Pandemic Influenza A/H1N1, Seasonal Influenza and Pneumococcal Vaccines: Frequently Asked Questions
QUESTIONS:
ANSWERS:
The pandemic influenza A/H1N1 (H1N1 or pH1N1) virus is a new strain of influenza. It contains parts of genes from pig, bird and human influenza. This combination of genes in H1N1 has never been seen before and everyone is susceptible.
Yes, there is a vaccine. There are two types of vaccines available in Canada to prevent H1N1. The first is the adjuvanted vaccine, and it was approved for use by Health Canada on October 21st, 2009. The second is the non-adjuvanted vaccine. It is recommended for pregnant women. The non-adjuvanted vaccine can also be used in healthy people 10 to 64 years old, and in children 3 to 9 years old (upon parental request).
2. When will the vaccine be available?
The adjuvanted and non-adjuvanted H1N1 vaccines are both available now for all British Columbians.
3. Who should get the H1N1 vaccine? Why?
The H1N1 vaccine is being offered, free of charge, to all British Columbians who need or want it.
The Public Health Agency of Canada has outlined guidelines identifying groups which will benefit most from the vaccine. These can be classified as:
A: Those for whom the vaccine is strongly recommended
B: Those for whom the vaccine is recommended
A: Those for whom the vaccine is strongly recommended are:
- People under 65 with chronic medical conditions because they are at higher risk of complications due to H1N1 infection.
- Pregnant women because they are at highest risk of severe disease. The vaccine will also potentially protect their fetus and infant once they are born.
- Children 6 months to less than 5 years old because children aged 6 months to 2 years are at particular risk of severe disease and hospitalization and children 2 to less than 5 years old are at higher risk of severe disease and hospitalization than are older children.
- Persons residing in remote and isolated settings because they often have limited access to medical care. They may have higher concentrations of persons with chronic conditions. High rates of morbidity and mortality were observed in some remote Aboriginal communities in Canada.
- Health care workers because this will protect health care workers, prevent outbreaks, and stop the potential spread of H1N1 to vulnerable patients.
- Household contacts and care providers of persons at high risk who cannot be immunized or may not respond to vaccines because this will protect those individuals who are at high risk.
- Populations otherwise identified as high risk. These populations can be identified based on local conditions and observed disease spread.
B : Others for whom the vaccine is recommended:
- Children 5 to 18 years old. This group has the highest rate of H1N1 infection and can transmit the infection to many other people.
- First responders because they frequently attend emergency health situations.
- Poultry and swine workers in order to reduce their risk of being infected with H1N1 and other influenza strains, which could lead to the emergence of new influenza strains.
- Adults 19 to 64 years of age because they have an increased risk of severe H1N1 disease at this time.
- Adults 65 years of age and older because, although they have low rates of H1N1 infection, there is the potential for reduced response to the vaccine.
Contact your local Public Health Unit or your doctor to get your vaccine(s). Use the online Flu Clinic Locator to locate an influenza clinic near you!
The vaccine is safe and available for everyone. However, if you had laboratory-confirmed H1N1 infection, you should have natural immunity and would not need the vaccine.
Most people will not have had laboratory testing of their illness. If you do not know for certain that you had H1N1 influenza, you should get the vaccine. Many viruses can cause influenza-like illness and you may still be vulnerable to H1N1.
No. Evidence has suggested that there is no significant cross-protection between the seasonal influenza vaccine and H1N1.
7. Is the H1N1 vaccine safe?
Yes. Vaccine safety is a priority. Clinical trials of the adjuvanted vaccine in adults have been conducted and other trials in other age and risk groups are being done. All results to date indicate safety of this vaccine. The non-adjuvanted vaccine, which is recommended for pregnancy, is formulated the same way as seasonal vaccines and is expected to have the same safety profile as seasonal vaccine.
8. What side effects can I expect after the H1N1 vaccine?
The influenza vaccines can cause pain, redness and swelling at the location where the injection is given. Nine out of 10 people who get the adjuvanted vaccine will have pain, which lasts a few days and resolves by itself. Those who have had the seasonal influenza vaccine in the past may notice that the adjuvanted vaccine causes more pain than the seasonal vaccine. The vaccines can also cause transient muscle or joint aches, which also resolve in a few days. Other symptoms such as fever, headache, and fatigue are less common.
Yes. Either of the two types of vaccine for A/H1N1 can be given to pregnant women. However the non-adjuvanted vaccine is recommended in BC for use in pregnancy. It is very similar to the normal seasonal influenza vaccine, for which excellent safety data in pregnant women are available. There are no specific safety concerns about using the adjuvanted vaccine in pregnancy but its use in pregnancy will not be studied.
