What you should know about flu

******

CORRECTION

An article Tuesday in the Life, etc. section gave incorrect information about who can safely take FluMist, the nasal spray vaccine to fight influenza. It is approved for people ages 2 to 49.

******

Q. Is the H1N1 virus still as much of a threat as it was last year? No. The pandemic has been declared over, though the virus remains a concern. Just because you received an H1N1 shot or became ill with swine flu last year does not mean you're immune this year. Health officials recommend that you get this year's vaccine, which includes protection against three flu strains, including the 2009 H1N1.

Q. Should people 65 and over consider the new high-dose vaccine?The high-dose vaccine, approved only for people 65 and older, is an alternative to the regular seasonal vaccine. It was produced because of longstanding concern that regular flu vaccines don't work as well in the frail elderly, who are more susceptible to flu and complications than healthier adults. The high-dose vaccine, approved by the FDA, contains more antigen, and in clinical trials, produced higher antibody levels for a potentially better immune response. It produced more side effect such as soreness at the injection site. The high-dose vaccine is not recommended as better, just as an option.

Q. Will there be another pandemic?Yes, but no one knows when. Health officials continue to worry that the H5N1 avian virus could mutate and infect humans more readily. H5N1, known as the bird flu virus, was thought to be the most likely candidate to cause the next flu pandemic before H1N1 erupted last year.

H1N1 continues to circulate. It was stable last year, meaning it didn't mutate to become more virulent or more transmissible, as some had expected. But because a lot of people got sick from the H1N1 flu last year and many also got vaccinated, "We might see more changes in the 2009 H1N1 this year," said Dr. Anne Schuchat, a flu expert at the U.S. Centers for Disease Control and Prevention.

Q. Will young people still be the most susceptible to H1N1? No one knows. Because teens and young adults were highly susceptible to H1N1 last year, it's likely they will be again this year. But influenza is unpredictable, and the virus could change. Health officials encourage people to get vaccinated again even if they got the H1N1 vaccine last year.

Q. Is the vaccine safe? Hundreds of millions of people have received seasonal flu vaccines safely over the years, health officials say. The egg-based manufacturing process is slow, but it's time-tested and produces safe vaccines. "This is the best we've got, and the truth of it is, it's pretty good," said Dr. Tony Moody, an infectious disease specialist at Duke University Medical Center.

Q. Some people say the vaccine gave them the flu. Is that possible? The injectable vaccine is made from a killed virus, and "you cannot get influenza from getting that shot," Moody said. The nasal spray, which is made from a live attenuated virus, will not cause the flu, but could cause a mild reaction, including lethargy. The nasal spray has been shown to be safe, but is not recommended for children under 5, adults over 49 or anyone with a chronic illness. Moody speculated that some people who get flu symptoms after getting a flu shot may have been exposed to the virus before they got the vaccine or before it took effect. It takes about two weeks for immunity to kick in. Also, flu vaccine does not protect against other viruses that sometimes feel like the flu.

Q. Health care workers are encouraged to get flu shots, but they have low rates of vaccination. Is there a move to require them to be vaccinated? Some hospitals have considered making the vaccine mandatory for health-care workers who have direct contact with patients. But CDC director Dr. Thomas Frieden stopped short of recommending mandatory vaccination. Some people, including those allergic to eggs, have good reason to avoid the vaccine.

Q. How much does vaccine cost, and where can I get it? The cost for adults is $24 to $30, but many insurance plans cover the cost. It's available through retail pharmacies, local health departments and doctors' offices.

Last year, the vaccine was free for children 18 and under. This year, because of state budget cuts, it is free only for children who qualify for the federal Vaccines for Children program. That includes children who are Medicaid-eligible, uninsured or underinsured, American Indians or Alaska natives. Underinsured means they have private insurance that doesn't cover vaccines, only selected vaccines, or has a cap on vaccine coverage. See www.immunizenc.com. The free vaccine for children is available through health departments and some doctors' offices.

Q. Is September too early to get a flu shot? Could the effects wear off before the season peaks?

No. It's not too early to get the vaccine. It will provide protection through the season, which usually peaks in January or February but can run through March and April.

Karen Garloch