Flu shot plans vary across Canada

Provinces and territoriesappear to haveno standard approach to flu vaccinationsas they examinepreliminary research suggesting people who have hadseasonal flu shots might be at greater risk of catching swine flu.

Ontario's chief medical officer of health announceda three-pronged approach to flu vaccination in the province Thursday:

• Seasonal flu vaccinations for people older than 65 and residents of long-term care homes will take placein October, sincethose groupsare considered to be at greater risk from that fluthan from swine flu.
• Awiderswine flu vaccination campaignforthe rest of the population starting in November, whena vaccine becomes available against the H1N1 influenza Avirus, the swine flu strain that has been spreading worldwide since April.
• Seasonal flu vaccinations for peopleyounger than65 but only after the H1N1 shots have beengiven.

A similar approach in delaying seasonal flu vaccinations has been adopted by Quebec, which will hold off seasonalshots until January, as well as by Saskatchewan andNova Scotia.Other provinces, including British Columbia, are also considering it.

But New Brunswick hopes to complete its seasonal vaccination program by mid-October, instead of offering the shots in November as in previous years.

Newfoundland and Labradorhasrecommendedthe seasonal flu shot be given out starting in October to anyone over the age of 65, residents of long-term care homes and adults and children with chronic heart or lung disease. The provinceplans tooffer swine flu shotsstarting in November, or earlier if deemed necessary.

Other provinces and territories haven'tformally announced their flu shot plans yet.

Call for national approach

Most provinces and territories have been reviewing their vaccination plans since Canadian researchers found people who had received the seasonal flu vaccine in the past were twice aslikely to get the H1N1 virus. The research has not yet been peer-reviewed or published.

Theoretically, antibodies created by the immune system after exposure to bacteria or a virus canfacilitate the entry of another strain of the virus or disease. The effect has been seen for otherviral vaccinations but never for influenza, said Dr. DonaldLow, chief microbiologist at Mount Sinai Hospital in Toronto.

"I think it's a reason that it would be great to have a national policy on this because we're now hearing messages from different provinces about different approaches to this issue with these new results that have come out," Low said Friday.

"That is also going to confuse individuals," especially sincethe research findsare confusing to doctors and medical researchers as well, he said.

Dr. David Butler-Jones, Canada's chief public health officer, said people should followvaccination advice from their provincial and territorial medical officers of health.

"I'm not worried about the seasonal vaccine," he told reporters.

The head of the U.S. Centers for Disease Control said Fridayhis agencywould love to see Canadian data that appear to link getting a seasonal flu shot with catching swine flu.

U.S.data don'tsuggest that the seasonal flu vaccine "has any impact on the likelihood of getting H1N1," Dr. Thomas Frieden said.Hehas ordered his own scientists to review the findings.

Meanwhile, the CDCis recommending that vaccinations for both seasonal and H1N1 flu go ahead as quickly as possible.

Butler-Jones noted that the Canadiangovernment has purchased 600,000more doses of H1N1 vaccine that does not include an adjuvant, a substance used to boost immune response.

About1.8 million doses will be offered to pregnant women and children under the age of three, since there islittle clinical data on the safety and effectiveness of the adjuvant inthose two groups.

As of Thursday, there were 78 deaths in Canada among people with confirmed H1N1, up by two since Sept. 12. There were also 15 people in hospital and three admissions to intensive-care units in that time, Health Minister Leona Aglukkaq told reporters.