title: Seasonal Influenza Vaccine Allocation in the Canadian Population during a Pandemic.
abstract: BACKGROUND
  Emerging data suggest that receipt of the seasonal influenza vaccine may be associated with an enhanced risk of infection with pandemic (H1N1) 2009 (pH1N1). We sought to evaluate different seasonal vaccination strategies during a pandemic in the presence of varying levels of pH1N1 infection risk following seasonal influenza vaccine receipt.
  
  
  METHODS
  We developed a deterministic, age-structured compartmental model of influenza transmission in the presence of two circulating strains (pH1N1 and seasonal). We examined the effect of different seasonal vaccination strategies on total influenza-attributable mortality in the Canadian population for the 2009-2010 influenza season.
  
  
  RESULTS
  Seasonal vaccination strategies that focused on individuals aged >/=65 or delayed seasonal vaccine delivery until January tended to minimize mortality. In the presence of low levels (<2%) of co-circulating seasonal influenza, mortality estimates were sensitive to the seasonal vaccine-associated relative risk (RR), with small increases in RR resulting in enhanced mortality compared to the no seasonal vaccination option. Timing of the peak of pH1N1 activity and the amount of circulating seasonal influenza modified the impact of enhanced risk on total mortality.
  
  
  CONCLUSIONS
  In the presence of uncertainty surrounding enhanced risk of pH1N1 acquisition with seasonal vaccine receipt, delaying seasonal vaccine delivery or restricting vaccine to individuals aged >/=65 may reduce overall influenza-attributable mortality in the Canadian population.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada and Public Health Agency of Canada.
authors.forename: Ashleigh
authors.initials: A
authors.lastname: Tuite
authors.forename: David N
authors.initials: DN
authors.lastname: Fisman
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Kwong
authors.forename: Amy
authors.initials: A
authors.lastname: Greer