Influenza (or flu) is a common respiratory illness affecting millions of Canadians each year. The most familiar aspect of the flu is the way it can “knock you off your feet” as it sweeps through entire communities. In Canada, flu season usually runs from November to April and an estimated 10-25% of Canadians may get the flu each year. Although most of these people recover completely, an estimated 4,000 to 8,000 Canadians die each year from pneumonia related to flu and many others die from other serious complications of flu.

The most effective way to protect yourself from flu is to be vaccinated each year. The Ministry of Health and Long Term Care provides free influenza vaccine to everyone who lives, works or attends school in Ontario. Information on influenza, a list of community clinics and a list of resources have been included on this website.

If you have any questions concerning influenza immunization, please feel free to contact the Health Unit at (705) 743-1000.


Frequently Asked Questions (FAQ's)

• What is influenza ("the flu")?
• How is the flu spread?
• What is the difference between the common cold and the flu?
• What should I do if I get the flu?
• How do I protect myself from the flu?
• How well does the flu vaccine protect against the flu?
• Who should get the flu vaccine?
• Who should not get the flu vaccine?
• Why should healthy adults and children get the flu vaccine?
• Do I need a flu vaccine every year?
• When should the flu vaccine be given?
• Is the flu vaccine safe?
• Is it safe to receive the flu vaccine if I am pregnant or breastfeeding?
• What are the flu vaccine recommendations for children?
• Where can I get immunized against the flu?
• What happens at a flu clinic?
• If I notice anything unusual after the vaccine is given, when should I see a doctor?

What is influenza ("the flu")?
Influenza (commonly known as “the flu”) is an acute respiratory infection caused by influenza viruses. A true case of influenza typically starts with a headache, chills and  dry cough. This is followed rapidly by fever (usually high), loss of appetite, muscle aches and extreme tiredness, runny or stuffy nose, sneezing, watery eyes and throat irritation. Children can also get ear aches, nausea, vomiting and diarrhea but these symptoms are not common in adults. Most people recover within five to ten days but the cough and fatigue can last many weeks, sometimes making it difficult to return to normal physical activities. Only about 50% of those infected come down with full blown influenza with the classic symptoms. Some people are at a greater risk for more severe and longer lasting complications such as pneumonia. The groups that are at higher risk include very young children, people over 65, and people who already have medical conditions, such as chronic respiratory disease, heart or kidney disease, diabetes and a weakened immune system because of cancer, HIV infection, or some other cause. 

How is influenza spread?
Flu viruses spread easily from an infected person to another by coughing or sneezing. Influenza is spread in the droplets of a cough or sneeze. People can become infected when these droplets are inhaled through the mouth or nose. It is also spread through direct contact or touching surfaces such as toys, telephones, doorknobs, keyboards and hands that are contaminated by the influenza virus  On hard non-porous surfaces such as a desk, the virus can survive for 24 to 48 hours. It can live on the hands for 5 minutes. If a person touches a surface contaminated with flu viruses on it, then touch their nose, they may come down with influenza. 
The virus grows and develops inside a person and takes an average of about 2 days (1-4 days) before the person will become ill.  Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 days after becoming sick. That means that you can pass on the flu to someone else before you know you are sick, as well as while you are sick. Children can be infectious and carry the virus for 10 days or longer after the illness begins.

What is the difference between the common cold and the flu?
Colds, vomiting and diarrhea (often referred to as the stomach flu) and other viral infections are often confused with the flu. These are not caused by the influenza virus.
 

Symptoms	Cold	Influenza
Fever	Rare	Usual high fever - sudden onset lasts 3-4 days
Headache	Rare	Usual - can be severe
General aches and pains	Sometimes - mild	Usual - often severe
Fatigue and weakness	Sometimes - mild	Usual early onset - can be severe
Runny, stuffy nose	Common	Sometimes
Sore throat	Common	Common
Cough, chest discomfort	Sometimes - mild to moderate	Usual - can become severe
Complications	Can lead to sinus congestion or earache	Can lead to pneumonia - can worsen a current condition and can be life threatening

What should I do if I get the flu?
• Drink fluids and get plenty of rest.
• Take an analgesic (acetaminophen (Tylenol), acetylsalicylic acid (Aspirin) if you do not have a contraindication to these drugs to relieve headaches and muscle aches. Please note: Children and teenagers should avoid aspirin unless specifically directed by a physician.
• Cover your mouth with a tissue when coughing or sneezing and properly dispose of used tissues.
• Wash your hands frequently with soap and water and in between hand washing, use alcohol based hand sanitizers.
• Stay home! Do not expose others at school or the workplace to influenza. It is very contagious. Your co-workers or classmates will likely become infected.
• Keep away from people who are elderly, or under two years of age, the chronically ill or those with respiratory problems. While adults shed the virus for only a few days after infection, remember young children can shed the virus for 10-14 days. 

