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.

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.