
Compiled by Naomi Powell
The Hamilton Spectator
(Oct 24, 2009)
Who's vulnerable?
All of us, but especially people with compromised immune systems or underlying medical conditions such as heart and lung problems. Pregnant women, particularly in their second and third trimesters, have a higher risk of hospitalization and death than non-pregnant women. Health-care workers and people in isolated or remote communities are also at high risk.
The symptoms of H1N1 include coughing, sore throat, runny nose, body aches, headaches, chills and fever. Most people will get better with rest and fluids.
What about older people? Aren't they in the high-risk group?
People over the age of 60 have shown relative immunity to H1N1. Experts believe that those born before 1957 were exposed to H1N viruses that are similar to the one circulating now. That exposure likely gave them some immunity from the current flu.
"We had an outbreak in a long-term care home in Burlington but the strange thing was, it was the much younger staff, not the older residents, who were sick," said Dr. Bob Nosal, Halton's medical officer of health.
"It really is unusual. I've never seen anything like that in my 20 years here."
Great, I'm over 60. That means I don't need a flu shot, right?
Wrong. People over 60 appear less likely to catch the flu, but if they do catch it, they have a greater chance of severe illness and hospitalization.
Are women at higher risk?
In Hamilton, 32 people with H1N1 have been hospitalized. Two-thirds of those people were women. Still, no controlled studies have been done that prove women are more vulnerable to H1N1 than men.
And the higher number of infections among women may be circumstantial, because women typically have more contact with children, said Dr. Michael Gardam, director of infectious disease prevention and control at Ontario's Agency for Health Protection and Promotion.
Why are pregnant women at greater risk?
When women become pregnant, their immune system becomes somewhat suppressed. The extra burden of carrying a child can also make it harder for them to breathe and clear respiratory secretions. Both of those factors make them more vulnerable to H1N1.
The risk of hospitalization or death is four to six times higher if you are pregnant, Gardam said. Still, he cautions that the number of pregnant women who get seriously ill is very small.
How long will I be contagious if I come down with the flu?
People infected with the flu may be able to infect others from one day before getting sick, to five to seven days after, according to the U.S. Centers for Disease Control. The virus sticks around longer in children and people with compromised immune systems. The latter can sometimes shed the virus for months.
What happened to the seasonal flu? Do we still need to worry about it?
At the moment, the seasonal flu is on a "potentially permanent vacation," Gardam said. Most people who have tested positive for the flu have had the H1N1 virus. When a new flu strain appears -- as H1N1 did this year -- it tends to replace the old one, leading many to believe that H1N1 may be the new "seasonal flu." Still, no one knows for sure and it's still possible that the old flu strain will make a comeback later this year.
Are the symptoms of H1N1 different from those of seasonal flu?
Not really. The only difference, officials say, is that H1N1 seems to cause more nausea and vomiting in children.
When will flu season be over?
The flu typically hits an area in waves lasting eight to 12 weeks. Seasonal flu usually arrives around Christmas and sticks around until March.
But with H1N1, all bets are off. The virus has already broken with tradition by causing a wave of illness that started in the spring and continued to cause illness through the summer. Experts had expected a second wave to begin in September when kids returned to school and transmission rates increased. But the infection rate was much lower than expected.
"It's taken until now for the virus to really take off," Nosal said.
The vaccine
Which vaccine should I get?
Canada is currently rolling out the largest vaccination campaign in its history to deal with H1N1. Over the coming weeks, Hamilton public health officials hope to administer the H1N1 shot, called Arepanrix, to about 400,000 people. Canada has actually developed two versions of the vaccine: one with adjuvant and one without.
What's an adjuvant?
These are compounds that boost the body's immune response to the vaccine. Including them in the H1N1 shot allows practitioners to immunize people using smaller doses.The adjuvant in Canada's vaccine has two components: vitamin E and squalene, a natural fat that occurs in the liver and is "essentially a fish oil," Gardam said.
Are adjuvants dangerous?
The 2009 H1N1 vaccine is the first licensed flu vaccine containing adjuvant in Canada, though they have been used in other Canadian vaccines in the past. Adjuvant has also been part of flu vaccines in Europe for many years.
There is no data on the use of adjuvanted flu vaccine on children and pregnant women. Pregnant women in Canada can choose to wait for the unadjuvanted vaccine, though it likely won't be available for two weeks. Because the body usually takes two weeks to build antibodies against the vaccine, Nosal recommends women in the latter half of their pregnancy get the adjuvanted vaccine now rather than risk catching the flu. Given the rising infection rates in the area, it is better to do this than wait, he said.
Which version will I get?
Everyone 10 years of age or older should receive one dose of adjuvanted vaccine. Children between six months and 10 years should receive the adjuvanted vaccine in two half-doses, administered at least 21 days apart. Pregnant women are advised to get one dose of unadjuvanted vaccine, though if they are 20 weeks or more into their pregnancy and the unadjuvanted vaccine isn't available, they are advised to get the adjuvanted shot. Infants younger than six months old aren't vaccinated for influenza.
Why do kids up to 10 have to get two shots?
Children's immune systems are different from adults' and the vaccine appears to be less effective in kids, said Dr. Chris Mackie, Hamilton's medical officer of health.
How does it work?
The vaccine injects an antigen, or small dead part of the virus, into your muscle. When your body recognizes the antigen as foreign, it begins developing an immune response to it. When your body is hit with the real thing, it will already have a defence.
Is there enough vaccine for everyone?
There's plenty. Canada contracted GlaxoSmithKline in Ste-Foy, Que., to provide 50.4 million doses of the vaccine. Health Canada initially thought two doses of the vaccine would be necessary for everyone, but the agency now says one is enough.
What about the seasonal flu?
A seasonal flu vaccine has also been produced, though not in large quantities. Given the dominance of the H1N1 virus, the government is recommending the shot only for people over 65 or who are in chronic care homes.
If I do get sick, will my doctor give me Tamiflu?
Tamiflu is an antiviral pill that prevents the flu from replicating. In order to be effective, it must be administered within the first 48 hours of illness. Officials are urging that it only be given to those who are seriously ill or hospitalized. The more people receive Tamiflu, the greater the chances that a Tamiflu-resistant strain of the flu will proliferate.
I've already been sick with what I suspect was H1N1. Do I still have to get the vaccine?
Yes, because unless you were tested, you can't be sure you had H1N1.
My kids were sick with H1N1 and I was exposed to the bug while caring for them. Do I still have to get the vaccine?
Yes. The "clinical attack rate" (the rate of transmission in special circumstances such as a home setting) in families runs between 10 and 20 per cent, Gardam said. If someone living with you has the flu, the odds are you're still not going to catch it from them. "Get your vaccine," he said.
I've heard H1N1 is travelling from the western to eastern provinces. Is that true?
Yes. British Columbia and the Northwest Territories experienced waves of H1N1 activity that began four weeks ago. Just this week, B.C. had 17 outbreaks of the bug, while the Northwest Territories had eight outbreaks.
Why is it taking this route?
No one knows. Viruses often travel in unpredictable patterns, Gardam said. For example, no one is quite sure why both B.C. and the Northwest Territories have had a significant increase in cases while Alberta has not.
The H1N1 toll so far
Canada
Number of hospitalizations due to H1N1: 1,541
Number of deaths due to H1N1: 80
Ontario
Number of hospitalizations due to H1N1: 439
Number of deaths due to H1N1: 28
Hamilton
Number of hospitalizations due to H1N1: 32
Number of deaths due to H1N1: 4
Halton
Number of hospitalizations due to H1N1: 7
Number of deaths due to H1N1: 0