So are there any legitimate reasons to skip a flu shot?
In fact, three very good reasons to skip a flu shot include:
being younger than 6 months of age
having a severe allergic reaction (e.g., anaphylaxis) after a previous dose of flu vaccine or to any component of the flu vaccine
Actually, although folks might have many of bad excuses, there are only two good reasons to skip a flu shot…
So, infants who aren’t old enough to be vaccinated yet, and anyone who has had a life-threatening reaction to a previous dose.
Additional precautions, but not true contraindications, do including having had Guillain-Barré syndrome <6 weeks after a previous dose of influenza vaccine and having a moderate or severe acute illness with or without fever when you are planning to get vaccinated.
Even if you have had a severe reaction to eggs, you can still get a flu shot. Just get it get it in an inpatient or outpatient medical setting (such as a hospital, clinic, health department, or physician’s office), so that you can be supervised by a health care provider who is able to recognize and manage severe allergic reactions.
Are you skipping the flu shot because you never get sick? How lucky do you feel this year? Don’t continue to gamble that you won’t get the flu. Increase your chances of staying well by getting a flu shot, the best way to avoid the flu.
Everyone should get a flu vaccine each year, as long as they are at least six months old and have no true contraindications.
That has been the recommendation since at least the 2010-11 flu season.
And while most kids get vaccinated, not all do.
Are Your Kids at High Risk for Flu Complications?
There are some kids, those at high risk for flu complications, who definitely shouldn’t skip or delay their flu vaccine.
all children aged 6 through 59 months (younger than age 5 years);
children who have chronic medical conditions, including pulmonary (such as asthma and cystic fibrosis), cardiovascular (excluding isolated hypertension), genetic (Down syndrome), renal, hepatic, neurologic (cerebral palsy, epilepsy, stroke, muscular dystrophy, and spina bifida, etc.), hematologic (sickle cell disease), or metabolic disorders (including diabetes mellitus and mitochondrial disorders);
children who are immunocompromised due to any cause (including immunosuppression caused by medications or by HIV infection);
teens who are or will be pregnant during the influenza season;
children and adolescents (aged 6 months through 18 years) who are receiving aspirin- or salicylate-containing medications (like for Kawasaki disease) and who might be at risk for experiencing Reye syndrome after influenza virus infection;
residents of nursing homes and other long-term care facilities;
American Indians/Alaska Natives;
children who are extremely obese (body mass index ≥40).
You also shouldn’t skip or delay getting a flu vaccine if your:
kids are household contacts of children aged ≤59 months (i.e., aged <5 years) and adults aged ≥50 years, particularly contacts of children aged <6 months;
kids are household contacts of someone with a medical condition that puts them at higher risk for severe complications from influenza.
Again, since everyone should get a flu vaccine, these higher risk classes shouldn’t determine whether or not you vaccinate your kids, but they might influence the timing.
Again, don’t skip your child’s flu vaccine because they aren’t in a flu high risk group.
In most flu seasons, about 80% of children with the flu who die are not vaccinated. And many of them will be otherwise healthy, without an underlying high risk medical condition.
Get your child vaccinated against the flu. And if they are in a high risk group, make sure you do it well before flu season starts and maybe as soon as flu vaccine becomes available in your area.
Can you breastfeed while your child is getting their vaccines?
How to Breastfeed Your Child During Vaccinations
While the smallpox vaccine and yellow fever vaccine are contraindicated for moms who are breastfeeding, there are no contraindications on vaccinating kids while they are breastfeeding.
Why breastfeed while your kids are getting their vaccines?
While some moms just breastfeed immediately afterwards, others understand that breastfeeding at the same time as the shots are being given can help decrease any pain associated with getting those vaccines even more.
“If you are breastfeeding, feed your baby before, during and after immunization. The physical closeness and familiar taste of breast milk will calm your baby. Breastfeeding during immunization is safe for babies, even newborns. There is no evidence that babies will choke or associate their mothers with pain.”
Tips For Parents For A Positive Immunization Experience
Will it make it harder for health professionals to hold your child while the shots are being given? Not usually, especially if you help hold your child.
In general, infants should get the least painful vaccine first. And oral vaccines are typically given before shots. So they can get their Rotavirus vaccine before you begin breastfeeding and get prepared for the rest of their vaccines.
