The Herald's health reporter tries to wade through the confusion surrounding the H1N1 pandemic. If you want to have your questions answered e-mail ahill@paherald.sk.ca or post your question in the "comment" area. It will be reviewed by Herald staff. The best questions will then be posed to local health officials.

November 19, 2009

Q: Are health officials worried that the H1N1 virus might mutate into something the vaccine won’t protect the public from?
A: “It won’t mutate into something the vaccine cannot protect the public from at this time,” said Dr. Khami Chokani, medical health officer for the Prince Albert Parkland Health Region.
If there are changes, they will be handled as they emerge, he said.
There can be variances with viruses, which is why there are constantly new vaccinations for the seasonal flu. There already are some small variances with the pandemic H1N1, but as to whether a mutation produces a totally new thing, health officials don’t know and at this point won’t speculate.

November 17, 2009

Q: What are some of the secondary infections going along with H1N1? How severe are symptoms? How are people with these co-infections being treated?
A: According to Dr. Mandiangu Nsungu, medical health officer with the Northern Inter-Tribal Health Agency, with H1N1 (and influenza in general) one would expect pneumonia as a secondary infection.
“It is also being seeing in the cases that are being admitted,” he said.
When you get an influenza infection, one of the things the virus does is to multiply in the respiratory system and as a result of the multiplication we have some destruction to tissues.
Bacteria can easily multiply and cause a secondary infection.
If the treatment is not started early enough, people can become more prone to complications — with secondary infection the treatment should be more aggressive.
In the present situation, if there are signs that pneumonia is starting, the patient should start receiving an anti-viral, such as Tamiflu.
People with underlying conditions such as asthma or COPD, the treatment with an anti-viral is recommended to be started early as a way of trying to prevent the multiplication of the virus in the lungs.

Q: When should people go to the hospital? How bad must symptoms they be?
A: “People who have underlying conditions should see a health care provider (as soon as they start with bad symptoms), not necessarily a hospital, but a nurse practitioner or nurse or family physician or walk-in clinic,” said Dr. Mandiangu Nsungu, medical health officer, with the Northern Inter-Tribal Health Agency.
Those who don’t have underlying condition can wait for a while. However whenever people have shortness of breath, it is an indicator that your body telling you that there is a complication and it should be a trigger to see a health care provider.
“It’s as if you are running out of air. Different people have different ways of experiencing that that ... the oxygen exchange is not happening like it should.”
Chest pain is another sign that you could be having a complication.
If the fever has been going on for three days or more, that’s another sign telling you the virus is multiplying.
Another important sign is difficulty or fast breathing in children. The lungs are struggling to provide the adequate oxygen exchange, so the person would be breathing faster than normal.

November 16, 2009

Q: How long is the H1N1 flu season expected to last? And when are the numbers of cases going to peak?
A: According to Doug Dahl, communications co-ordinator for the Prince Albert Parkland Health Region, the region hasn’t yet estimated when the number of H1N1 flu cases may peak.
The typical flu season in Saskatchewan starts in the fall months and continues until February or March. Dahl said the influenza viruses are around all the time and that they don’t expect pandemic H1N1 to be any different.
The region continues to be busy as they continue to see a number of cases going into Victoria Hospital.

Q: Who in this health region will get adjuvanted versus unadjuvanted vaccine?
A: The people who have weakened immune systems, children between six months and nine years, and people 65 years of age and older are recommended to not use the unadjuvanted because it would not provide as strong of an immune response, said Doug Dahl, communications co-ordinator for the Prince Albert Parkland Health Region.
Everyone else can get the unadjuvanted, but health officials recommended the adjuvanted depending on availability. They are currently using both types of vaccine at the PAPHR.
Women who are at less than 20-weeks gestation are recommended to get the unadjuvanted.
The region is following the guidelines set out by the Public Health Agency of Canada.

November 13, 2009

Q: How does the anti-viral Tamiflu work?
A: The way Tamiflu works is it stops the ability of the virus to lock onto the cell. In order for the influenza virus to cause an infection, it has to latch on to a cell and Tamiflu stops the attachment.
Like most types of medication, it works only for a period of time. Without at place to attach, the virus dies because for a virus to survive it has to inject the RNA into the cell. Tamiflu has to be prescribed for each infection.
On the other hand, the vaccination provides white blood cells the information to see if the virus is killing a cell. If the white blood cells see this, they then kill the virus and the infected cell.

