Alta Care Resources
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November 23rd update
Flu vaccine available to everyone
Monday November 23, 2009
Clinics expected to be able to immunize 50,000 a day
Everyone in Alberta will be eligible to receive the H1N1 shot starting Monday, three weeks after mass immunization clinics were closed to the general public after unexpected demand jeopardized the availability of a dwindling supply of vaccine to those most at risk.
"We have to anticipate the demand will be high," said Dr. Gerry Predy, senior medical officer of health for Alberta Health Services.
To help prevent lineups similar to the ones in late October that forced pregnant women, people in wheelchairs and those with asthma to wait in hours-long lineups alongside healthy people, people will be offered wristbands and an estimated time to return if the waits exceed one hour. On Thursday, when the clinics were opened to all seniors--the last of several high-risk groups to be added to the vaccination rollout --lineups ranged between 30 and 60 minutes. Some people turned down wrist bands, saying they were content to wait. Just under 41,000 people were vaccinated.
"It was brisk," Predy said.
With the province now expecting regular shipments of the vaccine through December, nurses will be able to immunize up to 50,000 people each day. More than 600,000 Albertans have been vaccinated so far.
Predy urged people to bide their time so clinics aren't flooded. Discussions are also in the works to create vaccination clinics at some postsecondary institutions, and to supply clinics of family physicians and pharmacies with doses so people can schedule appointments.
"We have now a good supply of vaccine and anticipate we will be providing vaccine to other settings within a week or two from now," said Dr. Andre Corriveau, Alberta's chief medical officer of health. "If 100 per cent of Canadians wanted to be immunized by Christmas, there might not be enough(doses from the manufacturer)by then, but certainly we believe we'll have enough vaccine to immunize anybody who wants to be immunized."
Corriveau said about 25 per cent of people won't get immunized no matter what.
Predy urged people to get their shots. No Albertans died Thursday from the flu and low patient volumes have convinced Alberta Health Services to close flu assessment clinics in Edmonton, Calgary and Lethbridge on Monday. The one in Medicine Hat is already closed. While the illness is no longer widespread, a third wave of influenza is expected this winter. So far, 45 people with confirmed H1N1 flu have died since April. During the seasonal flu, between 11 and 91 people die directly from the flu. Overall, 250 to 450 Albertans die directly and indirectly from the flu each year. The flu might trigger a heart attack in people with weak hearts, for instance.
Alberta Liberal Leader David Swann called on the government to reveal more information about the deaths so far.
He wants to know the comparable death rates for people in high-risk groups who received the vaccine and those who didn't get their shots.
"If the vaccine prevents the disease and if the vaccine prevents death in high-risk groups because they don't get the infection in the first place, then the logical conclusion is people who don't get the vaccine in the high-risk groups are going to die at a higher rate than if they had had the vaccine," Swann said. "To what extent have the delays in reaching those high-risk groups contributed to the deaths in province? To what extent was the political interference in this vaccine rollout responsible for some deaths relative to the rollout in other provinces?"
Corriveau said such comments are "unfortunate."
More than one million Albertans fall into high-risk categories, and even if they had received their vaccinations on the first day of the campaign (Oct. 26), they wouldn't have achieved full protection from H1N1 until two weeks later, Corriveau said. He said the province made the vaccine available to high-risk people from the start, even though healthy people weren't turned away initially.
Predy agreed.
"We really wouldn't expect the vaccine to have had much of an impact on severe illness and death, given the timing it was available. It would have taken at least 2.5 weeks to vaccinate all the people in the high risk groups who wanted the vaccine....It's unfortunate this gets raised without the full consideration of some of those facts."
Earlier this week, Alberta's auditor general announced he will examine the province's swine flu vaccination program over the next few months to see if the plan was properly implemented and clearly communicated.
Monday November 23, 2009
Clinics expected to be able to immunize 50,000 a day
Everyone in Alberta will be eligible to receive the H1N1 shot starting Monday, three weeks after mass immunization clinics were closed to the general public after unexpected demand jeopardized the availability of a dwindling supply of vaccine to those most at risk.