How do I protect myself from the flu?
The single best way to prevent the flu is to get the flu vaccination each fall. The “flu shot” is an inactivated vaccine (containing killed virus) that is given with a needle. The flu shot is approved for use in people older than 6 months, including healthy people and people with chronic medical conditions. It is also important for all persons who provide services to those who are in the high risk group to have a flu shot (see “Who should get the flu vaccine?”). The flu shot or influenza vaccine is provided at no charge for all persons who are residents of Ontario who are over 6 months of age, including healthy people providing that they have no medical reasons not to have the vaccine. 

About 10 to 14 days after vaccination, antibodies develop that protect against influenza virus infection. The antibodies will protect healthy adults from 6 months to approximately 12 months after being vaccinated. When you are exposed to the influenza virus, the antibodies will help prevent infection or reduce the severity of the illness. 

There is a new vaccine produced each year in order to keep up with the changes in the strains of the virus. October or November is the best time to get vaccinated, but getting vaccinated anytime of the year is still beneficial. Flu season can begin as early as October and last until late May. The annual flu shot will NOT provide protection from a new pandemic strain of influenza if it should appear. It will take about 4-6 months for an influenza vaccine to be produced that will provide protection from the pandemic influenza strain. However, it is important to be vaccinated to reduce the chances of getting seasonal influenza. 

How well does the flu vaccine protect against the flu?
Most flu vaccines contain three strains of influenza virus. Each year, the vaccine is updated yearly with the most current circulating strains.  The effectiveness of the vaccine varies, depending on the age of the individual receiving the vaccine and their immune system. It is also dependent on how well the strains in the vaccine match those circulating in the community. 

With a good match between the strains of influenza in the vaccine and those in circulation, the vaccine is 70% to 90% effective in preventing flu in healthy adults and children. It can protect them for up to one year. In children aged 2 to 5 years, the vaccine is about 31% to 83% effective. Immunized children who are immunized with influenza vaccine have fewer middle ear infections. 

The effectiveness of influenza vaccine may be lower in certain populations such as those with weakened immune systems and the elderly. However, it is important to protect those at high risk because the protection will reduce the number who become ill or will die because of influenza.  In long term care facilities, the effectiveness is lower - about 30% to 40% in preventing influenza. However, fewer institutionized residents will be hospitalized or die from influenza. It is 50% to 60% effective in preventing hospitalization and pneumonia and 85% to 95% in preventing death. 

Who should get the flu vaccine?
Influenza viruses are classified by the characteristics of two surface proteins: hemagglutinin, or "H" protein, and neuraminidase, or "N" protein.  There are 16 "H" types and 9 "N" types that can exist in any combination.  Some combinations are more pathogenic (deadly) to birds, but this does not mean they are more likely to cause disease in humans.
 

Who should not get the flu vaccine?
The health care provider may decide not to the administer the influenza vaccine to anyone who:
• has had a severe allergic reaction to a flu immunization in the past
• has had a severe allergy to any part of the vaccine, such as neomycin, thimerosal, or gelatin
• has a severe allergy (anaphylaxis) to eggs or chicken that causes hives, throat and/or tongue swelling, difficulty breathing or shock
• has a fever or has started antibiotics in the last 24 hours because of an acute infection (the vaccine can be given at a later date) is under 6 months of age
• plans to donate blood within the next 48 hours

Why should healthy adults and children get the flu vaccine?
Flu immunization is the best way to protect against influenza. Healthy people should get vaccinated each year to protect themselves and avoid spreading the virus to others in their family, to co-workers and in the community.

For workplaces, if employees are encouraged to be immunized against influenza; the costs of absenteeism can be reduced and productivity increased with more employees present to get the work done.  It translates into reducing replacement and overtime costs, less service interruptions and meeting product delivery times. For the employees in the workplace, it means an improved quality of life. And if an individual is not paid when they are absent from work due to illness, it may mean a loss of wages. By avoiding influenza, there will be less disruption in home life and holidays as well. 

Influenza means that you may be so ill that you will be in bed for a few days. It is much worse than a cold. No one enjoys being sick or miserable. We know that influenza in preschoolers is associated with acute middle ear infections. It can also lead to hospitalization in healthy children and in those with other health problems. 

Do I need a flu shot every year?
Adults require one dose of influenza vaccine every year. Annual immunization against influenza is required in order to give optimal protection. The influenza virus is always changing, therefore the vaccine is updated yearly with the most current circulating strains needed to protect against new infections. From 1982-1983 to 1996-1997, the match between the recommended vaccine strains and those circulating was appropriate during 12 of 15 influenza seasons (80%).

When should the flu vaccine be given?
The most ideal time to receive influenza immunization is before influenza season begins. In the northern hemisphere, the influenza season starts as early as December and lasts until April or later. The best time to be immunized is in November or early December. However, it is never too late to be immunized. 

