Every year the influenza vaccine recommendations are updated. Here’s a summary of this year’s AAP recommendations for flu vaccine with additional supporting information from the CDC.
Vaccination against influenza is especially important due to the pandemic. By protecting against influenza infection we can keep our healthcare resources available to treat those with significant infections that are less preventable. Preventing influenza infection can also help kids stay in school and allow adults to go to work.
Components of this year’s vaccine include
- influenza B/Victoria
- B/Yamagata (* not in trivalent vaccines)
All pediatric influenza vaccines are quadrivalent (contain these 4 components). Some adult vaccines are trivalent and contain only the first three components above.
There are several different companies that make the vaccine. No one brand is preferred over another.
Vaccine options for children this season include:
- Standard dose flu shots are available for infants and children over 6 months of age. These do NOT contain any live viral particles. It is not possible to get influenza from the vaccine.
- Shots made with virus grown in cell culture are available for people 4 years of age and older. These do NOT contain any live viral particles. It is not possible to get influenza from the vaccine.
- Live attenuated influenza vaccine (LAIV) is the “nose spray” vaccine. It is made with a weakened live virus and can be used between 2 and 49 years of age with some exclusions (see also below). The weakened live virus will not cause significant influenza disease but may lead to mild upper respiratory symptoms. If these symptoms occur, they typically only last a couple of days.
In addtion to the two vaccine types generally available for pediatric patients, there are others that are available for adults.
- High-dose shots for people 65 years and older.
- Shots made with adjuvant for people 65 years and older.
- Recombinant vaccine for people over 18 years of age.
Who should get a flu vaccine?
Everyone over 6 months of age should be vaccinated against influenza.
If children through 8 years of age are receiving influenza vaccine for the first time, they may need two doses. If they have received only 1 dose ever before July 1, 2020, they should receive 2 doses of vaccine.
Most people with mild illness (with or without fever) can still get a flu vaccine – talk to your physician if you’re concerned.
Pregnant and breastfeeding women should be vaccinated against influenza. This can help to protect the baby in addition to themselves. (Pregnant women should not get the LAIV – the inactivated vaccine is preferred.)
Who should NOT get a flu vaccine?
- If the age appropriate vaccine is not available, wait until the appropriate vaccine is available. Infants must wait until they are 6 months of age to receive any flu vaccine.
- People with a history of life-threatening allergies to any ingredient in the vaccine should be evaluated by an allergist to assess risks and to determine if vaccination is appropriate.
- People who have a history of Guillain-Barré Syndrome (GBS) should talk to their physician prior to getting any vaccine. The vaccines are not necessarily contraindicated, but risks and benefits should be considered. GBS is a severe paralyzing illness that can be caused by influenza infection or the vaccine, but the vaccine may be protective. If you’re not sure what it is, you have not had it.
- Children with a moderate or severe illness (high fever or requiring hospitalization) may benefit from waiting until their illness resolves prior to vaccination. Talk to your doctor.
- Children with symptomatic COVID19 infection should wait until symptoms of illness have resolved.
What about egg allergy?
I continue to hear that people don’t get the flu vaccine because of an egg allergy. It has been many years since this has been a contraindication.
If a person is able to tolerate products made with egg without allergic reaction, they can receive any flu vaccine without special precautions.
If only hives develop after ingesting egg, it is also acceptable to receive any flu vaccine without special precautions.
People who have a history of severe egg allergy (angioedema, respiratory distress, lightheadedness, recurrent vomiting, or who required epinephrine or another emergency medical intervention after egg exposure) should be vaccinated in a medical setting to allow for recognition and management of possible allergic reactions.
Special considerations for the nasal spray vaccine (LAIV/FluMist)
- FluMist is only approved for people between 2 and 49 years of age.
- Anyone who has had antiviral medications in the previous 48 hours should wait to get the FluMist or get the injectable vaccine. If antivirals are needed the week after a FluMist is given, revaccination should be done.
- Children 2 -4 years who have asthma or who have had a history of wheezing in the past 12 months should not get the FluMist because it might trigger wheezing.
- Children 5 and over with uncontrolled asthma should not get the FluMist. Those with well controlled asthma may get the FluMist, but you might consider discussing risks and benefits with your physician first.
- Children with certain medical conditions (metabolic disease, diabetes, hemoglobinopathies, or lung/heart/kidney disease) should talk to their physician prior to receiving the FluMist.
- Other live virus vaccines, such as MMR or oral typhoid, must be either given on the same day as FluMist or at least 4 weeks from one another.
- If there is significant nasal congestion, either wait until it has cleared or get the injectable vaccine. Too much mucus might keep the spray from being effective.
- Pregnant women should not get this live attenuated vaccine.
- Anyone with a CSF leak, new cochlear implants,should not get the Flumist.
- Immunocompromised people should not get the nasal spray vaccine.
- People who are missing a spleen (or who have functional asplenia) should not get the FluMist.
- Children and teens who are on aspirin should not get the FluMist. (Children should only take aspirin with the guidance of a physician.)
- Anyone who is a close contact of a severely immunocompromised person who requires a protected environment should either get an injectable flu vaccine or avoid contact with the severely immunocompromised person for 7 days after getting the FluMist.
When should we get the influenza vaccine?
As soon as flu vaccines are available, most people can start getting vaccinated.
September and October are the most recommended times.
There is some evidence that waiting until September is beneficial (especially for older adults), but the everyone should ideally be vaccinated by the end of October.
If unable to be vaccinated by Halloween, it is still recommended to get a vaccine when it is available throughout the influenza season.