"We have to anticipate the demand will be high," said Dr. Gerry Predy, senior medical officer of health for Alberta Health Services.
To help prevent lineups similar to the ones in late October that forced pregnant women, people in wheelchairs and those with asthma to wait in hours-long lineups alongside healthy people, people will be offered wristbands and an estimated time to return if the waits exceed one hour. On Thursday, when the clinics were opened to all seniors--the last of several high-risk groups to be added to the vaccination rollout --lineups ranged between 30 and 60 minutes. Some people turned down wrist bands, saying they were content to wait. Just under 41,000 people were vaccinated.
"It was brisk," Predy said.
With the province now expecting regular shipments of the vaccine through December, nurses will be able to immunize up to 50,000 people each day. More than 600,000 Albertans have been vaccinated so far.
Predy urged people to bide their time so clinics aren't flooded. Discussions are also in the works to create vaccination clinics at some postsecondary institutions, and to supply clinics of family physicians and pharmacies with doses so people can schedule appointments.
"We have now a good supply of vaccine and anticipate we will be providing vaccine to other settings within a week or two from now," said Dr. Andre Corriveau, Alberta's chief medical officer of health. "If 100 per cent of Canadians wanted to be immunized by Christmas, there might not be enough(doses from the manufacturer)by then, but certainly we believe we'll have enough vaccine to immunize anybody who wants to be immunized."
Corriveau said about 25 per cent of people won't get immunized no matter what.
Predy urged people to get their shots. No Albertans died Thursday from the flu and low patient volumes have convinced Alberta Health Services to close flu assessment clinics in Edmonton, Calgary and Lethbridge on Monday. The one in Medicine Hat is already closed. While the illness is no longer widespread, a third wave of influenza is expected this winter. So far, 45 people with confirmed H1N1 flu have died since April. During the seasonal flu, between 11 and 91 people die directly from the flu. Overall, 250 to 450 Albertans die directly and indirectly from the flu each year. The flu might trigger a heart attack in people with weak hearts, for instance.
Alberta Liberal Leader David Swann called on the government to reveal more information about the deaths so far.
He wants to know the comparable death rates for people in high-risk groups who received the vaccine and those who didn't get their shots.
"If the vaccine prevents the disease and if the vaccine prevents death in high-risk groups because they don't get the infection in the first place, then the logical conclusion is people who don't get the vaccine in the high-risk groups are going to die at a higher rate than if they had had the vaccine," Swann said. "To what extent have the delays in reaching those high-risk groups contributed to the deaths in province? To what extent was the political interference in this vaccine rollout responsible for some deaths relative to the rollout in other provinces?"
Corriveau said such comments are "unfortunate."
More than one million Albertans fall into high-risk categories, and even if they had received their vaccinations on the first day of the campaign (Oct. 26), they wouldn't have achieved full protection from H1N1 until two weeks later, Corriveau said. He said the province made the vaccine available to high-risk people from the start, even though healthy people weren't turned away initially.
Predy agreed.
"We really wouldn't expect the vaccine to have had much of an impact on severe illness and death, given the timing it was available. It would have taken at least 2.5 weeks to vaccinate all the people in the high risk groups who wanted the vaccine....It's unfortunate this gets raised without the full consideration of some of those facts."
Earlier this week, Alberta's auditor general announced he will examine the province's swine flu vaccination program over the next few months to see if the plan was properly implemented and clearly communicated.
Tamiflu could become overprescribed,
Tamiflu could become overprescribed, experts say
Symptoms should be critical before using
As public health officials urge more rapid use of antivirals for H1N1, some experts worry the drugs could become over-prescribed for what is a relatively mild illness in most people.
More than one million antiviral doses have been drawn from the federal stockpile in recent months, and the number of prescriptions filled by Canadian retail drugstores for Tamiflu and Relenza, the frontline drugs being used in the pandemic, nearly doubled between September and October.
