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The Informed Parent

Winter Wonders: Indications For A New Vaccine

by Shanna R. Cox, M.D., F.A.A.P.
Published on Oct. 03, 2003

Fall finds our office and our hospital service bustling, with winter just around the corner. For a pediatrician, tis the season, and the same can be said for our patient’s families. Whether with infants, toddlers, adolescents, or college students winter brings along with it a slew of illnesses that leave many affected, leading to missed school or work days for the family and occasionally even requiring hospitalization. Influenza virus is one of the most universally known of these pathogens, and also one of the most dangerous.

While “having the flu” is a phrase many of us utter to describe a general feeling of malaise and ill health, influenza virus in itself is a very real and specific virus. Influenza A, B, and C are the three major types and within these types there also exist many different strains. Influenza A and B produce the largest majority of disease, while Influenza C is responsible only for sporadic cases of mild respiratory symptoms. Historically, influenza has been associated with both epidemic and pandemic outbreaks. In 1918, the Influenza A virus underwent a large change in its serotype, which resulted in a pandemic that led to greater than 20 million deaths.

A vaccine is available to attempt to prevent the flu. There have been many changes over the years in recommendations to dictate which segment of the population should receive the flu vaccine. This year brings not only new recommendations for who should be vaccinated, but also new recommendations for how that population may be vaccinated. Currently, both the American Academy of Pediatrics and the Advisory Committee on Immunization Practices for the Centers for Disease Control and Prevention are universally recommending the influenza vaccine for ALL children between six months and two years of age, as well as all their household contacts including siblings and parents. This is in addition to the previous recommendations for the influenza vaccine to be given to children with chronic health problems including asthma, all school and medical personnel, women in their second or third trimester of pregnancy, and all adults over the age of fifty. These criteria apply for the administration of the inactivated trivalent influenza vaccine, which cannot cause flu symptoms. In addition, patients must be aware that this vaccine is a combination of the suspected most likely strains of influenza that will cause disease that particular year. Therefore, it is not foolproof and is not protective for any potential influenza outbreak, just what researchers believe to be the most likely and virulent strains this season. In addition, this vaccine is changed yearly and therefore is not protective in subsequent years. Children younger than nine years of age require two doses of the vaccine in each particular season to generate immunity.

This year there will be another influenza vaccine available that is different than the traditional “flu shot”. FluMist is currently being placed on the market and will be available for the protection of healthy children five years and older and adults. It is an intranasal vaccine that contains a trivalent live attenuated virus. Although the preparation is attenuated, unlike the “flu shot”, FluMist may cause a degree of flu symptoms. However, researchers hope that in using this type of vaccine individuals may develop a heartier immunity against influenza using the body’s natural mechanisms. Importantly, the vaccine is not for use in children under five years of age or for anyone with a chronic illness. Similarly to the “flu shot”, two doses of FluMist are required for children under nine years of age. It is the hope of epidemiologists, infectious disease workers, as well as physicians that this needle free option will encourage greater general population participation in influenza virus prevention and transmission.

Generally, the influenza vaccine becomes available between October and November. Individuals at high risk, such as those with chronic disease and the elderly are vaccinated with priority against the chance that there may be any vaccine shortage. Prevention of this potentially deadly disease cannot be stressed enough, not only for its individual mortality but also for the associated complications that frequently accompany a true flu infection. Influenza A and B can be detected in nasal secretions through a specific laboratory test, and these results are monitored not only at a hospital level but also at a county and city level. Don’t let yourself be one of the numbers! Get vaccinated to protect yourself and your community!

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