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The History of Flu Vaccine Recommendations

While you likely get your kids a flu vaccine, it is just as likely that you didn’t get a flu vaccine as a child.

It’s not that flu vaccines are new, it’s just that the recommendations to vaccinate all or most people is relatively new. In the ‘old days,’ flu shots were mainly given to “groups who are at increased risk for influenza-related complications.” Of course, this included many children, such as:

  • children who have chronic disorders of the pulmonary or cardiovascular systems, including asthma
  • children who have required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases (including diabetes mellitus)

That changed in 2001, when a new recommendation was made for the 2002-03 flu season (also when some thimerosal free flu vaccine became available):

“Because young, otherwise healthy children are at increased risk for influenza-related hospitalization, influenza vaccination of healthy children aged 6-23 months is encouraged when feasible.”

A few years later, vaccinating all healthy children aged 6-23 months became a formal recommendation – for the 2004-05 flu season.

It was expanded to include healthy children between 24 and 59 months before the 2006-07 flu season and again to include healthy children between 5 and 18 years before the 2008-09 flu season.

We got the current universal flu vaccine recommendation, all people who are at least 6 months old who don’t have any contraindications, before the 2010-11 flu season.

Flu Shot Recommendations in Pregnancy

Flu vaccine recommendations during pregnancy have changed over time too.

Since the 2004 flu season, it has been recommended that “women who will be pregnant during the influenza season” get vaccinated, “in any trimester.”

Before that, the recommendation for pregnant women was that:

  • 1983-84 flu season – Physicians should evaluate a pregnant woman’s need for influenza vaccination on the same basis used for other persons; i.e., vaccination should be advised for a pregnant woman who has any underlying high-risk condition.
  • 1990-91 flu season – …pregnant women who have other medical conditions that increase their risks for complications from influenza should be vaccinated, as the vaccine is considered safe for pregnant women. Administering the vaccine after the first trimester is a reasonable precaution to minimize any concern over the theoretical risk of teratogenicity. However, it is undesirable to delay vaccination of pregnant women who have high-risk conditions and who will still be in the first trimester of pregnancy when the influenza season begins.
  • 1994-95 flu season – …pregnant women who have other medical conditions that increase their risks for complications from influenza should be vaccinated because the vaccine is considered safe for pregnant women — regardless of the stage of pregnancy. Thus, it is undesirable to delay vaccination of pregnant women who have high-risk conditions and who will still be in the first trimester of pregnancy when the influenza season begins.
  • 1995-96 flu season – …additional case reports and limited studies suggest that women in the third trimester of pregnancy and early puerperium, including those women without underlying risk factors, might be at increased risk for serious complications from influenza. Health-care workers who provide care for pregnant women should consider administering influenza vaccine to all women who would be in the third trimester of pregnancy or early puerperium during the influenza season. Pregnant women who have medical conditions that increase their risk for complications from influenza should be vaccinated before the influenza season, regardless of the stage of pregnancy. Administration of influenza vaccine is considered safe at any stage of pregnancy.

And finally, for the 1997-98 flu season, the flu vaccine recommendation was updated to “Women who will be in the second or third trimester of pregnancy during the influenza season.”

Other Changes to Flu Vaccine Recommendations

Can you think of any other changes to flu vaccine recommendations over the years?

Remember when we didn’t give flu vaccines to kids who were allergic to eggs?

Other changes over the years have included:

  • the need for two doses of flu vaccine if previously unvaccinated (2006)
  • that vaccination begin as soon as vaccine is available, instead of waiting until October or November (2010)
  • that most kids with egg allergies can get a flu vaccine, although some may need to be observed afterwards, and others might need allergy testing (2011)
  • a preference for Flumist (2014)
  • a recommendation that Flumist not be used (2016)

The big change for the 2018-19? Flumist is once again an option.

There have been some other smaller changes, like the introduction of quadrivalent vaccines and other flu vaccines for adults.

For More Information on Flu Vaccine Recommendations:

Updated August 25, 2018

 

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