Wednesday, October 18, 2006

Influenza Vaccine

Dear Lisa,

Is it necessary to get my five year old the flu shot this year?

“Flu shot?”

Dear “Flu shot?”,

The Advisory Committee on Immunization Practices (ACIP) recommends annual vaccination for healthy children aged 24 to 59 months. (1,2) The ACIP also recommends that household contacts and out- of-home caregivers of children aged 6 months to 6 years receive the influenza vaccine . (1,2) Decisions made by the ACIP influence the pracitce of health care practitioners throughout the country.

Just so you know who is making this recommendation, the ACIP consists of 15 experts in fields associated with immunization. These experts have been selected by the Secretary of the U. S. Department of Health and Human Services. The ACIP provides advice and guidance to the Secretary, the Assistant Secretary for Health, and the Centers for Disease Control and Prevention (CDC) on the most effective means to prevent vaccine-preventable diseases. The overall goals of the ACIP are to provide advice which will assist the Department and the Nation in reducing the incidence of vaccine preventable diseases and to increase the safe usage of vaccines. (3)

In the United States, epidemics of influenza have been associated with an average of approximately 36,000 deaths per year during 1990—1999. (1) Between January and June 2005, 36 pediatric deaths associated with laboratory-confirmed influenza infection were reported to the CDC. (3) The interesting thing is that many of the casualties were otherwise healthy children. (4) This is why there is an interest in vaccinating all children, and not just those with chronic medical conditions.

The rates of serious illness and death from Influenza are highest among persons older than 65 years and children aged less than two years old. Children particularly at risk for developing complications from Influenza infection include those with chronic heart disease, chronic lung disease (Asthma), chronic metabolic disease (Diabetes), chronic Kidney disease, blood disorders (Sickle Cell Anemia) and immunosupression (HIV or cancer). (5) Despite the long standing CDC recommendation that call for annual influenza vaccination of children with Asthma, estimates show that only 1/3 of this high-risk population receives the vaccine.

Efforts in preventing Influenza in children and controlling flu outbreaks stem from the reports that children are more susceptible to complications and serious illness from influenza infection. These complications include respiratory and non-respiratory complications. Respiratory complications include Croup, Bronchiolitis, secondary bacterial Pneumonia, Sinusitis and Otitis media (middle ear infection). Non-respiratory complications include myositis, myocarditis, encephalitis and febrile seizures (4)

In children the symptoms of Influenza include a sudden onset of symptoms. These symptoms include high fever, headache, malaise, muscle aches, runny nose, cough, nausea, vomiting and abdominal pain. (4) Influenza is spread via respiratory secretions, by droplets from sneezing or coughing or by direct contact with articles contaminated with respiratory secretions. (4) Respiratory secretions from persons with influenza are most infectious 24 hour before the onset of symptoms and during the entire symptomatic period. (4) The best ways to prevent spread of the Influenza virus is to vaccinate and practice good hand washing. Frequent cleaning of toys and other contact surfaces should be carried out in daycare centers. (4)

In regards to your question, is it necessary for your five year old to get the flu shot this year? It is highly recommended if your child has a chronic disease or health problem that puts him at risk for complications from the flu. In addition, it would be a good idea to get the flu shot if your child is in day car or school. It is in these situations that children have a greater risk of exposure to the flu.

Basically, the flu shot is a recommendation. It is not mandatory to get the vaccine in order to attend daycare or school. So it is your decision if you want your child to receive the vaccine, knowing the complications and risk of contracting the flu at a young age. In making this decision, I recommend talking to your child’s Doctor or Nurse Practitioner. They are the ones that know your child’s history and social situation best and can discuss your child's risk.

In my practice, I frequently came across parents who preferred not to give their child the Flu vaccine. Most of these parents came to this conclusion because of their child’s low risk of contracting the Flu. Many of these children did not attend daycare or school and the primary care giver did not work outside of the home. If this is the case, I would recommend that the adult who works outside of the home get vaccinated so that they do contract the Flu from their place of employment and spread it to their family.

I hope you and your child stay well this Flu season.

References:
(1)CDC. MMWR Recommendations and Reports. Available at:

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5510a1.htm?s_cid=rr5510a1_e. Accessed Oct 2006.
(2) CDC. National Immunization Program. Advisory Committee on Immunization Practices. Available at:

http://www.cdc.gov/nip/ACIP/. Accessed Oct 2006.
(3)Centers for Disease Control and Prevention. Update: Influenza activity- United States and world-wide, 2004-2005 season. MMWR.2005;54:631-634.
(4) Nield l, Kamat D. “Flu” Season: Here We Go Again…Consultant for Pediatricians. 2005. Octorber:411.
(5)Cheung M. Lieberman J. Influenza. Contemporary Pediatrics. 2002. 19(10):82-94.


Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Keeping Kids Healthy

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