AAP Issues Flu Shot Recommendations for the 2010-2011 Flu Season

Image courtesy epmonthly.com

Yesterday, the American Academy of Pediatrics released its recommendations for this year’s seasonal flu vaccine.  They recommend that all children and adolescents over 6 months of age be vaccinated as well as anyone falling in one of the following high-risk groups (which appear to be consistent with the H1N1 high risk groups from last year):

  1. Children younger than 5 (and according to the CDC especially children younger than 2)
  2. Children with high-risk conditions such as asthma, diabetes, or neurologic disorders
  3. People who live with or care for those at high risk – family members, health care workers, and day care providers
  4. Pregnant women

The seasonal flu vaccine protects against the three flu viruses that scientists expect will be the most common during the upcoming season. This year, the seasonal flu vaccine will protect against the 2009 H1N1 virus, the H3N2 virus, and an influenza B virus and will be available in three forms:

  1. Nasal spray flu vaccine, also referred to as FluMist or “live attenuated influenza vaccine”
  2. Inactivated flu vaccine
  3. Preservative-free inactivated flu vaccine (thimerosal-free)

Thimerosal is a mercury-containing organic compound used as a preservative to prevent bacterial contamination in vaccine vials that contain multiple doses. Some parents have concerns about the use of thimerosal in vaccines, so many pediatric offices offer the thimerosal-free single dose injections for children under 3. Anyone over the age of 3 interested in the preservative-free vaccine should consider the FluMist vaccine assuming they don’t meet any of the criteria below.

According to the CDC, the following people should not receive the FluMist vaccine:

  • People less than 2 years of age
  • People 50 years of age and over
  • People with a medical condition that places them at high risk for complications from influenza, including those with chronic heart or lung disease, such as asthma or reactive airways disease; people with medical conditions such as diabetes or kidney failure; or people with illnesses that weaken the immune system, or who take medications that can weaken the immune system.
  • Children <5 years old with a history of recurrent wheezing
  • Children or adolescents receiving aspirin
  • People with a history of Guillain–Barré Syndrome that occurred after receiving influenza vaccine
  • Pregnant women
  • People who have a severe allergy to chicken eggs or who are allergic to any of the nasal spray vaccine components.

Now, here’s where it gets tricky. The number of doses depends on the child’s age at the time of the first dose and their vaccine history for both seasonal and H1N1 vaccines:

  • Children younger than 6 months are too young to receive influenza vaccine.
  • Children 9 years of age and older need only 1 dose.
  • Children younger than 9 years need a minimum of 2 doses of 2009 pandemic H1N1 vaccine. If they did not receive the H1N1 vaccine during last year’s flu season, they will need two doses of seasonal influenza vaccine this year.
  • Children younger than 9 years who have never received the seasonal flu vaccine before will need 2 doses.
  • Children younger than 9 years who received seasonal flu vaccine before the 2009-2010 flu season need only one dose this year if they received at least 1 dose of the H1N1 vaccine last year. They need 2 doses this year if they did not receive at least 1 dose of the H1N1 vaccine last year.
  • Children younger than 9 years who received seasonal flu vaccine last year for the first time, but only received 1 dose, should receive 2 doses this year.
  • Children younger than 9 years who received a flu vaccine last year, but for whom it is unclear whether it was a seasonal flu vaccine or the H1N1 flu vaccine, should receive 2 doses this year.
  • All children who need 2 doses should receive the second dose at least 4 weeks after the first dose.

Did you catch that?? Sheesh. To attempt to put it in easier terms, children between the ages of 6 months and 9 years will need 2 doses, 4 weeks apart, unless they have received:

  1. at least 1 dose of 2009 H1N1 vaccine last flu season, and
  2. at least 1 dose of seasonal flu vaccine before the 2009-2010 flu season or 2 doses of seasonal flu vaccine last flu season.

So it appears my two year old will need only one dose since she received two doses of the H1N1 vaccine last season and at least 1 dose of seasonal flu vaccine before last season. She only received 1, not 2 doses, of seasonal flu vaccine last year.

Fortunately, the AAP recognizes that this is confusing and says that it has created a concise flow chart to help you determine the required number of doses. The flow chart should be published in the October 2010 issue of Pediatrics with its policy statement on flu vaccination. We’ll plan to post it once we can get our hands on it. In the meantime, it’s probably best to review your child’s vaccination history and consult your pediatrician.

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11 Responses to “AAP Issues Flu Shot Recommendations for the 2010-2011 Flu Season”

  • I think I am be the only parent that chose to not do flu vaccines last year. My second child was to young and my first I decided against it. Maybe I am not being smart about this but I wonder when we should start to say enough is enough with these shots. (This doesn’t mean I think it is bad and I think whatever choice a parent makes is the best for their family). Anyway I am torn again this year on what to do…last year my children did get sick but not with the flu…we had a ton of ear infections though. I am wondering others thoughts on this…anyone not getting vaccines? Does anyone feel like we vaccine to much? Although I would never want my children sick they do have immune systems that are there for a reason. Would love to hear others thoughts on this…

    • Thanks for your comment, Melody!

