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By contactus@priority-pediatrics.com
September 19, 2019
Category: Immunizations
Tags: Influenza   Vaccination   flu shot   immunization   Fluzone   FluMist  

Take time to get a flu vaccine.

  • CDC recommends a yearly flu vaccine as the first and most important step in protecting against influenza and its potentially serious complications.
  • While there are many different flu viruses, flu vaccines protect against the 3 or 4 viruses that research suggests will be most common. Three-component vaccines contain an H3N2, an H1N1 and a B virus. Four component vaccines have an additional B virus component. (See Vaccine Virus Selection for this season’s vaccine composition.)
  • Flu vaccination can reduce flu illnesses, doctors’ visits, and missed work and school due to flu, as well as prevent flu-related hospitalizations.
  • Flu vaccination also has been shown to significantly reduce a child’s risk of dying from influenza.
  • Also, there are data to suggest that even if someone gets sick after vaccination, their illness may be milder.
  • Everyone 6 months and older should get a flu vaccine every year before flu activity begins in their community. CDC recommends getting vaccinated by the end of October. Learn more about vaccine timing.
  • For the 2019-2020 flu season, CDC and its Advisory Committee on Immunization Practices (ACIP) recommend annual influenza vaccination for everyone 6 months and older with any licensed, age-appropriate flu vaccine (inactivated, recombinant or nasal spray flu vaccines) with no preference expressed for any one vaccine over another. (See Types of Flu Vaccines).
  • Vaccination of high risk persons is especially important to decrease their risk of severe flu illness.
  • People at high risk of serious flu complications include young children, pregnant women, people with chronic health conditions like asthma, diabetes or heart and lung disease and people 65 years and older.
  • Vaccination also is important for health care workers, and other people who live with or care for high risk people to keep from spreading flu to them.
  • Infants younger than 6 months are at high risk of serious flu illness but are too young to be vaccinated. Studies have shown that flu vaccination of the mother during pregnancy can protect the baby after birth from flu infection for several months. Additionally, people who live with or care for infants should be vaccinated.
 

Take everyday preventive actions to stop the spread of germs.

  • Try to avoid close contact with sick people.
  • While sick, limit contact with others as much as possible to keep from infecting them.
  • If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone for 24 hours without the use of a fever-reducing medicine.)
  • Cover your nose and mouth with a tissue when you cough or sneeze. After using a tissue, throw it in the trash and wash your hands.
  • Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
  • Avoid touching your eyes, nose and mouth. Germs spread this way.
  • Clean and disinfect surfaces and objects that may be contaminated with germs like flu.

Take flu antiviral drugs if your doctor prescribes them.

  • If you are sick with flu, antiviral drugs can be used to treat your illness.
  • Antiviral drugs are different from antibiotics. They are prescription medicines (pills, liquid or an inhaled powder) and are not available over-the-counter.
  • Antiviral drugs can make illness milder and shorten the time you are sick. They may also prevent serious flu complications.
  • CDC recommends prompt antiviral treatment of people who are severely ill and people who are at high risk of serious flu complications who develop flu symptoms.
  • For people with high-risk factors, treatment with an antiviral drug can mean the difference between having a milder illness versus a very serious illness that could result in a hospital stay.
  • Studies show that flu antiviral drugs work best for treatment when they are started within 48 hours of getting sick, but starting them later can still be helpful, especially if the sick person has a high-risk health condition or is very sick from flu. Follow your doctor’s instructions for taking this drug.
  • Flu-like symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people, especially children, may have vomiting and diarrhea. People may also be infected with flu and have respiratory symptoms without a fever.

Why should people get vaccinated against the flu?

Influenza is a potentially serious disease that can lead to hospitalization and sometimes even death. Every flu season is different, and influenza infection can affect people differently, but millions of people get the flu every year, hundreds of thousands of people are hospitalized and thousands or tens of thousands of people die from flu-related causes every year. An annual seasonal flu vaccine is the best way to help protect against flu. Vaccination has been shown to have many benefits including reducing the risk of flu illnesses, hospitalizations and even the risk of flu-related death in children.

