Dr. Elizabeth Richardson, the city’s medical officer of health, said the H1N1 campaign has had a “substantial impact on services.”

Of the public health department’s 500 employees, Dr. Richardson said 220 have been redeployed for the H1N1 campaign.

“Our essential services are being maintained, like our sexual health clinics, dental program, tobacco cessation, child mental health services, but we are robbing from other programs,” she said.

“We are seeing a decline in flu activity, so we will re-assess and if there is not a lot of demand, we will be looking at where to go from there.”

Hamilton is not alone. Across the country, public health programs including support groups and sexual health clinics to food-safety inspections are being postponed or suspended, as officials redirect nurses and other staff to vaccinating against H1N1.

For example, hundreds of Toronto's public- health workers, ranging from registered nurses to clerks and health inspectors, have been retrained and redeployed –many of them to staff the 10 clinics administering doses of vaccine across the city. That redeployment has closed sexual health clinics and strained or suspended family health programs. Toronto’s food-safety inspectors are postponing routine inspections for low-risk sites and prioritizing medium-risk inspections.

In Hamilton, the services being maintained, at least at minimum levels are sexual health clinics and case management, dental clinics, tobacco cessation, the community health bus, needle exchange van and street health services.

Postpartum and longer-term home visiting to new moms, alcohol, drug and gambling services, outreach to homeless clients and children's mental health services are also running, as well as the Health Connections phone line, health hazard and drinking water complaints investigation, food recall response, reportable disease follow-up, outbreak control and TB case management.

Ms. Richardson said services that have been curtailed are those with longer-term impacts that are not expected to lead to immediate health effects if discontinued.

“In the long term, continued inability to provide these programs and services will impact the health of Hamilton’s residents. It is anticipated that the disruptions to the following programs and services will continue throughout the H1N1 response,” she wrote in a report to city council.

These include support to elementary and secondary schools through the Health Promoting Schools approach, dental screening in schools, initiatives like THINK injury prevention presentations and asthma management.

Also on hold are prenatal classes, the Women Health Educator program, Workplace Health Promotion program, nutrition and physical activity advice line, Welcome Baby program, hospital liaison to maternal/newborn units and various information technology projects and marketing campaigns.