The nasal spray vaccine is approved only for healthy people ages 2 to 49. The nasal spray vaccine is NOT approved for pregnant women.

The flu shots, depending on the manufacturer, are approved for kids as young as 6 months of age and are safe for pregnant women.

Who is first in line to get the H1N1 swine flu vaccine?

So who will get the first doses?

Five groups:

1. Pregnancy increases a woman's risk of severe flu sixfold, so pregnant women are a priority group.
2. Household contacts and caregivers of children younger than 6 months of age, including day care providers. Infants under 6 months of age are too young to vaccinate and are at high risk of severe flu.
3. H1N1 swine flu most often strikes young people, so people ages 6 months to 24 years are a priority.
4. Health care workers and emergency medical personnel.
5. Any adult aged 25 to 64 with a medical condition, such as asthma or COPD, that increases risk of flu complications.

If I'm not at the front of the line, will there be enough H1N1 swine flu vaccine for me?

The first 6 or 7 million doses is the tip of the iceberg. By Oct. 12, the CDC says 40 million doses of vaccine will have been shipped. Every week thereafter, 20 million doses will ship.

Overall, the U.S. has now purchased 251 million doses of H1N1 swine flu vaccine. The U.S. has donated 10% of the supply to nations not able to afford the vaccine, leaving 226 million doses for the U.S.

Since adults need only one dose (children under 10 need two doses), and since not everyone will choose to be vaccinated, this means everyone who wants the vaccine eventually will be able to get it.

Is the H1N1 swine flu vaccine safe?

The H1N1 swine flu vaccine, both the shots and the nasal spray, are made the same way as the seasonal flu vaccine.

Every year or so, the seasonal flu vaccine -- which includes a component based on the seasonal H1N1 virus -- is tweaked to match a flu virus that has changed its genetic makeup. The same kind of tweaking resulted in the H1N1 swine flu vaccine.

That's why the FDA approved it: They considered it just a strain change, and not a brand new vaccine.

Even so, both long- and short-term clinical trials are under way. Results from the short-term studies already are here: Other than causing the usual soreness and perhaps redness at the site of injection, the vaccines cause no major side effects.

And like the seasonal flu vaccine, the H1N1 swine flu vaccine can't be taken by everybody. The vaccine is produced in hens' eggs, so people with egg allergies cannot take the vaccine.

Will there be long-term side effects?

That's not likely -- but the CDC is taking no chances. The CDC and vaccine manufacturers have beefed up their safety monitoring process to look for anything unusual in people who get vaccinated against the new flu.

Is the H1N1 swine flu vaccine safe?

Millions of people are going to get the vaccine. Odds are, something bad is going to happen to some people around the same time they get their vaccine. If they have a car wreck two days after getting the vaccine, it's not likely to be blamed on the vaccine.

But what if, say, a pregnant woman has a miscarriage soon after vaccination? There will be scary media reports and the CDC will investigate. Public health experts are warning people to understand that events such as miscarriages are not all that uncommon; it will take some time to learn whether they are more common in women who get vaccinated than in women who do not get vaccinated.

Who should get the H1N1 swine flu vaccine?

Because it is a new virus to which humans have never before been exposed, everyone is vulnerable to H1N1 swine flu. That means everyone could benefit from the vaccine.

But cases among people over age 65 have so far been rare. And few healthy adults over age 24 have suffered serious swine flu illness. These groups are asked to wait until others have had a chance to get vaccinated.

Eventually, there will be enough H1N1 swine flu vaccine for everyone who wants it.

The vaccination program is voluntary.

If I think I've had swine flu, do I need the vaccine?

Even during a flu pandemic, colds and all kinds of flu-like illnesses circulate. In fact, most flu-like illnesses are NOT caused by the flu.

If you came down with a flu-like illness since April 2009, you may have had the H1N1 swine flu. But the only way to know for sure is if your doctor took a nasal or throat swab, sent it off to a lab, and had that lab confirm the infection.

If that didn't happen, it's not safe to assume you already had the flu. Especially if you're at risk of severe flu illness, it's a very good idea to get your H1N1 swine flu shot AND your seasonal flu shot. The vaccine is perfectly safe for people who actually had swine flu.

What's the difference between the nasal spray and injectable vaccines?

The traditional flu shot contains proteins separated from the flu virus. Those proteins can't cause illness. But your immune system learns to recognize them, and mounts a protective reaction if a real live flu virus tries to infect you.

The FluMist nasal spray works differently. It contains a live flu virus that has been weakened to the point that it can't cause the flu. That sounds pretty scary, but millions of people have safely taken this kind of vaccine.

The advantage of the nasal spray is that in children who have never had the flu or a flu vaccine before, it seems to elicit a stronger immune response than the flu shot.

The disadvantage of the nasal spray is that in older people who've had the flu or flu vaccines before, it may not be quite as protective as the flu shot. That finding is based on a single study, based on just a single flu season. And since nobody has had the H1N1 swine flu before, the FluMist H1N1 swine flu vaccine is expected to work just as well in adults as the flu shot does.

I know studies show vaccines preserved with thimerosal are safe, but is there an alternative?

Tiny doses of a mercury compound called thimerosal keep multidose vials of flu vaccine safe from contamination with bacteria. Before thimerosal was added to multidose vials, contamination caused serious adverse events.

Exhaustive studies fail to find any reason to believe that thimerosal is unsafe. But if you don't want thimerosal, you don't have to have it. Single-dose syringes of flu vaccine don't need thimerosal and don't have any. Neither does the FluMist nasal spray vaccine.

   If you prefer a thimerosal-free vaccine, check with your provider to see if one is available. If not, check with your state or local health department to see where you can find one.

Where can my children and I get the swine flu vaccine?

Medical practices and clinics that want to offer the H1N1 swine flu vaccine have already registered with their state health departments. Check with your medical providerr to see if she or he is offering the vaccine.

Because children are especially vulnerable to H1N1 swine flu -- and are especially likely to spread the disease to others -- many states will be offering H1N1 swine flu vaccinations in schools.

   Coos County is planning vaccination clinics at some of the schools and other sites that they will publicize in advance.  Providers will be vaccinating in some medical offices and at Waterfall Clinic.  Vaccination locations and date will be announced in the media.  Parents are urged to sign permission forms for H1N1 vaccine as soon as you receive them and return them promptly to the school.

How much will the H1N1 swine flu vaccine cost?

The U.S. government purchased the vaccine from manufacturers and is providing the vaccine at no cost.  An administrative cost for vaccination may be charged particularly for clients with medical insurance.  This cost will be modest.

Private medical clinics may charge or bill insurance to administer the vaccine, but not for the vaccine itself.  The Health Department may bill insurance, but no person will be asked to pay anything out of pocket at the public health vaccine clinics.

I've heard H1N1 swine flu shots are mandatory. Is that true?

Swine flu shots are voluntary for most Americans. For those not in the military, there is no federal requirement to get the H1N1 swine flu vaccine.

But would YOU get the swine flu vaccine yourself?

Most medical providers will definitely get the Swine Flu (H1N1) vaccination as soon as possible to protect themselves and their patients.

Coos County is now seeing many cases of swine (H1N1) flu in the emergency rooms and pediatric practices.  Getting the swine (H1N1) flu vaccination is the best protection to prevent this illness.  Most of the swine flu cases occur in young people, as do most of the hospitalizations.   Even though hospitalizations are rare, up to 45% of hospitalizations for swine flu in the U.S. have been in children between the ages of new born to 18 years old. This is a complete reversal of a typical “seasonal” flu that mainly causes hospitalizations in people over 60.

Hugh Tyson MD Coos County Health Officer