By Nurse Judy
Once again, I am sharing some useful information on the Flu shots from famed San Francisco based pediatric Nurse Judy who has over 30 years experience. She was a pediatric nurse at Noe Valley Pediatrics when we lived in the city. I hope you find this helpful for this upcoming flu season.
-Daphne Howe
Covid is getting most of the attention, but influenza is not something that deserves to be ignored. Where pediatrics is concerned, influenza is one of the deadliest vaccine-preventable childhood diseases. Each year, influenza kills more children in the United States than meningococcal infection and whooping cough combined.
The flu season in 20/21 was the mildest one we have seen in ages. It is not hard to figure out why. Schools were closed and people were for the most part wearing their masks. That is not the case this year.
I mentioned in an earlier post that RSV had a lighter than average season last year but is now exploding. I hope I am wrong, but I wouldn’t be surprised if the flu does the same thing.
As with the covid vaccination, getting the vaccine is not just about keeping you or your children from getting ill. It is also about minimizing spread within your family and community.
Getting the shot means protecting people who are vulnerable, including infants under 6 months who are too young to get the shot.
In addition, flu vaccines can reduce the burden of flu illnesses, hospitalizations, and deaths on our health care system that is overstressed with all the covid patients. Children under 12 are not quite eligible to get a vaccine for covid yet, but they can get one for the flu.
All children over the age of 6 months should get the flu shot. If you have a baby at home who is too young to get vaccinated for the flu, please take extra care to make sure that all the household contacts are protected so that you don’t bring the virus home. Pregnant and nursing moms can and should get the shot.
Children, especially those younger than 5 years, are at higher risk for serious flu-related complications. Folks of any age with chronic health problems like asthma, diabetes and disorders of the brain or nervous system are also at higher risk of serious flu complications.
Anyone who is under the age of nine, and is getting the flu vaccine for the very first time, needs to receive two doses of the vaccine in order to be considered fully protected. The first dose “primes” the immune system; the second dose provides immune protection. The two doses need to be separated by at least four weeks. Over the years I have seen patients who have had only their first shot come down with the flu. One dose will not fully protect them.
If your child has ever had more than two previous doses of any flu vaccine, they only need one this year. It takes about 2 weeks for the shot to take effect. For children aged 6 months through 35 months, flu vaccine dose volume is dependent on the product that is administered. Some brands require only half of the adult dose.
Every year the disease trackers do the best they can to predict which strains of the virus will circulate and try to match the flu vaccine to the anticipated strain. Typically the vaccine changes from year to year. This year's vaccine is not the same as last seasons. Some years have better matches than others. This year the flu mist is available and approved for kids over the age of 2.
As I do every year, I keep my fingers crossed that this year has the magic combination. This season’s flu vaccines were recently updated to better match viruses expected to be circulating in the United States.
For 2021-2022, recommendations were made for egg-based, cell-based, and recombinant flu vaccines as listed below.
Egg-based vaccine composition recommendations:
an A/Victoria/2570/2019 (H1N1) pdm09-like virus;
an A/Cambodia/e0826360/2020 (H3N2)-like virus;
a B/Washington/02/2019- like virus (B/Victoria lineage);
a B/Phuket/3073/2013-like virus (B/Yamagata lineage)
Ask for the preservative free vaccine, which should be an option. This is mostly an issue for pregnant women and young children.
All flu seasons have their own uniqueness. In my years as a nurse, some were memorably worse than others. There is no way to know how bad this one will be until we are in the midst of it.
Since we never really know when the flu season will start with a vengeance, getting your child vaccinated early in the season is your best bet. As soon as a baby turns 6 months old you can get them started with their first dose.
Because we don’t have experience with this particular flu vaccine, I can't have a sense of what kinds of side-effects to expect. Major reactions are quite rare, but the mild symptomatic reactions do seem to vary from year to year.
Last season it was mostly low grade fevers for a day or two for a small percentage. For most people, including myself, the vaccine was tolerated very well except for a sore arm. Remember that a day or two of aches and a bit of fever is still better than a full-blown case of the flu.
If your child has a mild egg sensitivity it is okay to get the standard shot. In my 30 years of giving flu shots, I only had one child have a reaction, and interestingly, it caught us a bit by surprise because no one had ever labeled her as having egg issues. For folks with a known severe egg allergy, be aware that there are now options for a special batch where no eggs are involved in the production. Ask your doctor if that is available for you. It may be that only allergists carry it.
In any event it is important to keep a close eye on your child for at least 30 minutes after the shot. If they seem to be having any breathing issues or exceptional fussiness they should get checked out immediately (an emergency room is the best choice.)
It is impossible to predict possible delays and shortages with the supply. The safest way to prevent having an issue with a potential shortage is to get the shot on the early side. Assuming that the vaccine is available, I would suggest getting it sometime in late September/early October, but anytime is fine at this point.
If your child isn’t feeling well, ideally you should wait until they are better before giving them the shot. When it gets deep into the season, most places will give the shot to mildly sick kids. You start planning early enough so that you have options.
When you go in for any appointment that involves an injection, it is helpful if your child is wearing short sleeves or clothes that will allow them easy access. Perhaps bring an ice pack with you and give yourself a bit more time for some icing in advance. The shot usually doesn’t hurt too much but an ice pack gives some kids a little boost of confidence. You might also order a product called a Shot Blocker from Amazon and bring it with you. These little gizmos have helped a few of my ‘shot haters’ have an easier experience.
Dr. Sophia Hurd, A UCSF physician at the Laurel Heights location says that the flu shot visit is a great time to get caught up on any other vaccines that you child might be missing.Their office has the flu vaccine in stock already and is giving it by appointment only.
For frequently asked questions, here is a great resource from the CDC