A: High blood pressure and recurrent sinusitis are not conditions that increase the risk of hospitalization or death from influenza, so you are not in the priority groups for receiving vaccine before the general public. Once people in the priority groups have had an opportunity to be vaccinated, vaccine will be made available to everyone who wants it. About 50% of the population are in the priority groups, which is close to 100,000 people in Whatcom County. We have received about 15,000 doses of vaccine which have been used to target pregnant women, household members and caregivers of infants under 6 months of age, healthcare workers with direct patient contact, children under 5 years and those up to 18 years with high-risk medical conditions. These groups make up about 15% of the population (30,000 people in Whatcom). We have just expanded eligibility to healthy people up to age 24 and to people up to age 64 with conditions that increase their risk of complications. Vaccine is being shipped as soon as it is manufactured and cleared for use, and we know our allocation on a week-by-week basis, so we can't predict when we will have enough to open up vaccine to everyone. We will announce it to the press, to the medical community, and on the health department H1N1 web site: www.whatcomcounty.us/health/h1n1 , so please check the news and the site for updates. We encourage everyone to get vaccinated when eligible and as vaccine becomes more available.

A: Yes. Diabetes is one of the conditions that increases the risk of complications from influenza. Everyone with diabetes, asthma, and other conditions that increase risk should be vaccinated unless they have a medical reason not to be. Pregnancy is another one of the risk factors. Because vaccine has been delivered as it is produced and we don't have enough to meet immediate needs, we are giving it to priority groups first, but eventually will have enough for everyone that wants to be immunized. Because younger people were more likely to get infected and hospitalized, we used our initial vaccine to cover pregnant women, caregivers of infants under 6 months of age, healthcare workers, children under 5, and children under 18 with high-risk medical conditions. We are expanding our eligible group, now that we have received enough vaccine, to cover healthy people up to age 24 and people with chronic health conditions through age 64. Once they have had an opportunity to get vaccinated, we will open up eligibility to anyone who wants to be vaccinated, and we encourage everyone to do so.

A: Since other viruses can cause flu-like illness, we recommend that children who have had the flu receive the vaccine. There is no harm in getting vaccinated after having the flu. The only exception about recommending vaccine after having influenza is if the person had a positive confirmatory test for the pandemic influenza virus when they were ill. This is not the rapid influenza test, but is the RT-PCR test for 2009 H1N1 influenza that is done at public health laboratories and has recently been made available through commerical medical laboratories. The test is usually done only for severely ill patients requiring hospitalization and most people who are ill do not need either the rapid influenza test or the confirmatory test.

A: Since Novartis influenza vaccine (both the single- and multiple-dose forms) are licensed for people age 4 and up, the Novartis single-dose vaccine will be used only for pregnant women. Single-dose vaccine from sanofi-pasteur is reserved for children 6 to 36 months of age and for pregnant women. All of the thimerosal-free single-dose vaccines will be reserved for pregnant women and children under 3, although they should not postpone vaccination if thimerosal-free vaccine is not available. So far, our multi-dose vials have been from sanofi-pasteur, for use for age 6 months and over, but we will be receiving multi-dose vaccine from Novartis as well. As vaccine continues to be produced and distributed, we will probably get vaccine from other manufacturers.

A: Although you definitely should be vaccinated against 2009 H1N1, you are not in the eligibility group for this week's clinic and will be turned away. Please register again [CORRECTION:THURSDAY afternoon](Friday afternoon) for next week's vaccine clinics in Ferndale or Lynden. We have enough vaccine for the highest priority groups, including children 6 months to 4 years of age and those 5 to 18 years with chronic medical conditions. We will have enough vaccine next week to expand eligibility to include people up to 24 years of age and those 25 to 64 years with conditions that put them at high risk of complications from influenza. Eventually everyone who wants to be vaccinated will have the opportunity, as long as they don't have a medical reason not to receive vaccine. We want to make sure that those at highest risk of hospitalization, complications and death from influenza infection, and those who provide their care, are the first to be vaccinated. You are in the second priority group, which means that you will be able to get the vaccine before we open it up to everyone. I know that it is frustrating to be told you need the vaccine but have to wait while others get it, but this is what we figured was the fairest and most effective way to assure that those at highest risk were protected earliest. For information on vaccination availability and registration for vaccine clinics, check www.whatcomcounty.us/health/h1n1