How do flu vaccines work?

Flu vaccines cause antibodies to develop in the body about two weeks after vaccination. These antibodies provide protection against infection with the viruses that are in the vaccine.

The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season. Traditional flu vaccines (called “trivalent” vaccines) are made to protect against three flu viruses; an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus. There are also flu vaccines made to protect against four flu viruses (called “quadrivalent” vaccines). These vaccines protect against the same viruses as the trivalent vaccine and an additional B virus.

What kinds of flu vaccines are available?

CDC recommends use of any licensed, age-appropriate influenza (flu) vaccine during the 2019-2020 influenza season. Options include inactivated influenza vaccine [IIV], recombinant influenza vaccine [RIV], or live attenuated influenza vaccine (LAIV). Different vaccines are licensed for different age groups, and some vaccines are not recommended for some groups of people. But where more than one suitable vaccine is available, no preference is expressed for any influenza flu vaccine over another.

Both trivalent (three-component) and quadrivalent (four-component) flu vaccines will be available for 2019-2020. Most vaccines will be quadrivalent.

Trivalent flu vaccines include:

  • high-dose trivalent flu shot, approved for people 65 years and older, which contains a higher dose of antigen (the part of the virus the immune system develops antibodies against), to help create a stronger immune response.
  • trivalent flu shot made with adjuvant, (an ingredient that helps create a stronger immune response), approved for people 65 years and older.

Quadrivalent flu vaccines include:

  • Standard-dose quadrivalent flu shots without adjuvant that are manufactured using virus grown in eggs. Several different brands of this type of flu shot are available, and they are approved for different age groups. Some are approved for children as young as 6 months of age. Most flu shots are given in the arm (muscle) with a needle. One quadrivalent flu shot can be given either with a needle (for people aged 6 months and older) or with a jet injector (for people aged 18 through 64 years only).
  • quadrivalent cell-based flu shot containing virus grown in cell culture, which is approved for people 4 years and older.
  • recombinant quadrivalent flu shot (a flu shot that is made without influenza viruses or eggs) approved for people 18 years and older.
  • quadrivalent live attenuated influenza nasal spray vaccine (LAIV4) made with attenuated (weakened) live flu viruses, approved for use in people 2 years through 49 years of age. This vaccine is not recommended for use in pregnancy or for use among people with some specific medical conditions.

 

Who should get vaccinated this season?

Everyone 6 months of age and older should get a flu vaccine every season. Vaccination is particularly important for people who are at high risk of serious complications from influenza. See People at High Risk of Developing Flu-Related Complications for a full list of age and health factors that confer increased risk.

Flu vaccination has important benefits. It can reduce flu illnesses, doctors’ visits, and missed work and school due to flu, as well as prevent flu-related hospitalizations. Flu vaccine also has been shown to be life-saving in children. In fact, a 2017 study showed that flu vaccination can significantly reduce a child’s risk of dying from flu.

Different flu vaccines are approved for use in different groups of people. There are flu shots approved for use in children as young as 6 months of age and flu shots approved for use in adults 65 years and older. Flu shots also are recommended for use in pregnant women and people with chronic health conditions.  The nasal spray flu vaccine is approved for use in non-pregnant individuals, 2 years through 49 years of age. People with some medical conditions should not receive the nasal spray flu vaccine.

There are many vaccine options to choose from.  CDC does not recommend one flu vaccine over another. The most important thing is for all people 6 months and older to get a flu vaccine every year. If you have questions about which vaccine is best for you, talk to your doctor or other health care professional.

More information is available at Who Should Get Vaccinated Against Influenza.

Who Should Not Receive a Flu Shot:

Factors that can determine a person’s suitability for vaccination, or vaccination with a particular vaccine, include a person’s age, health (current and past) and any relevant allergies.