Pregnant women are at increased risk of complications from H1N1 compared to those who are not pregnant. The risk rises as the pregnancy progresses and is highest in the second half of pregnancy.
When a women gets immunized during pregnancy it protects protects the baby in two important ways. First, babies receive antibodies from their mother through the placenta during the pregnancy and through breastfeeding after birth. Second, immunization prevents the mother from getting sick with the H1N1 influenza virus and passing it to her baby after birth.
Other household members and caregivers of babies under 6 months of age should also get H1N1 vaccine because the vaccines will not be approved for use before 6 months of age. That’s because influenza vaccines don’t work well in very young babies.
Yes. Babies and young children of this age can receive the adjuvanted vaccine. They will need two half-doses.
Neither the seasonal nor the H1N1 influenza vaccines have been proven effective in this age group. These vaccines are not licensed to be used for infants.
These young infants can be protected from exposure to the virus if their caregivers and household contacts and caregivers get immunized.
Breastfeeding does provide some protection against infections in babies. Antibodies in the mother’s blood pass into breast milk. In addition, mothers who are immunized during pregnancy will pass some protection to their infants through the placenta, and the baby will have some ‘maternal’ antibodies for some time. Both respiratory infections and those that cause vomiting and diarrhea occur less often in breast-fed infants.
Breast feeding does not provide perfect protection however, and care should be taken to avoid infecting young babies. For babies too young to be vaccinated themselves (under 6 months old) important prevention measures include immunizing household members with A/H1N1 vaccine, and keeping babies away from people with coughs and flu-like illness. If the mother becomes ill, breastfeeding will not infect the baby and can be continued. She should take care to avoid infecting the baby with her coughs, sneezes, and hands by covering her mouth when coughing, washing hands frequently, and avoiding touching the baby’s mouth and nose with potentially contaminated hands.
13. Will my child need 1 or 2 doses?
Infants and children 6 months to less than 3 years of age will get 2 doses. Those aged 3 to less than 10 years of age with chronic medical conditions will get 2 doses. Healthy children aged 3 to less than 10 years of age will get 1 dose for now. Please check back for more information.
All people 10 years of age and older will receive 1 dose of H1N1 vaccine.
14. Will the H1N1 vaccine be mandatory?
No. Vaccines in British Columbia are not mandatory. People are encouraged to get information about the benefits and side effects of the vaccine, get their questions answered by their health care provider, and to make their individual decision. The H1N1 vaccine will be available to all who need or want it. Getting the vaccine is the best way to prevent catching H1N1 and is recommended.
15. What is in the H1N1 vaccine?
Influenza vaccines are made with killed and split parts of the H1N1 virus strain. These killed parts of the virus cannot replicate and cannot cause influenza infection. All of the H1N1 vaccines contain A/California/7/2009 (H1N1)v-like strain, so that the vaccine recipient will create an immune response to the H1N1 virus.
There are 2 types of H1N1 vaccine available. One contains an adjuvant and will be available to most of the BC population. The other will be non-adjuvanted and will be available to pregnant women. It can also be used in healthy people 10 to 64 years old, and in children 3 to 9 years old (upon parental request). The non-adjuvanted vaccine is very similar to the seasonal influenza vaccine but contains protection against H1N1.
An adjuvant is a substance that is added to the vaccine in order to increase the individual’s immune response to an antigen. In the case of the influenza vaccine, the antigen is the killed split parts of the H1N1 virus.
The adjuvant used in the H1N1 vaccine is called AS03. It contains:
- Squalene: a natural substance produced by plants, animals and humans. In humans the production of squalene is essential for life. It is made by the liver and is needed to produce cholesterol and steroid hormones. Squalene is also a component of cell membranes and circulates in the bloodstream. Over 45 million doses of squalene-containing vaccine have been given worldwide. Squalene-containing vaccines have an excellent safety record.
- Vitamin E: also known as alpha-tocopherol, an anti-oxidant.
- Polysorbate 80: a stabilizer used extensively in many vaccines, as well as other medical and non-medical products.
All of the H1N1 vaccines also contain trace amounts of substances which are left over from early stages of production, although the majority has been removed through purification steps. These substances include: egg proteins (because the virus is grown in fertilized hen’s eggs), formaldehyde (which is used to inactivate the virus), and sodium deoxycholate (which is a virus splitting agent and comes from bovine or ovine origins). The H1N1 vaccine also contains trace amounts of thimerosal, a preservative that helps prevent multi-dose vaccines from contamination with bacteria or fungi.