As of Oct. 30, 151,688 prescriptions had been dispensed by retail pharmacists nationwide so far this year--an increase of 73,291 prescriptions over September, according to prescription-drug-tracking firm IMS Health Canada.
Nationally, the number of visits to doctors for flu-like symptoms are at levels not seen in 12 years.
The World Health Organization is recommending that people in at-risk groups, including pregnant women, children under two and those with underlying conditions such as asthma, be treated with antivirals as soon as possible when they have flu symptoms, and that people without risk factors should also be treated if their symptoms worsen or persist.
"It's a bit of a catch-22, when the best impact of the oseltamivir is if you give it early. And yet we're not suggesting that the huge majority of people get oseltamivir," said Dr. Brian Ward, an infectious-disease physician and associate director of The Research Institute at McGill University Health Centre.
"Most of the people who have true influenza should not be prescribed oseltamivir," Ward said. The drugs can cause nausea and vomiting, and widespread use could lead to H1N1 developing resistance to the only effective antivirals available.
"Really, the cutoff is clinical symptoms out of proportion for what you would expect for routine influenza," Ward said. He had H1N1 in the summer, "and I very specifically did not take oseltamivir. I didn't want to spread a resistant bug to my children and family. And I had flu. I didn't have unexpected symptoms.
"We should be reserving the oseltamivir for people who are presenting with unusual symptoms."
Symptoms should be critical before using
As public health officials urge more rapid use of antivirals for H1N1, some experts worry the drugs could become over-prescribed for what is a relatively mild illness in most people.
More than one million antiviral doses have been drawn from the federal stockpile in recent months, and the number of prescriptions filled by Canadian retail drugstores for Tamiflu and Relenza, the frontline drugs being used in the pandemic, nearly doubled between September and October.
As of Oct. 30, 151,688 prescriptions had been dispensed by retail pharmacists nationwide so far this year--an increase of 73,291 prescriptions over September, according to prescription-drug-tracking firm IMS Health Canada.
Nationally, the number of visits to doctors for flu-like symptoms are at levels not seen in 12 years.
The World Health Organization is recommending that people in at-risk groups, including pregnant women, children under two and those with underlying conditions such as asthma, be treated with antivirals as soon as possible when they have flu symptoms, and that people without risk factors should also be treated if their symptoms worsen or persist.
"It's a bit of a catch-22, when the best impact of the oseltamivir is if you give it early. And yet we're not suggesting that the huge majority of people get oseltamivir," said Dr. Brian Ward, an infectious-disease physician and associate director of The Research Institute at McGill University Health Centre.
"Most of the people who have true influenza should not be prescribed oseltamivir," Ward said. The drugs can cause nausea and vomiting, and widespread use could lead to H1N1 developing resistance to the only effective antivirals available.
"Really, the cutoff is clinical symptoms out of proportion for what you would expect for routine influenza," Ward said. He had H1N1 in the summer, "and I very specifically did not take oseltamivir. I didn't want to spread a resistant bug to my children and family. And I had flu. I didn't have unexpected symptoms.
"We should be reserving the oseltamivir for people who are presenting with unusual symptoms."
November 11th update
Chronic illness groups to get shots
EDMONTON — Vaccination clinics for the H1N1 flu will open up to a large segment of the population with underlying health conditions this week as the death tolls continues to rise.
People with chronic conditions aged 10 to 17 and 55 to 64 can begin using the clinics Thursday. On Friday, the group expands to include those aged 45 to 54 with chronic conditions.
The decision was made after a careful assessment of remaining vaccine supplies and the number of people getting shots, said Andre Corriveau, Alberta's chief medical officer of health.
He added that he did not think there was enough vaccine to include those aged 18 to 44 with underlying health conditions.
Corriveau continued to urge patience. "We would like to avoid having people stand in line for excessive periods of time." Today, Edmonton clinics are open from noon to 8 p.m.
