• H1N1 is the name applied to a mix of three viruses that causes respiratory illness (influenza). H1N1 was first identified in spring of 2009 in Mexico.

• A pandemic is when there is widespread transmission of an infectious disease, such as influenza, from person to person in several countries throughout the world.  People usually have little or no natural immunity to the virus/disease.
• A pandemic refers to the number of cases and not the severity of the disease.

• H1N1 was first detected in Saskatchewan in May 2009 and the first wave peaked in June. H1N1 continued to circulate at a low level of cases throughout the summer.
• In October influenza like illness reports increased substantially.
• Pandemic H1N1 vaccinations began October 26.  Immunization will continue until everyone who wants to be vaccinated receives one.

H1N1 influenza to date has shown to spread the same way as regular seasonal influenza.

• It can be spread directly from person to person by breathing it in, such as through someone who is infected and is coughing or sneezing.
• It can be spread indirectly by touching an object that has been contaminated by an infected person, then by touching the eyes, nose or mouth.
• Influenza is spread the easiest during the first few days someone becomes ill and is showing signs of obvious illness. It is recommended that persons who are ill with influenza symptoms should stay home from work or school and limit contact with others and not return to routine activities outside the home until at least 24 hours after the fever has gone away - without the use of fever medication.
• Influenza is a respiratory illness and cannot be spread through food.

There are very simple but effective measures that everyone can use to reduce their risk of getting sick.

• Wash hands often with soap and warm water for at least 20 seconds, or use hand sanitizer.
• Keep your hands away from your face.
• Cough and sneeze into your arm, not your hand. If you use a tissue, dispose of it as soon as possible and wash your hands.
• Get immunized. 
• Keep common surface areas-for example, doorknobs, light switches, telephones and keyboards-clean and disinfected. 
• Eat healthy foods and stay physically active to keep your immune system strong.
• Keep doing what you normally do, but if you get sick, stay home. 
• Stay two metres (six feet) away or turn away from a coughing or sneezing person if possible. 
• Talk to a health professional if you experience severe flu-like symptoms. 

• In almost all cases it includes sudden onset of high fever and cough.
• There may also be sore throat, muscle aches, joint pain, chills, fatigue or weakness.
• Vomiting and/or diarrhea may be present and fever may not be prominent. This occurs more often in children.

• Most H1N1 illness to date in Saskatchewan and Canada have been mild to moderate. Visit FluWatch for statistics.
• Severity can range from mild to severe and appears to be more severe in people with underlying illnesses including chronic lung diseases, heart disease, diabetes, asthma, immune deficiency, and in the 2nd and 3rd trimester of pregnancy.

You do NOT need to see a doctor if your symptoms are mild or moderate, and you are otherwise healthy.

You should see a doctor as soon as possible if you have:

• difficulty breathing
• shortness of breath
• chest pain 
• severe or persistent vomiting 
• Adults - high fever that lasts more than two days 
• Children - severe tiredness 
• confusion or difficulty waking an ill person 
• and if you are at high risk for complications from influenza

To help understand the difference between mild, moderate and severe review the information on the H1N1 Decision Chart.

The average length of illness for mild to moderate symptoms is 3-4 days.

In most cases of getting influenza, life long immunity develops. The same is expected for H1N1.

A cough by itself is not an indication for assessment. However, if you are concerned and your child has a persistent cough or interfering with the child's normal activity then you should seek medical advice from your health care provider.

If the child is experiencing difficulty breathing, is turning blue around the lips, etc. you should seek immediate medical attention. Go to the hospital emergency department immediately. Call 9-1-1, if necessary. For information about when to seek medical attention, review the H1N1 Decision Chart. Additional symptoms in children include not waking up or interacting, not eating or drinking enough fluids, being irritable and not wanting to play or be held.

Please go to the website for additional information on How to Differentiate: Cold Allergy Flu.

No, if you do not have signs or symptoms of illness it is recommended you continue with daily activities as normal.

The majority of influenza like illness circulating at this time is H1N1. This has been confirmed by other testing that has occurred. In most cases, it is not necessary to know for certain if someone has H1N1 or another strain of influenza.

The first line of treatment in most cases is stay home, drink plenty of healthy drinks and rest as much as possible.

Antivirals

Antivirals are available only by prescription. They can help to reduce symptoms, shorten the length of illness and reduce the risk of complications. Your health care professional will determine if antivirals are suitable. Antivirals are not advised unless symptoms are moderate-severe to severe, or if influenza symptoms occur in individuals with underlying illness. It is best if they are prescribed within 48 hours of illness.

Vaccine

A vaccine is not a treatment.  It is a way to prevent getting H1N1 by producing immunity to the disease. However, it should not be given if you are currently sick. You should wait until you are feeling better and then get the vaccine.  It is available free to everyone who wants it throughout Saskatchewan. The clinics are currently being run by the regional health authorities. For vaccination information, consent form and a list of clinics in your area check H1N1 Flu Vaccinations in Saskatchewan.

