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Yesterday Dr. Arlene King, Ontario's Medical Officer of Health, announced the plan for flu vaccination this year in Ontario. It is a little different from past years, which is not surprising given that H1N1 – the pandemic strain – was unknown a year ago. Therefore, UHN's annual flu campaign will also change and below you'll find a bulleted sequence for our campaign, with additional information in the questions and answers at the end of this e-mail. It is my understanding that H1N1 has represented about 90% of the flu cases seen in populations in the southern hemisphere so it really has become the dominant strain this season.
I'd like to thank Dr. Susy Hota and Karen Stockton from IPAC and Jane Sloggett from Occupational Health & Safety for ensuring that UHN tailors its flu campaign to the provincial recommendations and for turning around the attached Q&A so quickly. As always, if you have additional questions, you may call either IPAC or Occupational Health & Safety.
Thank you for staying on top of this issue and for planning to get your flu shots. It's important for your health and for the health of your family and the patients you care for…
UHN Influenza Vaccination Q&A – September 24, 2009
When will the seasonal and H1N1 flu vaccines become available?The seasonal flu vaccine will be ready in the beginning of October. However, this year the Ontario Ministry of Health has decided to offer it to the public in 2 stages. In the first stage, during the early fall, the seasonal flu shot will be available only to people over the age of 65 years and those living in long-term care facilities. This is because people in these groups are at highest risk of complications from seasonal flu infection. In the second stage, which will likely start late December or early January, the seasonal flu vaccine will be offered to everyone else.
The H1N1 vaccine should be ready in November. Although everyone will eventually be offered the vaccine, the Public Health Agency of Canada has decided on a sequence for vaccinating the public, based primarily on risk of complications from H1N1 infection. Health care workers in acute care facilities are considered a priority for vaccination. Thus, at the UHN, we expect to receive our batch some time in November.
What is the UHN plan for flu vaccination this year?This year, we will be doing things a little differently. It is not yet clear whether we will receive a supply of seasonal flu vaccine in October to immunize our staff over the age of 65 or if they will have to get their flu shots from family physicians or public health clinics. If we do get a limited supply, we will offer vaccination to staff over age 65 within the Occupational Health Clinics.
Once we obtain the H1N1 vaccine in November, we will offer it to everyone working at UHN through an H1N1 vaccination campaign. This campaign will look similar to what is done every year for the flu campaign – there will be roaming carts going to inpatient units and carts stationed at various spots in the hospitals where staff can get vaccination. The campaign is expected to last no more than 6 weeks.
When the seasonal flu vaccine is released to the general public in December-January, we will offer it to all UHN staff. Depending on how much seasonal flu (compared to H1N1 flu) is circulating in the community at that time, we will either launch another flu vaccination campaign or simply offer it through the Occupational Health Clinics. We will determine and communicate the plan closer to that date.
Why are we changing our vaccination strategy? The main reason for the change is that we expect the first wave of influenza this fall to be caused almost entirely by H1N1 influenza. Therefore, it is important to put as much effort as possible into vaccinating people against H1N1 first. Once the initial wave of H1N1 flu goes down, it is possible but not certain that there will be a rise in seasonal influenza infections. For most people except for those at highest risk for complications with seasonal flu, it makes sense to delay seasonal flu vaccination until we see what flu strains are circulating in the winter.
There have also been reports in the media that having been vaccinated against seasonal influenza in years past may increase your risk for getting H1N1 infection. This statement is based on a Canadian observational study that has not yet been reviewed or published. The findings have not been corroborated by other countries and it is difficult to explain the biology behind the results. This may be important information, but until the study is released it is difficult to understand its true significance. Nevertheless, our vaccination strategy minimizes the possibility of such a negative effect by promoting H1N1 vaccination first and offering seasonal flu vaccination later.
This sounds confusing. Do you think I should get a flu shot at all? Vaccination is an individual choice and is currently not mandatory for health care workers. However, as health care providers, you are working with vulnerable populations and may also be exposed to risks like influenza on a daily basis. For this reason, vaccination with BOTH flu shots is strongly recommended at the UHN.
Who should not get the vaccine? From all the testing to date, the H1N1 and seasonal flu vaccines are felt to be safe for most people, including immunocompromised people and pregnant and breastfeeding women. Neither of the vaccines contain live virus. The H1N1 vaccine does contain a substance called an adjuvant, which may result in a slightly higher chance of getting a fever from the shot. Adjuvanted vaccines have not been studied in pregnant women, but are believed to be safe. If you are pregnant and concerned about receiving the H1N1 vaccine, please speak to your doctor or the OHS department for more advice.
People with an allergy to eggs, other influenza vaccine components or those who have had previous serious reactions to influenza vaccination should not receive either flu vaccine. Also, if you are already sick with a fever, you should delay getting vaccinated until you're feeling better.
What are the side effects? The most common side effects of the seasonal and H1N1 flu shots are redness and swelling at the injection site, mild fever and general malaise. These symptoms should not last more than 24-48 hours and can be managed with acetaminophen (Tylenol).
With past seasonal influenza vaccines, there has been a very small risk of a problem called oculorespiratory syndrome, characterized by red eye, sore throat and difficulty breathing. If any of these symptoms occur within 24 hours of getting the vaccine, seek immediate medical attention and notify Occupational Health.
In 1976 when a new vaccine for a swine influenza was rapidly produced and given to a large population in the US, there was an increase in Guillain-Barre syndrome (GBS). GBS is a serious neurological problem that may result in paralysis. The vaccine in 1976 was a very different one from the current H1N1 vaccine (it was also a different "swine flu") and at the time, regulatory review of new vaccines was not as tight as they are now. We have no information to suggest that the current H1N1 vaccine poses an increased risk of GBS.
How many doses of vaccine will be needed?Current information suggests that the H1N1 vaccine is effective after one dose but confirmatory studies are still underway. The seasonal flu vaccine requires only one dose. The two shots should not be given at the same time, as it is unknown whether one may affect the safety or effectiveness of the other. It is recommended that the shots be separated by at least 3 weeks.