Information for who cannot get a flu vaccine and who should talk to their doctor before getting a flu vaccine is available at Who Should & Who Should NOT Get Vaccinated.

Special Consideration Regarding Egg Allergy

People with egg allergies can receive any licensed, recommended age-appropriate influenza (flu) vaccine (IIV, RIV4, or LAIV4) that is otherwise appropriate. People who have a history of severe egg allergy (those who have had any symptom other than hives after exposure to egg) should be vaccinated in a medical setting, supervised by a health care provider who is able to recognize and manage severe allergic reactions.

When should I get vaccinated?

You should get a flu vaccine before flu viruses begins spreading in your community, since it takes about two weeks after vaccination for antibodies to develop in the body and provide protection against flu. Make plans to get vaccinated early in fall, before flu season begins. CDC recommends that people get a flu vaccine by the end of October, if possible. Getting vaccinated later, however, can still be beneficial and vaccination should continue to be offered throughout the flu season, even into January or later.

Getting vaccinated early (for example, in July or August) is likely to be associated with reduced protection against flu infection later in the flu season, particularly among older adults.

Children who need two doses of vaccine to be protected should start the vaccination process sooner, because the two doses must be given at least four weeks apart.

What are the benefits of flu vaccination?

There are many reasons to get a flu vaccine each year. Below is a summary of the benefits of flu vaccination, and selected scientific studies that support these benefits.

  • Flu vaccination can keep you from getting sick with flu.
    • Flu vaccine prevents millions of illnesses and flu-related doctor’s visits each year. For example, during 2016-2017, flu vaccination prevented an estimated 5.3 million influenza illnesses, 2.6 million influenza-associated medical visits, and 85,000 influenza-associated hospitalizations.
    • In seasons when the vaccine viruses matched circulating strains, flu vaccine has been shown to reduce the risk of having to go to the doctor with flu by 40 percent to 60 percent.
  • Flu vaccination can reduce the risk of flu-associated hospitalization for children, working age adults, and older adults.
  • Flu vaccination helps prevent serious medical events associated with some chronic conditions.
  • Vaccination helps protect women during and after pregnancy.
    • Vaccination reduces the risk of flu-associated acute respiratory infection in pregnant women by up to one-halfexternal icon.
    • 2018 studyexternal icon showed that getting a flu shot reduced a pregnant woman’s risk of being hospitalized with flu by an average of 40 percent.
    • Getting vaccinated can also protect a baby after birth from flu. (Mom passes antibodies onto the developing baby during her pregnancy.)
      • A number of studies have shown that in addition to helping to protect pregnant women, a flu vaccine given during pregnancy helps protect the baby from flu infection for several months after birth, when he or she is not old enough to be vaccinated.
  • Flu vaccine can be life-saving in children.
    • A 2017 study was the first of its kind to show that flu vaccination can significantly reduce a child’s risk of dying from influenza.
  • Flu vaccination has been shown in several studies to reduce severity of illness in people who get vaccinated but still get sick.
    • A 2017 study showed that flu vaccination reduced deaths, intensive care unit (ICU) admissions, ICU length of stay, and overall duration of hospitalization among hospitalized flu patients.
    • 2018 studyexternal icon showed that among adults hospitalized with flu, vaccinated patients were 59 percent less likely to be admitted to the ICU than those who had not been vaccinated. Among adults in the ICU with flu, vaccinated patients on average spent 4 fewer days in the hospital than those who were not vaccinated.
  • Getting vaccinated yourself may also protect people around you, including those who are more vulnerable to serious flu illness, like babies and young children, older people, and people with certain chronic health conditions.

*References for the studies listed above can be found at Publications on Influenza Vaccine Benefits. Also, see the A Strong Defense Against Flu Factsheet pdf icon[237 KB, 2 pages] fact sheet.

