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Posts for tag: Flu

November 27, 2018
Category: Treatments
Tags: Influenza   Flu   tips   colds   Free   Webinar   treatments  

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Join Dr. Shu Thursday, December 6, 2018 at 1 pm Central Time!
Cold and flu season is upon us—so chances are you may find yourself dealing
with kids' sniffles, sneezes, coughs and more at some time during the next several months!
Join host Dr. Jennifer Shu, medical editor for, for timely tips on how to soothe your family's cold and flu symptoms at home. In this 30-minute webinar, she will also discuss when to call your pediatrician and how to help prevent illness in the first place! A Q&A session will follow the presentation. 

Coming soon.

November 06, 2018
Tags: Influenza   Flu   immunizations   Vaccines   death   Myths  


A child in Florida has become the first person to die of the flu this season, according to state health officials. State epidemiologists say the child had not been vaccinated and was otherwise healthy before getting sick with the flu.

The child, who tested positive for influenza B, died sometime during the week of Sept. 30, although privacy concerns prevent officials from saying exactly where, CBS affiliate WTSP reports.

Last flu season, 183 children in the U.S. died from flu or flu-related causes. That's the most since the CDC began keeping these records in 2004. Overall, an estimated 80,000 Americans died from flu last season.

CBS News medical contributor Dr. Tara Narula says this latest news should be a wake-up call to parents to get their children vaccinated. 

"What this is a strong clear message to parents about the importance of vaccination," she told "CBS This Morning." "This vaccine is safe. It is the most effective tool we have. And we know of the pediatric deaths last year, 80 percent were in kids who were unvaccinated."

8 common myths about cold and flu debunked

A new survey suggests that many children may not be getting the potentially life-saving flu shot because of their parents' misconceptions about the safety and importance of vaccines.

The survey by Orlando Health Arnold Palmer Hospital found:

More than half of parents think that their child can get the flu from the flu shot.30 percentof parents feel flu vaccines are a conspiracy.28 percentof parents believe flu vaccines can cause autism.

"None of these things are true. It's important that we deal with the science and the facts," Narula said.

The CDC recommends everyone age 6 months and older get vaccinated against the fluevery year.

"Officials have said it's like wearing a seat belt," Narula said. "This is really a no-brainer for parents."

June 11, 2018
Category: Infectious Disease
Tags: Influenza   Flu   flu shot   vaccine   immunization   death   epidemic  


This Year’s Flu Season Killed Record Number Of Children.

The Washington Post (6/8) said a new Centers for Disease Control and Prevention report indicates that the flu “killed 172 children between October and May, making this season one of the deadliest since federal health authorities began tracking pediatric deaths 14 years ago.” The new figure “exceeds the 171 child deaths reported for 2012-2013, the previous record for a regular season,” according to the Post, which added, “Only the 2009 swine flu pandemic, which killed 358 children, was worse.” Daniel Jernigan, head of the CDC’s influenza division, explained that the number of deaths “is a record number since we’ve been keeping track, outside of the pandemic” and is considered to be an undercount because it only includes cases confirmed by laboratories listed on death certificates and reported to the CDC.

        The AP (6/8) reported, “The past flu season wasn’t a pandemic, but it was long – 19 weeks” – and “also was unusually intense, with high levels of illness reported in nearly every state for weeks on end.

        Newsweek (6/8) reported that according to the CDC, “About 80 percent of the fatalities were among children who hadn’t been vaccinated.”


Let's all hope the flu vaccine picked for next epidemic season will be right on and effective.

Dr.  T


December 10, 2017
Tags: Cough   Influenza   Flu   Vaccines   colds   prevention   Hand Washing   Hand Hygiene   Hygiene  

Some Things Old and Some Things New & Some Things Never Change


Let’s repeat the basics.  Most Winter illness is viral and spreads through body fluid contact.  What fluid is this, you might ask? I speak of air-borne (and hand-borne) small droplets of saliva and mucus that sprays from our mouths and noses when we sneeze or cough. This means when one has a cold and/or sore throat, no matter how young or how old we are or how sick we feel, we will ALWAYS be contagious to others.


