André Picard, The Globe and Mail’s public health reporter, is answering a question a day from readers about the H1N1 pandemic (link here). Last week he was asked this very interesting question I thought you’d all like to see the answer to:

Q: Why aren’t teachers and daycare workers considered “high-priority” for the H1N1 vaccine? Teachers are in daily contact with children (and sick children). Also, many teachers are in their childbearing years and lots of them get pregnant. I don’t understand why teachers aren’t at the front of the line for vaccination.

A: When outbreaks of infectious disease occur, schools and daycare centres are invariably among the places hit first and hardest. Children are virtual microbe-spreading machines and teachers know this well – they tend to get every bug out there. By virtue of being in contact with large groups of children, teachers at relatively high risk of contracting H1N1.

However, the priority groups for vaccination are not those at highest risk of contracting the disease, but those at highest risk of suffering complications and dying if they are infected. This in an important distinction.

The priority groups are:

- People under 65 with chronic health conditions;

- Pregnant women;

- Children aged six months to five years of age;

- People living in remote and isolated communities, particularly First Nations;

- Front-line health workers;

- Care providers to those at high-risk.

As you can see, pregnant women (including teachers) are a high priority for the vaccine. Some jurisdictions, like Quebec, are also urging all pregnant teachers, daycare workers and health professionals to take “preventive early maternity leave” to lessen their risk of contracting H1N1 influenza.

Daycare workers who care for children under the age of six months are a high-priority group and should be vaccinated. Daycare workers and teachers of children aged six months to five years, as well as those care for or teach children with chronic health conditions like cystic fibrosis are also considered a high-priority group in most jurisdictions though there are varying interpretations of what the term “care provider to those at high-risk” means.

So, while not all teachers and daycare workers are at the front of the line for vaccination, some of them should be.

Many have wondered why front-line health-care workers are considered high priority and teachers are not. After all, nurses and doctors are not at higher risk of complications and dying if they are infected. There are two reasons: 1) Front-line health-care workers treat a lot of high-risk patients and could put those patients at grave risk if they passed on the flu bug; 2) They are needed to treat people who are sick with the flu (and other conditions), particularly if there is a pandemic that causes widespread illness. Put crudely, a sick nurse would cause a lot more sickness and social disruption than a sick teacher.