October and November are the best months to get Flu vaccine. Much past emphasis has been on protecting older individuals, especially those with chronic diseases. But, now there are new recommendations for immunizing healthy infants and toddlers against the flu. Many older children should also get the flu vaccine. Pediatrician and “Today” contributor Mark Widome offers viewers some recommendations, as well as answers about the new nasal spray flu vaccine.
WHAT IS THE FLU?
The flu is a respiratory infection cause by the influenza virus. Flu differs from the common cold in that people with the flu feel sicker, and they become sick faster. Most adults who get the flu not only remember the day they got sick, they remember the hour! Some describe it as if they had it a brick wall. There is sudden fever, chills, headache, and muscle aches. Sore throat and cough are common, but it is the feeling of exhaustion that knocks people off their feet and sends them home to bed.
In young children the flu is often milder, but still usually distinguishable from the common cold and other viral respiratory infections. Some children with flu will wheeze, while others will get the croup. Fevers are often high. Yet, in both children and adults, diarrhea or digestive tract symptoms are uncommon. Hence, there is really no such thing as “stomach flu.”
WHO GETS THE FLU?
Influenza occurs throughout the world and in all age groups every year in the cold-weather months. In the United States, there are yearly outbreaks that vary in intensity, depending upon the specific strains of the virus that are present. Last year was a mild one for the flu, but no one can yet be sure what this winter will bring. On average, 10 to 20 percent of the population get the flu each winter, about 100,000 persons are hospitalized, and there are about 36,000 “excess” deaths from the flu annually.
While most of the deaths attributable to the flu each winter are in the elderly, and particularly in those with underlying diseases, the flu is actually more common in young people, Among preschool and school age children, flu is about twice as common as among older people. While children rarely die of the flu, complications and hospitalization are common in infants and toddlers. These young children have hospitalization rates from flu that are similar to that of people over the age of 65.
HOW THE FLU SPREADS
Flu is very contagious. It is spread be small aerosol droplets expelled into the air when a person with the flu coughs or sneezes. Unlike the common cold, which is usually spread hand-to-hand and hand-to-face, the flu can spread from person to person “through thin air.”
Although the flu takes it’s heaviest toll on old people, it is spread through communities by young people-particularly school-age children. Adults who get the flu, usually get very sick, very fast. Soon after adults come down with the flu, they go home and go to bed. Children, on the other hand, get sick a bit slower. Therefore they may spend a day or two in school as the infection is developing, and that gives them enough time to infect their classmates. These classmates go home and infect their parents.
PROTECTION FROM THE FLU
Flu vaccine is the most important and effective way to protect people from the flu. As the virus changes from year to year, those seeking protection must get the vaccine each fall, to protect themselves from flu during the height the flu season, which extends from December to April in the Northern Hemisphere.
For years, health authorities have recommended routine flu vaccine for individuals over the age of 65 and for those people at increased risk for complications. This includes people with heart disease, chronic respiratory conditions, diabetes, and other chronic diseases. People with impaired immune systems, either because of a disease or medications, should also get the flu vaccine. Women who will be in the second or third trimesters of their pregnancies should get flu vaccine because they are at increased risk of complications from the flu. Many people over the age of 50 will also benefit from flu vaccine, because these individuals often have risk factors.
Those people who can transmit the flu to “high risk” people should get flu vaccine. This includes health care workers, employees in nursing homes, and family members and caretakers of people at increase risk from the flu.
Healthy people can also get the flu vaccine simply to protect themselves from the flu. This would include almost anyone over the age of six months who is not allergic to eggs (used in the manufacture of the vaccine) or to other components of the vaccine.
WHAT ABOUT CHILDREN?
There are two reasons why some children should get flu vaccine: either to protect themselves or to protect someone in their family. The same high risk conditions for which vaccine is recommended in adults, also apply to children:
- Chronic heart or respiratory conditions, including asthma an cystic fibrosis
- Chronic metabolic conditions including diabetes and kidney disease
- Chronic anemia and blood conditions including sickle cell disease
- Weakened immune systems because of disease (cancer, HIV infection) or medications
- Children on long-term aspirin therapy (because of Reye Syndrome)
- Children living in the same household as adults over the age of 65, or in the same household with other children or adults with chronic conditions ought to receive flu vaccine to help keep flu out of the household, since the vaccine is not 100 percent effective. Therefore, if there is one person in a household at increased risk for complications from the flu, it makes sense to consider flu vaccine for everyone — children and adults — living with that person.
