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Q & A: the flu With the vaccine shortage in the U.S, supply worries here and fears about avian flu, readers have concerns. Public health reporter ANDRÉ PICARD answers your queries

With the vaccine shortage in the U.S, supply worries here and fears about avian flu, readers have concerns. Public health reporter ANDRÉ PICARD answers your queries

One day, a group of blue-ribbon scientists says everybody should get a flu shot; the next day, Canada's chief medical health officer says it's not a good idea. Why the disagreement?

It's not so much as disagreement as a difference between theory and practice. There is a surprising level of agreement among scientists and public-health officials that getting a flu shot is a good idea. The study by the Canadian Task Force on Preventive Health Care said that, in theory, the vaccine could reduce flu cases by up to 93 per cent if everyone were immunized.

David Butler-Jones, the chief medical health officer, did not question the science. What he said is that, in practice, between one-third and half the population actually get a flu shot; a vaccination program won't make the number of cases fall that dramatically. He questioned whether all provinces and territories should offer the vaccine free to all citizens (as Ontario and the Yukon currently do), saying that, spent differently, that money might have a bigger public-health impact.

I want to get a flu shot but I hate needles. Can I take a pill?

Public-health officials say the single greatest barrier to increasing the number of people vaccinated against the flu is the widespread fear of needles. But the flu vaccine takes only seconds to administer and the needle is tiny.

There is a nasal-spray version of the vaccine called FluMist. However, the manufacturer, MedImmune Inc. of Gaithersburg, Md., has not asked for the product to be licensed in Canada. The nasal spray contains live virus (which the injectable version doesn't), so it is not appropriate for those at high risk, such as the elderly, young children and people with chronic diseases.

In the not-too-distant future, most injections will likely be administered using an ultrasound device that painlessly opens pores in the skin, allowing medication to pass into the bloodstream.

Vaccines don't come in pill form (save for oral polio vaccine) because stomach acids manage to destroy most vaccines before they get to the bloodstream.

My doctor says I can't have the vaccine because I'm allergic to eggs. Are there alternatives?

Flu vaccines are produced by injecting influenza viruses into the embryos of chicken eggs, which are incubated, harvested and then blended into vaccine. As a result, people who are truly allergic to eggs should not get a flu shot.

Currently, there is no alternative. The nasal-spray vaccine is also egg-based. A number of biotechnology companies are working on producing vaccine from other cell lines, from sources as diverse as dogs' kidneys, human retinas and the skin of green monkeys. (Cell tissue can be genetically engineered to replicate, making it possible to grow infinite amounts of a virus instead of waiting on the viruses to grow in chicken eggs.)

Does the flu shot protect against avian flu?

No. Each year, the flu shot protects against three predominant strains circulating among humans. This year, the vaccines marketed in Canada target A/New Caledonia, A/Wyoming and B/Jiansu. The flu strain in birds, known as H5N1, has to date infected only 44 humans.

My husband has Addison's disease. Is a flu shot safe for him?

Generally, people with chronic illnesses -- and Addison's, a kidney disease -- should be the first to get the shot because they are at highest risk. But there are many variables, and individual decisions should be made with your doctor.

If I don't want to get a flu shot, what can I do to lower my risk?

The best ways to reduce your risk are frequent hand washing (you can pick up viruses by touching surfaces that are shared by many people, such as doorknobs and poles on buses), maintaining good general health (a strong immune system), not smoking and not kissing anyone with a runny nose.

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