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Are you flu prepared?
June 10, 2013
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Well, parents, another confusing flu vaccine season is upon us! As compared to last year, there will be only one flu vaccine to deal with, which will be significantly easier, but the question of whether a child needs one dose or two doses of this year’s vaccine may require a little contemplation. I will try to simplify things a bit below. First, some basic info about this year’s vaccine:

1. As always, the flu vaccine will include protection for the top three influenza strains expected to circulate this year. Each year the circulating strains vary, so the vaccine components are changed — this is the reason a new flu vaccine is required each fall. This year’s vaccine will provide protection against influenza strains A-H1N1, A-H3N2, and B-Brisbane.

2. The flu vaccine is recommended for everyone over 6mo of age this year — children and adults. This is the recommendation of the CDC, the American Academy of Pediatrics, and a variety of other healthcare organizations.

3. For those of you who had concerns about the safety of the H1N1 vaccine last season, you can be reassured that millions of doses of H1N1 vaccine were given around the world last year, without any unusual side effects being found. H1N1 turned out to be the only influenza strain that circulated in any significant numbers last year, and it is highly likely to be a key player again this year. Bear in mind that children are at higher risk for complications of H1N1 illness than with previous seasonal flu illnesses. In fact, in the 2009-2010 flu season, the number of H1N1-related pediatric deaths was nearly 4x the average number of flu-related deaths reported in the previous five flu seasons.

4. There are two forms of the flu vaccine available: injectable vaccine and intranasal vaccine (Flumist). Both vaccines cover the same strains. Some studies have shown the intranasal vaccine to be a little more effective, so we typically recommend it first-line for eligible children (the children usually prefer it too!). The injectable vaccine is an inactivated (killed) vaccine, and the Flumist is a very weakened live virus vaccine. Neither vaccine can cause influenza. With the injectable vaccine, there is 10-35% chance of fever within 24hrs in infants/toddlers 6mo – 2yrs, but fever is unusual in older children. There is a small chance of nausea, headaches, fatigue, muscle aches, and chills. The most common side effect by far is soreness at the injection site. With Flumist, occasional reported side effects in children include fever, runny nose, nasal congestion, cough, wheezing, chills, fatigue, sore throat, and headache. These side effects are typically mild and short-lasting. The vast, vast majority of children do not have any significant side effects with either vaccine.

5. Egg allergy is sometimes, but not always, a contraindication to flu vaccine. If your child has an egg allergy, please check with your allergist as to whether your child may receive the vaccine.

6. To qualify for Flumist, your child must meet the following guidelines: 1) Must be at least 2yrs of age. 2) Must not have used any breathing treatments in the past year (including albuterol, Xopenex, Flovent, Advair, Qvar, Pulmicort, Symbicort). 3) Must not have been diagnosed with “wheezing” by a healthcare professional in the past year. 4) Must not have diabetes, kidney disease, metabolic disease, chronic lung disease, sickle cell disease, or heart problems. 5) Must not have any immune system deficiencies. 6) Must not be taking aspirin.

Now, how to figure out how many doses of vaccine your child needs this year:

<6mo of age – Not eligible for the vaccine yet. However, we do recommend that all household members and out-of-home caregivers get vaccinated to help create a protective “cocoon” around the baby.

> or = 9yrs of age – Only one dose of vaccine needed.

6mo – 8yrs of age – This is where it gets tricky. Will need two doses unless the child has received the following: at least one dose of H1N1 vaccine last season, plus either a) two doses of seasonal flu vaccine last year or b) at least one dose of seasonal flu vaccine prior to (not including) the 2009-2010 season. If you can’t remember exactly what your child has had in the past, then it is recommended to get the two doses this season.

The booster dose of the vaccine is given 4wks after the first dose.

September-October is the ideal time to get vaccinated, and our Saturday morning flu vaccine clinics are open for scheduling. Call our office to set up your appointment (277-6102). See you soon!

Michelle Bennett, M.D., F.A.A.P.
Pediatric & Adolescent Associates