When asked last month about what’s ahead for the H1N1 virus , an infectious disease specialist, a school administrator and officials at two regional health departments all said they wouldn’t be surprised if a third wave hit by the end of winter.

Pandemics tend to come in waves, they said -- the first and smaller wave of the virus hit last spring; the second in the fall. That third wave has yet to come, and there's no assurance it ever will. All remains mostly quiet on the H1N1 front: The Centers for Disease Control and Prevention reports  that flu activity is “relatively low.”

When we talked in January, Craig LeFebvre, a spokesman for the St. Louis County Department of Health, said he feared that a prolonged quiet period for the virus would lead people to “believe that [the H1N1 window] has come and gone.”

Whether or not a major spike in H1N1 cases is ahead of us, it appears that LeFebvre’s concern about the public’s perception of the virus was valid.

A recent poll from researchers at the Harvard School of Public Health revealed that nearly half of Americans believe the H1N1 flu outbreak is over. Only 18 percent of people surveyed from Jan. 20-24 said it’s “very likely” that there will be another widespread H1N1 outbreak in the next year – though significantly more people said it’s “somewhat likely.”

Fewer and fewer people report being concerned about getting sick, which helps explain the abundance of swine flu vaccines that are available and still being pushed by health departments. The survey showed that among young adults, 37 percent either got the H1N1 vaccine (21 percent) or intend to do so before the end of the month (16 percent). More than half of parents either got the vaccine for their children or plan to get it before February ends. In all, about 6 of 10 people surveyed said they had not gotten the vaccine and didn’t intend to do so.

One population that has a recent history of being widely vaccinated for the seasonal flu: employees of BJC HealthCare. Washington University announced last week that making flu shots mandatory in 2008 vastly increased the vaccination rate (more than 98 percent that year) among the nearly 26,000 St. Louis-based BJC employees.

BJC had in past years tried to push voluntary flu vaccinations, followed by a program in which employees who declined to get a flu shot were asked to sign a statement saying they understood the risks of their decision. The mandatory vaccination policy – which allows employees to request religious or medical exemptions – seemed to have its intended effect of widespread coverage. (Though as Wash U. points out, physicians employed by BJC were required to get the flu shot, but most physicians affiliated with BJC HealthCare are in private practice or are employed by Washington University School of Medicine and are not covered by the mandatory policy.)

Such mandatory vaccination policies are becoming more popular for health-care employers – although the idea isn’t without controversy. Data are still being collected on BJC for the 2009 flu season, when employees have been required to get both the seasonal flu and the H1N1 vaccines.