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Q&A on the flu

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Here are some questions and answers about influenza:

Q: I got vaccinated against both seasonal and that so-called H1N1 flu last year, so why do I need vaccine this year?

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A: It protects against a different strain of the H3N2 influenza family that has cropped up, as well as last year's swine flu, part of the H1N1 family, and a Type B strain. Every year a different flu vaccine is brewed to match the constantly changing flu strains that circle the globe.

Q: Why is there a new high-dose version for seniors?

A: Your immune system weakens with age, so it doesn't respond as actively to a flu shot. Sanofi Pasteur's Fluzone High-Dose quadruples the standard dose for people 65 and older. This winter, scientists will track if that translates into less illness. Until that proof's in, the CDC says it's OK to choose either option.

Sanofi is finalizing how much to make, and availability may vary with location. For example, Dr. Marvin Bittner of the Veterans Affairs Medical Center in Omaha estimates the new shot might benefit one in four seniors and said his center has ordered enough for that population, while other VA clinics aren't ordering as much.

Q: Will I need just one shot?

A: Most people will, but any children under 9 getting their first-ever flu vaccine will need two, a month apart, to prime their immune systems.

Q: What if my child's first-ever vaccine was last year and she got one dose of seasonal and one dose of swine flu vaccine?

A: She wasn't primed enough and needs her two doses this year, said Dr. Michael Brady of Nationwide Children's Hospital, who co-authored the Am-erican Academy of Pediatrics flu vaccination guidelines.

Q: Will there be enough vaccine?

A: Manufacturers project 170 million doses. Obviously that won't cover the entire population, but the CDC knows its near-universal vaccination policy won't spark a stampede for shots. Before last year, flu vaccine was recommended for 85 percent of Americans but only about a third got vaccinated. Last year nearly all 114 million doses of seasonal vaccine were used, but as the swine flu outbreak slowed, just 90 million doses of the special vaccine were used out of nearly 162 million eventually produced for the general public.

Q: Who's at high risk from flu?

A: Young children, anyone 50 or older, anyone with chronic medical conditions such as asthma or heart disease, pregnant women. Also, health workers and caregivers of infants can infect the vulnerable unless vaccinated.

Q: Who can use the nasal spray vaccine?

A: FluMist is for healthy people 2 to 49, no pregnancy or underlying health conditions.

Q: When should vaccination start?

A: Chain pharmacies already have started vaccinating; protection will last all winter. It takes about two weeks to kick in, and flu typically starts circulating around November.

Q: How do I know it's safe?

A: Unprecedented safety monitoring last year turned up no rare side effects from the special swine flu-only vaccine sold in the United States. "We're hoping a lot of the myths people had about the influenza vaccine may be a little bit less of a concern," said pediatrics specialist Brady.

Abroad, a few reports of narcolepsy after a European swine flu vaccine are being probed; that vaccine didn't sell here. An Australian seasonal vaccine dosed for young children won't be sold here after being linked to some fever-related seizures in that country.

Q: Why should I bother since fewer people than usual died last year?

A: Last year's U.S. toll: about 12,000 deaths, 60 million illnesses and 265,000 hospitalizations. New CDC statistics last week suggest flu strain mortality varies widely, from 3,000 in an exceptionally mild year to 49,000 in a recent really bad one -- and it's impossible to predict how bad each year will be.

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