A: Your IgA deficiency reduces your ability to defend yourself from influenza, so I would have considered you among the intial priority group for the vaccine. This included people under 65 with health conditions that increased their risk of complications from influenza. A mild respiratory illness, with or without fever, should not keep you from getting vaccinated, but a moderate to severe illness will require waiting until you are better. This is a judgement to be made by you and your clinician. It takes one to two weeks after vaccination to develop protective levels of antibodies. The good news is that influenza activity is back down to the levels found this summer, between the first and second wave. You should get vaccinated to protect yourself from an anticipated third wave this winter.

A: People can receive vaccines while they are taking antibiotics. However, vaccination should be postponed if the person has a moderate or severe illness. This is because possible vaccine mild side effects, like fever or aches, may complicate the assessment of the course of a serious illness. A mild illness, like a cold, with or without fever, does not require postponement. Although your question was about influenza shots, there is another consideration for the nasal spray vaccine. It should be postponed, or the injectable vaccine used, if there is significant nasal congestion which may limit delivery of the vaccine to the nasal lining.

A: Unless you had a specific test (viral culture or RT-PCR) that confirmed that what you had was the pandemic H1N1 influenza virus you should still get the H1N1 vaccine. Influenza-like illness can be caused by viruses that are not influenza, such as parainfluenza, metapneumovirus, adenoviruses, and others. Check with your doctor or the Whatcom Pandemic Joint Information Center at http://www.em.whatcomcounty.org for information on availability of the H1N1 vaccine. Many pharmacies and medical offices have the vaccine now and everyone over 6 months of age is encouraged to get the vaccine, especially if they have health conditions that increase their risk of complications from influenza.

A: You can get infected with different strains of influenza A at the same time. The viruses can mix genetic material when this happens, which is how reassortant strains, like the 2009 H1N1 influenza, emerge. I am not sure of the effect on symptoms when this happens. Fortunately, at this time 99% or more of the influenza that is circulating is of the 2009 H1N1 strain, so mixing is very unlikely unless that changes. We recommend that everyone get vaccinated when they are eligible because the risk from the disease is so much higher than any risk from the vaccine. If you want to know more about the safety of the H1N1 vaccine, check with the CDC at http://www.cdc.gov/h1n1flu/vaccination/vaccine_safety.htm

A: Yes! One of the target groups is people under 65 with medical conditions that increase their risk of complications from influenza. You should definitely get vaccinated. Check www.whatcomcounty.us/health/h1n1 for information on vaccine availability. Everyone should be vaccinated unless they have a medical reason not to receive vaccine. You are currently eligible for vaccine and we hope to have received enough vaccine in the next several weeks to open up vaccination to everyone who wants it. It is much better to acquire immunity to influenza from vaccination rather than taking your chances with the infection.

A: The four week wait allows the first dose to prime the immune system and there is no need to repeat it if it takes longer than four weeks to get the second dose. Also, the first dose provides protection to many who receive it. The recommendation for two doses is based on the fact that more children have protective levels of antibodies against 2009 H1N1 after two doses than after one dose. The only problem with delaying the second dose is that full protection is postponed and your daughter could be infected in the meantime. If another opportunity opens up to be vaccinated after December 20, you can do that and cancel the January 11 appointment, opening it up for others.

A: The vaccine isn’t available yet for people over 64 years of age. Because of the limited supply and because people over 64 are less likely to become infected, current supply is reserved for people in the groups with the highest rate of hospitalization and death from the pandemic influenza. It is also given to healthcare and emergency medical service personnel to reduce their transmission of influenza to high-risk patients. Although as a group seniors have higher rates of immunity to 2009 H1N1 influenza and are not in the priority group for receiving vaccine at this time, people over 64 who do become infected have an increased risk of complications. Seniors and people with high-risk medical conditions should get early medical attention if they have signs of influenza and should be considered for early treatment with antiviral medications. This applies particularly to you, given your close contact with your wife. Vaccines take about a week to 10 days to stimulate protective levels of antibodies to the H1N1 influenza virus, so vaccination would not provide you significant protection from catching influenza from your wife. For more information on seniors and the pandemic influenza and vaccine, see http://www.cdc.gov/H1N1flu/vaccination/vaccine_seniors.htm

A: Some pharmacies may have vaccine now or are expecting a shipment, but supplies are limited nationally. Check for updates on seasonal influenza vaccine availability at the Whatcom County Health Department web site: http://www.whatcomcounty.us/health/community/immunizations/pdf/flu_clinic_schedule.pdf

A: Thimerosal is the vaccine component that most people express concern about, because it contains mercury. Elemental mercury is metabolized into methyl mercury when it is inhaled or ingested. Because of the effects on the nervous system of long-term consumption of fish with high methyl mercury levels, and the fact that methyl mercury accumulates in the body (which is why it is found in higher levels in contaminated fish farther up the food chain), mercury exposure has been reduced by removing it from many products. Thimerosal is a mercury compound used as a preservative in vaccines and other products and is metabolized into ethyl mercury. It has been eliminated from all routine childhood vaccine, except for the multiple-dose forms of inactivated influenza vaccine, in the general campaign to reduce mercury exposure. Studies have not shown adverse neurological effects from the use of thimerosal in children in the past. In addition, ethyl mercury from thimerosal in injections is excreted from the body faster than oral methyl mercury and ethyl mercury is less toxic than methyl mercury. The safety standards for mercury exposure have been based on what is known about the toxicity of methyl mercury. There are several good sources of information on thimerosal and vaccine safety: CDC H1N1 site: http://www.cdc.gov/h1n1flu/vaccination/vaccine_safety.htm , CDC vaccine site: http://www.cdc.gov/vaccines/vac-gen/safety/default.htm , and the article on mercury excretion in infants in Pediatrics: http://pediatrics.aappublications.org/cgi/reprint/121/2/e208.pdf . The New England Journal of Medicine published a large study, “Early Thimerosal Exposure and Neuropsychological Outcomes at 7 to 10 Years”, that showed no connection between thimerosal from vaccines and neuropsychological problems years later: http://content.nejm.org/cgi/content/abstract/357/13/1281 . For a good review of the licensing, evaluation and safety monitoring of the H1N1 vaccine, see the Center for Biosecurity of the University of Pittsburgh Medical Center at http://www.upmc-biosecurity.org/website/focus/2009_H1N1_updates/isssue_briefs/2009-11-13-IssBrf_lcnsre_evl_advrse.html . The bottom line is that vaccine safety is being monitored, that thimerosal has been eliminated from most pediatric vaccines as a precaution but that there is no evidence of long-term adverse effects from its use, that influenza can cause severe complications and death, and that the vaccines we have available reduce the risk of complications safely and effectively, whether or not they contain thimerosal.

A: Because the vaccine supply currently doesn't meet the demand, we are first using it for groups at the highest risk of hospitalization and death before opening it up to everyone who needs and wants it. Risk is determined by both susceptibility (likelihood of becoming ill) and likelihood of complications if one becomes ill. Although older people who are hospitalized for influenza have a higher risk of dying from it, they have a lower likelihood of becoming ill and being hospitalized than younger people. This results in a lower complication rate for people over 65 as a group than for younger people. People who provide medical care to high-risk groups and who live with or care for infants under 6 months (because they can't be vaccinated) are also eligible. We recommend that everyone get vaccinated when eligible and it is available. Because of your risk of complications from influenza, if you develop flu symptoms you should contact your healthcare provider early in the illness and treatment with an antiviral should be considered.