Flu season is here, and this year, people are actually taking notice. The outbreak of the H1N1 influenza virus, commonly known as swine flu, has people reevaluating the way they live, travel, interact with each other, and even how they eat.

The World Health Organization (WHO) officially declared the virus a pandemic in June, and it announced in early September that at least 3,205 people have died from the virus. And while more than 60% of Americans say they are “not too” or “not at all” worried about swine flu affecting them or their families, according to a Washington Post–ABC News poll, the scare has left its mark on many parts of society, both in the United States and abroad. Here, eight ways swine flu is changing the world.

1. People may finally get flu shots.
In the 2005–2006 season, so many people did not get the vaccine that 18 million doses had to be thrown away. If this pandemic has a silver lining, it’s that more people are making the decision to actively protect themselves against germs in general—and that’s good news, since every year even the “regular” seasonal flu (and complications from the flu) kill about 36,000 Americans, and anywhere from 250,000 to 500,000 people worldwide.

An August Gallup poll found that 55% of respondents see themselves getting a swine-flu vaccine if one becomes available, up from 46% in May. And while the H1N1 vaccine won’t be available until at least mid-October, seasonal flu shots this year are being administered earlier than usual—and recommended more strongly by health officials—in anticipation for increased interest.

Many drug stores, employers, and schools are already offering the seasonal flu vaccine, and some counties are administering the shots at no charge. On September 22, for example, CVS pharmacy will give free flu shots in New York City on the plaza of CBS’s The Early Show.

Still, many people are skeptical of either shot’s effectiveness, and probably won’t get vaccinated or give the vaccine to their children. Pregnant women are especially at risk, but typically have very low rates of vaccination due to worries that the shots won’t be healthy for their babies.

2. People are reconsidering cultural greetings.
The French are well known for offering la bise, a quick peck on each cheek, as a way of saying hello and good-bye. But with the fear of transmitting the H1N1 virus, some schools and companies—and even the health ministry’s swine-flu hotline—recommend avoiding this practice. One mayor in a small French town has actually banned the kisses, telling National Public Radio, “What’s the point in the preventative hand-washing when people are still kissing each other all the time?”

Spanish, Mexican, and Lebanese government officials have also discouraged kissing greetings, and school officials in New York have even discouraged students from exchanging high fives. John M. Barry, the author of The Great Influenza, warns that handshaking too could come under fire if the spread of the virus gets worse. “Any specialist would say that shaking hands is not a great habit if you’re interested in controlling an infectious disease.”

3. It’s scarier than religion.
Swine flu is even changing some long-held religious practices: The Archdiocese of New York told Catholic New Yorkers they may refrain from the traditional handshaking at mass. One rabbi in Brookline, Mass., told National Public Radio that he suggested congregants at his temple greet each other with a “Buddhist bow” or an “Obama fist bump” during September’s High Holy Days.

Muslims celebrating Ramadan in Kuwait and Lebanon have been advised not to hug, and, if the flu outbreak worsens, mosques could consider asking people to bring their own prayer mats to services. In Spain, Roman Catholics are being asked to refrain from kissing a statue of the country’s patron saint, and Italy has banned the kissing of two vials thought to contain the blood of a saint.

4. Schools, workplaces, and day-care centers are changing policies.
Telling an entire country or religious congregation to stop shaking hands or kissing may prove tricky to control, however. “It’s easier to implement when a school or an institution or a company collectively decides, ‘We’re not going to do this for the duration of this epidemic,’” says Pascal James Imperato, MD, a dean and distinguished professor of public health at SUNY Downstate Medical Center, in Brooklyn. And many are doing just that.

Colleges have updated handbooks to urge students and professors to stay home with even the slightest feeling of illness and to frequently clean often-touched objects in their dorms, such as remote controls and doorknobs. Offices are creating policies allowing employees to work staggered shifts or providing them with the materials needed to work from home. And day-care organizations have urged parents to consider making back-up plans should the centers need to cut their services with short notice.

5. People are scared to eat pork.
China, Russia, and Ukraine were quick to ban pork produced in the United States when the virus was first detected, and soon a total of 27 countries had followed suit. The boycotts have wreaked havoc on the pork industry, causing the government to actually bail out farmers who have been forced to sell their pork at lower costs, Time magazine reports.

The irony, of course, is that it’s not at all possible for H1N1 to spread through eating infected bacon or hot dogs—and even so, there have been zero cases of infected pigs in the United States. The H1N1 virus actually has avian, swine, and human genes, and it may not even make pigs sick, scientists say. Unfortunately for pork producers, “swine flu” is a much more sensational and media-friendly name.

6. Tourism to Mexico has suffered.
When the first cases of swine flu were thought to have originated in Mexico, the Centers for Disease Control and Prevention initially recommended canceling all travel plans south of the border unless the trip was absolutely essential. Three weeks later, the warning was lifted.