Antiviral Questions

Most cases of H1N1 have been mild. If you are in otherwise good health and develop a mild influenza like illness you should stay home, rest, drink plenty of fluids and may choose to take over the counter medications that you would normally take to relieve symptoms of fever, cough, sore throat, etc. If you develop signs of severe illness, seek medical attention immediately.

If you have influenza like illness and have additional health risks that may increase your risk of complications from influenza, are pregnant or are under 2 years of age, it is recommended you seek advice regarding treatment with antivirals from a health care provider within 48 hours of becoming ill. Your health care provider will determine if antivirals would be effective in treating your illness.

Inform the health care provider who prescribed the antivirals of your symptoms.

Antiviral drugs can be taken with the H1N1 shot because this vaccination contains an inactivated (killed) virus. You can receive vaccination while on antivirals, but you must be well at the time of vaccination. If you have been recently sick with influenza wait until your fever is gone before going to a vaccination clinic.

Vaccine Questions

Yes. Vaccination is recommended for everyone.

Informed Consent is an essential pre-condition to providing health care. It is the professional legal responsibility of the immunization provider to obtain informed consent prior to administering the immunization. Signed consent is a method of helping to make sure you receive all the information you need to in order to decide if you should get the flu shot. It also serves as a checklist for the nurses and a method of keeping track of the number of people receiving vaccination.

Pre-screening before getting the flu shot reduces the chances of severe allergic reaction. The pandemic vaccine continues to remain an extremely safe vaccine. Any and all unusual events after vaccination are fully investigated. Everyone who receives a flu shot is asked to wait in the waiting area for 15 minutes. In rare severe allergic situations, immediate care is available on site and further treatment will follow. Most allergic reactions respond very quickly to treatment, such as epinephrine.

Influenza vaccinations contain a preservative called thimerosal. This same preservative is commonly found in many products, such as contact solution. There are a number of well designed population-based studies documenting the safety profile of thimerosal. World Health Organization (WHO), Global Advisory Committee on vaccine safety concluded that there is currently no evidence of mercury toxicity in infants, children or adults exposed to thimerosal in vaccines. The amount of mercury in thimerosal is barely traceable and considered completely safe. 

Yes. Getting the flu shot before surgery can assist your recovery by preventing influenza during the early stages of healing. It can also be given after a surgical procedure. Talk to you doctor/ care provider and he/she will advise you when the best time for you to received the vaccine.

The H1N1 influenza vaccination given in Canada is safe and is compatible with most medications. If you are taking warfarin or theophylline talk to your doctor as the vaccine may slow down your body's ability to process these medications.

No, you are able to receive both vaccinations at the same time if the clinic you are attending has both vaccines available. Also, if not given on the same day, either vaccine can be given anytime after receiving the other one.

The Public Health Agency of Canada is currently recommending the H1N1 vaccination even for people who have been exposed to H1N1. There is no contraindication to getting the vaccine. In fact, it may even boost your immune response.

The adjuvanted vaccine is recommended for everyone except pregnant women, for whome the unadjuvanted vaccine is preferred.

The dose for individuals 10 years of age and older is 0.5 ml. The dose for children 6 months to less than 10 years is considered a half dose because it is 0.25 mL.

Children 6 months to 3 years should receive a second half dose of vaccine. Children 3-9 years of age with underlying health conditions require a second half dose to produce better protection against H1N1.

Three weeks or more.

The body begins to produce immunity very soon after receiving a vaccine. It takes about two weeks to be fully effective but there is partial immunity after a few days.

Pain or fever medication is not recommended before immunization. After immunization either of these pain and fever relief medications are acceptable. Talk to your physician, nurse or pharmacist to find out which one would be best for you. ASA (Aspirin) is not recommended for children.

A mild fever is a common side effect within 1-2 days after immunization. High fever or vomiting is not a common side effect after getting an immunization. A dry cough is a possible reaction within 6-12 hours of receiving the vaccine, and the cough could last a day or two. Report any illness that is not an expected reaction of vaccination to your physician or nurse.

Children under six months of age are not eligible for vaccination. Childhood immunizations can remain on schedule with the H1N1 vaccination.

It is not a prerequisite to have eaten eggs before getting this vaccine. Eggs are usually not recommended for infant until 12 months of age. If your child is breastfed they are less likely to have allergies. Family history is also important to consider when screening for allergies. If your child has had an allergic reaction to anything (i.e. hives, swelling, difficulty breathing) it is important to inform your doctor or nurse. He/she will help to determine if it is safe to give the vaccination.

A mild illness, without fever, is not a reason to avoid immunization. If you have any signs of influenza at the time of vaccination you will be asked to come back when the symptoms have gone away. To learn the difference between a cold, allergies and influenza review the information sheet How to Differentiate: Cold, Allergy, Flu.

You should not attend a flu clinic if your cough was due to recent influenza and is still causing you to cough up darker or greenish coloured mucous, or if you have a fever. If you are uncertain about your cough and you do not have a fever and are feeling well otherwise, you may choose to attend the clinic and the nurse will assess you there.

