IQALUIT - More than 40 Nunavummiut have been hospitalized with H1N1 since the outbreak began in the territory, but none have been elders.

"This virus isn't behaving the same way as seasonal influenza. It's affecting people very differently," said Nunavut's chief medical officer of health Dr. Isaac Sobol.

Aside from elders, every other age group has been affected including children. The first confirmed cases of H1N1 in Nunavut were two children who were treated in the paediatrics ward of Stanton Territorial Hospital in Yellowknife in April.

Sobol said it was possible elders have a resistance to H1N1 because in 1957 there was a worldwide outbreak of a genetically similar strain of flu virus. Elders who were infected at the time might still be resistant even decades later.

There are other ways in which the virus is unusual.

According to Sobol, many of the standard symptoms of a flu infection do not show up in H1N1 cases. Scientists who tracked the outbreak in one community – Sobol did not say which – found that of the lab-confirmed cases in town, less than 30 per cent had the usual signs of flu such as fatigue, muscle pain and lack of appetite. The only reliable symptoms of H1N1 were a cough and a fever of over 38 C.

After the death from H1N1 of a young woman from the Kivalliq who was pregnant, Nunavut's Department of Health and Social Services has been emphasizing pregnancy is a risk factor for complications from flu.

"As H1N1 progressed we became aware of the fact that pregnant women were more susceptible ... in the beginning we weren't specifying that as a high-risk category," Sobol said. "We've tried to change our message to include that and emphasize that a lot. The same thing with the Public Health Agency (of Canada). In the beginning of this they weren't talking a lot about pregnancy... so we're learning as we go along."

Nunavut has the highest birthrate nationwide and a younger population than the Canadian average. Sobol said Nunavut has also had more confirmed cases of H1N1 relative to its population than any other jurisdiction in Canada. Most, but not all, of the communities in Nunavut have reported lab-confirmed cases of H1N1.

Despite the numbers, in one way Sobol said he was surprised the infection rate wasn't even higher. In recent weeks Nunavut has celebrated Canada Day and Nunavut Day and community festivals should have been fertile ground for infection. Influenza takes two weeks to create symptoms after infection, so Sobol expected a spike in reported cases two weeks after the festivals.

He credited the fact that this did not happen to the department's personnel who attended all the festivals across the territory, handing out educational materials on the flu and squirting hand sanitizer on the hands of everyone around.

"To date, the number of cases we've seen in the Baffin region is still quote low compared to the other two regions, so my hypothesis is the public health intervention we did at Alianait was successful, because we didn't have an explosion of cases after that mass gathering," he said.