Flu season is here, and with the relative uncertainty of H1N1 many have questions regarding the flu's pending impact and the state of vaccinations.

Of course with any public health debate, there are several sides and thoughts on how best to tackle prevention. I read Dr. Joseph Mercola's Web site regularly and was struck by some of his thoughts on the flu shot and its ingredients, effectiveness and necessity.

So, before I jumped to conclusions I contacted the Milwaukee Health Department and asked Paul A. Biedrzycki, Director of Disease Control & Environmental Health for the City of Milwaukee Health Department five questions about the flu and flu shot.

Milwaukee Health Department: Morbidity and mortality numbers are heavily based on level of surveillance conducted and laboratory specimen confirmation used to initially identify and characterize the magnitude severity and magnitude of this novel virus and associated disease spread in the population.

The CDC has suspended case counts in July of this year because it was an inaccurate representation to the public regarding how widespread the disease really is (did not account for thousands of mild or asymptomatic cases of disease that were not tested).

This is a novel virus with a high level of uncertainty as to future mutations and severity in the population and must be followed closely.

Also historically, second waves of pandemic influenza can be more severe than the initial wave of disease.

OMC: This site and video seem to make a good case against vaccination. What's your take on it?

MHD: The video contains misinformation on intent of H1N1 vaccination including references to it being mandatory, purposely creating public fear mongering and part of deception by government.

H1N1 influenza has symptoms similar to seasonal flu but has an higher incidence rate (during the first wave in spring) including hospitalization in young persons especially under 24 years of age and less infection in persons older than 65 years of age which is not at all like seasonal influenza.

This virus continues to circulate unabated over the summer which for flu is unusual and remains the primary source current influenza being seen in the community now as we begin the seasonal influenza epidemic.

The co-circulation of both seasonal and novel H1N1 virus will be problematic in terms of level of disease spread Within the population this year. While H1N1 is not as virulent as the 1918 flu, it is still considered a novel virus with unknown trajectory

In terms of potential mutation and subsequent severity of disease, sensitivity to antivirals and rapidity of transmission. It is well worth monitoring and slowing the spread of transmission over the coming year(s).

OMC: Is the City of Milwaukee recommending flu shots (regular and H1N1) for every one?

MHD: The MHD is recommending flu shots (seasonal and H1N1) for all persons that do not have medical contraindications and desire to avoid influenza infection (seasonal and H1N1) and/or transmission to others.

OMC: What's in a regular flu shot?

MHD: The seasonal tiv (trivalent influenza vaccine) contains three inactivated flu viruses (2 type A and o1 type B).

Seasonal laiv (live attenuated influenza vaccine i.e., Flumist) contains 3 live attenuated flu viruses that cannot cause disease in humans.

In addition, both formulations may contain preservatives (Thimerosol) but also come preservative free given public concerns about these additives.

OMC: Are all the ingredients safe, even formaldehyde?

MHD: All ingredients are safe. I am unaware of formaldehyde being a primary ingredient in flu vaccines.

OMC: Where are shots available?

MHD: Seasonal influenza vaccine is available at a number or public and private healthcare settings. Individuals should call their local health department and/or medical provider to determine if seasonal vaccine is available.

H1N1 flu vaccine will be made available sometime mid-to-late October to both public and private healthcare providers for initial use in identified target populations at high risk of severe disease, spread of disease to high risk persons including health care workers.