The average normal temperature taken by mouth is 37ºC (98.6ºF); by armpit is 36.5ºC (97.7ºF).

If you have a fever, wait till the fever is gone and you are back to your usual day to day activities before coming to the immunization clinic. A mild illness, without fever, is not a reason to avoid immunization.

Talk to a health care provider to determine if it is appropriate to immunize at this time. She/he may suggest deferring the immunization to a later date to ensure the child is well. Children can sometimes have a slightly higher than normal temperature. A slight temperature with no other signs of illness might still allow for the flu shot but will need to be monitored more closely.

Regional health authorities make the decision to offer one or both vaccines through their public health office.  For information on vaccinations, check H1N1 Flu Vaccinations in Saskatchewan.

High Risk Questions

A Body Mass Index greater 30% is considered obese. Visit the Health Canada website for more information.

High risk include: asthma; diabetes and endocrine disorders; neurological disorders including cerebral palsy, epilepsy and other seizure disorders as well as those associated with difficulty swallowing and managing respiratory secretions; down's syndrome and other developmental delays which effect managing respiratory secretions; chronic heart disease including congenital heart abnormality; chronic lung disease including cystic fibrosis which require ongoing treatment; non-white cell haematogical disorders and hemoglobinopathies (eg sickle cell, etc); obesity BMI > 30; cancer (other than leukemia or lymphoma) and not on chemotherapy; and, liver disease.

Immuno-compromised includes: chronic renal failure; hemodialysis; leukemia, lymphoma; chemotherapy; radiotherapy; transplants (solid organ, bone marrow, etc); HIV/AIDS; and, congenital immunodeficiency; and on high dose steroids or other medications causing immuno-suppression such as Remicaide.

Immuno-suppressed clients should consult with their doctor or health care provider to ensure you receive the appropriate vaccine that provides you with the best protection. H1N1 vaccination is highly recommended for immuno-suppressed people in order to prevent complication from the influenza.

Yes, it is recommended you get the H1N1 vaccination.

Science has shown that the first 4 weeks after having a baby is a higher risk because the body is healing and going through the most adjustments back to pre-pregnancy.

We also recommend vaccinating a woman who presents within 4 weeks of a loss of pregnancy regardless of weeks of gestation before the event occurred.

The seasonal and H1N1 influenza are both safe and recommended for breastfeeding mothers. Breastfeeding mothers can pass on immunity through breast milk to her infant.

It is recommended that everyone who lives with or gives care to an infant less than 6 months of age get both the seasonal and H1N1 influenza vaccines.

Your infant can also be protected by ensuring that everyone around the child practices good infection prevention and control (cough/sneeze hygiene, washing hands, keeping ill visitors/family members away from baby, etc).

Miscellaneous Questions

Vaccination is voluntary but highly recommended, especially for certain professions like health care workers. NACI (National Advisory Committee for Immunization) states that getting the influenza vaccine as a health care worker is expected as a duty of care in protecting yourself and your patients.

Some workplaces (such as a health care workplace) can exclude individuals who have not been vaccinated from a certain facility during an outbreak; or require that during an outbreak affected individuals remain on antivirals. Also, during a pandemic, unvaccinated workers may pose an increased risk of passing the virus on to clients/patients and co-workers.

Mass immunization clinics do not offer a way for employers to gather this information. Individual health client data is considered confidential and must be maintained as confidential medical information.

Call your local public health office if you have two or more cases of influenza like illness within a one week period. Maintain good infection prevention and control practices in your facility.

   How can I help to ensure everyone gets immunized? 
If the residents are unable to be transported contact your local public health office for advice. It is best if you are able to transport residents to a clinic.

Operators of a facility, such as a personal care home or a custody facility, should isolate residents who are sick with influenza until he/she is fever free for 24 hours. In case of an outbreak throughout the facility, further restrictions, such as group activities, may also be issued.

Remote and isolated can mean an area a certain distance from service or not having year-round road access. A remote or isolated community is one where health care services are not readily available at an on-site location and maybe at greater risk of complications from delayed treatment or access to intensive care.

If you are traveling within Canada you will be eligible for the H1N1 immunization free of charge at any national clinic, providing you meet the criteria outlined to receive the vaccination.

If you are traveling out of the country you may be refused the opportunity to obtain the vaccine until all country residents have been served. You will not be reimbursed.

If you are from another province you can get the flu shot in Saskatchewan. All that is required is some proof of identification - such as your provincial health card or another form of identification. If you are from another country for an extended period, such as a student or for work, you can still get the flu shot here. You should bring your passport with your work/student visa to the immunization clinic. If you are new to the province, bring something that identifies why you are here and for how long, such as acceptance from your school or a signed and dated letter from your employer when you come for your needle.

Each regional health authority sets the dates, times and eligibility for vaccination clinics in their area. Check H1N1 Flu Vaccinations in Saskatchewan for updates in your region regarding the availability of vaccine and the times and locations of clinics across the province.