Extensive scientific evidence has shown NO link between thimerosal and autism, other neurodevelopmental disease, or brain damage. Thimerosal is a safe and effective preservative that has been used in some vaccines since the 1930s. It contains ethyl mercury, which is metabolized and excreted by the body more quickly, and not methyl mercury, which is associated with mercury poisoning in environmental contamination.
The ASO3 adjuvant has been tested in over 45,000 people around the world and has been evaluated by Health Canada as part of the review of the related A/H5N1 avian influenza pre-pandemic vaccine. No safety concerns regarding the use of the adjuvanted vaccine have been seen.
Yes. The squalene in the vaccine is highly-purified and contains no fish proteins. Proteins are the allergenic parts of food, including fish. Squalene is naturally produced by the body by the liver and cannot trigger an allergic response.
Influenza, often called the ‘flu’, is an infection of the nose, throat and lungs caused by an influenza virus. Symptoms include fever, body aches, a headache, a dry cough, and a sore or dry throat. You will probably feel tired and less hungry than usual. The symptoms usually are the worst for the first 3 or 4 days,but it can take 1 to 2 weeks to get completely better. While people may refer to having had a “stomach flu”, that illness is not caused by an influenza virus, although children can have some gastro-intestinal symptoms with influenza.
A person with influenza is also at risk of other infections including pneumonia, an infection of the lungs that may lead to severe breathing difficulties.
No. Influenza vaccines are made with killed parts of the influenza virus that cannot multiply and therefore cannot cause influenza infection.
Influenza vaccines are given at times when there are other viruses in the community that can cause influenza-like symptoms. You may happen to catch a different virus at the same time as you get immunized.
Some people experience swelling of the arm, aches, and a low fever after getting the vaccine, which could be mistaken for a very mild influenza infection. This should pass in a day or two.
In British Columbia, both seasonal influenza vaccine (given every year) and vaccine for pandemic influenza A/H1N1 (H1N1) will be given. The seasonal vaccine was offered to people 65 years of age and older and residents of long-term care facilities starting mid-October. The elderly are more susceptible to serious complications and hospitalization from seasonal influenza infection.
The H1N1 vaccine is free for anyone who needs or wants it. The H1N1 and the seasonal influenza vaccines may be given at the same time to those who are eligible for both.
Recommendations for who should receive the seasonal influenza vaccine are unchanged from previous years, and include seniors and those living in long-term care facilities, those under 65 with certain chronic medical conditions, infants and toddlers aged 6 months to under 2 years, women who will be in their third trimester of pregnancy during the influenza season, household contacts of such individuals, health care workers, and first responders.
Pandemic H1N1 vaccine is now available to all British Columbians, and can be given at the same time as seasonal vaccine.
People who don’t wish to receive the two vaccines at the same time should get the pandemic H1N1 vaccine first, pandemic influenza is circulating currently. Seasonal vaccine can be given at any interval following H1N1 vaccination.
- Heart or lung disorders that require regular medical care, including asthma, chronic obstructive pulmonary disease, cystic fibrosis
- Kidney disease, diabetes, cancer, anemia, or weakened immune systems
- Those with health concerns causing difficulty breathing, swallowing, or a risk of choking on food or fluids (including persons with severe brain damage, spinal cord injury, seizures or neuromuscular disorders)
- Children and teenagers taking Aspirin (ASA) for long periods of time
Contact your local Public Health Unit or your doctor to get your vaccine(s). Use the online Flu Clinic Locator to locate an influenza clinic near you!
Yes. British Columbia has ordered enough H1N1 vaccine for everyone who needs or wants it. The seasonal influenza vaccine is offered for free to certain groups of the population, as is the pneumococcal vaccine, and more doses than usual have been purchased to ensure all who are eligible can get their shots.
The symptoms of H1N1 are similar to those of normal seasonal influenza. These include fever, cough, sore throat, headache, body aches, chills, fatigue, eye pain, shortness of breath, and lack of appetite. Some people and especially children also experience nausea, vomiting, and diarrhoea. Symptoms or complications such as severe problems breathing or pneumonia may develop in moderate or severe cases. People with chronic health conditions are more likely to develop complications from H1N1 infection.
No. The H1N1 pandemic is very different from typical influenza seasons. While H1N1 infections, so far, have been generally mild, H1N1 is infecting more and younger people than usual. It is very unusual to have a higher risk of severe influenza infection among younger people. Compared with seasonal influenza, we are expecting a greater proportion of the young population to suffer severe outcomes.