WHAT ABOUT CHILDREN UNDER THE AGE OF TWO?
This year, the Centers for Disease Control is recommending injectable flu vaccine for healthy children between the ages of 6 months and 2 years old. (Injectable flu vaccine is not licensed for infants less than 6 months old.) This is because these youngest children are at increased risk for complications and hospitalization, should they get the flu. The flu vaccine can be given at the same visit as the routine immunizations, or it can be given at a separate visit.
If you have an infant less than six months old, the best way to protect him is to get everyone else in the household immunized against the flu. In fact, if there are any children under the age of two in the home, the older kids and adults in the home should get flu vaccine.
DOES MY CHILD NEED ONE OR TWO FLU SHOTS?
The rule is simple. If a person is less than nine years old and they have never had the flu shot before, they need two shots, at least a month apart. Everyone else can get protection from a single dose each fall. For those requiring two shots, protection begins about two weeks after the second shot.
WHAT IS THE NEW FLUMIST VACCINE?
This past June, the FDA licensed FluMist vaccine, which is given by nasal spray, rather than by injection.
This vaccine differs from the injectable vaccine in that it contains a live (though weakened) virus. The injected vaccine, in contrast, contains no live virus (it contains an “inactivated” virus, meaning that the virus has actually been killed before being injected.)
The live virus in FluMist has also been “cold adapted” so that it grows and replicates best at about 77 degrees, rather than at warmer body temperatures of 98 degrees and above. Therefore, when the vaccine is sprayed into the nose, the virus replicates there and stimulates the body’s production of protective antibodies. But when the virus moves closer to the lungs where it is warmer, it becomes inactive and unable to replicate. The vaccine can sometimes cause nasal congestion, fever and mild symptoms. But, because the virus is weakened and cold adapted, it is incapable of causing a full-blown case of the flu.
FOR WHOM IS THE NASAL SPRAY VACCINE AN ALTERNATIVE?
FluMist is not a substitute for the traditional flu vaccine. While it appears to be very effective, it has some limitations.
First, this nasal spray vaccine is only licensed for healthy individuals between the ages of 5 and 50 years. Preschoolers and seniors are not eligible for the vaccine. Likewise, those with chronic health conditions, weakened immune systems, and pregnant women should not receive this vaccine. Therefore, many of the people, for whom the injectable vaccine is specifically recommended, are not eligible for this needle-free alternative.
Second, the nasal spray vaccine is substantially more expensive. While a dose of injectable flu vaccine cost about seven dollars wholesale, FluMist costs $46 per dose. (When you add the cost of the office visit, this brings the total for FluMist to about $70.) And, while injected flu vaccine is often covered by health insurance, don’t expect insurance to cover FluMist.
Like the injectable vaccine, children under age 9 who have not had previous flu vaccine, will need two doses of FluMist this fall to get full protection.
FluMist will be an attractive vaccine for healthy older children and adults who want protection from the flu, do not want an injection, and are willing and able to pay for the vaccine. Some of these people will simply want to protect themselves from the flu, others will be getting the vaccine to help protect a household family member or other “at-risk” individuals with whom they are in close contact.
WHERE TO GET MORE INFORMATION
A good place to get more information is from your physician or your child’s physician. Whenever your child gets the flu vaccine or any other vaccine, be sure you ask about risks as well as benefits. You should read the “Vaccine Information Statement” that your physician will provide before giving the vaccine. Excellent information is available on the web from the CDC (http://www.cdc.gov/nip/flu/). The Vaccine Information Statements are available in several languages from the Immunization Action Coalition (http://www.immunize.org/vis/#influenza).
As always, this information is meant to complement, not replace information from your child’s physician. Your child’s pediatrician can suggest what measures are best to protect your child and your family.
Mark Widome is professor of pediatrics at the Penn State Children’s Hospital and a regular contributor to the TODAY show. His latest book, “Ask Dr. Mark: Answers for Parents,” is published by the National Safety Council.