 Q: Can public health have any control over who is out in the public and sick?
A: While the health region cannot quarantine people they can follow up on complaints by people who have experienced sick people working in food-eating or food-retail establishments.
In these cases, the flu is just like any other public health concern and the health region is collecting information on these cases.
When they receive information the region can then request that people have their staff tested for flu.
 
Q: Why the two doses for only the kids between the ages of six months and three years and the single dose for kids older?
A: According to Dr. Chokani, medical health officer for the Prince Albert Parkland Health Region, the Public Health Agency of Canada says the reason why this age group requires the second dose has to do with the ability of that age of child to mount an appropriate immune response. In order to help them and to protect them because they are a very vulnerable group, research shows that the second dose at least 21 days later will help booster their immunity and for the moment it is sustained.
A newborn child up to six months of age is totally dependent on the mother’s antibodies. After six months and up to 18 months, the baby learns to produce its own antibodies, and up to three years the immune system is maturing and knowing how to respond. The health officials vaccinate the child in case the immune system is not able to mount that response.

November 12, 2009

Q: If a child is receiving a vaccination and they are not even eating eggs yet, how do people know if they are allergic to eggs?
A: “Egg allergies are not common allergies ... it’s an allergy that can present. The amount of the egg protein in the vaccine is less than one-tenth than the amount of egg protein required to elicit an immune response, an allergic response according to the Canadian society of immunologists.
“If someone does have an allergic reaction or an anaphylactic reaction then our staff are trained to manage that,” said Dr Khami Chokani, medical health officer for the Prince Albert Parkland Health Region.

Q: I've heard that if a person has had a confirmed case of H1N1 they are then immune to it, such as chicken pox, is this true?
A: “No, not necessarily.
“If you do have a chronic condition the ability of the body to mount an adequate immune response to protect you again, a second time, is not there. It is better for you to receive the vaccine.
“Secondly if you are healthy and you do get infected by the strain which was there in the beginning of October and the strain does undergo a mutation and in December you get it again because it is a different strain and your body is not used to it,” said Dr Khami Chokani, medical health officer for the Prince Albert Parkland Health Region.

November 10, 2009

Q: If a person is presently ill with a cold or flu, can they recieve the flu shot or does he/she have to wait until they are recovered?
A: If the person does not have a fever, the H1N1 vaccine can still be received.
If the ill person has a fever, health practitioners say there needs to be 24 hours after the fever subsides, without the aid of Motrin or other fever controlling medications, before they should receive the shot.
“The reason for the wait is because your body’s immune system is really primed and sensitive so the moment when you give a vaccination that is proving a challenge,” said Dr. Khami Chokani, medical health officer for the Prince Albert Parkland Health Region.
“If the body’s defense mechanism is over challenged the person can become sicker — not because of the vaccination, but because of the current, acute disease.”

Q: After receiving the shot, are there long-term effects that may come on months later down the road?
A: None that have been reported, said Dr. Khami Chokani, medical health officer for the Prince Albert Parkland Health Region.
There can be side effects from any vaccines up to eight weeks after immunization, however it is an extremely rare occurrence, less than one in 500,000. The occurrence is called Guillian-Barre Syndrome (GBS).
“It’s the same with every single vaccine; this vaccine is based upon studies and the usage that has gone on before in the same types of formulation in Europe ... The similar vaccine has been used before, these groups have not have any extra reported side effects,” Chokani said.
“Yes, there is a bit of an ache at the site of the injection (immediately after), but that happens with all injections.”
People can feel lousy after the vaccine and likely it’s that they were already carrying a virus or bacteria and it was only a matter of time before they were sick anyway. It was not a true reaction to the vaccination, he said.

Q: Why are some firefighters able to receive the H1N1 vaccination even though they are not health workers?
A:Fire fighters who work as EMT within the fire departments are eligible because they are considered health workers. They would have been offered it at the in house sessions for health workers or they could have waited in line.
According to Fire Chief Les Karpluk, Prince Albert Fire Department has about 10 to 12 of those specially-trained fire fighters, who were offered the vaccine. The rest of the department have not been offered it nor have received the H1N1 vaccine.

