The World Health Organization has declared the 2009 H1N1 pandemic over, but health officials expect the virus will return this season. The H1N1 virus, which made its first-ever appearance last year, is still classified as “novel,” but low to moderate turnout at local flu clinics suggests some of its novelty among the general public may have worn off.

Ann Graves, infection control and prevention coordinator at Waldo County General Hospital, said attendance was light at two children’s flu clinics the hospital held earlier this season at Troy Howard Middle School in Belfast and the Mount View School in Thorndike. The hospital gave around 300 vaccinations, compared with around 1,000 at similar clinics last year.

Graves attributed the low turnout, in part, to last season’s outbreak being less severe than some had predicted.

“Of course, one of the main contributions to that was that Maine had a huge number of people who were vaccinated last year,” she said.

The Maine Center for Disease Control confirmed the first flu case of the season last week when an adult in Sagadahoc County tested positive for Influenza B. H1N1 and Influenza A have yet to appear, but both are anticipated in the coming months.

This year’s seasonal flu vaccine protects against H1N1 in addition to Influenzas A and B, the strains that were most prevalent worldwide during the previous year.

For the first time this year, the U.S. Centers For Disease Control and Prevention’s Advisory Committee on Immunization Practices advocated universal seasonal influenza vaccination for anyone over 6 months old. Previously, the group recommended flu shots for all children 6 months to 19 years old, adults over 50, and health-care professionals.

Maine has typically limited its flu-shot recommendation to high-risk groups — young children, the elderly, pregnant women and people with underlying conditions. But State Epidemiologist Stephen Sears said last year’s H1N1 outbreak, during which there was a push to vaccinate school-age children, highlighted the role the rest of the population plays in the transmission of the virus.

“When you add [lower-risk demographics] to those high-risk groups, it pretty much adds up to everyone,” he said. “We’ve been moving that way over time.”

Regina DeGraff, primary care practice coordinator for WCGH’s five remote health centers — Arthur Jewell Community Health Center in Brooks, Donald S. Walker Health Center in Liberty, Lincolnville Regional Health Center, Searsport Health Center and Stockton Springs Regional Health Center — said patients had been coming in for seasonal flu shots, but the facilities had not been overwhelmed, as they were last year, when there were two separate vaccinations and supplies of the regular seasonal flu vaccine were short and late coming.

“Last year there was an epidemic, and people were panicked, even though there wasn’t an epidemic,” she said. “This year it’s business as usual.”

DeGraff noted that many patients had not mentioned or asked about H1N1 this year.

Seaport Family Practice, an independent practice in Belfast, has seen a similar number of requests to for vaccination compared with last year, according to Pediatric Nurse Practitioner Stephanie Taylor, who said that the health center had held several clinics and offered the shots during regular office visits.

Both Taylor and DeGraff confirmed that most insurance plans cover the shots. For patients of the health centers who are uninsured, the shot is available for around $15.

For people not affiliated with one of the local medical providers, many local pharmacies are offering vaccinations for around $25.

A representative of Walgreens, which recently opened a branch in Belfast and has been advertising walk-in flu shots, said requests for immunizations hade been steady this year, and he anticipated increased demand as the flu season gets under way. Nationally, the company claimed in a Nov. 3 news release to have given nearly as many seasonal flu shots this year as during all of last year’s flu season.

Belfast Public Health Nurse Diane Whitten said attendance at flu-shot clinics had varied from season to season during the 10 years she had been giving clinics, and was largely dependent upon how much media attention the flu was getting at any given time.

Turnout was very low at several Public Health Nursing Clinics held earlier in the season, she said, but Whitten and another nurse gave 50 immunizations during a two-hour clinic Nov. 10 at the WCGH Education Center.

Cathy Makofski of Camden, who was among those vaccinated, said she had been coming to the Belfast Public Health clinics for several years because she liked the staff and finds it well organized. On Wednesday, her husband Robert was with her.

“It’s a date thing,” she said. “Really.”

Robert elaborated. “If we time it right, we can go for lunch at the Co-op,” he said.

Before she got her flu shot, Makofski asked about a disclaimer on the consent form noting that the injection contains the mercury-based preservative Thimerosal.

The controversial preservative has been removed from many vaccines, but Whitten explained that the trivalent — three-in-one — vaccine contained trace amounts of it, comparable with other toxins a person might encounter out in the world.

“You don’t know what’s on the pumpkins,” she said.

The 2010-11 seasonal flu vaccine is available in two forms: an intranasal spray or an injection. The spray uses a live but weakened virus, while the injection uses an inactivated (killed) virus. Flu shots are recommended for people over 50 years old and children between 6 and 23 months. People between age 2 and 50 can receive the intranasal spray.

According to Maine CDC it takes up to two weeks for protection to develop after the vaccination. For most people flu shots last for a full year. But according to several providers interviewed for this article, children who had single doses of one of the flu vaccines last year may need two doses this year.

General recommendations from Maine CDC on avoiding the flu include the usual precautions against contagious diseases: cover coughs and sneezes with a tissue or sleeve, Wash hands frequently and stay home if ill with a fever.