So one of life’s lessons we want to teach our children is how NOT TO SHARE these body fluids, when they are ill. Now here’s a fact most people don’t know:


Viruses commonly live in our noses and mouths intermittently and episodically even when one is completely well__without symptoms of illness at all. This is called viral shedding and it happens frequently, and we have no clue that we are contagious! Yes, you can be infectious to others even when you are completely well.  Who knew!?


So another life lesson that we should teach our kids is not to share saliva or mucus with others even when one is well. If you think we don’t do this all the time, think again. Kids and adults share gum, pizza, cookies, cupcakes, drinks, utensils, toys, etc without a second thought when they are well, and often when they are ill.  This is a behavior that can be altered more easily when one is sick, but occurs unconsciously when we are well. I am not saying we should make our kids phobic, over-anxious or compulsive about germs, or ourselves, for that matter, but that good hygiene habits of behavior are in the best interest of everyone.


Since it is fairly obvious that saliva sharing is a fact of life__like frequently touching our faces with our hands unconsciously every day__teaching our kids and ourselves how to contend with this reality is another life lesson to learn. It’s called handwashing and the use of hand sanitizers safely.  Sounds like a simple thing to teach our kids, but it is not. As parents we want handwashing to become an automatic behavior, not just something the kids do when we are watching and ask them to do it. We want them to do it at school, when they are out with their friends, and at home before sitting down to a meal, for example.


Believe it or not, it’s never too late to learn this behavior         [].


Handsanitizers [] with greater than or equal to 60% alcohol are effective hand-hygiene products but they should not be licked off the hands. So allowing young children under 5 years old to use them independently without supervision is not safe, since hands often end up in mouths. As soon as the hands are dry (after waving them in the air for a few seconds) there is no danger. Of course the sanitizing benefit of these products are short term since hands rapidly touch the world and end up in mouth not long after.  But you have to start somewhere. Choosing time and place to use an alcohol-based hand sanitizer is a good idea. You can’t do it every 5 minutes through the day but certain situations, like the petting zoo, necessitate applying sanitizer frequently. After visiting a public restroom, even if you’ve washed your hands, is another good time to use sanitizer.  Remember to use it when visiting the mall or taking your seat at a movie theater (or leaving the theater), and after using an escalator in the mall or airport.  What these places have in common is that they are all public, meaning the world has touched all the areas you and your children are touching as you go through the day.


Sanitizer hand wipes are OK, but my guess is they are used less effectively than the gels which can be rubbed into tiny spaces on cuticles and between fingers by you and your children very easily. And there is no tissue to dispose of afterwards.


I don’t have anything against against hand washing. It’s great if you have the time to do it, but when you don’t hand sanitizers come to your rescue.


So that’s hand care. What about cough and sneeze hygiene? Not complicated. Most grown ups were taught to cover their mouths with their hands when they were kids. No question this is polite, but think about it..... totally ineffective in preventing the spread of body fluid (saliva and runny nose juice) between people since our hands then go on to touch other people and objects.


Today, kids in preschool and nursery school are being taught correctly, the 21st century way, the Elbow Cough-Cover. It’s quick and readily accessible and in itself NOT impolite to whip your elbow to your face and cover your mouth and nose with your elbow. Sure, no question, you will have germs on your elbow, but NOT YOUR HANDS! You can teach this to your children of all ages. You can role model it as well.