November 6, 2009

Q: What is the explanation from the manufacturer as to why the number of doses being sent to Canada is decreasing?
A: According to Dr. Moira McKinnon, chief medical health officer for Saskatchewan, they have received information about the decreased doses.
“The vaccine manufacture GlaxoSmithKline ceased the manufacture of the adjuvanted vaccine and went to manufacture the non-adjuvanted vaccine, the non-adjuvanted vaccine requires fives times as much viral material in it ... so the process is much longer to produce non- adjuvanted vaccine. So they switched their production to that vaccine and as a consequence we’re only able to produce one-fifth the amount of vaccine they would have produced in that week.”

Q: Was the vaccine rushed through testing?
A: According to Wanda Atcheson, manager of public health nursing, for the Prince Albert Parkland Health Region, the vaccine wasn’t rushed through testing.
“It’s not that they sped up the testing, they didn’t cut any corners ... but they submitted the data to Health Canada (throughout the process),” she said.
Normally the data is submitted at the end of all the trials, however with this vaccine the information was submitted to the regulatory board throughout the process. The difference was in how the data was analyzed.
“The process was quicker, but the testing wasn’t sped up,” she said.
The testing started in June and has all been completed to have Health Canada give the final approval.

Q: Why are we not having school clinics in the Prince Albert Parkland Health Region?
A: “Saskatoon and Regina are two of the main ones that are doing them; many other health regions with the rural communities have decided to do mass immunization clinics.
Here in PAPHR we tried to look at getting the consents back in a timely enough period so that we could do them. Also the population we are in now, young children really require a lot of support for immunization. Immunization can be a traumatic event for them. We felt it best to really encourage parents to bring the children in instead of doing through a school-based program. The school-based programs that we do with our routine programs for the most part (involve) older children,” said Wanda Atcheson, manager of public health nursing, Prince Albert Parkland Health Region.
School clinics also require greater numbers of staff, which can present a problem.
“We have 51 schools within our region, we are getting help from other staff, but still to try to get out to 51 schools and do a population from kindergarten to Grade 6 at each of those schools I would suggest at least a half a day at every school. If we are doing that then we can’t offer to as broad a group as we are in our mass immunization clinics. We still need to be running our mass immunization clinics as well,” she said.


Q: I heard a rumour that nurses were throwing out vaccine at the end of the day, is this true?
A: “We don’t throw out vaccine.  Adjuvanted vaccine must be used within 24 hours of mixing however we really monitor what we’re are giving so towards the end of a clinic day instead of having multiple vials open especially if we are not having a clinic the next day — such as a Saturday and we are not having a clinic on Sunday — then we’ll be monitoring and sharing that vial among the nurses that are administering rather than have multiple vials open.
The vaccine itself is in one vial and the adjuvant is in another vial and so we have to mix them prior to injecting,” said Wanda Atcheson, manager of public health nursing, Prince Albert Parkland Health Region.

November 5, 2009

Q: Why are inmates receiving the flu vaccine before the general public?
A: Currently the prison populations in Prince Albert, both federal and provincial have not received vaccinations for H1N1. However inmates are considered to be part of the high-risk groups due to their close living conditions, said Dr.Khami Chokani, medical health officer of the Prince Albert Parkland Health Region. The region will provide supplies and will receive the reports of how many people are vaccinated on each day, but administering the vaccinations is predominately in the hands of the staff in corrections and the penitentiary. It is still under decision as to when the immunizations will begin.

Past Questions

Q: What is the difference between H1N1 and the seasonal flu?
A: The difference is in terms of the virus. The seasonal flu is one that has been going around in the communities for several years and as such we have sort of built up immunity to it, so our bodies are used to the seasonal flu. The pandemic H1N1 is a new virus, it is as a result of the re-assortment of various different viruses to produce this new strain and as such our bodies are not used to it ... The rate at which the signs and symptoms appear and can progress is the difference.

Q: Why does the information we hear keep changing?
A: It keeps changing because this is ... a new virus, a new type of infection that we have not experienced before. Because we are trying to get as much data and our health-care system is rather more advanced and different, so we are able to access information much faster than before.

Q: Are people more at risk of H1N1 if they have had the seasonal flu shot?
A: No, definitely not.
(There was a study several months ago that suggested this might be the case. This has since been proved incorrect, as the sample group used was one that already had additional illness.)