Four more people with H1N1 died between Monday afternoon and Tuesday afternoon. Of the two men and two women, three were from the Edmonton area. One was from southern Alberta. All were over 30 and had underlying health conditions. Alberta Health Services would not be anymore specific than that about their ages.
That brings the number of people with H1N1 who have died in Alberta to 29.
During a typical flu season, 11 and 90 people die directly from the flu, and three times that number die from related conditions.
Corriveau said Alberta Health Services will continue to focus on vaccinating high-risk groups for the next couple of weeks.
There were an estimated 200,000 to 210,000 vaccine doses left before the two new groups were added Tuesday morning.
An additional 237,000 doses are expected to arrive Thursday. However, almost 127,000 of those doses will be unadjuvanted, intended for pregnant women.
Last year, a record 50,543 infants were born in the province. It's not known why the Public Health Agency of Canada decided to send Alberta a total of 155,500 doses of unadjuvanted vaccine, more than that supplied to British Columbia.
Corriveau acknowledged there would be an excess of the unadjuvanted vaccine.
The Public Health Agency of Canada could not be reached for comment Tuesday.
Dr. Henry Pabst, a pediatrician at the Misericordia Hospital, said he would advise his patients, including children with underlying health conditions, to get the adjuvanted vaccine.
"I don't think there's any point" in giving the unadjuvanted vaccine at all, said Pabst, who also tested vaccines and taught immunology and pediatrics at the University of Alberta for nearly 30 years.
"The adjuvant makes a big difference in the immune-system response."
Overall, he said it would be wise if parents with children who are most susceptible would get their children vaccinated.
This advice is particularly relevant for children who have cystic fibrosis or heart conditions, he said.
Clinics opened Tuesday to children under 10 with chronic health conditions, as well as to parents and caregivers of children under six months of age. The other groups that continue to be eligible were children over six months of age on the vaccination date and less than five years of age as of Nov. 1.
Proof of age is required, such as a birth certificate or an Alberta Health Care card. Pregnant women are also eligible.
H1N1 flu shot sites:
Commonwealth Stadium
11000 Stadium Road Parking on the west side, enter through Gate 2
Westmount Center
114 Avenue and Groat Road Clinic accessible ONLY via the very far north wall of the mall. Access NOT available through the mall.
Northgate Centre
9499 -137 Ave.
Clinic located in the health unit on the upper floor at the east end of the mall above Zellers
Rutherford Health Centre
11153 - Ellerslie Rd., 2nd Flr Clinic located on the upper floor of the strip mall, above the bake shop. Elevator is thru the 2nd door, to the left, by the dentist's office.
Millbourne Mall
7609 38 Avenue 38 Ave @ Millwoods Road Inside the mall near the food court.
Bonnie Doon Shopping Centre
82 Ave - 83 St Clinic is located at the south end of the mall near Safeway.
Strathcona county Health Centre
2 Brower Drive Sherwood Park
Grandin Park Plaza
22 Sir Winston Churchill Ave. St. Albert
EDMONTON — Vaccination clinics for the H1N1 flu will open up to a large segment of the population with underlying health conditions this week as the death tolls continues to rise.
People with chronic conditions aged 10 to 17 and 55 to 64 can begin using the clinics Thursday. On Friday, the group expands to include those aged 45 to 54 with chronic conditions.
The decision was made after a careful assessment of remaining vaccine supplies and the number of people getting shots, said Andre Corriveau, Alberta's chief medical officer of health.
He added that he did not think there was enough vaccine to include those aged 18 to 44 with underlying health conditions.
Corriveau continued to urge patience. "We would like to avoid having people stand in line for excessive periods of time." Today, Edmonton clinics are open from noon to 8 p.m.
Four more people with H1N1 died between Monday afternoon and Tuesday afternoon. Of the two men and two women, three were from the Edmonton area. One was from southern Alberta. All were over 30 and had underlying health conditions. Alberta Health Services would not be anymore specific than that about their ages.
That brings the number of people with H1N1 who have died in Alberta to 29.
