Flu & Flu Vaccination Questions

To read more about the flu and current flu activity, go to CDC: Flu in the United States.

What is the flu?

The flu is a respiratory illness, it involves high fever, headache, cough, and body aches and often lasts a week or more.

It doesn’t cause diarrhoea!!

It commonly causes complications such as ear infection, wheezing (especially in known wheezers), sinusitis or pneumonia.

In children, complications requiring prescription medications or hospital admission are most common under age 2 years, and in those with underlying conditions such as asthma, diabetes, or a weak immune system.

Who should be vaccinated?

High risk groups for complications from the flu, especially hospitalization or death from the flu or a complication of the flu, guide formal recommendations for those who should receive flu vaccine. To protect high risk people, those in close contact with them (such as household members and healthcare providers) are also targeted for yearly flu vaccination.

Here are some facts: deaths from 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 contrast, an average of 92 deaths occurred annually in children under age 5. 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.

These facts underlie national medical care guidelines that incorporate influenza vaccine as part of the routine childhood immunization schedule for certain groups.

This year’s recommendations for those who should receive flu vaccine:

all persons, including school-aged children, who want to reduce the risk of becoming ill with influenza or of transmitting influenza to others;
all children aged 6-59 months (i.e., 6 months-4 years);
all persons aged 50 years and older;
children and adolescents (aged 6 months-18 years) receiving long-term aspirin therapy who therefore might be at risk for experiencing Reye syndrome after influenza virus infection;
women who will be pregnant during the influenza season;
adults and children who have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological or metabolic disorders (including diabetes mellitus);
adults and children who have immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus;
adults and children who have any condition (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration;
residents of nursing homes and other chronic-care facilities;
health-care personnel;
healthy household contacts (including children) and caregivers of children aged less than 5 years and adults aged 50 years and older, with particular emphasis on vaccinating contacts of children aged less than 6 months; and
healthy household contacts (including children) and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza.

Italics are mine, and highlight those groups that account for the bulk of practice patients.

But note that an important group I did not include in italics is women who are pregnant women during the flu season. Pregnant women are advised to receive the flu SHOT but not the nasal spray vaccine (which is “live”).

Note that children under 9 years of age require two doses if they have not been previously vaccinated. However, available vaccine should be given to targeted groups on a first-come, first-served basis.

To read this year’s complete statement regarding flu prevention, you may view the CDC’s Recommendations of the Advisory Committee on Immunization Practices here.

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?

There are several different types of injectable flu vaccine, and there is also a nasal spray vaccine. All vaccines in a given year are directed against the same three flu strains, and the combination of strains varies from year to year according to the recommendations of the World Health Organization (WHO).

This year’s flu vaccines contain two flu A strains (one H1N1 and the other H3N2) and 1 flu B strain. The strains are called A/Solomon Islands/3/2006 (H1N1)-like (new for this season), A/Wisconsin/67/2005 (H3N2)-like, and B/Malaysia/2506/2004-like.

This year, again, I ordered “thimerosal free” (“preservative-” or “p-free”) injectable vaccine for the 6 month to 35 month age group and the 3 year and up dose of thimerosal-free vaccine too. Thimerosal is a mercury containing preservative that the medical establishment states is safe for use in vaccines but some groups believe it poses a risk to a child’s developing brain. The other form of injectable flu vaccine that we are giving is licensed for use from age 6 months, but I will give it only from age 7 years, approximately, as long as the supply of the children’s “p-free” lasts.

The nasal spray vaccine, “FluMist”, is live but weakened, and can now be given to children from age 2 years as long as they are not “recurrent wheezers” and do not have any other high risk health problem (such as diabetes, or an immune disorder).

Besides vaccination, what can I do to prevent getting the flu, or my children getting the flu?

It comes down to basic hygiene, which does not mean use of antibacterial soaps (which can increase the risk of antibiotic resistance) or poisonous cleaners in your home or workplace!

The Centers for Disease Control have old fashioned advice, like what mom always said, here.

What treatment is there for the flu?

Antibiotics don’t help the flu, but they may be prescribed to treat flu complications such as ear infections, sinusitis or pneumonia.

There are prescription antiviral medications available, but they are only somewhat effective in reducing the severity and duration of the flu. They are also expensive, may not be covered by insurance, and they are approved for ages two and over only.

The mainstay of treatment is rest at home, and pain and fever relievers. Asthmatics usually need to use reliever medications, such as albuterol, too. They may have severe enough symptoms to need to take prednisone.

What about the bird (avian) flu?

There is a form of flu A spreading amongst wild and captive birds worldwide. There are only three known subtypes of human flu virus, H1N1, H1N2, and H3N2. Bird flu is an H5N1 strain. People infected have primarily been those living in close proximity to birds, ie sharing their house or hut with ducks or geese. But there has been a handful of documented cases where transmission seems to have been human to human.

Death rates from this bird flu in humans have been much higher than death rates from usual flu strains.

The WHO and others in the healthcare community are concerned that the virus may change to a form that is easily transmitted from person to person.

One mechanism could be bird flu occuring in a person who at the same time had a human flu. The two viruses could combine (“reassortment“) and lead to a strain more easily transmissible between humans than the current H5N1 strain.

This could cause a pandemic (a world wide epidemic), as the strain is one that people do not have immunity against.

The CDC provides more information on this topic, with regular updates here.

Is this year’s flu vaccine effective against bird flu?

No. This year’s vaccines contain the three human strains which were predicted to be circulating this season. Two are A type strains and one is B. Bird flu is a type A strain which normally does not circulate in humans. It would need to change in some way to be a human hazard. If this were to happen, vaccine manufacture would be based on whatever the new strain were found to be. There are efforts to produce a human bird flu vaccine, despite lack of certainty about whether it will be needed, and the strain concerned.

You can read more about this from the National Institutes of Health here.