H1N1 Influenza Vaccine Questions and Answers (Q & A)

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St. Michael's Hospital

H1N1 Influenza Vaccine Questions and Answers (Q & A)

Everyday new information about H1N1 comes at us -- on the web and in the media. Read the questions and answers below for the most up to date information about the H1N1 vaccine. The Q & A was prepared by Infection Prevention and Control and Corporate Health and Safety at St. Michael’s Hospital.

Who should get the H1N1 Vaccine?

Vaccination (a shot) is the best way to protect against infection from the H1N1 Influenza virus. Everyone (except infants less than 6 months of age) should get vaccinated to protect themselves and their families from the H1N1 virus as soon as the vaccine is available. It is especially important for high risk groups of people to be vaccinated. The highest risk groups are:

Pregnant women
People with other health problems or chronic medical conditions
Children who are 6 months to 5 years of age
Those who live with, or provide care to, anyone in a high risk category that has not or cannot be vaccinated

In fact, vaccine is recommended for all Canadians over the age of 6 months.

How well will the vaccine protect against the H1N1 flu virus?

Most people will develop immunity (be protected) against H1N1 about 10 days after getting the H1N1 flu shot. Clinical trials have shown 85% to 98% of healthy adults developed an immune response strong enough to protect against the H1N1virus¹

How well will the vaccine protect me if I have am immuno-compromised (have other health problems) or am on medicine which suppresses my immune system?

The vaccine may not work as well in people who are immuno-compromised and for those on medicine which suppresses the immune system. People who are immuno-compromised or on medicine that suppresses the immune system should get the first available H1N1 flu shot.

How does the Infection Prevention and Control department at St. Michael’s know what to do about H1N1?

Infection Prevention and Control continues to receive information about H1N1 from both the Ontario Ministry of Health and the Public Health Agency of Canada.

Who should NOT get the H1N1 flu vaccine1?

The H1N1 vaccine is not allowed to be given to babies younger than 6 months of age.

You should not get the H1N1 vaccine if:

You have ever had a previous allergic reaction to any part of the vaccine.
You have had a severe reaction to previous vaccinations
You are allergic to eggs.
You have a high fever (vaccine can be given once the fever is gone).
You have contracted Guillain Barre Syndrome within 8 weeks of receiving a seasonal vaccine.

If you have a blood disorder, or are taking medication that could affect blood clotting, you may require further assessment by your family physician to determine if you can have the vaccine.

Can I get the flu from the vaccine?

No. You cannot get the flu by getting the vaccine.

Are there any side effects from the flu vaccine?

The most common side effects of the flu vaccine are:

Soreness in the arm where the vaccine was given
Sore, red and itchy eyes
A mild fever
Some people also experience muscle aches and fatigue (tiredness)³.

About one out of every million people will have a severe reaction to a flu vaccine, including anaphylaxis (severe allergic reaction) or the Guillain-Barre Syndrome (GBS). The associated between GBS and the flu vaccine is controversial and appears to be very small (~1 per 1,000,000 or less)².

How likely am I to have side-effects from the vaccine?

Most people that receive the vaccine have no side effects or a sore arm for one to two days. Other possible side effects that occur less commonly are listed below:

Very common (10% of people will have these side effects): Headache, tiredness, a hard lump at the injection site and joint pain.

Common (1% to 10% of people will have these side effects): Warmth, itching or bruising at the injection site; more sweating/shivering, flu-like symptoms, swollen gland in the neck, armpit or groin.

Uncommon (0.1% - 1% of people will have these side effects): Tingling or numbness of the hands or feet, sleepiness, sleeplessness; dizziness, diarrhea, vomiting, stomach pain, feeling sick, itching or rash.

The above-listed side effects usually disappear within 1-2 days without treatment. If they continue please consult your doctor.

What is in the H1N1 Adjuvanted Vaccine?

The H1N1 vaccine has two parts: 1.) Inactivated H1N1 virus (dead virus) and 2.) an adjuvant (medicine & vitamin) which boosts your body’s ability to fight off sickness. The adjuvant consists of vitamin E, squalene and polysorbate. The adjuvant in the vaccine has been tested in 45,000 people and no safety concerns for healthy adults or children were found. However, the adjuvant was not tested widely in children under 3 years of age and pregnant women¹.

What is Squalene?

Squalene is a natural substance found in plants, animals and humans. Squalene for the H1N1 vaccine is usually extracted from fish oil³. Shark liver oil is most commonly used.

Has squalene ever been used in vaccines before?

Squalene has not been used in Canadian influenza vaccines in the past. An influenza vaccine containing squalene has been used in Europe since 1997, with no severe adverse effects noted.

How safe is the H1N1 flu vaccine?

Clinical trials from several countries around the world have shown the H1N1 flu vaccine is safe. It is produced in a similar way to seasonal flu vaccines, which have been used safely and effectively in Canada for many years.

I am pregnant. I thought I was supposed to get a vaccine without the adjuvant and now I am told that I should receive the vaccine with adjuvant. Why was there a change in the recommendation?

Since the vaccine with adjuvant has not been tested in pregnant women, the Public Health Agency of Canada ordered the vaccine without adjuvant for pregnant women. However, the vaccine without adjuvant is not ready yet and we are now in Phase 2 of the Pandemic, in Canada and in the Toronto region. It takes 10 days for the vaccine to produce immunity.

So should pregnant women get the vaccine with the adjuvant since the one without is not ready?

Women who are more than 20 weeks pregnant or women who are less than 20 weeks pregnant and have other risk factors for complications should get the vaccine with adjuvant. The experts advising the Ontario Ministry of Health and Long Term Care believe that the risk to pregnant women of getting very sick and possibly needing mechanical ventilation to help them breathe if they get H1N1 is higher than any theoretical risk of side effects from the vaccine with adjuvant.

I heard that the vaccine contains mercury. Isn’t this dangerous?

It is not dangerous. The vaccine contains thimerosal. This is a form of mercury used to keep the vaccine fresh during storage. Thimerosal is a different form of mercury than the mercury known to cause health problems. The amount in the flu vaccines is much less than the daily limit for good health. A can of tuna fish has more mercury than the thimerosal in the H1N1 vaccine.

I heard that squalene causes Gulf War Syndrome?

This theory has been proven wrong. We all have squalene in our bodies, since it is naturally manufactured by the body.

What else can I do to protect myself and others?

Practice good hand hygiene using alcohol hand rub or soap and water. Soap and water works well against influenza viruses⁴.
Keep your hands away from your face. In most cases the H1N1 virus enters the body through the eyes, nose or mouth.
Use a tissue when you cough or sneeze. Discard it into the garbage as soon as possible and wipe your hands. If you do not have a tissue, cough and sneeze into your elbow.
Encourage your friends and family to get immunized.

References:

What you need to know before receiving the H1N1 Flu Vaccine. Public Health Agency of Canada. October, 2009.
Considering the Options. Getting the flu versus getting a vaccine or taking an antiviral. Public Health Agency of Canada. October, 2009.
SMH Consent form for the administration of H1N1 Adjuvanted Pandemic Influenza Vaccine (Arepanrix)
Your H1N1 Preparedness Guide. Public Health Agency of Canada.