With the flu season now upon us, controversy swirls around the H1N1 vaccination, with half the population or more in some countries, including health care professionals, refusing to take it, and many questioning its safety, its efficacy and the need for it. In the United States, government forecasts of how much vaccine would be available for the public at this time have proven massively inaccurate, causing many to doubt the government's ability to handle an epidemic, should one develop. A great deal of misinformation about who should get the vaccine and what the side effects could be adds to the general sense of confusion. But the flu is here and it's not going away anytime soon.  

In Canada, Saskatchewan received its first supplies today, just as a new outbreak of the flu hit the southeastern part of the province. Twenty people in the Sun Country Health Region are confirmed to have the swine flu virus. So far, five people have died from the virus in Saskatchewan.

In Europe the flu is spreading and claiming more fatalities, with the global death toll now approaching 5,000. Most of these fatalities (3,539) have been in the Americas, according to the World Health Organization (WHO), but as winter approaches in the North, countries like the Netherlands are seeing greater numbers of people infected with the flu virus.

Britain's new H1N1 cases shot from 27,000 to 53,000 in just a week, making it the worst-hit country in Europe.

 Health care workers among the most resistant to being vaccinated

Flu vaccine has been around for many years now and has been administered to countless millions with few ill effects. One might expect that the public would jump at the chance to ward off a potentially deadly virus with just another simple flu shot. For the average person, there is virtually no risk—nothing to lose and much to gain. Yet reluctance to be vaccinated runs deep in much of the population, especially among those one would expect to be more favourably disposed. In many jurisdictions, health workers are split down the middle, with about 50 percent in Ottawa refusing to accept the vaccine. Ontario's 54,000 nurses are far from unanimous in accepting the benefits of vaccination. For many, the reluctance is based on uncertainty: is it safe? Is it necessary? What are the possible side effects?

At present, the shot is not mandatory for health workers in Ontario, though New York State has made it so. Previous attempts to make vaccination of health workers for seasonal flu mandatory in Ontario have been met with threats by paramedics to walk off the job and a legal challenge by their union, the Canadian Union of Public Employees. The union is in favour of vaccination, but supports members' right to refuse. The Ontario Public Service Employees Union, the union representing hospital workers, supports the vaccination program, but can do little to make its members comply. Public health officials must therefore face the quandary: how can health workers provide care for the public if they themselves fall ill with the flu? An even more dangerous scenario could be one in which infected health workers are themselves spreading the virus.

Shortages of vaccine and public skepticism in the US

In the United States, shortages of the H1N1 vaccine are causing delays in getting it to the population, though much of the population is in no apparent hurry to get the vaccine. A poll conducted by the Washington Post and ABC news suggests that six in ten respondents will not be getting the vaccine and just over half (52 percent) will have their children vaccinated. This wariness of the vaccine is in spite of the growing numbers of school closures caused by the flu. At present, enough vaccine is available for just a fraction of the population.

The Centers for Disease Control and Prevention says it will be widely available in mid-November. The US government had originally announced that 120 million doses would be available by now, but that number has dropped to barely 15 million available as of today. In some communities like Seattle, health-care workers are being given priority in receiving what vaccine is available. Meanwhile, health departments are struggling to keep up, not because of overwhelming demand, but rather because of shortages of the vaccine.

Should you get the vaccine?

The US Centers for Disease Control and Prevention (CDC) recommends that these target groups receive the 2009 H1N1 vaccine*

• pregnant women
• people who live with or care for children younger than six months of age healthcare and emergency medical services personnel
• persons between six months and twenty-four years of age
• people from twenty-five through sixty-four years of age who have chronic health disorders or compromised immune systems.

*Seasonal flu vaccine may be given at the same time as the H1N1, though not at the same site; i.e., one to the left arm, the other to the right arm.

The CDC cautions that people who are allergic to eggs might be at risk for allergic reactions to influenza vaccines, including the 2009 H1N1 vaccine. Anyone who has had any of the following symptoms or experiences should consult with a doctor or other medical professional before considering any influenza vaccination:

• hives or swelling of the lips or tongue
• acute respiratory distress (trouble breathing) after eating eggs
• documented hypersensitivity to eggs, including those who have had asthma related to egg exposure at their workplace or other allergic responses to egg protein

The CDC is explicit about the recommended vaccination of pregnant women at any time during pregnancy, stating that the flu shot is "the single best way to protect against the flu. It is important for a pregnant woman to receive both the 2009 H1N1 flu shot and the seasonal flu shot. A pregnant woman who gets any type of flu has a greater chance for serious health problems . . . Pregnant women are also more likely to have serious illness and death from 2009 H1N1 flu."

Note: the CDC does specify that "pregnant women should not receive nasal spray for the seasonal or 2009 H1N1 flu vaccine . . . The nasal spray vaccine can be used in healthy people 2-49 years of age who are not pregnant and in women after they deliver, even if they are nursing."

Side effects

The side effects from 2009 H1N1 flu shots are expected to be like those from seasonal flu shots. The most common side effects are mild, such soreness and tenderness, redness and swelling where the shot was given. Some people might have headache, muscle aches, fever, and nausea or feel tired.  If these problems occur, they usually begin soon after the shot and may last as long as one or two days.  Some people may faint after getting any shot. Sometimes, flu shots can cause serious problems like severe allergic reactions. But, life-threatening allergic reactions to vaccines are very rare. 

A person who has a severe (life-threatening) allergy to eggs or to anything else in the vaccine should not get the shot, even if she is pregnant. Pregnant women should tell the person giving the shots if they have any severe allergies or if they have ever had a severe allergic reaction following a flu shot.

Following are those recommended to have the seasonal flu shot

• Children between six months and nineteen years of age
• Pregnant women
• People fifty years of age and older
• People of any age with certain chronic medical conditions
• People who live in nursing homes and other long-term care facilities
• People who live with or care for those at high risk for complications from flu, including:Health care workers
• Household contacts of persons at high risk for complications from the flu
• Household contacts and out of home caregivers of children less than six months of age (these children are too young to be vaccinated)

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