The WHO now insists that international travel does not need to be restricted. Barry agrees: “At this point, the virus is everywhere,” he says. “Where are you not going to go to avoid it? But that doesn’t mean that there aren’t people who wouldn’t be a little panicked.”

Those panicked travelers delivered quite a hit to Mexico’s tourism industry, which was already in trouble due to violence- and drug-related publicity. Travel website TripAdvisor.com reported a 50% decrease in searches for Mexican destinations by May, according to SmartMoney.com. Hotels and airports sat empty in May, and airlines flying to Mexico have also reported millions of dollars in losses that they claim are flu-related.

The good news? If you still want to go, you can get flights and hotel rooms on the cheap.

7. Precautionary (and bizarre) merchandise is flying off shelves.
Quickly after the virus first surfaced, consumers became caught up in the hype about the pandemic, says Dr. Imperato; they turned to whatever precautionary merchandise they could get over-the-counter. Logical purchases included face masks and antibacterial soaps, but plenty of other companies have cashed in on the marketing craze in over-the-top and even unrelated ways, as well.

There are flu kits (complete with full-body suits), swine-flu-spam computer-virus protection, a viral stop-the-spread online game, and, of course, all sorts of pig paraphernalia.

8. Coughing and sneezing are practically federal crimes.
Symptoms of sickness may not be against the law quite yet, but there does seem to be an abundance of dirty looks going around in response to simple public throat clearing. It seems that everyone is more aggressively cautious of coughing and sneezing in public, and perhaps rightly so.

A simple sneeze sends as many as 100,000 droplets of germs from your mouth and nose into the air within 3 to 5 feet at about 100 miles an hour, according to CNN’s AC360°. The germs can then hang in the air for up to a minute, so even if the droplets don’t land on a nearby person, he or she could still walk through the germy cloud and catch a virus. Even worse, coughing or sneezing into a hand and then touching a public space, like a subway pole, a door handle, or a shared computer keyboard, spreads the range of the germs.

But even if you’ve seen dirty looks exchanged on the train or in the grocery store, it’s probably a mild reaction compared to what Asian countries—which suffered through a deadly SARS epidemic in 2002 and 2003—are now experiencing. Jane Parry, a science journalist and researcher living in Hong Kong, notes that the emergence of H1N1 has strongly reinforced flu prevention techniques and attitudes about germ transmission.

“Handshaking fell out of favor during SARS, and it’s totally acceptable now to not shake hands, especially if you are wearing a face mask,” Parry says. “It’s considered common courtesy now to wear a mask when you have a cold to protect others. Once swine flu came along, that expectation that you wouldn’t cough near anyone else became even more pronounced. People would visibly reel away from you if you coughed.”

In schools in Hong Kong, children with runny noses or coughs are required to wear masks, and any child with a fever is automatically sent home, Parry adds. Staff members working in food stores are also required to wear masks at all times, and Asian people are much more likely to wear face masks on airplanes, where air is filtered and recirculated through the cabin.

These measures may seem over-the-top to Americans, but is it possible they could become commonplace throughout the world? Only time will tell. For now, remember traditional cold and flu etiquette: Cough or sneeze into a tissue, or at least use your elbow and sleeve (instead of your hands) to cover your mouth.

No one wants the aches, fever, and nausea associated with influenza—especially not fibromyalgia patients who already deal with chronic pain and discomfort on a daily basis. But is a shot the best option for people with potentially compromised immune systems?

Jessica Capelle, a 35-year-old part-time lawyer from Houston, wants to get a flu shot this year. But as her fibromyalgia has worsened over time, she says she’s become more sensitive to vaccines—a side effect often reported by people with chronic pain.

Based on anecdotal evidence, it does seem that vaccines, for influenza or otherwise, could temporarily increase or trigger fibromyalgia symptoms. Seasonal flu shots are made from inactivated (dead) viruses, which could theoretically trigger flu-like symptoms or allergic reactions. (Another type of flu vaccine, administered through a nasal spray, is made from live, weakened influenza viruses and is not recommended for people with underlying medical conditions.)

Since there is little formal research backing these experiences, however, doctors’ recommendations vary almost as much as patients’ opinions. While the Centers for Disease Control and Prevention states that you cannot catch the flu from a vaccine, it does note that minor side effects from the shot can include soreness at the injection site, aches, and a low-grade fever—and that’s in perfectly healthy people.

Added swine flu concern
There are even more questions to be answered this year, thanks to the outbreak of the H1N1 influenza virus, commonly referred to as swine flu. Two vaccines for swine flu—a nasal spray that contains weakened virus and a shot that contains inactivated virus—were approved in September, but skepticism and worry about such new vaccines may prevent people from taking advantage of them.