 

Flu Vaccine and People with Egg Allergies

CDC and its Advisory Committee on Immunization Practices have not changed their recommendations regarding egg allergy and receipt of influenza (flu) vaccines. The recommendations remain the same as last season (2016-2017). Based on those recommendations, people with egg allergies no longer need to be observed for an allergic reaction for 30 minutes after receiving a flu vaccine. People with a history of egg allergy of any severity should receive any licensed, recommended, and age-appropriate influenza vaccine.  Those who have a history of severe allergic reaction to egg (i.e., any symptom other than hives) should be vaccinated in an inpatient or outpatient medical setting (including but not necessarily limited to hospitals, clinics, health departments, and physician offices), under the supervision of a health care provider who is able to recognize and manage severe allergic conditions.

Most flu shots and the nasal spray flu vaccine are manufactured using egg-based technology.  Because of this, they contain a small amount of egg proteins, such as ovalbumin. However, studies that have examined the use of both the nasal spray vaccine and flu shots in egg-allergic and non-egg-allergic patients indicate that severe allergic reactions in people with egg allergies are unlikely. A recent CDC study found the rate of anaphylaxis after all vaccines is 1.31 per one million vaccine doses given.

Recommendations for flu vaccination of persons with egg allergy have not changed since the 2016-2017 flu season. CDC recommends:

  • Persons with a history of egg allergy who have experienced only hives after exposure to egg should receive flu vaccine. Any licensed and recommended flu vaccine (i.e., any form of IIV or RIV) that is otherwise appropriate for the recipient’s age and health status may be used.
  • Persons who report having had reactions to egg involving symptoms other than hives, such as angioedema, respiratory distress, lightheadedness, or recurrent emesis; or who required epinephrine or another emergency medical intervention, may similarly receive any licensed and recommended flu vaccine (i.e., any form of IIV or RIV) that is otherwise appropriate for the recipient’s age and health status.  The selected vaccine should be administered in an inpatient or outpatient medical setting (including, but not necessarily limited to hospitals, clinics, health departments, and physician offices). Vaccine administration should be supervised by a health care provider who is able to recognize and manage severe allergic conditions.
  • A previous severe allergic reaction to flu vaccine, regardless of the component suspected of being responsible for the reaction, is a contraindication to future receipt of the vaccine.

What is considered an egg allergy? What are the signs and symptoms of an egg allergic reaction?   

Egg allergy can be confirmed by a consistent medical history of adverse reactions to eggs and egg-containing foods, plus skin and/or blood testing for immunoglobulin E antibodies to egg proteinsPersons who are able to eat lightly cooked egg (e.g., scrambled egg) without reaction are unlikely to be allergic. Egg-allergic persons might tolerate egg in baked products (e.g., bread or cake). Therefore, tolerance to egg-containing foods does not exclude the possibility of egg allergy. Egg allergies can range in severity.

How common is egg allergy in children and adults?

Egg allergy affects about 1.3 % of all children and 0.2 % of all adults.

What vaccine should I get if I am egg allergic, but I can eat lightly cooked eggs?

If you are able to eat lightly cooked egg (e.g., scrambled egg) without reaction, you are unlikely to be allergic and can get any licensed flu vaccine (i.e., any form of IIV, LAIV, or RIV) that is otherwise appropriate for your age and health status.

What flu vaccine should I get if I get hives after eating egg-containing foods?

If you are someone with a history of egg allergy, who has experienced only hives after exposure to egg, you can get any licensed flu vaccine (i.e., any form of IIV, LAIV, or RIV) that is otherwise appropriate for your age and health.

What kind of flu vaccine should I get if I have more serious reactions to eating eggs or egg-containing foods like cardiovascular changes or a reaction requiring epinephrine?

If you are someone who has more serious reactions to eating eggs or egg-containing foods, like angioedema, respiratory distress, lightheadedness, or recurrent emesis; or who required epinephrine or another emergency medical intervention, you can get any licensed flu vaccine (i.e., any form of IIV, LAIV, or RIV) that is otherwise appropriate for your age and health status, but the vaccine should be given by a health care provider who can recognize and respond to a severe allergic response.

