A: I did not see your message until after the Ferndale vaccine clinic. Our supply of single-dose thimerosal-free vaccine varies, and we reserve it for children 6-36 months of age and for pregnant women when it is available. We recommend against postponing vaccination for young children or pregnant women if the single-dose vaccines are not available. The risk from influenza for them is far greater than any risk from the vaccine. Children under 10 years of age should get two doses of 2009 H1N1 vaccine one month apart, whether or not they are single-dose thimerosal-free injections, injections from multiple-dose vials, or the live nasal vaccine.

A: Children without chronic health problems over two can receive the live nasal vaccine. Either of the vaccines, nasal or injectable, can be used for the second dose for children under 10. There is no evidence of neurodevelopmental delays from thimerosal in vaccines, and autism has not been found to be associated with it. For information on the safety of thimerosal in the influenza vaccine and other concerns, see http://www.cdc.gov/h1n1flu/vaccination/vaccine_safety.htm

A: Because the influenza vaccine is manufactured from virus grown in eggs, there is a small amount of egg protein in both the live and the inactivated vaccines. People who have egg allergies (generalized reactions like anaphylaxis or hives) should not get vaccinated with the current influenza vaccines unless they have been desensitized under the care of an allergist. This is a consideration only for people with conditions that put them at very high risk for complications from influenza. Over the next several years, we anticipate a change in influenza vaccine manufacturing, moving from growing vaccine virus in eggs to making vaccine from cell cultures. When this happens, people with egg allergy will be able to get influenza vaccine.

A: The live, attenuated influenza vaccine should be fine. You mentioned she gets frequent UTIs (urinary tract infections). The antibiotics she has taken for them will not affect her immune system. If she has a URI (upper respiratory infection), nasal congestion might make it harder for the live vaccine to get established and may reduce the protection she will get from it. We recommend waiting until the infection clears if there is a lot of congestion. Unless your daughter has asthma or a diagnosed immunodeficiency disorder, she can go ahead with the live nasal vaccine. It is designed to not replicate at normal core body temeperature and is attenuated (weakened) so that it doesn't cause disease when it grows on the upper respiratory lining and triggers the immune system.

A: Your child should get a second 2009 H1N1 vaccine four weeks after the first dose. Studies show that two doses of the H1N1 vaccine are more protective than a single dose in children. A single dose is sufficient for older children and adults, including pregnant women. The seasonal influenza vaccine and the 2009 H1N1 influenza vaccine cover different viruses and don't provide cross-protection. What is probably causing the confusion is that the seasonal flu vaccine covers an H1N1 influenza strain, as well as an H3N2 and an influenza B strain. The 2009 H1N1 influenza A virus is very different from the seasonal H1N1 influenza A virus, which is why so many people are susceptible to it. Their immune systems are not primed to react to it from earlier exposure to a similar virus.

A: People are given the location of the clinics when they make an appointment for vaccination. The clinics are fully scheduled beforehand and people cannot drop by the day of the clinic. We have been able to avoid the four or five hour waits that other counties have experienced with open drop-in mass vaccination clinics and can assure vaccine for those who have appointments and are eligible for vaccine.

A: When your children are due for their second doses of vaccine, check on vaccine availability a week or so before they are due, at www.whatcomcounty.us/health/h1n1. We anticipate that vaccine will be available in medical offices, at pharmacies, at the health department, and possibly at more mass vaccine clinics. We will eventually have enough vaccine to provide it to everyone who wants it, including second doses for children under 10, but the vaccine is being used as it is available and not being held for second doses. Your children will not have to start over if the second dose is given more than four weeks after the first, and they benefit from the vaccine they have received, although two doses are more effective than a single dose in children.

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.