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Flashback: Seasonal flu shot may increase H1N1 risk | Swine flu death rate similar to seasonal flu: expert | Swine flu unlikely to become superbug | UK: Half of all pregnant women will refuse swine flu jab, poll reveals | Flu vaccine plan will be too slow: CMAJ | Swine flu jab link to killer nerve disease: Leaked letter reveals concern of neurologists over 25 deaths in America | Canada to order 50.4 million H1N1 vaccine doses – with adjuvant additive | Genetically modified Swine Flu hybrid may provide vaccine yield solution | Washington Post: Swine Flu Vaccine Will Contain Mercury | UK Government Swine Flu Advisor On Vaccine Maker Payroll | Fast-tracked swine flu vaccine will be safe, officials insist | Swine flu: How scared should we be? | Top Epidemiologist Slams Swine Flu Fearmongering | Legal immunity set for swine flu vaccine makers | Lessons of 1976: swine flu, fear, mass vaccinations, wasted millions | ‘Accidental’ Contamination Of Vaccine With Live Avian Flu Virus Virtually Impossible | Officials investigate how bird flu contaminated vaccines in Europe

Update (2009/9/26): The CDC is expressing some skepticism and wants to see the data.

Theresa Boyle, Toronto Star
September 25, 2009

Ontario’s plan: 1. Seasonal shot for seniors. 2. H1N1 vaccine for all. 3. Seasonal shot for people under 65

Ontario is delaying the seasonal flu shot program until after a pandemic vaccine is administered, due in part to concerns the seasonal flu shot could raise the risk of catching swine flu.

The fears are prompting the province to take the unusual step of responding to a an unpublished Canadian study, which has not been peer reviewed or independently validated, Dr. Arlene King, Ontario Chief Medical Officer of Health, told a news conference yesterday.

“There is emerging, unpublished evidence from some Canadian studies that suggest the possible association between prior seasonal flu vaccination and getting the H1N1 flu. The nature of this association is unclear at this time, so we want people under 65 to wait to get the seasonal flu shot after the H1N1 flu vaccine until we learn more about this,” she said.

Ontario’s vaccination program will be rolled out in three stages.

The seasonal flu shot will be available in October to people 65 and older and residents of long-term care facilities.

The H1N1 vaccine will be available in November, first to those who are most susceptible to serious illness.

The province will provide the seasonal flu shot to the rest of the population in December and January.

That approach also takes into account the fact some populations are more susceptible to H1N1 than others, King said.

The unpublished data – from a series of studies out of Ontario, Quebec and British Columbia – appear to suggest that people who were inoculated against the seasonal virus last year are about twice as likely to catch swine flu as those who were not vaccinated. The findings are causing concern internationally.

Normally, Ontario has a single vaccination program for seasonal flu that starts in October. This year, however, there are two programs: one for seasonal flu and one for the H1N1 virus. The seasonal vaccine was already in production when the H1N1 pandemic hit earlier this year, and protects against different strains of influenza.

“It’s a different flu season this year and rolling out two flu vaccine programs is a great example of how different it is,” King said.

Ontario has opted not to administer both inoculations at the same time because there is no scientific information to show that doing so is safe and effective, King added.

People ages 65 and older will receive the seasonal flu shot first because they are less likely to catch the H1N1 virus than the rest of the population, King said, adding, “We know that the elderly are more susceptible to serious complications from seasonal flu.”

Starting next week, every home in Ontario will receive mail regarding the vaccination programs and who to contact for more information. Based on the experience of countries in the southern hemisphere, where winter has just ended, H1N1 is expected to be the main virus circulating during flu season.

Ontario has 19.5 million doses of H1N1 vaccine, enough to immunize 75 per cent of the population with two doses. It’s not yet known whether a second shot will be required and clinical trials are ongoing in Ontario.

A special form of vaccine will be made available to pregnant women and possibly to children under 3. The regular vaccine contains an additive, or adjuvant, that boosts its impact and extends the supply of the vaccine so it can cover more people. There is no safety data on the use of adjuvanted vaccines for pregnant women and little data on its use on small children.

Ontario health officials had expressed hope that all provinces would adopt the same H1N1 vaccination strategy, but the findings from the study are resulting in different approaches.

New Brunswick announced yesterday that it is moving its seasonal flu vaccination forward to the first three weeks of October to avoid confusion with the H1N1 program, which will start in November.

Quebec is considering dropping or delaying its seasonal flu vaccination.

MP Dr. Carolyn Bennett, health critic for the Liberal party, has questioned the absence of a pan-Canadian approach, arguing that different responses by different provinces could lead to confusion.

“I had thought these were decisions taken in a consensus way, that there would be one plan for the country. I’m very surprised,” Bennett said, adding that it would be preferable if a single directive on vaccines came from Canada’s chief public health officer, Dr. David Butler-Jones.

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