A: Oseltamivir (Tamiflu) and zanamivir (Relenza) are effective at reducing the length of illness if given within 48 hours of the beginning of symptoms. They also reduce the risk of complications from influenza in people with conditions that put them at higher risk. Most people do not need to be treated with antiviral medications, however some groups of people have a higher risk of complications and hospitalization from influenza. Those who should be considered for treatment if they have symptoms of influenza include: Children younger than 2 years old; persons aged 65 years or older; pregnant women and women up to 2 weeks postpartum (including following pregnancy loss); persons of any age with certain chronic medical or immunosuppressive conditions; and, persons younger than 19 years of age who are receiving long-term aspirin therapy. People who are hospitalized with influenza will be treated with antivirals even if they have been ill for more than 2 days. Detailed recommendations from the CDC on antiviral use can be found at: www.cdc.gov/H1N1flu/recommendations.htm

A: See my answer to Chelsea's question below. We anticipate having enough vaccine in the county to provide the second dose to children. The one month wait until the second dose allows the first dose to prime the immune response, so even if it takes a little longer than 4 weeks to get the second dose, the first dose doesn't have to be repeated.

A: The reason two doses of the 2009 H1N1 influenza vaccine are recommended for children under 10 is that many of those who get one dose don't have protective levels of antibodies until they get the second dose. One study of the live attenuated seasonal influenza vaccine (nasal spray) in children 6-36 months of age showed one dose to be 58% effective in preventing lab-confirmed influenza and two doses to be 74% effective. Although this study doesn't address more serious complications, other studies of influenza vaccine effectiveness show that although the vaccine doesn't prevent influenza illness in elderly people as well as it does for younger people, it is effective in reducing their risk of hospitalization and death. One dose of vaccine provides some protection, and two provides more.

A: The 2009 H1N1 vaccines, both the injectable inactivated virus vaccine and the live attenuated virus vaccine given by nasal spray, are made the same way as the seasonal vaccines have been made for years. The testing that was done before releasing the vaccines showed similar results to tests done each year with seasonal vaccines. The live vaccine contains no mercury and single dose forms of the injectable vaccine are being produced that contain no mercury, to be given to pregnant women and children under 3. The multi-dose vials of injectable vaccine contain thimerosal, which is a mercury compound used as a preservative. There is 0.25 mg of mercury per pediatric dose and 0.5 mg per adult dose. Thimerosal is metabolized into ethyl mercury, which is less bioaccumulative than elemental mercury and methyl mercury. The CDC has information on vaccine composition in the Advisory Committee on Immunization Practices (ACIP) reports on specific vaccines and has some general information on vaccine safety and thimerosal as well. The ACIP report on seasonal influenza vaccine is at http://www.cdc.gov/mmwr/pdf/rr/rr5808.pdf , the report on 2009 H1N1 vaccine is at http://www.cdc.gov/mmwr/PDF/rr/rr5810.pdf and general information on vaccine safety related to H1N1 is at http://www.cdc.gov/h1n1flu/vaccination/vaccine_safety.htm . The seasonal influenza virus protects against influenza B and influenza A (H1N1) and (H3N2) (the seasonal H1N1 is different from the 2009 H1N1 (which is not a swine flu, but is has a combination of RNA from influenza A strains adapted to humans, birds, and swine.) Seasonal influenza vaccine does not protect against the 2009 H1N1 virus. The 2009 H1N1 vaccine protects only against that virus and not the seasonal influenza viruses. The influenza A H5N1 virus is the avian influenza that has infected many people but has not become easily transmitted from person to person. Vaccines have been developed for H5N1 in case it mutates and starts a pandemic, but these are not currently in use and would not protect against the seasonal influenza viruses or the 2009 H1N1 virus, nor do the other vaccines protect against H5N1. Currently, about 99% of the influenza circulating in the US is 2009 H1N1. There have been some sporadic reports of influenza B hospitalizations and deaths, and an occasional H1N1 or H3N2 reported by the CDC in the past couple of months.

A: Since influenza activity is increasing throughout Western Washington, there are no identified "hot spots" and you should take precautions to avoid influenza wherever you go when flu activity is high. The health department gets reports only of specific cases of hospitalized patients with lab-confirmed influenza and of deaths associated with influenza. We follow flu activity indirectly through reports of school absenteeism (which may or may not be caused by influenza), by reports of the numbers and percent of positive tests for influenza at PeaceHealth Labs, and by reports from some clinics of the number and percent of patients they see who have influenza-like illness, which might not be due to influenza since other viruses can cause similar symptoms. We look at all of these indicators to see if they are all moving in the same direction, which would reflect increasing or decreasing influenza activity. Our weekly influenza surveillance report is posted at www.whatcomcounty.us/health/h1n1 and the CDC and the state Department of Health both post weekly flu reports at http://www.cdc.gov/flu/weekly/ and at http://www.doh.wa.gov/EHSPHL/Epidemiology/CD/fluupdate.pdf