Q: Why are First Nations and Métis populations on the more at-risk list?
A: One of the things is due to an overrepresentation within the high-risk groups and what are those high-risk groups ... One is pregnant women and (the other) is in the age groups of 18-45. Because they seem to be a large representation within those particular high-risk groups ... (With) the data that has been collected, it seems that a disproportionate number of (aboriginals) are affected.

Q: What is the difference between an adjuvanted and an unadjuvanted vaccine?
A: The difference between it is (that) one contains an adjuvant the other one does not. The adjuvant that is in there is known as AS03 and AS03 contains squalene (shark liver oil), water, and vitamin E. ... The reason the adjuvant has been added is that it reduces the amount of the killed virus that is required to elicit an immune response ... The cells easily get hold of (the vaccine) compared to when it is unadjuvanted.

Q: Who should get which vaccine and why?
A: Everybody should get the adjuvanted, except pregnant women. With pregnant women it is important that we do offer unadjuvanted to them irrespective of the stage of pregnancy. It is important that they do receive the unadjuvanted within the first half of pregnancy, which is up to the first 20 weeks, the first trimester. In the last two trimesters or the last half, the unadjuvanted is great, but if there is a situation whereby a pregnant mother (is around the people with the flu she should go ahead and get the adjuvanted at any stage of the pregnancy).

Note: For more information and the detail, see the Public Health Agency of Canada website at phac-aspc.gc.ca

Q: Is the vaccine safe?
A: Yes.

Q: When people call it an experimental vaccine, why?
A: I've heard that term and it's rather unfortunate because the experimental stage was passed long, long ago. In order for it to go through the first stage of its authorization for use in Canada it has to have passed that experimental stage, then go on to further advanced stages ... where they see what the effects are and seeing how much of the vaccine is required to provide the immune response.

Q: What about mercury in the vaccines?
A: The mercury in the vaccines is part of the solution that maintains the stability. Of great interest within this instance of the pandemic influenza vaccine, it contains not more than five micrograms per half-millilitre dose, which is the single dose anyone over the age of nine gets. It is less than the amount of mercury in a can of tuna fish. In order for you to get the amount of mercury in your body that can start to create a problem you need to have eaten five large cans of tuna fish in one sitting.

Q: Is there a link between mercury and autism?
A: The link has been debunked. There is no evidence to show that mercury causes autism.

Q: Who should not receive the vaccine?
A: It is those people who have a severe anaphylactic reaction to eggs.

Q: What is the likelihood of getting the flu without having the vaccine?
A: The likelihood will increase exponentially as the virus starts to circulate more, and more and more within the community.

Q: How do people know if the flu people have is the serious flu?
A: It is very dependent on the clinical assessment. The key component ... is when you are not feeling any better. If you first went to see your doctor and you just had sniffles and an occasional cough and a few days later you are feeling shortness of breath, that is an added complex situation. That means you need to see your family physician or at least a health-care professional who can give you advice if you really do need to go in or not.

Q: Is the vaccine free?
A: Yes, the pandemic vaccine is free of charge to every single person who resides within Canada.

Q: If I've had the flu, do I still need to get the vaccine?
A: This is the million-dollar question. It is very dependent upon on whether you were a lab-confirmed case or not. If you had all the signs symptoms of having the flu and you did happen to have the lab test done and it wasn't positive it is advisable that you get the flu shot. If you have any chronic underlying conditions, especially if it is something that affects your immune system, you definitely do need to because even though you may have been lab confirmed ... The reason being that there is no guarantee that you will be able to mount the appropriate immune response that would be able to offer you the protection when you are exposed to it again.

Thirdly, because it is a new vaccine, our bodies have not learned to respond to it that well. If you have had (the flu), it's not going to hurt you to get the vaccine. It's better to be safe than sorry.

Q: If I've had the vaccine, can I still get the flu?
A: The chances are there, but the way you are going to get ill will be greatly mitigated. Inside of getting it and ending up in a situation where you are hospitalized, it may just be a touch of a runny nose, or you may get a fever for a day then it is gone.

Q: Are the vaccinations coming out too late?
A: This is a rather challenging situation and challenging, in that, yes, we are starting to see more cases, and yes, it is starting to go (through) its rounds in the communities ... The vaccine (will) help high-risk people who may still get it because they may only present with a mild case and we think it's gone and then 24 hours later, a week later, it comes back with a vengeance. It's never too late to be vaccinated.