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Seasonal Flu and H1N1

Our guest expert in October 2009 was Sonja Cobham, an infection control practitioner working under the Quality, Equity and Performance portfolio at Women’s College Hospital in Toronto.

Cobham is a registered nurse with over 27 years experience working in health care in nursing, sterile processing and infection control. At Women’s College, she spearheads the development, execution and evaluation of infection control practices, ensuring compliance with government standards.

She is also a member of the Toronto Practitioners in Infection Control, a chapter of Community and Hospital Infection Control – Canada (CHICA), and received her certification in infection control from the Association for Professionals in Infection Control and Epidemiology (APIC).

Here are her answers on Seasonal Flu and H1N1.

Q: How important is it to get the H1N1 vaccine?

A: The H1N1 virus is a novel strain of influenza A that has not been seen before and although most of the cases continue to be mild, some cases have been severe, including some resulting in deaths.


Q: Flu has always existed. So why is such a big fuss being made about H1N1, and why is there so much conflicting information from government and the medical field about it?

A: The H1N1 virus is a novel strain of influenza A that has not been seen before. Because people do not have immunity to this influenza virus it is anticipated that about one-third of the population will get H1N1 influenza.

Scientists are continually learning new information about H1N1 and the Public Health Agency of Canada provides updated advice as new information becomes available.


Q: How can we be confident that the H1N1 vaccine is safe? What are the short- and long-term side-effects of the vaccine?

A: Flu vaccines are safe. They will not give you the flu. The vaccine is made in a way that makes this impossible.

Vaccines produce immunity to specific diseases by stimulating the production of antibodies.

Adverse effects from vaccines are extremely rare. Sometimes people will have soreness in the muscle near the spot where they were injected.

We sometimes hear of people getting ill after they receive a vaccine. In almost all cases, it turns out that they are experiencing another illness unrelated to the vaccination.

Vaccines are authorized for use by Health Canada only after undergoing rigorous reviews to ensure their safety, efficacy and quality.


Q: Who is at risk of dying from H1N1?

A: The following groups are at higher risk of complications from H1N1 influenza:

  • children under five years
  • women who are pregnant
  • people with chronic conditions such as heart or kidney disease, diabetes, asthma and chronic lung disease, suppressed immune systems, neurological disorders, liver disease, blood disorders and severe obesity


Q: Is there anything I can do to build up my immune system so it can fight H1N1?

A: It is recommended that everyone more than six months old get vaccinated with the H1N1 vaccine. Together with frequent hand washing; coughing or sneezing into tissues or sleeves; and keeping commonly touched surfaces disinfected, it will help you stay healthy this winter.


Q: I have recently finished six rounds of chemotherapy for non-Hodgkin’s lymphoma. I work at a long-term care facility. Should I be immunized against the H1N1 flu, as well as the seasonal flu virus?

A: You should contact your health-care provider. The Ministry of Health and Long-Term Care recommends that health-care workers involved in the delivery of essential health-care services be vaccinated to prevent outbreaks and the potential spread of the infection to vulnerable patients and to protect essential health infrastructure.  Household contacts and care providers of persons at high risk who cannot be immunized or may not respond to vaccines should also be immunized against the H1N1 influenza virus.


Q: I will turn 63 in December, just about the time my husband and I leave for Florida for the winter. I am in good health. I have been receiving mixed messages about having both or just one or none of the vaccines. I normally receive the regular flu shot each year. What should I do? 

A: The recommendation is that healthy people under 65 receive the H1N1 vaccine which is currently available, and then be vaccinated with the seasonal influenza vaccine in November or December.


Q: I am a teacher who is five months pregnant. Since I am in contact with a lot of people daily, I know I have a higher chance of catching the flu. I am worried about the effects that thimerosal will have on my developing baby if I get a flu shot. On the other hand, I also know pregnant women have a higher chance of serious complications if they catch H1N1. I heard they are manufacturing a flu shot without thimerosal for pregnant women and young children. Do you know if this is true? If not, what is your opinion about pregnant women getting a flu shot with thimerosal in it?

A: The Ministry of Health and Long-Term Care states that the H1N1 vaccine does contain thimerosol, an organic mercury compound that is used as a preservative and that thimerosol has not been shown to have adverse health effects in the levels found in vaccines.

The World Health Organization Strategic Advisory Group of Experts (SAGE) recommended in July that pregnant women should receive non-adjuvanted vaccine. The World Health Organization has recommended that if the non-adjuvanted vaccine is not available and there is increasing H1N1 illness in a local jurisdiction, pregnant women in their second and third trimester should discuss receiving adjuvanted vaccine with their health-care provider.

The adjuvanted vaccine includes a substance that boosts an individual's immune system and increases their response to a vaccine.


Q: I had the flu in June and it lasted 28 days. I found it hard to breathe. I went to my doctor and he said they were no longer testing for H1N1 and gave me antibiotics that didn't work. Should I still get the H1N1 vaccination?

A: Yes, you should still receive the H1N1 vaccine since you don’t know if you have had the H1N1 influenza.


Q: Why do health-care workers get flu shots less often than members of the general public?

A: The vaccination rate for the health-care population is measurable, whereas the vaccination rate in the general population is unknown.


Q: If I get sick with the flu this season, how will I be able to tell if it is seasonal flu or H1N1?

A: Your health-care provider can make a diagnosis of H1N1 once the result of a nasopharyngeal swab is taken and sent to the laboratory for testing has come back positive for H1N1.


Q: Should a pregnant woman (less than 20 weeks) carrying twins wait until the H1N1 vaccine without the adjuvant is available, or take the vaccine now with the adjuvant?

A: Ontario is recommending that all pregnant women with pre-existing health conditions and healthy pregnant women in the second half of their pregnancy (more than 20 weeks) should speak to their health-care provider about receiving the adjuvanted vaccine. Healthy pregnant women in the first half of their pregnancy are at lower risk of complications from the flu, and should wait to receive the unadjuvanted vaccine, when it is available. 



Ontario Ministry of Health and Long-Term Care. H1N1 Flu Virus.

The Public Health Agency of Canada. Frequently Asked Questions – H1N1 Flu Virus

Ontario Ministry of Health and Long-Term Care. H1N1 Flu Vaccine and Immunization. October 21, 2009

Ontario Ministry of Health and Long-Term Care. Backgrounder H1N1 Vaccine Delivery Logistics in Ontario. October 21, 2009

Ontario Ministry of Health and Long-Term Care. Guidance for the Management of Influenza-Like Illness in Emergency Departments during Pandemic (H1N1) 2009 – Summary. Version:1 IHN: issue 6, Volume 18.  October 14, 2009


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