You and the fluIt’s that time of the year again. Fall season. Cooler weather, leaves turning, and… time to get ready for flu and cold season. Our shopping carts are full of pumpkins, decorations, hand sanitizer and tissues. Anything to keep our children (and ourselves) healthy. When it comes to protecting our little ones against influenza virus (flu) there are a few choices we have to make.

First, to immunize or not immunize. A lot of questions come to mind when trying to make that decision. Is it safe? Is it necessary? Will it make my child sick? To make an educated decision, it is important to first understand what exactly we are immunizing our children against, how does the immunization work, what choice of vaccine is available and what are the possible side effects.

What is the flu?

The flu virus causes serious illness that may result in hospitalization or death. It mostly affects the breathing system, but may also affect the whole body. The flu season usually starts in the fall and ends in the spring.

People can get the flu many times in their lives. Flu viruses are always changing over time and from year to year. Three seasonal flu viruses are expected to make children sick again this flu season.

What is a flu vaccine? How does it work?

Safe vaccines are made each year to protect against the flu. This year’s flu vaccine protects against the same threestrains of influenza virus in last year’s vaccine. These are:

  • Influenza A (H3N2)
  • Influenza A (H1N1)
  • Influenza B

The number of vaccine doses your child needs this year depends on his or her age at the time the first dose is given and his or her flu vaccine history.

  • Children 6 months through 8 years of age should get two doses if they did not get a flu vaccine last year and 1 dose if they did.
  • Children 9 years and older need only one dose.

Everyone should get the flu vaccine each year to update their protection because:

  • Protection from the flu vaccine lasts for about six to 12 months.
  • The virus strains in the vaccine may change, so your protection usually needs updating.

One of the more common complaints about the flu vaccine is that it doesn’t work: “I got the flu vaccine and still got the flu.” Well maybe. Maybe not. It takes a few weeks to get protection, so the flu could have developed before the antibody response to the vaccine. The vaccine does not protect against the numerous other viral infections that circulate each winter, so perhaps you had an adenovirus (a respiratory issue), but thought it was the flu.

Bottom line is studies show that the influenza vaccine, while not a 100-percent effective in preventing disease, is close to 100-percent safe, and much safer than the disease.

Who should get which flu vaccine?

There are two types of flu vaccine. Trivalent inactivated influenza vaccine (TIV) is given as a shot. There are two kinds of shots. The intramuscular (into the muscle) shot is licensed and recommended for children 6 months and older, and adults, including people with and without chronic medical conditions. The new intradermal (into the skin) shot has been licensed for the 2011–2012 season to use in people 18 through 64 years of age. Vaccination is especially important for people at higher risk of getting severely ill from the flu and their close contacts, the close contacts of healthy children younger than 5 years old, all health care personnel, and all pregnant (or postpartum) women.

Live-attenuated influenza vaccine (LAIV) is sprayed into the nose. LAIV is recommended for healthy children 2 years and older. Both types of flu vaccine are very safe and work well to protect your child from the flu. Check with your doctor about which is best for your child and family.

Are there side effects of the flu vaccine?

There are very few side effects of the flu vaccine. The area where the TIV flu shot is given may be sore for a day or two. Fever may occur within 24 hours in about 10 to 35 percent of children younger than 2 years old, but rarely in older children and adults.

Because LAIV is sprayed into the nose, your child might get a stuffy, runny nose within the first few days. LAIV may produce mild symptoms, including rhinitis, headache, wheezing, vomiting, muscle aches and fever.

You or your children will not get the flu from the vaccine. It takes two weeks for the vaccine to start working, so people can catch the flu before they are protected.

Is the flu vaccine safe for children with egg allergies?

In the past, children with egg allergies were not recommended to get the flu vaccine because they might have a reaction. There is now enough scientific information to show that the influenza vaccine given in a single, age-appropriate dose is well received by nearly all children and adults who have egg allergies. While visiting your with questions, go in with this information:

  • Children with a history of mild egg allergies (hives) can get the flu vaccine safely at their doctor’s office.
  • Children with a history of severe egg allergies should have their doctor consult with their allergist before getting the flu vaccine.

The next question to consider is where to take your child for the flu vaccine. Seems like everywhere you go they are offering flu vaccines. Quite convenient considering our busy lives.

Is it OK to check off that flu vaccine from the to-do list while doing some grocery shopping?

Certainly if a pharmacy, convenience store or retail-based clinic is your only option my recommendation is to go ahead and get it done. However, when it comes to children their pediatrician’s office is for sure the best option. If the child needs the influenza vaccine, as well as one or two other immunizations, many of these commercial flu clinics are only prepared to give influenza vaccine.

If the child is receiving influenza vaccine at a commercial site and all other immunizations at the pediatrician’s office, no one will have the child’s complete vaccination record. Once again, this speaks to a lack of continuity of care. This fragmented record-keeping could cause trouble in the future. It is also important to consider that these commercial sites cannot deal with complex medical issues.

If children have any type of chronic medical problem, their medical home (such as their pediatrician’s office or one of our neighborhood clinics) is the safest place to get the immunization to avoid complications. The need for an ongoing source of health care — ideally a medical home — for all children has been identified as a priority for child health policy reform at the national and local level. Over the next decade, with the collaboration of families, insurers, employers, government, medical educators and other components of the health care system, the quality of life can be improved for all children through the care provided in a medical home.

To summarize my thoughts, I think the answer is that the flu vaccine is of benefit. And the more children who get the vaccine at their pediatrician’s office, the greater the benefit for everyone, even if not completely 100-percent effective.

Maria del Pilar Levy, M.D., is a Cook Children’s pediatrician at The Morris Foundation for Innovation in Children’s Health in Fort Worth.

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