During a typical flu season, 11 and 90 people die directly from the flu, and three times that number die from related conditions.
Corriveau said Alberta Health Services will continue to focus on vaccinating high-risk groups for the next couple of weeks.
There were an estimated 200,000 to 210,000 vaccine doses left before the two new groups were added Tuesday morning.
An additional 237,000 doses are expected to arrive Thursday. However, almost 127,000 of those doses will be unadjuvanted, intended for pregnant women.
Last year, a record 50,543 infants were born in the province. It's not known why the Public Health Agency of Canada decided to send Alberta a total of 155,500 doses of unadjuvanted vaccine, more than that supplied to British Columbia.
Corriveau acknowledged there would be an excess of the unadjuvanted vaccine.
The Public Health Agency of Canada could not be reached for comment Tuesday.
Dr. Henry Pabst, a pediatrician at the Misericordia Hospital, said he would advise his patients, including children with underlying health conditions, to get the adjuvanted vaccine.
"I don't think there's any point" in giving the unadjuvanted vaccine at all, said Pabst, who also tested vaccines and taught immunology and pediatrics at the University of Alberta for nearly 30 years.
"The adjuvant makes a big difference in the immune-system response."
Overall, he said it would be wise if parents with children who are most susceptible would get their children vaccinated.
This advice is particularly relevant for children who have cystic fibrosis or heart conditions, he said.
Clinics opened Tuesday to children under 10 with chronic health conditions, as well as to parents and caregivers of children under six months of age. The other groups that continue to be eligible were children over six months of age on the vaccination date and less than five years of age as of Nov. 1.
Proof of age is required, such as a birth certificate or an Alberta Health Care card. Pregnant women are also eligible.
H1N1 flu shot sites:
Commonwealth Stadium
11000 Stadium Road Parking on the west side, enter through Gate 2
Westmount Center
114 Avenue and Groat Road Clinic accessible ONLY via the very far north wall of the mall. Access NOT available through the mall.
Northgate Centre
9499 -137 Ave.
Clinic located in the health unit on the upper floor at the east end of the mall above Zellers
Rutherford Health Centre
11153 - Ellerslie Rd., 2nd Flr Clinic located on the upper floor of the strip mall, above the bake shop. Elevator is thru the 2nd door, to the left, by the dentist's office.
Millbourne Mall
7609 38 Avenue 38 Ave @ Millwoods Road Inside the mall near the food court.
Bonnie Doon Shopping Centre
82 Ave - 83 St Clinic is located at the south end of the mall near Safeway.
Strathcona county Health Centre
2 Brower Drive Sherwood Park
Grandin Park Plaza
22 Sir Winston Churchill Ave. St. Albert
Know the Difference between a Cold and H1N1 Flu Symptoms:
| Symptom | Cold | H1N1 Flu |
| Fever | Fever is rare with a cold. | Fever is usually present with the flu in up to 80% of all flu cases. A temperature of 100°F or higher for 3 to 4 days is associated with the H1N1 flu. |
| Coughing | A hacking, productive (mucus- producing) cough is often present with a cold. | A non-productive (non-mucus producing) cough is usually present with the H1N1 flu (sometimes referred to as dry cough). |
| Aches | Slight body aches and pains can be part of a cold. | Severe aches and pains are common with the H1N1 flu. |
| Stuffy Nose | Stuffy nose is commonly present with a cold and typically resolves spontaneously within a week. | Stuffy nose is not commonly present with the H1N1 flu. |
| Chills | Chills are uncommon with a cold. | 60% of people who have the H1N1 flu experience chills |
| Tiredness | Tiredness is fairly mild with a cold. | Tiredness is moderate to severe with the H1N1 flu. |
| Sneezing | Sneezing is commonly present with a cold. | Sneezing is not common with the H1N1 flu. |
| Sudden Symptoms | Cold symptoms tend to develop over a few days. | The H1N1 flu has a rapid onset within 3-6 hours. The flu hits hard and includes sudden symptoms like high fever, aches and pains. |
| Headache | A headache is fairly uncommon with a cold. | A headache is very common with the H1N1 flu, present in 80% of flu cases. |
| Sore Throat | Sore throat is commonly present with a cold. | Sore throat is not commonly present with the H1N1 flu. |
| Chest Discomfort | Chest discomfort is mild to moderate with a cold. | Chest discomfort is often severe with the H1N1 flu. |
H1N1 pandemic information
Good Advice/H1N1 Preventive Methods
The only portals of entry are the nostrils and mouth/throat. In a global epidemic of this nature, it's almost impossible to avoid coming into contact with H1N1 in spite of all precautions. Contact with H1N1 is not so much of a problem as proliferation is.
