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September 23, 2009 10:08  by Dr. Neil Rau

We are approaching the time of year when the seasonal flu vaccine clinic ritual usually begins. High-risk and older patients and health care workers are usually the first to get their flu vaccines, while nursing homes obtain consent from families to administer the same. Then workplaces promote it, and ultimately anyone else who wants it is offered it, hopefully by the end of November.

But this is an exceptional flu year, and I foresee a well-informed departure from the ritual.

The recent Southern Hemisphere experience with the swine flu (pandemic H1N1) informs us of what to expect this fall. After the first few weeks into their flu season, more than 90% of flu disease was caused by the pandemic strain. By the end of our first wave (or should I call it our first ripple?), swine flu also predominated over seasonal flu. As it turns out, flu experts who advise the World Health Organization are now urging vaccine manufacturers in the Southern Hemisphere to drop the older H1N1 strain from the seasonal flu vaccine for next year's winter, to include the new swine flu pandemic H1N1 strain.

In essence, the Southern Hemisphere experienced a year with swine flu instead of seasonal flu. Not a bad trade now that we know that swine flu is less deadly than seasonal flu! Now that we in Canada will be facing swine flu in typical season, we can anticipate a similar picture this fall.

So is swine flu still a pandemic? Yes, if one looks at this from the virus’ perspective. Swine flu is indeed a new virus that is highly contagious, to which there is little population immunity. We have documented out-of-season spread, with sporadic activity through the summer in the Northern Hemisphere. In addition, we have witnessed “strain replacement” in the Southern Hemisphere, which describes how swine flu has temporarily “crowded out” seasonal flu.

All the same, it’s a pandemic without a punch – little population impact in terms of deaths, severe illness or community illness. As my colleague Dr. Richard Schabas has appropriately said, swine flu is pretty much a “pandemic dud.” 

So what to do with seasonal flu vaccination for the upcoming season? Given the virtual certainty that swine flu will predominate this fall, putting the seasonal flu vaccine on hold is a logical option, even though the U.S. is being recommended not to go this way. Some groups in Quebec are entertaining the idea holding off the seasonal flu vaccine until the swine flu vaccine has been given to those who need it.

Given that those over 50 are largely immune to swine flu, another strategy comes to mind. We could be selective with the seasonal flu vaccine this year, and give it only to high-risk patients over age 50 and those who look after them (this would mean health care workers, such as myself). Older patients are still at risk of complications from seasonal flu, as they always are. Younger adults, though, are less at risk of seasonal flu. We could spare the younger group the need for both seasonal and swine flu vaccines. Not only would this mean that healthy, young people wouldn’t have to undergo two needles, it would reduce the potential of patients being confused about which shot they’ve received and which they still need.

We could then certainly target the priority groups for swine flu vaccination as we await the new vaccine safety data before going after everyone else (See my previous blog on this topic). And if the late flu season shows hints of a resurgence of seasonal flu, we could always implement the seasonal flu vaccine for high-risk younger patients, at that stage.

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Dr. Marla Shapiroclose [x]

Dr. Marla Shapiro, MDCM CCFP MHSc FRCP(C) FCFP, is a family physician and the Health and Medical Contributor for CTV's Canada AM as well as the editor of Parents Canada magazine, launched in March 2007.

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