Flu Vaccination Questions
- Who should be vaccinated?
- When should the flu vaccine be given?
- What different kinds of flu vaccine could my child receive?
- What do the different vaccines contain?
To read more about the flu and current flu activity, go to CDC: Flu in the United States.
Who should be vaccinated?
Here are some facts: deaths from seasonal influenza are most common in those 65 and over. During the 1990’s about 33,000 Americans in this age group died from the flu annually. In the 2003-4 flu season, there were 153 lab-confirmed, flu-related deaths in American children. 70% of these children did not have a recognized, “high-risk” medical condition. Rates of hospitalization due to the flu are similar for children under age 1 year and adults 65 and older.
Public health specialists see children having the flu as risky not only to themselves, but also because kids can spread their germs to other people. Kids can be reservoirs that cause spread of the flu to higher risk groups, such as their more vulnerable elder family members and community contacts.
These facts underlie revised national medical care guidelines that incorporate influenza vaccine as part of the routine childhood immunization schedule.
This year’s recommendations for those who should get the seasonal flu vaccine:
- Children between ages 6 months and 18 years, unless they have a serious egg allergy;
- Family members and anyone else coming in close contact with people at risk of flu;
- Women who will be past the third month of pregnancy during flu season;
- Anyone who has a serious long-term health problem with heart disease, lung disease, asthma, kidney disease, diabetes, or anemia and other blood disorders;
- Anyone whose immune system is weakened because of HIV/AIDS or other diseases that affect the immune system; long-term treatment with drugs such as steroids; or cancer treatment with x-rays or drugs;
- Residents of long term care facilities housing persons with chronic medical conditions;
- Physicians, nurses, health care workers;
- Adults 50 or older.
Note that children under 9 years of age require two doses if they have not been previously vaccinated.
The groups recommended to have priority to receive the 2009 H1N1 influenza vaccine include:
- Persons aged 6 months to 24 years old;
- Persons who live with or provide care for infants less than 6 months old;
- Pregnant women;
- Persons aged 25 to 64 years who have medical conditions that put them at higher risk for flu-related complications; and
- Health care and emergency medical services personnel.
For 2009 H1N1 protection, children under age 10 (not age 9, as for seasonal flu) require two doses of vaccine.
When should the flu vaccine be given?
Peak flu illness in the Northeast usually occurs in January and February and the season is largely past by the end of March. However in the 2005-2006 season flu in Massachusetts didn’t peak until February-March and we still had cases in April. In contrast, in the 2003-2004 season we had an unexpectedly early and severe onset of the flu season.
The take-home message is that it is worth getting vaccinated early in the season, but we will still offer vaccine throughout the winter, as long as we have vaccine, which is according to the recommendations of the Centers for Disease Control (CDC).
What different kinds of flu vaccine could my child receive?
Because the World health Organization decided on the three flu strains for this season’s vaccine before the pandemic H1N1flu outbreak was discovered, there are both seasonal and 2009 H1N1 vaccines this year. These each come in both shot and nasal spray forms.
The seasonal flu vaccines all contain the same three strains (two are A strains and one is a B strain), and the pandemic 2009 H1N1 vaccines all contain the same flu A strain.
The shots can be given to children from age 6 months but different ones are licensed for different ages, and there are multiple different companies making different formulations. These formulations are approved for different age groups.
The nasal spray vaccines can only be given to children age 2 years and older and they cannot have asthma or wheezing in the previous 12 months. This vaccine is live and can cause mild flu symptoms for 1-2 days.
What do the different vaccines contain?
There are mercury-containing and mercury-free seasonal and pandemic flu shots, but as of October 2009, none of the FDA-approved 2009 H1N1 vaccines contain adjuvants (“stretchers”), that have been approved for use in some other countries.
I prefer to administer only mercury-free shots, especially for the youngest children, and that is possible for the seasonal flu vaccine. Seasonal flu hasn’t started as of October 2009, and mercury-free seasonal flu shots have been available, at least in small numbers, since late August (and we started to give them then).
But that’s not the case for 2009 H1N1 flu prevention. This outbreak started in Massachusetts last spring, and picked up its force in September. Therefore the infection has been spreading before the vaccine has been available. As a result, I am willing to give mercury containing H1N1 vaccine shots if that’s all that is available at a given time. Delaying and extending the child’s period of vulnerability to pandemic flu, versus giving a mercury containing vaccine now, can be a hard choice.
Here are the package inserts for the pandemic (2009 H1N1) vaccines we expect to have at some time this fall (go to the end of section 11 for the ingredients of any of them):
My favorite, the one I’d like to have for all patients not eligible for nasal spray or whose parents decline the nasal spray because it’s live:
- A shot for babies and kids from age 6 months that does not contain mercury (in the single dose formulations), whose package insert is here;
- A shot for kids from age 4 years, whose package insert is here.
The nasal sprays do not contain preservative or mercury but they are live.