A cute story I like to tell kids this time of year (with parent permission if Santa comes to their house) goes like this:  Santa doesn’t visit a home by himself. It’s a lot of work to deliver presents to good children all over the world, so he brings some of his helpers along in the sled. All the helpers want to go with him. (Remember the movie “Elf”. Good thing all the elves aren’t the size of Will Ferrell.) Some of the elves have colds, coughs and runny noses. So they have to know how to cover their face properly when they cough and sneeze. Santa doesn’t want elf germs to get on everyone’s gifts. So Santa’s helpers who can cover their faces with their elbows get to go, but the helpers who don’t know how, stay at the North Pole with Mrs. Clause practicing the Elbow-Cough-Cover so they can go with Santa next year. The punchline: Santa likes it when kids cover their faces with their elbows too when they cough and sneeze. I guess you can always add that the elves have to take and use their hand sanitizer every time before they go down the chimney with Santa to help deliver the presents.


If you like this parable, feel free to use it. No copyright on it as far as I know, since I made it up.


One more thing about our hands, we use them almost always to greet others__hand to hand shake.  It’s social and appropriate and certain to transmit illness back and forth with every greeting.  So why not greet one another with an elbow-bump or a fist-bump through the Winter virus season? Seems like such an easy solution, if we could only make it the social norm [].  If we could just get our media-TV physician personalities, like Dr. Oz and Dr. Gupta and Dr. Snyderman, to endorse the social greeting elbow-bump, this greeting could sweep the nation.  Well, we do what we can, us parents and physicians. Maybe our preschool and school teachers could teach this greeting, just as they teach the elbow-cough-cover technique. Bring it up at your next PTA meeting.


One More Time About Influenza Vaccine


If you have not yet obtained your adult Influenza vaccine or one time Tdap (Whooping Cough) booster and would like a housecall to update these important vaccines, please contact me or Shelly.

I can administer the appropriate influenza vaccine to your children, yourselves and close family, sitters, nannies, etc. who share time with your family. These vaccines can be offered through Winter and early Spring to enhance protection against the Flu and Pertussis among all persons over the age of 6 months.  Unfortunately, there is no Flu vaccine as of yet for infants under the age of 6 months.


We should also be aware that when we immunize, we are not just protecting ourselves and our families.  We are also helping those in our community who cannot get immunized because of weakened immunity from advancing age, illness disease, cancer or chemotherapy.  They depend upon the rest of us to do what we can to protect them from these diseases by keeping our vaccines current. If you believe that we are our brothers’ keepers and have an obligation not to make others seriously ill through immunization apathy, please give this issue serious thought and consider staying current with your vaccines even if you have never had the flu and don’t think that Whooping Cough will make you very sick.


Please call Shelly (404-654-0426) or me or shoot us a text message and I will get back to you to schedule a house visit for the vaccine(s) you request:


Fluzone® Influenza Virus Vaccine, Contains No Preservative: Pediatric Dose  Children 6-35 months of age (Single-dose, prefilled syringe, without needle, 0.25 mL) also available for over 35 months of age through adult years.    


You can learn more about this and all vaccines at


If my Influenza vaccine supplies run out, you should still be able to find the vaccine at your local neighborhood pharmacies for a while longer yet.

September 08, 2017
Category: Immunizations
Tags: Influenza   Flu   Vaccines   flu shot   flu vaccine   Tamiflu   guidelines   recommendations   the flu  

The American Academy of Pediatrics (AAP) recommends annual seasonal influenza vaccination for everyone 6 months and older, including children and adolescents, during the 2017–2018 influenza season.


Special effort should be made to vaccinate individuals in the following groups:

  • All children, including infants born preterm, 6 months and older (on the basis of chronologic age) with conditions that increase the risk of complications from influenza (eg, children with chronic medical conditions such as pulmonary diseases like asthma, metabolic diseases like diabetes mellitus, hemoglobinopathies like sickle cell disease, hemodynamically significant cardiac disease, immunosuppression, or neurologic and neurodevelopmental disorders);

  • All household contacts and out-of-home care providers of children with high-risk conditions or younger than 5 years, especially infants younger than 6 months;

  • Children and adolescents (6 months through 18 years of age) receiving an aspirin- or salicylate-containing medication, which places them at risk for Reye syndrome after influenza virus infection;

  • American Indian/Alaskan native children;

  • All health care personnel (HCP);

  • All child care providers and staff; and

  • All women who are pregnant, are considering pregnancy, are in the postpartum period, or are breastfeeding during the influenza season.

