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Hey, that didn't hurt a bit!

Winnipeggers line up for flu shots as immunization campaign kicks into high gear

Photo gallery H1N1 immunization by the numbers

Winnipeg Health Region
Wave Magazine, November / December 2009

Hand in hand with his mom, the little boy walks into the Winnipeg Health Region's Grant Park H1N1 Influenza clinic, big brown eyes wide with wonder - and a bit of uncertainty.

All around him, dozens of children and adults are sitting (or squirming) in their chairs, sleeves rolled, arms exposed, ready to be immunized - the cry of a child being jabbed with a needle rising every now and then above the din of the crowd.

But the little boy is oblivious to the action around him. He's focused on the nurse in front of him.

In a few minutes, he will become one of the thousands of Winnipeggers who have been immunized at mass clinics organized by the Region as part of its H1N1 influenza campaign, one of the largest public health efforts in recent memory.

As this issue of Wave goes to print, more than 175,000 people have been immunized against the H1N1 virus. Most people received their flu shots at one of the Region's mass clinics, but others were immunized through various community outreach programs.

Unlike some other jurisdictions in the country, Winnipeg's H1N1 campaign got off to a fast start, with nearly 60,000 people immunized in the first week the clinics were operating. And, although some lineups lasted up to three hours, the vast majority of those waiting were patient. "I would have liked it better if they had done the screening from the start," says Elli Naksmichi shortly after taking her three children for flu shots. "But the staff was excellent."

Lou Savelsbergh, 78, concurred. "I can't say enough about the nurses. We have the best health care in the world," he said after receiving his shot.

Savelburgh is referring to the public health nurses, people like Michele Rousseau who work to ensure the vaccine is injected safely into the waiting arms of all who want it. A registered nurse for 23 years, Rousseau is currently a part-time nursing instructor at Red River College and teaches at the Health Sciences Centre. She started working as an immunization nurse about four years ago, mostly because she loves working with the public. When the call went out for nurses to administer vaccine at the clinics, Rousseau became one of about 400 nurses who signed up.

For her, the job is all about helping people, educating them on the benefits of getting immunized against influenza. "I also like dealing with families and children, and trying to make this experience as comfortable as possible," she says.

And her passion and professionalism are there for anyone to see as she greets the little boy with the big brown eyes.

"How are you?" asks Rousseau, trying to put the boy at ease.

Nothing.

Rousseau tries again. "How old are you?"

Bingo!

"I'm going to be four in November," the boy says, flashing a wide smile and holding up four little fingers.

With the ice broken, and her little patient relaxed, Rousseau now turns her attention to Mom. She methodically goes over the consent form that each person or guardian must sign. Questions concerning a person's health, how they are feeling, medical history, possible allergies and allergic reactions to the vaccine are all discussed carefully.

Then it's show time.

Rousseau draws some of the milky-coloured, adjuvanted vaccine from a vial at her station. Adults and children over the age of 10 receive .5 ml of the vaccine while younger clients get half this amount. In this case, Rousseau extracts .25 ml of the solution.

The vaccine, which is refrigerated, must be prepared with care. Once pulled from the cooler, the vaccine must be used within four hours. Once loaded into the syringe, it is administered within the hour to maximize its effectiveness.

When the vaccine is ready, it is loaded into the syringe of a hypodermic needle. Adopted as the injector of choice for the Winnipeg Health Region about three years ago, the device features a retractable needle that enhances safety by preventing needle stick injuries among health-care workers.

With the needle loaded and ready to deliver its vaccine, Rousseau turns to the little boy and offers him a purple rubber toy that is intended to distract him. Next, she rolls up the little boy's sleeve and searches out the target area - usually a spot on the deltoid muscle of the arm, just below the bone at the top of the shoulder. In nurse-speak, this process is called "landmarking."

Hitting the landmark - an area the size of a postage stamp - is critical. The H1N1 vaccine is in fact a dead virus, and it must be injected into the muscle in order to fool the body into creating the antibodies needed to fight off an infection of the live H1N1 virus now circulating.

Once the landmark is located, Rousseau swabs the area with alcohol with one hand, and deftly sinks the needle into the arm with the other. As the vaccine is pushed into the muscle, the plunger clicks, and the needle automatically retracts back into the cartridge.

From swab to injection, the process takes about three seconds. The little boy doesn't feel a thing.

	About Wave Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books. Read the November / December 2009 issue of Wave