Anna Mendenhall, MD, FAAP

The Disease:
Almost every child gets the flu (influenza) from time to time. The flu is caused by an influenza virus and usually occurs from October through May. The rates of infection are highest among children and flu symptoms can last a week or longer. For most people, the flu can cause fever, cough, sore throat, headache, chills, muscle aches and fatigue. Some people (especially those who have other illnesses) can get much sicker and can develop symptoms such as high fever or pneumonia. On average, about 36,000 people die each year from influenza. Over 75% of the deaths that occur happen with unvaccinated people and over 50% of deaths are in healthy individuals with no pre-existing medical conditions.

The Immunization:
There are two types of seasonal influenza vaccine:
In-activated (killed) vaccine which is given by an injection (shot).
Live attenuated (weakened) vaccine that is sprayed into the nostrils. However, the American Academy of Pediatrics (AAP) has issued its policy statement for flu shot recommendations for the current flu season. The statement supports the recommendation by federal health officials not to use the live attenuated influenza vaccine (LAIV), administered by intranasal spray.

The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention found that the nasal spray vaccine did not protect against certain strains of the flu virus that were most prominent the past three seasons.

Information on strains of influenza circulating is collected worldwide to identify virus strains likely to cause the most illness during the upcoming influenza season.

Because influenza viruses are always changing, scientists work every year to match the viruses in the vaccine to those most likely to cause the flu that year.

There is always a possibility of a less than optimal match between the virus strains predicted to circulate and the virus strains that end up causing the most illness. However, even if the vaccine and the circulating strains are not an exact match, the vaccine usually will reduce the severity of the illness or may help prevent influenza-related complications.

Vaccination is recommended every year because protection lasts approximately 12 months after last year’s vaccination. It is recommended that everyone older than 6 months receive flu vaccine. Children younger than 9 years old who have never received a flu shot need to receive 2 doses of vaccine at least 1 month apart.

Why get vaccinated?
The best way to prevent the flu is by getting a flu vaccination each year. Complications of flu can include bacterial pneumonia, ear infections, sinus infections, dehydration and worsening of chronic medical conditions, such as congestive heart failure, asthma or diabetes. Remember, 36,000 people die from the flu each year. Many of these deaths are in healthy people.

Who should get influenza vaccine and when?
In general, anyone who wants to reduce their chances of getting the flu can get vaccinated. However, certain people should get vaccinated each year either because they are at high risk of having serious flu-related complications or because they live with or care for high risk persons. During flu seasons when vaccine supplies are limited or delayed, the Advisory Committee on Immunization Practices (ACIP) makes recommendations regarding priority groups for vaccination.

People who should get vaccinated each year are:
• Children age 6 months up to their 19th birthday
• Pregnant women
• People 50 years of age and older
• People of any age with certain chronic medical conditions
• People who live in nursing homes and other long-term care facilities

People who live with or care for those at high risk for complications from flu, including:
• Health-care workers
• Household contacts of persons at high risk for complications from the flu.
• Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated).
Some people should talk with a doctor before getting either influenza vaccine:
• People who are moderately or severely ill should usually wait until they recover before getting the flu vaccine.
• People with a mild illness can usually get the vaccine.
• People with a severe egg allergy should not get the vaccine.
However, there are now vaccine protocols available for people with severe egg allergies. Generally the vaccine needs to be administered in an allergist’s office, so families should talk to their doctor if they have children with severe egg allergies. Kids with mild egg allergies or an egg intolerance can generally get the vaccine at the pediatrician’s office.

What are the risks from influenza vaccine?
Getting influenza is much riskier than getting the influenza vaccine. However, a vaccine, like any medicine, is capable of causing problems such as severe allergic reactions. The risk of the influenza vaccine causing serious harm or death is extremely small.

Inactivated Influenza Vaccine:
Mild Problems: Soreness, redness or swelling where the shot was given.
If these problems occur, they usually begin soon after the shot and last 1-2 days.
Severe Problems: Life-threatening allergic reactions are very rare.
If they do occur, it’s within a few minutes to a few hours after the shot.