      I’m sure this is a question many parents ask themselves. For me, personally, I weighed the risks and made the decision to vaccinate my children including the H1N1 vaccine last year. With the H1N1, in particular, I researched it extensively as I was in a high-risk group myself as a pregnant woman in her second trimester and had concerns about the vaccine’s effects on my baby. Ultimately, in my mind, there is a proven risk of serious complications and death associated with H1N1 and other diseases against which we are vaccinated which outweighed the debatable risk of autism and risks of other side effects. And that was a risk I wasn’t willing to take having heard too many experiences from friends who lost or nearly lost children to H1N1 or other vaccine-preventable diseases. In fact, in the near future I plan to share a story from one of my good friends whose sister nearly lost her infant to whooping cough.

      I, too, would be interested to hear, though, from others who have weighed the decision – what decision they made and how they came to that decision.

  • jasmine-thanks for responding! matthew had whooping cough last year too:(. the thing is these shots only protect against that virus, correct? there is no way to protect your kid from getting whooping cough, or other random stuff that they might catch, right? now as many ear infections as we had last year i might sign up for a shot for that, :) .

    • Wow, Melody, I hadn’t heard about Matthew’s whooping cough! Did it get very serious at all? I’m glad he’s okay since that can be so serious in infants. The DTaP vaccine is supposed to protect against whooping cough, but it requires several doses – I believe at 2, 4, and 6 months and then a booster later on. I’m curious, how old was he when he caught it, and had he received any of his DTaP vaccines?

      Sorry to hear about the ear infections too. Juliana had a chronic ear infection her first year that would not go away after four different antibiotics, and we ended up getting ear tubes. After that, life was much easier for her, but I hope we don’t have to go through that again with Adeline.

  • Jasmine – thanks for the informative post. Like Melody, I did not vaccinate my children against the H1N1 virus. (As it turned out my eight year old caught it before the vaccine was available. She was out of school for 4 days with a 101 fever and no other symptoms.)

    As I continue to try to feed my children healthy, chemical and hormone-free food I am now looking at the other potentially harmful things in their environment, vaccines being one area in particular. I have been on the fence about vaccinations and feel guilty that I have not done more research to make more informed choices. For too long I have put my complete trust and faith in my pediatricians who follow the CDC’s recommendations to the letter. Thankfully we have not had any major reactions to any of the vaccinations, but even as my third child receives his vaccinations I pray each time that he will be okay.

    Now I have begun to researching vaccines and am not finding anything to alleviate my fears. My sister-in-law shared the Vaccine Information Coalition (www.vacinfo.org)site with me as well as the National Vaccine Information Center (www.nvic.org). They both have very informative sites, and the NVIC site has what they call a Vaccine Ingredient Calculator. It computes exposures to Aluminum, Bovine protein, Egg protein, Formaldehyde, Mercury (Thimerosal), Mouse protein, Phenol red, Phenoxyethanol, Polysorbate 80 and Yeast protein based on which vaccines your child will be receiving and their manufacturers. To try it out I looked up what my four year old received earlier this summer with his DTP/DTap and Polio vaccinations – 600 mcg of aluminum, 1 exp bovine protein, 100 mcg of formaldehyde, 2.5 mg phenoxyethanol and 100 mcg polysorbate 80!

    I post this just to help other mothers in their search to make informed decisions. I will not request the manufacturer info before I decide to vaccinate to see what exactly is being given to my children!

    Best wishes to all!

    I am still on the fence about vaccines and am rethinking the seasonal flu at this point. I know that natural immunity is better than a

    • Kristen, Thank you for your comments and the referrals to those websites! I’m sorry to hear that your daughter caught H1N1 but glad to hear that it didn’t get too serious. I will definitely check out the websites you mentioned. While I’ve done a lot of research, I still haven’t done as much as I would like. My research has mostly focused on mercury and vaccines (I have a little brother who has been diagnosed with autistic tendencies so I couldn’t ignore the possible connection) and the seasonal flu/H1N1 vaccine. I haven’t done as much research around some of the other components of vaccines like those you mentioned but definitely want to get into it more and will plan to share what I find. Thanks so much.

  • Oops…I know that naturally-derived immunity (having lived through something) is better overall and lasts a lifetime.

  • I think Matthew was 4-5 months when he got whooping cough and had borderline pneumonia. Poor little guy…so he hadn’t had all the shots. I am just hoping for a healthier family this year. Between Oct and March I think either me, Hannah or Matthew was sick. But it was all things you can’t prevent, ear infections, stomach flu, common cold, etc. I have an awful immune system so I really try to keep my kids healthy and away from germs because I always catch it and I am sick for weeks afterward. Although with Hannah starting preschool in a week I am nervous!!!

    • Poor things – all of you! I hope you all have a healthier year this year too. How fun for Hannah to be starting preschool. I hope she adjusts well and has a great time!

  • BTW-great topic!

    • Thanks, Melody! There will definitely be more to come. Your and Kristen’s comments have given me some thoughts and questions I’d really like to explore.

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