Current Recommendations

Seasonal influenza vaccination with a flu shot is recommended for all children 6 months and older. Nasal spray vaccine should not be used. Children and adolescents with certain underlying medical conditions, listed below, have an elevated risk of complications from influenza:

  • asthma or other chronic pulmonary diseases, including cystic fibrosis;

  • hemodynamically significant cardiac disease;

  • immunosuppressive disorders or therapy;

  • HIV infection;

  • sickle cell anemia and other hemoglobinopathies;

  • diseases that necessitate long-term aspirin therapy or salicylate-containing medication, including juvenile idiopathic arthritis or Kawasaki disease, that may place a child at increased risk of Reye syndrome if infected with influenza;

  • chronic renal dysfunction;

  • chronic metabolic disease, including diabetes mellitus;

  • any condition that can compromise respiratory function or handling of secretions or can increase the risk of aspiration, such as neurodevelopmental disorders, spinal cord injuries, seizure disorders, or neuromuscular abnormalities; and

  • pregnancy.

Additional vaccination efforts should be made for the following groups to prevent transmission of influenza to those at risk, unless contraindicated:

  • Household contacts and out-of-home care providers of children younger than 5 years and of at-risk children of all ages;

  • Any woman who is pregnant or considering pregnancy, is in the postpartum period, or is breastfeeding during the influenza season. It is safe to administer the influenza vaccine to pregnant women during any trimester. Any licensed, recommended, and age-appropriate flu vaccine may be used. Studies have revealed that infants born to immunized women have better influenza-related health outcomes than infants of unimmunized women. However, according to Internet-based panel surveys conducted by the CDC, only ∼50% of pregnant women during the 2015–2016 influenza season and 47% of women during the 2016–2017 season (according to preliminary data) reported receiving an influenza vaccine, even though both pregnant women and their newborn infants are at higher risk of complications from the flu. More data on the safety of influenza vaccination in the early first trimester are becoming available. First trimester flu vaccine was not associated with an increase in the rates of major congenital malformations. Similarly, no association between congenital defects and influenza vaccination in any trimester, including the first trimester’s gestation, were seen in a large study. Assessments of any association with influenza vaccination and preterm birth and small-for-gestational-age infants have revealed inconsistent results, with the authors of most studies reporting a protective effect or no association against these outcomes. Breastfeeding is also recommended to protect against influenza viruses by activating innate antiviral mechanisms in the baby, specifically type 1 interferons. In addition, human milk from mothers vaccinated during the third trimester contains higher levels of influenza-specific immunoglobulin A. Greater exclusivity of breastfeeding in the first 6 months of life decreases the episodes of respiratory illness with fever in infants of vaccinated mothers. 

  • American Indian/Alaskan native children and adolescents;

  • Close contacts of immunosuppressed people.

Key Points Relevant for the 2017–2018 Influenza Season

 1. The annual seasonal influenza vaccine is recommended for everyone 6 months and older, including children and adolescents, during the 2017–2018 influenza season.   It is important that household contacts and out-of-home care providers of children younger than 5 years, especially infants younger than 6 months, and children of any age at high risk for complications from influenza (eg, children with chronic medical conditions such as pulmonary diseases like asthma, metabolic diseases like diabetes mellitus, hemoglobinopathies like sickle cell disease, hemodynamically significant cardiac disease, immunosuppression, or neurologic and neurodevelopmental disorders) receive the annual influenza vaccine. In the United States, more than two-thirds of children younger than 6 years and almost all children 6 years and older spend significant time in child care or school settings outside the home. Exposure to groups of children increases the risk of contracting infectious diseases. Children younger than 2 years are at increased risk of hospitalization and complications attributable to influenza. School-aged children bear a large influenza disease burden and have a significantly higher chance of seeking influenza-related medical care compared with healthy adults. Reducing influenza virus transmission (eg, by using appropriate hand hygiene and respiratory hygiene and/or cough etiquette) among children who attend out-of-home child care or school has been shown to decrease the burden of childhood influenza and transmission of influenza virus to household contacts and community members of all ages.