Are there still people with egg allergies who should not get flu vaccine?

People with egg allergy can receive flu vaccines according to the recommendations above.  A person who has previously experienced a severe allergic reaction to flu vaccine, regardless of the component suspected of being responsible for the reaction should not get a flu vaccine again.

Why do flu vaccines contain egg protein?

Most flu vaccines today are produced using an egg-based manufacturing process and thus contain a small amount of egg protein called ovalbumin.

How much egg protein is in flu vaccine?

While not all manufacturers disclose the amount of ovalbumin in their vaccines, those that did from 2011–12 through 2014–15 reported maximum amounts of ≤1 µg/0.5 mL dose for flu shots and 0.24 µg/0.2 mL dose for the nasal spray vaccine.  Cell-based flu vaccine (Flucelvax) likely has a much smaller amount of egg protein since the original vaccine virus is grown in eggs, but mass production of that vaccine does not occur in eggs. Recombinant vaccine (Flublok) is the only vaccine currently available that is completely egg free.

Can egg protein in flu vaccine cause allergic reactions in persons with a history of egg allergy?

Yes, allergic reactions can happen, but they occur very rarely with the flu vaccines available in the United States today. Occasional cases of anaphylaxis, a severe life-threatening reaction that involves multiple organ systems and can progress rapidly, in egg-allergic persons have been reported to the Vaccine Adverse Event Reporting System (VAERS) after administration of flu vaccine. Flu vaccines contain various components that may cause allergic reactions, including anaphylaxis. In a Vaccine Safety Datalink study, there were 10 cases of anaphylaxis after more than 7.4 million doses of inactivated flu vaccine, trivalent (IIV3) given without other vaccines, (rate of 1.35 per one million doses). Most of these cases of anaphylaxis were not related to the egg protein present in the vaccine. CDC and the Advisory Committee on Immunization Practices continue to review available data regarding anaphylaxis cases following flu vaccines.

How long after flu vaccination does a reaction occur in persons with a history of egg allergy?

Allergic reactions can begin very soon after vaccination.  However, the onset of symptoms is sometimes delayed. In a Vaccine Safety Datalink study of more than 25.1 million doses of vaccines of various types given to children and adults over 3 years, only 33 people had anaphylaxis. Of patients with a documented time to onset of symptoms, eight cases had onset within 30 minutes of vaccination, while in another 21 cases, symptoms were delayed more than 30 minutes following vaccination, including one case with symptom onset on the following day.

Thimerosal in Flu Vaccine

What is thimerosal?

Thimerosal is an ethyl mercury-based preservative used in vials that contain more than one dose of a vaccine (multi-dose vials) to prevent germs, bacteria and/or fungi from contaminating the vaccine.

Do flu vaccines contain thimerosal?

Flu vaccines in multi-dose vials contain thimerosal to safeguard against contamination of the vial. Most single-dose vials and pre-filled syringes of flu shot and the nasal spray flu vaccine do not contain a preservative because they are intended to be used once.

list of available flu vaccines and their thimerosal content is available.

Why are preservatives sometimes used in vaccines?

Preservatives are used to protect vaccines packaged in multi-dose vials. Each time a vaccine dose is drawn from a multi-dose vial, bacteria or fungi can enter the vial. Receiving a vaccine contaminated with bacteria or fungi can be dangerous. Preservatives are needed to prevent contamination of multi-dose vials each time individual doses are drawn.

Thimerosal use in vaccines and other medical products has a record of being very safe. Data from many studies show no evidence of harm caused by the low doses of thimerosal in vaccines.

Where can I learn more about thimerosal?

Please visit CDC’s webpage Thimerosal in Vaccines for more information on thimerosal, including Frequently Asked Questions about Thimerosal.

Misconceptions about Flu Vaccines

Can a flu vaccine give you the flu?

