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STAYING HEALTHY AT HOME, WORK, SCHOOL AND IN THE COMMUNITY

It is difficult to predict the exact impact the H1N1 flu virus will have on Waterloo Region. Based on the information to date and provincial recommendation, Region of Waterloo Public Health is planning for the possibility of a "busy" flu season this fall/winter, with the circulation of the H1N1 flu virus and seasonal strains. 

The section below answers some questions about H1N1 and risk groups.  It also includes what individuals, families, workplaces and the general community can do to prepare for the upcoming flu season, how to stay healthy and what treatment options will be available.

Similar to other pages on this website, this webpage is organized in question and answer format.  Clicking on the question will direct you to the answer.

Questions and answers on staying healthy, preparedness and what to do if you're ill

H1N1 Flu Virus - Do I have it?
Influenza Self-Assessment Tool
Who will be at risk?
Are pregnant women and individuals with pre-existing chronic diseases at higher risk?
What can I do to protect myself from getting sick with the seasonal flu or the H1N1 flu virus?
When should I seek medical care? What else can be done to prepare?
Will there be a vaccine for the H1N1 flu virus? 
What is in the H1N1 flu shot?
What is an adjuvant?
What is the unadjuvanted H1N1 flu shot? Should pregnant women receive the adjuvanted or unadjuvanted vaccine?
Is it true that there is mercury in the vaccine? How much mercury?
Is the H1N1 flu virus vaccine safe?
Are there any side effects?
Will everyone receive the H1N1 vaccine at the same time?
Will the annual flu shot protect individuals during a pandemic?
What are antivirals?
How do I stay healthy when caring for a sick friend or family member?
Will schools or workplaces be closed if there is a case of H1N1 flu virus identified or suspected?
When should I return to work if I've been ill?

Guidance Documents for the Management of the H1N1 Flu Virus 

All levels of government including the Public Health Agency of Canada (PHAC), Ontario Ministry of Health and Long-Term Care (MOHLTC) and Region of Waterloo Public Health (ROWPH), are preparing, or continue to prepare guidance documents for a variety of community settings. These documents are designed to provide general direction or information on the measures workplaces should take with regard to the prevention and management of the H1N1 flu virus.

Guidance documents for shelters and faith communities should be released by the beginning of October 2009. Click on each link for the following:

Guidance document for faith communities by ROWPH
Guidance document for mass gatherings prepared by ROWPH
Guidance document for workplaces prepared by ROWPH
Guidance document for elementary and secondary schools prepared by MOHLTC
Guidance document for colleges/universities prepared by MOHLTC
Supplemental guidance for colleges/universities prepared by ROWPH
Guidance document for childcare facilities prepared by ROWPH

Information about Pregnancy and H1N1 Flu Virus

The Public Health Agency of Canada provides pregnant women, their families and communities with the information they need to make decisions that will help protect the health of both mother and child. Click here for key messages about pregnancy and H1N1 flu virus.

Information about Summer Camps and H1N1 Flu Virus

Information for summer camps providers/directors

The Ontario Ministry of Health and Long-Term Care has issued guidelines for the prevention and management of H1N1 flu virus in summer camps available here.

Signs/posters for summer camps can be printed here:

• How to cover your cough/sneeze
• Recognize and report symptoms

Information for parents of children in summer camps

• Summer Camps: What Parents Should Know - Fact Sheet

Other Resources

• Hand washing poster
• Cover your cough

Members of the community who have questions or want more information can call Region of Waterloo Public Health at 519-883-2000, or Telehealth Ontario at 1-866-797-0000. Individuals can also email Region of Waterloo Public Health directly; please click here.

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Who will be at risk?

Everyone is at risk of getting influenza. To date, most cases have been reported in young children, adolescents and young adults. Relatively few individuals 60 years of age or older have been infected. 

Are pregnant women and individuals with pre-existing chronic diseases at higher risk?

Pregnant women and individuals with pre-existing chronic diseases are not at an increased risk of becoming infected with the H1N1 flu virus. However, these groups appear to be at an increased risk of more severe illness if they get sick. Therefore, it is particularly important for these groups to wash their hands frequently and contact their health care provider as soon as possible if they become ill with symptoms of influenza.