12. What happens if I get H1N1?
In most cases of H1N1, the infections have been generally mild and most patients have recovered without treatment.
Antiviral drugs (e.g., Tamiflu) may be used early in the illness in those at higher risk for more severe disease. Speak to your doctor or pharmacist if you are in this group.
Antiviral drugs decrease the seriousness and length of illness. They work best if given within 48 hours of the onset of symptoms.
Antiviral drugs should not be used to prevent getting influenza because this can cause resistance of the virus.
More information is available at:
The seasonal influenza vaccine may be given together with H1N1 vaccine to those who are eligible for both.
It is expected that, similar to what happened in the Southern Hemisphere’s influenza season this summer, H1N1 will be the predominant strain of influenza. However, seasonal influenza is circulating although to a small degree. As it cannot be guaranteed that seasonal influenza will not occur this year, it is important to receive protection if you are in the recommended groups to receive seasonal vaccine.
Canadian studies have suggested that there is a possible association between previously getting the seasonal influenza vaccine and risk of acquiring H1N1 infection.
These results have not been observed in other countries. This research is currently being peer-reviewed internationally, and is expected to be published soon.
BC made a recommendation in late September to defer seasonal vaccine for those younger than 65 because of these findings. Most other provinces and territories in Canada made similar decisions. Now that it has been recommended that the pandemic and seasonal vaccines can be given at the same time, this is the best approach for people who need both vaccines.
Pneumococcal infection is caused by bacteria (pneumococcus), which can attack different parts of the body. These infections can cause serious and life-threatening illnesses, including meningitis (an infection of the lining that covers the brain) and septicaemia (an infection of the blood). They can also cause pneumonia (an infection of the lungs wherein the air sacs get filled with fluid). Pneumococcal disease can be very serious, especially in infants, adults with chronic medical conditions, and older adults.
Pneumococcus is spread by coughing, sneezing, or contact with respiratory secretions.
Pneumococcal infection is the most common complication of influenza.
A recent study found that 29% of the fatal H1N1 cases in the last few months also had an infection caused by bacteria. Almost half of these infections were caused by pneumococcus bacteria.
Yes. Two vaccines against pneumococcal infection are available.
- The Pneumococcal Conjugate vaccine protects against infection from seven types of pneumococcal bacteria. This vaccine is part of the routine immunization schedule for children in Canada. It is important that parents ensure their children are completely vaccinated on time. Healthy infants get vaccinated at 2, 4 and 12 months. Infants with chronic medical conditions are given 4 doses following a 2, 4, 6 and 12 month schedule.
- The Pneumococcal Polysaccharide vaccine protects against 23 types of pneumococcal bacteria. This vaccine is recommended for seniors 65 years and older, residents of long-term care facilities, and individuals two years of age and older with certain chronic medical conditions.
All children should receive their Pneumococcal Conjugate vaccine at 2, 4, and 12 months of age.
The Pneumococcal Polysaccharide vaccine is recommended for all seniors 65 years and older, residents of long-term care facilities, and individuals two years of age and older with certain chronic medical conditions. These medical conditions include:
- Sickle cell disease
- Immunosuppression related to disease (e.g., HIV, lymphoma, Hodgkin’s, multiple myeloma) or therapy (e.g. high dose, systemic steroids or severe rheumatoid arthritis requiring immunosuppressive therapy)
- Congenital immunodeficiency states (e.g., complement, properdin or factor D deficiency)
- Receipt of a hematopoietic stem cell transplant (HSCT)
- Solid organ or islet cell transplant (candidate or recipient)
- Chronic heart or lung disease (except asthma, unless management involves ongoing high dose oral corticosteroid therapy)
- Chronic liver disease including cirrhosis, chronic hepatitis B, chronic hepatitis C
- Chronic kidney disease
- Diabetes
- Cystic fibrosis
- Chronic CSF leak
- Cochlear implant (candidate or recipient)
- Anatomic or functional asplenia (children up to and including 16 years of age)
If your child has received 3 doses of Pneumococcal Conjugate vaccine at 2, 4 and 12 months of age, they do not require a booster. If they have a chronic medical condition, they should have had 4 doses given at 2, 4, 6, and 12 months. After two years of age, children with chronic conditions that put them at higher risk of pneumococcal disease should also get a dose of the Pneumococcal Polysaccharide vaccine that will protect them against more strains of the bacteria.
Most adults will only require 1 dose of Pneumococcal Polysaccharide vaccine, which should last their lifetime. People with certain medical conditions are recommended to get one revaccination.
Contact your local public health unit or your doctor to get a pneumococcal vaccine.
