UPDATED 12/13/2011
WE NOW HAVE INTRANASAL FLUMIST VACCINE (LAIV-SEE BELOW) AND
INJECTABLE FLU VACCINE (TIV-SEE BELOW)
The CDC and the Academy of Pediatrics recommend that ALL children and adolescents be immunized, especially those with chronic illnesses such as asthma.
This year's vaccine will contain 2 type A strains: A-California-H1N1; A-Perth-H3N2 and 1 type B strain : B-Brisbane which are anticipated to be the predominent seasonal Flu strains circulating this season.
The number of trivalent seasonal influenza vaccine doses to be administered this year depends on the child's age and vaccine history:
- Influnza vaccine should not be given to infants less than 6 months of age.
- Children 9 years of age and older need only one dose of vaccine regardless of whether they have received earlier doses of influenza vaccine.
- Children younger than 9 years who receive trivalent seasonal influenza vaccine (injection or intranasal) for the first time should receive a second dose this season at least 4 weeks after the first.
- Children younger than 9 years who received trivalent seasonal vaccine for the first time last season, but only received one dose, should receive 2 doses (at least 4 weeks apart) of trivalent influenza vaccine this year.
The CDC and the Academy of Pediatrics strongly recommend beginning community-wide immunization efforts AS SOON AS vaccine is available; protective immune responses persist throughout the influenza season. Immunization should continue until vaccine supplies are exhausted each season to ensure that as many children as possible receive the optimal number of doses.
There will be two types of flu vaccine available for 2011-2012. Each provides protection against the same three strains of influenza, and each is prepared using eggs and those with severe egg protein allergy should receive neither. Neither is 100% effective in preventing influenza, and both need to be given yearly for ongoing protection. In general, those who receive the vaccine and become ill with the flu can expect to experience less severe illness and a significantly decreased risk of hospitalization.
The first type is the typical “flu shot” (trivalent inactivated influenza vaccine -TIV), available to kids older than 6 months. There is no upper age limit for those receiving TIV. Inactivated influenza vaccine contains killed viruses, and thus cannot cause true Influenza but it may cause mild fever and soreness at the injection site in 10-35% of recipients during the first 24 hours after injection, especially in children under 2 years of age. Children less than 9 years old who have never received TIV should get a second dose at least a month later.Children less than 9 years of age who received only 1 dose of TIV the previous year should also receive a second dose. The TIV can be administered to those with chronic medical conditions, those with immunodeficiency, and those who might be closely exposed to immunocompromised individuals.
The second type of flu vaccine is FluMist (live attenuated influenza vaccine- LAIV) administered as a nasal spray. It is indicated in the prevention of disease caused by influenza A and B viruses in healthy children and adolescents, 2 to 17 years of age, and healthy adults, 18 to 49 years of age. Because it is a live attenuated viral vaccine there is a small potential for it to cause mild flu-like symptoms. For those 2 to 9 year old children who are receiving Flumist for the first time (and who have not had 2 doses of TIV in past years) a second dose is recommended at least 4 weeks later.
FluMist is contraindicated in the following circumstances:
1. Children with severe hypersensitivity to eggs
2. Children receiving aspirin therapy
3. Children with a history of Guillain-Barre syndrome
4. Children with known or suspected immunodeficiency or who are currently immunosuppressed.
5. Children who will have a household contact with immunodeficiency or immunosuppression.
6. Children with significant nasal congestion; the vaccine should be delayed until the nasal congestion has abated.
7. Pregnant women
8. Children with diabetes
9.Children with kidney dysfunction
10. Children with sickle cell disease
11. Children with moderate to severe asthma (reactive airway disease)
12. Children with a significant febrile illness within the past 3 days
13. Children who have taken an antiviral medication within the last 2 days or who are anticipated to to need an antiviral medication within 2 weeks of administration of FluMist.
Both types of vaccine are considered to be effective. Comparative studies are currently limited but in one study comparing LAIV with TIV in patients without asthma, LAIV showed significantly greater efficacy than TIV.
Thimersol. There is no evidence that the incidence of autism spectrum disorders is higher among children who receive thimersol-containing vaccines than among children who do not. Some formulations of TIV contain trace amounts of thimersol, but certain types are thimersol free. LAIV does not contain thimersol.
This year's flu season may be more complex than usual. We recommend that you seek frequent updated information at the following websites.
http://www.flumist.com/#
http://www.flumist.com/pdf/patientinfo.pdf
http://www.cdc.gov/flu
http://www.aap.org
