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New flu vaccine recommendations include a change

The American Association of Pediatrics wants to prevent a repeat of last year, which saw the highest number of flu-related deaths in kids in a single flu season, excluding pandemics

Braxton Fludd gets a flu shot
Braxton Fludd hams it up for the camera while getting a shot from certified medical assistant Shavazae Rivers. Photo by Sarah Pack
Helen Adams | adamshel@musc.edu | September 4, 2018

The nasal spray is back in the picture this year in newly-released flu vaccine recommendations from the American Academy of Pediatrics. It was out of the picture for the last couple of years because it wasn’t considered effective enough. 

But MUSC Children’s Health critical care specialist Elizabeth Mack, a spokeswoman for the AAP, said the nasal spray is still not the right choice for most people. “For people who otherwise wouldn’t get a vaccine, then the nasal spray is an allowable option. But the inactivated influenza vaccine, also known as the flu shot, is still the primary recommendation.” 
 
The difference between the nasal spray and the flu shot, apart from how you get them, is what’s in them. “The nasal vaccine contains live flu virus. The flu shot does not,” Mack said. “We worry about live vaccines in immunocompromised children. These children should not get the live attenuated influenza vaccine, also known as the nasal spray flu vaccine.”
 
Flu vaccines this year protect against three or four viruses: an influenza A (H1N1) virus, an influenza A (H3N2) virus and either one or two influenza B viruses.

Other key takeaways from the AAP’s flu vaccine recommendations:

  • Kids with egg allergies can get flu shots. Most shots contain a small amount of egg protein. But Mack said regardless of how you react to eggs, it’s OK to get a flu shot. “If you get hives from eggs, you don’t need any particular accommodation. If it’s a more serious reaction such as swelling of the lips or throat or breathing difficulty, it’s OK to get the flu shot but it needs to be done in a doctor’s office or a hospital.”
  • Pregnant women can get a flu shot. They can get it during any point of the pregnancy, according to the AAP. It protects them and their babies. Pregnant women are at a higher risk of getting seriously sick from the flu than women who aren’t pregnant.
  • People who work in health care should get flu shots. It protects them and their patients.
  • Antiviral medications are not a substitute for flu shots. “Antivirals are expensive and may have significant side effects,” Mack said. 
Last year’s flu season was almost unprecedented. “We saw the highest number of child deaths related to the flu ever, excluding pandemics,” Mack said. “In this country, that we know of, we had 172 deaths in children from the flu, which is quite high.”
 
As for people who fear that getting the flu shot will give them the virus, Mack said don’t worry — that’s not possible if you get the inactivated flu vaccine. You can get symptoms such as a low-grade fever as the body’s immune response kicks in, but it’s nothing like the actual flu.
 
“Also, keep in mind that flu vaccines are given during times when respiratory viruses are circulating, so often people get sick with another virus coincidentally after getting the flu vaccine but they often think the vaccine gave them the flu,” Mack said.
 
Don’t run to get that flu shot just yet. Timing is everything, Mack said. “Wait a couple of more weeks until end of September or early October so it lasts you through the season. The peak of the season typically is December, January, and then the season can continue through April or May.”

CDC reported flu deaths in children exceeds seasonal high (Centers for Disease Control and Prevention, June 8, 2018)

Flu hospitalizations at MUSC Health drop, but not rate of people coming to ER with flu symptoms (MUSC Catalyst News, Feb. 13, 2018) 

Flu season leads to spike in e-visits (MUSC Catalyst News, Jan. 19, 2018)

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