2. The 2016–2017 influenza season was moderate overall, and influenza A (H3N2) viruses predominated.   Severity indicators were within the range of what has been observed during previous H3N2-predominant seasons, which have been associated with more severe illness and mortality, especially in older individuals and younger children, compared with seasons during which H1N1 or B viruses predominated. The start of the season was typical in the United States, with increasing activity noted in mid-December 2016 and peak activity in late February. The majority of circulating strains matched vaccine strains well. Pediatric hospitalizations and deaths caused by influenza vary by the predominant circulating strain and from one season to the next. Historically, 80% to 85% of pediatric deaths have occurred in unvaccinated children 6 months and older. Influenza vaccination is associated with reduced risk of laboratory-confirmed influenza-related pediatric death. In the past 10 seasons, the rates of influenza-associated hospitalization for children younger than 5 years have always exceeded the rates for children 5 through 17 years of age. However, among healthy children hospitalized with influenza B, those 10 to 16 years of age were found to be at the highest risk for admission to the ICU. As of August 19, 2017, the following data were reported by the Centers for Disease Control and Prevention (CDC) during the 2016–2017 influenza season:

  • •104 laboratory-confirmed influenza-associated pediatric deaths occurred:

    • ∘ 66 of these were associated with influenza A viruses;

    • ∘ 37 of these were associated with influenza B viruses; and

    • ∘ 1 of these was associated with an undetermined type of influenza virus.

  1. Although children with certain conditions are at a higher risk of complications, 53.7% of the deaths during the 2016–2017 influenza season occurred in children with no high-risk underlying medical condition. Among children hospitalized with influenza and for whom medical record data were available, ∼41% had no recorded underlying condition, whereas ∼29% had underlying asthma or reactive airway disease. In a recent study of hospitalizations for influenza A versus B, the odds of mortality were significantly greater with influenza B than with A and were not entirely explained by underlying health conditions.

3. Vaccination remains the best available preventive measure against influenza.  Given the unpredictable nature of influenza each season, any licensed and age-appropriate influenza vaccine available should be used. The vaccine strains are predicted to match the circulating strains with the intent of providing optimal protection. Vaccination is effective in reducing outpatient medical visits for illness caused by circulating influenza viruses by 50% to 75%. The universal administration of the seasonal vaccine to everyone 6 months and older is the best strategy available for preventing illness from influenza. There is notable room for improvement in influenza vaccination, because overall influenza vaccination rates have been suboptimal during the past 7 seasons in both children (percentages in the mid- to high- 50s) and adults (percentages in the low- to mid- 40s). A child’s likelihood of being immunized according to recommendations appears to be associated with the immunization practices of their parents. The authors of 1 study found that children were 2.77 times more likely to also be immunized for seasonal influenza if their parents were immunized. When parents who were previously not immunized had received immunization for seasonal influenza, their children were 5.44 times more likely to become immunized for influenza.

4. The number of seasonal influenza vaccine doses to be administered in the 2017–2018 influenza season depends on the child’s age at the time of the first administered dose and vaccine history (Fig 2).