What can be done to avoid the flu and the risk of infection?

People can lower their risk by practicing the usual, preventative practices against a range of illnesses, that is:

• Cover your nose and mouth when you cough or sneeze by using a tissue or coughing into your sleeve or upper arm (or into the "crook of your elbow"). Throw the tissue in the garbage after you use it.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand rub/sanitizer (ABHR) with 60 to 90 per cent alcohol is also effective.
• Avoid touching your eyes, nose or mouth. Germs spread easily that way.
• Keep commonly touched surfaces clean and disinfected.
• If you get sick, Public Health recommends that you stay home from work or school until you no longer have a fever and are feeling well.  You should also limit contact with others during this time to keep from infecting them.
• If your symptoms worsen, contact your healthcare provider (doctor).
• Get the seasonal and H1N1 flu vaccines (when available).

Steps to Help Keep You Healthy

When should I seek medical care?

Call your health care provider or Telehealth Ontario if you experience flu-like symptoms and:

• Are pregnant
• Have heart or lung disease
• Have chronic health problems that require regular medical attention
• Are elderly
• Have an illness that affects your immune system, such as diabetes, cancer of HIV/AIDS

Seek medical care for children right away if you notice any of the following signs:

• Fast or difficult breathing
• Increased drowsiness and irritability
• Not drinking enough fluids or signs of dehydration
• Flu-like symptoms become worse

What else can be done to prepare?

Be informed. Understand what impact the H1N1 might have on your family, friends and neighbours if someone becomes ill. Also determine how you might help each other (e.g. check in with each other, provide care for a sick individual, pick-up groceries, walk their dog) during that time.

It is important that individuals have personal, child and elder care plans in the event a loved one becomes ill. For example, parents/guardians with children should ensure they develop alternate care arrangements for their child, especially if the parent/guardian still needs to go to work and their child is ill. 

Personal preparedness (for any emergency) will vary for each individual and family. Below are three links that individuals/families can review as they begin to prepare for the upcoming flu season:

Public Health Agency of Canada
Ontario Ministry of Health and Long-Term Care
Waterloo Region Emergency Measures

Will there be a vaccine for the H1N1 flu virus?

Yes. Ontario has ordered enough H1N1 vaccine to immunize 75 per cent of the population.  Interested primary care providers (doctors) will be able to immunize their priority targets for immunization the week of October 26.  See below for a the list of priority groups.  All other interested indiviudals will be able to receive the vaccine starting the week of November 2. 

Seasonal influenza vaccine will be available in October (before the H1N1 immunization campaign) for the following groups only:

• Individuals over 65 years
• Residents of long-term care homes

After the H1N1 vaccine has been rolled out, the seasonal flu vaccine will be available to everyone over 6 months who lives, works or attends school in Ontario.

What is in the H1N1 flu shot?

The H1N1 flu shot has two ingredients, an "antigen" and an "adjuvant". The antigen is the active ingredient that helps your body become immune to the H1N1 flu virus. The antigen is not a live virus, so will not make you sick with the H1N1 flu. The adjuvant in the H1N1 flu shot is made up of natural ingredients such as fish oil, water and vitamin E. Adjuvant is added to the H1N1 flu shot to boost the body's response to the vaccine. When adjuvant is added to vaccine, less active ingredient (i.e. antigen) is needed. That way we can produce more vaccine for everyone.

What is an adjuvant?

An "adjuvant" is added to vaccines so that less of the active ingredient (i.e. antigen) is required to boost the body's response to vaccine. The adjuvant in the H1N1 flu shot is made up of natural ingredients such as fish oil, water, and vitamin E.

What is the unadjuvanted H1N1 flu shot? Should pregnant women receive the adjuvanted or unadjuvanted vaccine?

There are two types of H1N1 vaccine approved by Health Canada for pregnant women: the adjuvanted H1N1 vaccine and the unadjuvanted (or non-adjuvanted) H1N1 vaccine. An adjuvant is a substance that helps stimulate the body's immune response. The adjuvant in the H1N1 vaccine is made up of natural ingredients such as fish oil, water, and vitamin E.