While you are still healthy and not showing any symptoms of H1N1 infection, in order to prevent proliferation, aggravation of symptoms and development of secondary infections, some very simple steps, not fully highlighted in most official communications, can be practiced (instead of focusing on how to stock N95 or Tamiflu):
1. Frequent hand-washing (well highlighted in all official communications).
2. "Hands-off-the-face" approach. Resist all temptations to touch any part of face (unless you want to eat or bathe.)
3. *Gargle twice a day with warm salt water (use Listerine or Hydrogen Peroxide if you don't trust salt). *H1N1 takes 2-3 days after initial infection in the throat/ nasal cavity to proliferate and show characteristic symptoms. Simple gargling prevents proliferation. In a way, gargling with salt water has the same effect on a healthy individual that Tamiflu has on an infected one. Don't underestimate this simple, inexpensive and powerful preventative method.
4. Similar to 3 above, *clean your nostrils at least once every day with warm salt water, or hydrogen peroxide. *Not everybody may be good at Jala Neti or Sutra Neti (very good Yoga asanas to clean nasal cavities), but *blowing the nose softly once a day and swabbing both nostrils with cotton buds dipped in warm salt water is very effective in bringing down viral population.
5. *Boost your natural immunity with foods that are rich in Vitamin C (Amla and other citrus fruits). *If you have to supplement with Vitamin C tablets, make sure that it also has Zinc to boost absorption.
6. *Drink as much of warm liquids (tea, coffee, etc) as you can. *Drinking warm liquids has the same effect as gargling, but in the reverse direction. They wash off proliferating viruses from the throat into the stomach where they cannot survive, proliferate or do any harm.
While you are still healthy and not showing any symptoms of H1N1 infection, in order to prevent proliferation, aggravation of symptoms and development of secondary infections, some very simple steps, not fully highlighted in most official communications, can be practiced (instead of focusing on how to stock N95 or Tamiflu):
1. Frequent hand-washing (well highlighted in all official communications).
2. "Hands-off-the-face" approach. Resist all temptations to touch any part of face (unless you want to eat or bathe.)
3. *Gargle twice a day with warm salt water (use Listerine or Hydrogen Peroxide if you don't trust salt). *H1N1 takes 2-3 days after initial infection in the throat/ nasal cavity to proliferate and show characteristic symptoms. Simple gargling prevents proliferation. In a way, gargling with salt water has the same effect on a healthy individual that Tamiflu has on an infected one. Don't underestimate this simple, inexpensive and powerful preventative method.
4. Similar to 3 above, *clean your nostrils at least once every day with warm salt water, or hydrogen peroxide. *Not everybody may be good at Jala Neti or Sutra Neti (very good Yoga asanas to clean nasal cavities), but *blowing the nose softly once a day and swabbing both nostrils with cotton buds dipped in warm salt water is very effective in bringing down viral population.
5. *Boost your natural immunity with foods that are rich in Vitamin C (Amla and other citrus fruits). *If you have to supplement with Vitamin C tablets, make sure that it also has Zinc to boost absorption.
6. *Drink as much of warm liquids (tea, coffee, etc) as you can. *Drinking warm liquids has the same effect as gargling, but in the reverse direction. They wash off proliferating viruses from the throat into the stomach where they cannot survive, proliferate or do any harm.