Influenza, Swine Flu, and the Special-Needs Child, Oh My!

To vaccinate or not to vaccinate for flu season? That is the question, but what is the answer? Most parents can empathize with the misery that flu season bestows on them and their children. In families with special-needs or chronically ill children, that misery is often multiplied when you combine flu and asthma, flu and epilepsy, flu and arthritis, flu and diabetes, etc.

In an August 2012 study of the 2009 H1N1 flu outbreak, CDC researchers found that a disproportionate number of children who died from the flu had a co-morbid medical condition. 

“Of the 336 children (defined as people younger than 18 years) with information available on underlying medical conditions who were reported to have died from 2009 H1N1 flu-associated causes, 227 had one or more underlying health conditions. One hundred forty-six children (64 percent) had a neurologic disorder such as cerebral palsy, intellectual disability, or epilepsy.”– (http://www.cdc.gov/media/releases/2012/p0829_neurologic_flu.html).

That same study also states that “Of the children with neurologic disorders for whom information on vaccination status was available, only 21 (23 percent) had received the seasonal influenza vaccine and 2 (3 percent) were fully vaccinated for 2009 H1N1.”  With this knowledge in mind I decided to ask a local pediatrician about the importance of flu vaccines in children, with a particular emphasis on children with special-needs and chronic illnesses. Rebecca Bergman, MD, MPH is a board-certified pediatrician in Lincolnshire.  

*Please note that the following questions are meant for a general audience and not intended to diagnose or treat specific cases or individuals. For information pertaining to your particular medical history, please contact your personal physician.

Let’s start with the basics. When is the official “Flu Season”?  
I tend to look at when patients should start to receive the vaccine.  In general, I recommend that patients receive the vaccine once it is available in the office which is usually August or September.  Flu season continues through winter and into spring.  I will sometimes continue to vaccinate until April or May.  It is important to keep in mind that flu season is not the same around the world.  In the Southern Hemisphere, for example, flu season is from April to September.  This becomes more relevant for families that plan to travel during the summer months.

Is it really necessary for kids to be vaccinated against the flu? Why is it of particular importance that a child with a medical condition like diabetes, cerebral palsy, Down Syndrome, or asthma get a flu vaccination?  
I highly recommend vaccination against influenza, especially for those with underlying medical issues.  The risks of complications (such as pneumonia), hospitalizations, or even death are greater for those children. 

Have you or will you vaccinate your own children?  Are there patients who should not get the flu shot?     
My family including my spouse, children, and myself have already received our flu vaccines. The main contraindication for the flu shot is a history of anaphylaxis (severe allergic reaction) to any of the components of the vaccine.  At this time, for patients who have a history of egg allergy, if the reaction to exposure is hives, most of those patients can still receive the inactivated flu vaccine (flu shot) assuming that the office staff/physicians are able to recognize and respond to symptoms of a possible allergic reaction.The vaccine is not for children who are less than 6 months of age.

Does the flu vaccine protect against the H1N1 virus? Doesn't the flu shot cause a person to get the flu? My mother swears that she got the flu from a flu shot. 
The flu vaccine for the 2012-13 season does include coverage for H1N1.    Some patients may need 2 doses of the vaccine for adequate coverage; others will only need one dose of this year's vaccine.  You cannot get the flu from the flu vaccine.  The virus in the injectable flu vaccine is a killed virus.  This cannot give you the flu.  The virus in the nasal flu vaccine is what is called an attenuated or weakened virus.  This virus may replicate in the nose and throat and provide protective immunity but cannot replicate effectively in the lungs.  Additionally, it can take 1-2 weeks to develop protection from the vaccine.  It is possible to be exposed to and develop symptoms of influenza before full protection has developed.

It’s my understanding that the flu vaccine doesn’t prevent us from getting the flu, but rather lessens the severity and complications from it. Is that correct?  
The vaccine can decrease both the risk of catching the flu as well as decrease severity of symptoms and complications for those who still get the flu.  Different factors can affect the effectiveness of the vaccine including the amount of similarity between the virus strains in the vaccine and the strains circulating in the environment (the vaccine is developed based on what is presumed to circulate during the upcoming flu season), the age of the patient, and the overall health status of a patient.

I’ve heard that flu vaccines contain poisonous ingredients that can adversely affect a child who, for example, has autism?  
Overall the vaccine tends to be safe.  There is the potential for side effects, but, overall, the benefits of the vaccine are much greater than the risks.Some people can be allergic to components of the vaccine.  Those individuals may need to avoid the vaccine.  There has been concern in the past regarding the preservative thimersol which is present in some multidose bottles of vaccines.  Studies have NOT demonstrated that thimersol leads to serious neurologic problems. 

Do flu shots always have to be painful? My kids hate needles! 
Some patients can receive a nasal form of the flu vaccine.  This is not for everyone, however.  Patients with underlying medical issues such as asthma, neurologic disorders, or diabetes (this is not a comprehensive list) should not receive the nasal vaccine.

Do you advise parents, caregivers, and pregnant moms to get flu shots? Why? 
I strongly recommend the flu vaccine for these individuals.  One of the best ways to protect kids from the flu is to decrease their risk of exposure by vaccinating those around them.  In regards to pregnant women, they should receive the injectable flu vaccine.  Pregnant women are at greater risk of complications from the flu if they become ill.   Additionally, they can give some protection to the newborn infant.

Finally, what are some easy measures that children and adults can take to stay healthy throughout the flu season? 
First, I recommend maintaining general healthy habits such as eating a healthy diet and getting plenty of sleep.  Kids and adults should wash hands with soap and water, or, if not available, use an alcohol based cleanser (but be careful with young children--eating alcohol based cleansers can be very dangerous).  I discourage touching the face as this can spread germs.

Dr. Bergman do you have flu shots available in your office?  
Yes, both the inactivated flu vaccine (injection) and attenuated vaccine (nasal) are available in my office.

*Dr. Rebecca Bergman is a graduate of University of Illinois at Chicago – College of Medicine. Her office is located at 185 N Milwaukee Ave, Suite 220, Lincolnshire IL 60069. More information can be found at www.premierpeds.com .