Despite potential complications, fibromyalgia patients should consider getting both vaccinations, says Jacob Teitelbaum, MD, the medical director of the Fibromyalgia and Fatigue Centers, which are located throughout the United States. “People with severe chronic illnesses that put them more at risk [for dangerous complications of the flu] are more likely to get benefit than harm from the vaccine,” he says.

But that doesn’t mean fibromyalgia patients must get either vaccine. The decision for many, like Capelle, to vaccinate or not to vaccinate can be a frustrating toss-up. “The last three times I’ve gotten a flu shot, I ended up in bed for three weeks just from the shot,” she says. “Last year I didn’t get one and got the flu.”

Who should get vaccinated?
It’s hard to say, even for experts. “If you feel like getting the shot, if you’re the type who catches everything, or if you find vaccines have been well-tolerated in the past, it’s not a big deal; go get it,” Dr. Teitelbaum says. “If past vaccines have knocked you for a loop, or your gut feeling is you don’t feel comfortable, don’t feel like you have to get it.”

Indeed, some fibromyalgia patients tolerate shots just fine. Lavila Weckwerth, of Watervliet, Mich., has gotten a seasonal flu shot for the past seven years—despite being diagnosed with fibromyalgia three years ago—and has never noticed any side effects. Weckwerth works in a hospital and knows she’s at increased risk of getting sick; however, when it comes to H1N1, she’s uncomfortable with the new vaccine’s lack of testing and doesn’t plan on getting it unless it’s required by her job.

Andrea Nixon, of Pahrump, Nev., on the other hand, has never received a flu shot (and luckily has never gotten the flu) and does not plan on getting one.

“Earlier this year I was given a B-12 shot [to help with fibromyalgia and chronic fatigue symptoms]; it nearly paralyzed my left arm for six months,” says Nixon, who was diagnosed with fibromyalgia in 2006. “Before being diagnosed, I was taking the Depo-Provera injection when numerous debilitating symptoms began occurring. So needless to say, I’m not much into receiving injections of any type!”

Capelle, who says she had the flu, three colds, and five sinus infections just this past summer, may simply be more susceptible to viruses, and therefore a better candidate for vaccination. In addition to evaluating your susceptibility to the flu, also consider your risk of exposure to the virus as you make your decision to get vaccinated. If you don’t spend much time around other people, you may not come into contact with the virus. But if you are in frequent contact with children or sick individuals, like nurses or teachers are, you are probably at increased risk.

What’s worse, flu or fibro?
Many patients are hesitant to get the vaccine in fear of bad fibro flare-ups. When deciding whether to get vaccinated, consider past flare-ups in comparison to past bouts with the flu, advises Dr. Teitelbaum.

“How your body has reacted in the past is the best predictor of how it’ll react in the future,” he explains. If a past vaccine triggered severe symptoms, maybe you’d be better off with a mild case of the flu.

In fact, Dr. Teitelbaum has observed that some patients actually feel a lessening of their fibromyalgia symptoms when they have the flu. “I’ve had people come to me and say, ‘The only days that I’ve felt half-decent in the last eight years are when I’ve had the flu or some other virus,’” he says.

Although the flu’s effects on fibro are nearly impossible to quantify, Dr. Teitelbaum says, doctors believe that when the virus stimulates the immune system, it naturally improves other immune-system conditions, including fibromyalgia.

Others, however, would take a vaccine’s side effects over the flu any day. “I decided to get a flu vaccination this year, and I also plan to get the H1N1 vaccination, despite the side effects,” says Deborah J. Norris, of Glendale, Ariz. “With [fibromyalgia], my immune system is impaired, and illness hits harder and takes longer to recover from.”

If you’ve never had a flu shot before, or never even had the flu, you won’t have any measure for comparison. For these rare cases, Dr. Teitelbaum says he would question why you want to start with vaccinations now. If it’s because of the panic surrounding the swine flu, he recommends looking at the facts: In the United States, seasonal flu kills tens of thousands more people every year than swine flu has so far in 2009.

Instead of putting your faith in the new H1N1 vaccine, he recommends getting a regular seasonal vaccine—at least at first. Although the swine-flu shot has successfully made it through clinical trials, has been approved by the Food and Drug Administration, and has been deemed safe for people with weakened immune systems, its large-scale distribution hasn’t yet been evaluated. “This is a whole new strain, and no one knows what the reactions are,” Dr. Teitelbaum says. “Why not wait and start with something a little more proven?”

Protect yourself, shot or not
In the meantime, be sure to take the necessary precautions against the flu—and fibro. Common stressors that trigger fibromyalgia flare-ups—including cold or damp weather, poor sleep, fatigue, physical or emotional stress, and overexertion—can also leave you more susceptible to the flu.

Fibromyalgia doctors recommend avoiding these triggers whenever possible and reducing their effects by lowering stress and improving sleep habits. Dr. Teitelbaum also recommends washing your hands, staying hydrated, and adding extra vitamin C and zinc to your diet to help boost immunity.