'Flu rage' erupts in Canada as cases spike and vaccine dwindles

It is not clear why Canadian health officials thought that Canada's experience with the H1N1 vaccine supply would be any different than that of the United States, which has had a shortage of vaccine almost since their program started.

But even up to last week, Canada's Health Minister, Leona Aglukkaq was promising Canadians that Canada was all over the H1N1 situation, and told the nation not to worry. Last week, just prior to the approval of Arepanrix, Canada's version of Pandemrix, one of the European-approved H1N1 vaccines, Canadians were told

"Hoards of the H1N1 influenza vaccine are being stockpiled in provincial and territorial warehouses, with the gates ready to swing open when Health Canada gives the green light..."

There was no inkling last week of any problems with the vaccine other than the reluctance of some people to get the shot. But the sudden deaths of children, reportedly previously healthy, said to have been caused by H1N1 took care of that problem. The minute immunization clinics have opened, public demand has been high. Just as the public was getting into a vaccination groove came yesterday's announcement that Canada is running out out of vaccine. After daily news reports of people turned away from clinics after waiting for hours, the announcement of a shortage has fanned the flames of public anger. In the midst of all this flu angst is an increase in influenza-like-illnesses across Canada. Some provinces have been reporting school closures attributed to H1N1 outbreaks. But a close look at the numbers, where available, tell a very interesting story. British Columbia experienced a surge in influenza-like-illnesses just ahead of the rest of the country this fall. Of the 2,174 specimens taken for H1N1 testing, slightly more than 1/2 of those cases have tested positive for that virus. The British Columbia Center for Disease Control has not said what caused the flu-like illnesses in the other 996 cases. An Ontario report, OAHPP Laboratory Pandemic H1N1 Surveillance Report states

"The percent positive pH1N1 has been increasing since September 1, 2009. At its highest it reached 40.7% on October 19, 2009. At the height of the Spring/Summer pH1N1 outbreak, percent positive pH1N1 reached approximately 54%."

The report does not say what caused the flu-like illness in the remainder of the nearly 6,000 samples tested for H1N1 this fall. The Laboratory Report has a chart that lists where samples came from. and how many of those samples were positive for H1N1, which is worth looking at. Algoma, for example, submitted 147 samples for testing; H1N1 was found in only 13 of those samples. Last week CBS news released an exclusive story that essentially said the U.S. Center for Disease Control had "over-estimated" the number of H1N1 cases earlier this year just before stopping widespread testing for H1N1. CBS said if you think you had H1N1, you probably did not. The CBS investigation did not draw any conclusions as to why testing was stopped, but highlighted the ongoing need to verify the source of a flu-like illness during a declared flu pandemic. Nobody is saying what is causing the high number of influenza-like-illnesses in North America. CBS notes "With most cases diagnosed solely on symptoms and risk factors, the H1N1 flu epidemic may seem worst than it is." This holds true in Canada. British Columbia, for example, said that illness caused by the flu was spiking up, and during the week of October 18 - 24, 100 schools were closed because of "influenza-like-illnesses." But testing for the virus is only done for "severe" cases of illness, and as the CBS report noted, the numbers do not support such a high incidence of H1N1. The recommendation to stop testing came from the World Health Organization in July, a month after declaring the H1N1 met the conditions for a pandemic. The WHO justified this recommendation saying

"The increasing number of cases in many countries with sustained community transmission is making it extremely difficult, if not impossible, for countries to try and confirm them through laboratory testing. Moreover, the counting of individual cases is now no longer essential in such countries for monitoring either the level or nature of the risk posed by the pandemic virus or to guide implementation of the most appropriate response measures."

Public heatlh officials in the United States told CBS that it was important to track the pandemic virus, and testing should be done on everyone, not just on severe cases. Testing for H1N1 takes days. The concern about the saftey of Canada's H1N1 vaccine has not gone away. The vaccine was not fully tested before it was approved, and Canada based its approval on Europe's approval of a similar vaccine. But Europe also has not fully tested the vaccine. The Toronto Star reported that Health Canada is covering the costs of law suits against GlaxoSmithKline should any Canadian experiencing a severe problem with the vaccine decide to sue the company. And in Europe, it is believed that four seniors with underlying health issues have died after receiving the Pandemrix vaccine, the one that is similar to Canada's Arepanrix. Neither vaccine has been tested on children under 18 years, people over 60 years of age, pregnant women and people with health conditions. With pharmaceutical companies poised to make record profits from the H1N1 vaccine, and doctors feeling shut out of the immunization program because of all the red tape, the public is starting to ask questions. While it does appear the H1N1 pandemic has been somewhat overblown, people should not dismiss the fact that the H1N1 virus, like any influenza virus, poses a serious health risk to some people. The best thing to do would be to consult with your doctor, who can advise you on the best course of action.