Not to downplay a recent global health emergency that killed thousands, but doesn't swine flu seem, like so totally yesterday's news? I barely received my H1N1 vaccine last week because they were giving them out free.

Not everyone has forgotten that farmy-sounding flu: Marketers of hoakie and fraudulent products are still fanning the dying embers of the outbreak to market weird wares.

More importantly, perhaps, is the question of whether H1N1 will be back, and how the public will respond to the next round of either swine or seasonal flu. Will vaccination rates increase for either?

Swine flu will return, though we can't say for sure when. This past year was only the latest, not first, outbreak of the strain. To be absolutely correct we should probably call it swine-based or H1N1 flu, since each time it, or any other flu circulates it mutates somewhat and becomes essentially a different beast. This most recent H1N1 strain was actually a hybrid swine, bird, and human flu strains. I have heard from folks working in the field for the CDC that the greater concern is a global outbreak of H5N1, or so-called avian flu.

Will we respond better to the next outbreak of novel flu virus? The public health infrastructure will respond better, having learned from the H1N1 experience. Investigation, response, and vaccine production and distribution have run the drill and found the bottle-necks, week spots, and most effective response plans. Better vaccine production methods are being developed.

How about the public? Will more folks get vaccinated, or at least wash their hands, cover their cough and stay home when they have symptoms? Probably not. Flu vaccine rates have been creeping up over time, but year to year they remain relatively stable. About 20% of those under 50, 40% of 50-64 year olds, and 67% of the 65 and over population get seasonal vaccine. As of December 2009, 15% of US population had received H1N1 vaccination (13% of adults and 24% of children). People don't change their health habits easily, so those who get vaccinated will tend to continue and those who don't won't. H1N1 probably won't lead to future increases in vaccine rates because of the perception that:

The threat was overhyped

It was publicized as something unique, special and infrequent.

If you're vaccinated and didn't get sick, was the vaccine a waste or a potential protector?

If you're unvaccinated and didn't get sick, the vaccine would have been a waste.

If you're unvaccinated and were mildly ill, the vaccine wasn't worth it

If you're vaccinated and were ill, then what was the point?

Parental fears of vaccine side effects can effect vaccine rates among children, and though all flu vaccines are exceedingly safe, those fears have proven difficult to extinguish. And until all jobs allow you tp stay home when you are sick, even a pandemic won't keep the mucus troopers home.

Has H1N1 changed your view of the flu?