Is the flu vaccine safe?
The influenza vaccine must go through many steps before it is approved for use in Canada. It must be shown to be safe and effective in preventing the disease that it targets. The Bureau of Biologics and Radiopharmaceuticals (BOBR) 

which is part of Health Canada regulates vaccines used in humans. Vaccines are licensed only if they meet acceptable standards of production, safety and potency. All batches of vaccine must pass the rigourous testing before they are released for use. 

Canada has systems to monitor the safety of vaccines that have been approved by the Bureau of Biologics and Radiopharmaceuticals (BOBR). It is a surveillance system where medical experts are made aware of unusual post-vaccine events.  In addition, a program called IMPACT (Immunization Monitoring Program. ACTive) tracks all severe adverse events related to vaccination. This program is funded by the Division of Infectious Disease Prevention and Control, Health Canada and is operated by the Canadian Pediatric Society. For more information about vaccine safety, go to the Public Health Agency of Canada website 

Is it safe to receive the flu vaccine if I am pregnant or breastfeeding?
The National Advisory Committee on Immunization (NACI) states that the “Influenza vaccine is considered safe for pregnant women at all stages of pregnancy and for breastfeeding women.  Immunization of pregnant women has the advantage of potentially protecting the fetus through transplacental antibody passage or through breast milk". (CCDR, July 1, 2007)

What are the flu vaccine recommendations for children?
Children under 9 years of age require two doses of influenza vaccine given 4 weeks apart if they have received one or no doses in the previous influenza season and have never received two doses within a single season.

Even healthy young children can become very ill from influenza. It has been estimated that 10% to 40% of healthy children get the flu every year. As well, children are at a higher risk of developing middle ear infections (otitis media) as a result of influenza infection. Children often contribute to the spread of the flu virus in both school and household settings. If children are visiting the elderly (e.g. grandparents) even when the elderly person has been immunized, they can still get influenza from the child. The vaccine is only 30%-40% effective in preventing illness in frail persons 65 years of age or older. Although the vaccine is not highly effective in preventing the elderly from getting influenza, it is effective in preventing complications and death.

Healthy children aged 6-23 months are at an increased risk of hospitalization related to influenza compared with older children and young adults. Therefore, the Ontario Ministry of Health and Long Term Care has included this age group among the high priority groups to receive the influenza vaccine.  In Ontario, there is no charge for influenza vaccine for any resident of the province.

Where can I be immunized against the flu?
The Peterborough County-City Health Unit will be offering free influenza immunization clinics throughout the County and City of Peterborough. The clinics for 2008/2009 Influenza season will begin October 30, 2008.

To obtain the schedule of clinics in our community: Click here

Influenza immunization is available at most family physicians offices in Peterborough County and City. It is important to call ahead and book an appointment. 

What happens at a flu clinic?
• All individuals receiving the vaccine from the clinics that are run by the Peterborough County-City Health Unit will be provided with a consent form. The consent form has written information about the risks and benefits of the vaccine, the side effects and a list of conditions that would prevent a person from receiving the influenza vaccine. 

• The information must be read and understood before an individual can receive the vaccine. Questions concerning the vaccine can be answered by the Registered Nurse who will be administering the vaccine.

• Once the information is read, the individual over 14 years must sign the consent form. Individuals under the age of 14 years must have the consent form signed a parent or by a legal guardian. Grandparents and other relatives cannot sign the consent form for those under the age of 14 years unless they are official legal guardian. The Registered Nurse will determine the individual’s capacity to provide an informed consent.

• The nurse will ask each client screening questions specific to the influenza vaccine before the nurse will administer the vaccine to ensure that the client is indicated to receive the vaccine. The questions are designed to determine if the client has any reason not to receive the influenza vaccine. To learn more about “Who should not receive the flu vaccine?”

Additional information about receiving the influenza vaccine at the Peterborough County-City Health Unit:
• You will be asked to remain at the clinic for 20 minutes after receiving the influenza vaccine.
• Persons who are acutely ill or have a fever should wait until they recover before getting the flu vaccine. Individuals with a minor illness or a cold may be immunized. 
• Children under the age of 14 years must be accompanied by a parent or legal guardian. Individuals 14 years of age and older may sign their own consent.
• The flu shot is given in the upper arm so it is helpful if a short-sleeved or loose shirt should be worn.
• In order to prevent fainting, it is important to have had a recent meal or snack prior to being immunized.

If I notice anything unusual after the vaccine is given when should I see a doctor?
If you experience any of the following symptoms after receiving the flu short in the two weeks following immunization, contact your family physician or go to the nearest emergency department:
• high fever ( equal to or greater than 40oC or 104oF) 
• hives
• swelling of the mouth, throat, tongue or face
• trouble breathing, hoarseness or wheezing
• lasting or worsening weakness
• fast heart beat, dizziness or convulsions
• any other unusual condition or serious reaction

Any of the symptoms listed above should also be reported to the Peterborough County-City Health Unit as soon as possible. 

If you have any questions about the influenza vaccine, please contact the Vaccine preventable Disease program at the Health Unit at (705) 743-1000.