  • • Influenza vaccines are not licensed for administration to infants younger than 6 months;

  • • Children 9 years and older need only 1 dose; and

  • • Children 6 months through 8 years of age:

    • ∘ Need 2 doses if they have received fewer than 2 doses of any influenza vaccine before July 1, 2017. The interval between the 2 doses should be at least 4 weeks; and

    • ∘ Require only 1 dose if they have previously received 2 or more total doses of any influenza vaccine before July 1, 2017. The 2 previous doses do not need to have been received during the same influenza season or consecutive influenza seasons. Despite recent evidence for poor effectiveness of nasal spray flu vaccine in the past, it is still expected to have primed a child’s immune system; there currently are no data that suggest otherwise. Therefore, children who received 2 or more doses of nasal spray flu vaccine before July 1, 2017 may receive only 1 dose of flu shot for the 2017–2018 season.

Any available, age-appropriate influenza vaccine can be used. A child who receives only 1 of the 2 doses as a quadrivalent formulation is likely to be less primed against the additional B virus.

Vaccination of adult close contacts of children at high risk of influenza-related complications is intended to reduce children’s risk of exposure to influenza (ie, “cocooning”). The practice of cocooning also will help protect infants younger than 6 months who are too young to be immunized with an influenza vaccine.

5. Pregnant women may receive an influenza vaccine at any time during pregnancy.   Pregnant women are of special concern because they are at an increased risk for complications from influenza. Any licensed, recommended, and age-appropriate influenza vaccine may be used. Substantial data indicate that the flu vaccine does not cause fetal harm when administered to a pregnant woman, although data on the safety of influenza vaccination in the early first trimester are limited. Assessments of any association with influenza vaccination and preterm birth and small-for-gestational-age infants have yielded inconsistent results, with most studies reporting a protective effect or no association with these outcomes. Vaccination of pregnant women also provides protection for their infants, potentially for as long as 6 months, through the transplacental transfer of antibodies. For example, one recent study documented that infants born to women reporting influenza vaccination during pregnancy had risk reductions of 70% for laboratory-confirmed influenza and 81% for influenza hospitalizations in the first 6 months of life.


6. As soon as the seasonal influenza vaccine becomes available locally, pediatricians or vaccine administrators should encourage immunization of HCP, notify parents and caregivers of vaccine availability and the importance of annual vaccination, and immunize children 6 months and older per recommendations, especially those at high risk of complications from influenza. Vaccination should occur by the end of October, if possible.  This is particularly important for children who need 2 doses of the influenza vaccine to achieve optimal protection before the circulation of influenza viruses in the community. Children should receive their first dose as soon as possible after a vaccine becomes available, to allow sufficient time for receipt of the second dose ≥4 weeks later, preferably by the end of October. Prompt initiation of influenza vaccination and continuing to vaccinate throughout the influenza season, whether influenza is circulating (or has circulated) in the community, are important components of an effective vaccination strategy. Although there is no evidence that waning immunity from early administration of the vaccine increases the risk of infection in children, recent reports raise the possibility that early vaccination of adults, particularly the elderly, might contribute to reduced protection later in the influenza season. Older adults are recognized to have a less robust immune response to influenza vaccines. A recent multiseason analysis from the US Influenza Vaccine Effectiveness Network found that vaccine effectiveness declined by ∼7% per month for H3N2 and influenza B and by 6% to 11% per month for H1N1pdm09 in individuals 9 years and older. Vaccine effectiveness remained >0 for at least 5 to 6 months after vaccination. Until there are definitive data that determine if waning immunity influences vaccine effectiveness in children, the administration of the influenza vaccine should not be delayed to a later date, because this increases the likelihood of missing the influenza vaccination altogether. Further evaluation is needed before any policy change in timing is made. An early onset of the influenza season is another concern about delayed vaccination.

7. Providers may continue to offer vaccines until June 30 of each year, the date marking the end of the influenza season, because influenza is unpredictable. Protective immune responses generally persist in children throughout the influenza season. Although peak influenza activity in the United States tends to occur from January through March, influenza activity can occur in early fall (October) or late spring (end of May) and may have more than 1 disease peak. This approach also provides ample opportunity to administer a second dose of the vaccine to children 6 months through 8 years of age when indicated, as detailed previously. This approach also allows for optimal ability to immunize travelers, particularly international travelers, who may be exposed to influenza year round, depending on destination.