No, flu vaccines cannot cause flu illness. Flu vaccines given with a needle (i.e., flu shots) are currently made in two ways: the vaccine is made either with a) flu viruses that have been ‘inactivated’ (killed) and that therefore are not infectious, or b) using only a single gene from a flu virus (as opposed to the full virus) in order to produce an immune response without causing infection. This is the case for  recombinant influenza vaccines.

Are any of the available flu vaccines recommended over the others?

For the 2019-2020 flu season, the Advisory Committee on Immunization Practices recommends annual influenza (flu) vaccination for everyone 6 months and older with any licensed, influenza vaccine that is appropriate for the recipient’s age and health status, including inactivated influenza vaccine (IIV), recombinant influenza vaccine (RIV), or live attenuated nasal spray influenza vaccine (LAIV4) with no preference expressed for any one vaccine over another.

There are many vaccine options to choose from, but the most important thing is for all people 6 months and older to get a flu vaccine every year. If you have questions about which vaccine is best for you, talk to your doctor or other health care professional.

Is it better to get the flu than the flu vaccine?

No. Flu can be a serious disease, particularly among young children, older adults, and people with certain chronic health conditions, such as asthma, heart disease or diabetes. Any flu infection can carry a risk of serious complications, hospitalization or death, even among otherwise healthy children and adults. Therefore, getting vaccinated is a safer choice than risking illness to obtain immune protection.

Do I really need a flu vaccine every year?

Yes. CDC recommends a yearly flu vaccine for just about everyone 6 months and older, even when the viruses the vaccine protects against have not changed from the previous season. The reason for this is that a person’s immune protection from vaccination declines over time, so an annual vaccination is needed to get the “optimal” or best protection against the flu.

Why do some people not feel well after getting the seasonal flu vaccine?

Some people report having mild reactions to flu vaccination. The most common side effects from flu shots are soreness, redness, tenderness or swelling where the shot was given. Low-grade fever, headache and muscle aches also may occur. If these reactions occur, they usually begin soon after the shot and last 1-2 days. In randomized, blinded studies, where some people get inactivated flu shots and others get salt-water shots, the only differences in symptoms was increased soreness in the arm and redness at the injection site among people who got the flu shot. There were no differences in terms of body aches, fever, cough, runny nose or sore throat.

Side effects from the nasal spray flu vaccine may include: runny nose, wheezing, headache, vomiting, muscle aches, fever, sore throat and cough. If these problems occur, they usually begin soon after vaccination and are mild and short-lived. The most common reactions people have to flu vaccines are considerably less severe than the symptoms caused by actual flu illness.

What about serious reactions to flu vaccine?

Serious allergic reactions to flu vaccines are very rare. If they do occur, it is usually within a few minutes to a few hours after the vaccination. While these reactions can be life-threatening, effective treatments are available.

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By contactus@priority-pediatrics.com
August 26, 2019
Category: Infectious Disease
Tags: Influenza   Flu   flu shot   Fluzone   FluMist   Nasal Spray  
What's the Latest with the Flu
Special Alert – June 25, 2019
Current Influenza Activity 
Influenza activity continues to decrease. As of June 15, 2019, there have been 119 influenza-associated pediatric deaths reported this season (187 deaths last season). The American Academy of Pediatrics (AAP) recommends continuing to encourage annual influenza vaccination through June 30, when this current season's vaccine expires. It is a good time to follow-up and vaccinate infants who were previously too young to get flu vaccine, but who are now 6 months of age (two doses given at least four weeks apart are recommended for children age 6 months through 8 years of age who are receiving an influenza vaccine for the first time). 

The AAP will no longer express a preference for the flu shot over nasal spray flu vaccine for children in the 2019-2020 flu season. The recommendation comes after the Academy reviewed current data on vaccine coverage and effectiveness and flu season characteristics. The supply of nasal spray flu vaccine will be limited during the 2019-'20 season due to manufacturing constraints.

What Parents Need to Know about the Flu.

Families Fighting Flu.

Dr. T