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 proteins. Persons 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.
A 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.
Child Passenger Safety Week starts today! Celebrate with us and help raise awareness about buckling children in age- and size- appropriate car seats, booster seats, or seat belts. This is a great week to learn how to:
- buckle kids correctly,
- identify and understand the car seat stages, and
- avoid the common mistakes when using car seats, booster seats, and seat belts.
What you need to know:
For the best possible protection, infants and toddlers should be properly buckled in a rear-facing car seat, in the back seat, until they reach the upper weight or height limits of their seat. Check the seat owner's manual and/or labels on the seat for weight and height limits.
- Rear-facing car seat: Birth until age 2–4.
When children outgrow their rear-facing seats, they should be properly buckled in a forward-facing car seat, in the back seat, until they reach the upper weight or height limit of their seat. Check the seat owner's manual and/or labels on the seat for weight and height limits.
- Forward-facing car seat: After outgrowing rear-facing seat and until at least age 5.
Once children outgrow their forward-facing seat, they should be properly buckled in a belt positioning booster seat, in the back seat, until seat belts fit properly. Seat belts fit properly when the lap belt lays across the upper thighs (not the stomach) and the shoulder belt lays across the chest (not the neck). Proper seat belt fit usually occurs when children are about 4 feet 9 inches tall and aged 9–12.
- Booster seat: After outgrowing forward-facing seat and until seat belts fit properly.
Children no longer need to use a booster seat once seat belts fit properly. Seats belts fit properly when the lap belt lays across the upper thighs (not the stomach) and the shoulder belt lays across the chest (not the neck). Proper seat belt fit usually occurs when children are about 4 feet 9 inches tall and aged 9–12.
Remember, always properly buckle children age 12 years and younger in the back seat!
- Seat Belt: Once seat belts fit properly without a booster seat.
Heat injury of children and pets left in a car for short periods of time is and has been in the news. nsc.org/heatstroke
This is an excellent Free online tool to prevent heat stroke in a car: https://training.nsc.org/hot-cars/.
I highly recommend it to you.
From the American Academy of Pediatrics
Spending time outdoors is a common activity on spring breaks or summer vacations, but remember to protect against the sun’s rays. Everyone is at risk for sunburn. Children especially need to be protected from the sun’s burning rays, since most sun damage occurs in childhood. Like other burns, sunburn will leave the skin red, warm, and painful. In severe cases, it may cause blistering, fever, chills, headache, and a general feeling of illness. The American Academy of Pediatrics offers tips to keep children safe in the sun.
Sun Safety for Babies Under 6 Months
- Babies under 6 months of age should be kept out of direct sunlight. Move your baby to the shade under a tree, umbrella or stroller canopy. Dress babies in lightweight clothing that covers the arms and legs and use brimmed hats that shade the neck to prevent sunburn.
- When adequate clothing and shade are not available, parents can apply a minimal amount of sunscreen with at least 15 SPF (sun protection factor) on infants under 6 months to small areas, such as the infant's face and the back of the hands. Remember it takes 30 minutes to be effective.
- If an infant gets sunburn, apply cool compresses to the affected area.
Sun Safety for Kids
- The first, and best, line of defense against harmful ultraviolet radiation (UVR) exposure is covering up. Stay in the shade whenever possible, and limit sun exposure during the peak intensity hours - between 10 a.m. and 4 p.m.
- Select clothes made of tightly woven fabrics. Cotton clothing is both cool and protective.
- Try to find a wide-brimmed hat that can shade the cheeks, chin, ears andback of the neck. Sunglasses with ultraviolet (UV) protection are also a good idea for protecting your child's eyes.
- Apply sunscreen with an SPF 15 or greater to areas of your child's skin that aren't covered by clothing. Before applying, test the sunscreen on your child's back for an allergic reaction. Apply carefully around the eyes, avoiding eyelids. If a rash develops, talk with your pediatrician.
- Be sure to apply enough sunscreen -- about one ounce per sitting for a young adult.
- Reapply sunscreen every two hours, or after swimming or sweating.
- If your child gets sunburn that results in blistering, pain or fever, contact your pediatrician.
Sun Safety for the Family
- The sun's rays are the strongest between 10 a.m. and 4 p.m. Try to keep out of the sun during those hours.
- The sun's damaging UV rays can bounce back from sand, water, snow or concrete; so be particularly careful of these areas.
- Wear commercially available sun-protective clothing, like swim shirts.
- Most of the sun's rays can come through the clouds on an overcast day; so use sun protection even on cloudy days.
- When choosing a sunscreen, look for the words "broad-spectrum" on the label - it means that the sunscreen will protect against both ultraviolet B (UVB) and ultraviolet A (UVA) rays. Choose a water-resistant sunscreen and reapply every two hours or after swimming, sweating or towel drying. You may want to select a sunscreen that does not contain the ingredient oxybenzone, a sunscreen chemical that may have hormonal properties.
- Zinc oxide, a very effective sunscreen, can be used as extra protection on the nose, cheeks, top of the ears and on the shoulders.
- Use a sun protection factor (SPF) of at least 15. The additional benefits of using sunscreen with SPF 50+ are limited.
- Rub sunscreen in well, making sure to cover all exposed areas, especially the face, nose, ears, feet and hands, and even the backs of the knees.
- Put on sunscreen 30 minutes before going outdoors - it needs time to work on the skin.
- Sunscreens should be used for sun protection and not as a reason to stay in the sun longer.
Drowning Is Leading Cause Of Unintentional Deaths Among Children Between Ages Of One And Four
The Washington Post (7/4) reported, “According to the Centers for Disease Control and Prevention, drowning is the leading cause of unintentional deaths among children between” the ages of one and four. What’s more, “for every child who drowns, another five visit the emergency department for a nonfatal injury associated with submersion.” Currently, the Consumer Product Safety Commission is running “a national public education campaign aimed to reduce child drownings and swimming pool entrapments.” Called Pool Safely, the campaign “was designed to educate parents and children about pool risks – and how to sidestep them without giving up the pursuit of summer fun.”
According to the Washington Post (7/5), Sarah Denny, “lead author of the American Academy of Pediatrics’ Prevention of Drowning policy statement,” feels that “parents need to start by honestly acknowledging that drowning is a threat to their children.” Denny said, “If your child has swimming lessons, don’t assume that they’re drown-proof; assume they need supervision.” She added, “Parents must be aware of the risks and take proper precautions,” including knowing that drowning “happens both when children are expected to be around water and when they’re not expected to be around water,” such as when a child sneaks into a pool enclosure. The AAP “recommends four-sided” pool “fencing with a minimum height of four feet and self-closing, self-latching gates” which should be “shut and locked” during non-swim times.
Even though Summer is almost over, it's never too late to be aware!
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