8. Antiviral medications are important in the control of influenza but are not a substitute for influenza vaccination. The neuraminidase inhibitors (NAIs) oral oseltamivir (Tamiflu [Roche Laboratories, Nutley, NJ]) and inhaled zanamivir (Relenza [GlaxoSmithKline, Research Triangle Park, NC]) are the only antiviral medications that are recommended for chemoprophylaxis or treatment of influenza in children during the 2017–2018 season. Recent viral surveillance and resistance data from CDC and the World Health Organization (WHO) indicate that the majority of currently circulating influenza viruses likely to cause influenza in North America during the 2017–2018 season continue to be susceptible to oseltamivir and zanamivir. 

In children, the most common injection site adverse reactions after administration of the flu vaccine were pain, redness, and swelling. The most common general sytemic adverse events were drowsiness, irritability, loss of appetite, fatigue, muscle aches, headache, arthralgia, and gastrointestinal tract symptoms.

9. A large body of scientific evidence demonstrates that thimerosal-containing vaccines are not associated with increased risk of autism spectrum disorders in children. Thimerosal from vaccines has not been linked to any medical condition. As such, the AAP extends its strongest support to the current WHO recommendations to retain the use of thimerosal as a preservative in multiuse vials in the global vaccine supply. Some people may still raise concerns about the trace amount of thimerosal in some IIV vaccine formulations, and in some states, including California, Delaware, Illinois, Missouri, New York, and Washington, there is a legislated restriction on the use of thimerosal-containing vaccines. The benefits of protecting children against the known risks of influenza are clear. Therefore, to the extent authorized by state law, children should receive any available formulation of IIV rather than delaying vaccination while waiting for reduced thimerosal-content or thimerosal-free vaccines. Although some flu shot formulations contain a trace amount of it, thimerosal-free vaccine products can be obtained. Vaccine manufacturers are delivering increasing amounts of thimerosal-free influenza vaccine each year. Priority Pediatrics uses a thimerosal-free influenza vaccine product. 

10. Influenza Vaccines and Egg Allergies. The flu vaccine administered in a single, age-appropriate dose is well tolerated by recipients with an egg allergy of any severity. Special precautions for egg-allergic recipients of the flu vaccine are not warranted, because the rate of anaphylaxis after flu shot administration is no greater in egg-allergic than in non–egg-allergic recipients or from other universally recommended vaccines. Standard vaccination practice for all vaccines in children should include the ability to respond to rare acute hypersensitivity reactions. Patients who refuse to receive an egg-based vaccine may be vaccinated with an age-appropriate recombinant or cell-cultured product.

Contraindications and Precautions

Minor illnesses, with or without fever, are not contraindications to the use of influenza vaccines, particularly among children with mild upper respiratory infection symptoms or allergic rhinitis. Children diagnosed with a moderate to severe febrile illness, on the basis of the judgment of the clinician, should not be vaccinated with a flu vaccine until resolution of the illness. Infants younger than 6 months should also not be vaccinated with the flu vaccine as it is not approved at this age. A previous severe allergic reaction to an influenza vaccine (ie, anaphylaxis involving cardiovascular changes, respiratory or gastrointestinal tract symptoms, or reactions that necessitate the use of epinephrine), regardless of the component suspected of being responsible for the reaction, is a contraindication to future receipt of the vaccine.

The estimated risk for Guillain-Barré syndrome (GBS) is low, especially in children. Although influenza infection is recognized to be a cause of GBS, there is no elevated risk of GBS from influenza vaccination. As a precaution, people who are not at high risk for severe influenza and who are known to have experienced GBS within 6 weeks of influenza vaccination generally should not be vaccinated. However, the benefits of influenza vaccination might outweigh the risks for certain people who have a history of GBS and who also are at high risk for severe complications from influenza.