All evidence suggests that adjuvanted vaccines are just as safe as unadjuvanted vaccines; however the adjuvanted vaccine has not been specifically studied in pregnant women. That is why the WHO's Strategic Advisory Group of Experts (SAGE) has recommended that pregnant women receive non-adjuvanted vaccine if possible.

However, unadjuvanted vaccine won't be available in Canada until at least the second week of November. Given that influenza rates are rising in our community, it is recommended that pregnant women with pre-existing health conditions or who are more than 20 weeks pregnant be offered the adjuvanted vaccine that is available now. This advice is consistent with that given by the Society of Obstetricians and Gynaecologists of Canada (see www.sogc.org).These pregnant women are at greater risk of complications from H1N1.

Is it true that there is mercury in the vaccine? How much mercury?

The H1N1 vaccine contains a small amount of thimerosal. Thimerosal is a form of mercury used in the H1N1 flu vaccine to stabilize it and maintain its quality during storage. Thimerosal is a different form of mercury than the mercury known to cause health problems. The amount in the H1N1 adjuvanted flu vaccine is much less than the daily limit recommended for environmental exposure to mercury. For example, there is significantly less mercury in the vaccine than you would find in a can of tuna fish.

Is the H1N1 flu virus vaccine safe?

Yes. Health Canada is responsible for approving vaccines. They have a strong regulatory process to ensure the vaccines are safe before they are given to the general public. Health Canada has done a review of both the vaccine and the adjuvant. The benefit of immunization - the prevention of serious illness and death - far outweighs any risk associated with being immunized.

Are there any side effects?

Side effects are expected to include: pain and swelling where the injection is given, tiredness, muscle and joint pain, and headaches. Children may have a mild fever, be tired and irritable and not want to eat.

As with the seasonal influenza vaccine, it is expected that most side effects will be mild, and that serious side effects will be very rare.

Will everyone receive the H1N1 vaccine at the same time?

The PHAC and MOHLTC will sequence the distribution of the H1N1 vaccine. This means that individuals at higher risk for getting the H1N1 flu virus will be immunized first. 

The H1N1 flu shots will be given in two stages.  The first shipments of the vaccine will be given to primary care providers (doctors) so they can immunize individuals who are at higher risk of getting complications from influenza.  These include:

• People 65 and under with chronic conditions (e.g. diabetes, cancer)
• Children 6 months to under five years of age;
• People living in remote or isolated communities;
• Pregnant women;
• Health care workers; and
• Household contacts and care providers of persons at higher risk who cannot be immunized (e.g. children under 6 months) or may not respond to vaccines (e.g. those who are immune-compromised)

Primary care providers (doctors) will start giving these individuals the vaccine the week of October 26. 

Starting the week of November 3, other individuals will be able to get the H1N1 flu shot.  Not everyone who wants it may be able to get the H1N1 flu shot that week, as initial supplies are limited. Public Health will offer clinics from November to mid-December to ensure everyone who wants the vaccine can get it. 

Will the annual flu shot protect individuals during a pandemic?

The regular seasonal flu shot will protect you against seasonal flu.  This year's seasonal flu shot will not protect you against H1N1 flu virus. A separate vaccine is being developed to protect individuals again the H1N1 flu virus. It is recommended that all Ontarians get both the annual and H1N1 flu vaccines. 

What are antivirals?

Antivirals are drugs used for the prevention and early treatment of influenza. Antivirals continue to be recommended at this time only for treatment of severe cases or those at higher risk of complications.

How do I stay healthy when caring for a sick friend or family member?

Public Health completed a Fact Sheet that provides guidance on how to stay healthy when caring for a sick friend or family member.  You can download the Fact Sheet by clicking here.

Will schools or workplaces be closed if there is a case of H1N1 flu virus identified or suspected?

School, childcare, university, college and workplace closures are not being considered at this time. This is similar to seasonal influenza where these measures are not taken.

When should I return to work if I've been ill?

Individuals working in a non-healthcare setting should remain off work until the fever has been absent for 24 hours and the individual is feeling well enough to resume normal activities. Some individuals may experience a cough for days to weeks after infection. Presence of a cough in the absence of other symptoms should not prevent an employee from returning to work.