And while it might depend on the age and size of your child, in general, to breastfeed your child while they are getting their vaccinations, once everything is prepared and ready, you should:
hold your child on your lap, understanding that until age three years, most shots will be given in your child’s thighs, although toddlers can sometimes get them in their arms
once you have your child well positioned, have a good latch and have started nursing, make sure your child’s arm or leg remains exposed (wherever the shot will be going) and help hold your child securely so that they don’t move while getting their vaccines. For example, you might hold an arm or leg with your free hand and anchor their legs between your thighs or your other hand if possible
continue nursing after your child has gotten their vaccines, keeping in mind that you may have to switch positions if they are getting multiple shots
Also understand that it might not always be a good idea to nurse while getting vaccines. Is your baby a distracted eater? Is it going to be hard to hold your child while they are nursing and getting their shots? Does your health care provider not have experience giving vaccines to a child while they are breastfeeding? Does your health care provider have a lot of experience giving vaccines, and they think that giving them while you are nursing will just make the whole process take a lot longer?
“Breastfeeding moms may wish to breastfeed baby during vaccination or immediately after to lessen pain and stress.”
AAP on How can I comfort my baby during vaccinations?
In general though, especially as it is recommended by the WHO and the AAP, consider breastfeeding your child while they are getting their vaccines.
More On Breastfeeding Your Child During Vaccinations
It seems to be a big surprise to many folks, but kids can get most vaccines when they are immunosuppressed. In fact, they sometimes get extra some extra vaccines, like Pneumovax, because the “incidence or severity of some vaccine-preventable diseases is higher in persons with altered immunocompetence.”
They should also get all of their vaccines if they are around someone who is immunosuppressed.
Vaccines While Immunosuppressed
Which vaccines your kids can get while they are immunosuppressed is going to depend greatly on the reason why they are immunosuppressed.
Were they born with a specific immunodeficiency, like X-linked agammaglobulinemia, selective IgA deficiency, severe combined immunodeficiency, or chronic granulomatous disease?
Whatever the reason, they likely won’t get a medical exemption to skip all of their vaccines.
“Killed vaccines will not cause infection in immunodeficient or any other children. The fear of increased community-acquired vaccine-preventable diseases should lead to adherence to and completion of recommended immunization schedules in the community to reinforce herd immunity, such that all vaccine-preventable diseases become exceedingly rare.”
Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts
In most cases, immunocompromised kids can get all inactivated vaccines. It is only live vaccines that could pose a problem. Even then, it depends on the specific immunodeficiency as to whether avoiding live vaccines is necessary.
For example, after chemotherapy and a stem cell transplant, kids can usually get live vaccines.
Your doctors can review the latest guidelines to come up with a safe vaccination plan for your child with an immune system problem. If necessary, consultation with an infectious diseases or immunology specialist can also be helpful.
Don’t overlook other causes of possible immunosuppression when getting vaccinated, like taking daily oral steroids for more than two weeks, certain biologic immune modulators, or other medications like methotrexate, azathioprine, 6-mercaptopurine.
“Limited evidence indicates that inactivated vaccines generally have the same safety profile in immunocompromised patients as in immunocompetent individuals. However, the magnitude, breadth, and persistence of the immune response to vaccination may be reduced or absent in immunocompromised persons.”
2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host
And keep in mind that just because they can and should get vaccinated, it doesn’t mean that their vaccines are going to work as well as in someone who isn’t immunocompromised.
Vaccines for Close Contacts of Immunocompromised People
What about people who come into contacts with kids and adults who are immunocompromised?
Can they get vaccines?
“Close contacts of patients with compromised immunity should not receive live oral poliovirus vaccine because they might shed the virus and infect a patient with compromised immunity. Close contacts can receive other standard vaccines because viral shedding is unlikely and these pose little risk of infection to a subject with compromised immunity.”
Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts
Yes, close contacts can get vaccinated, especially since we don’t use the oral polio vaccine in the United States anymore.
There are some exceptions for the smallpox vaccine, which few people get, and Flumist, but only in very specific situations, including a recent hematopoietic stem cell transplant.
Among those measles deaths in Europe, there have been at least twelve measles deaths in Italy (five in 2017 and seven in 2018, among just 7,697 cases), all either unvaccinated or partially vaccinated, including:
If you haven’t guessed yet, as in other countries in Europe, we are seeing more deaths from measles simply because folks aren’t vaccinated and more people are getting measles.
Measles is a life-threatening disease, even in an age of modern medicine, indoor plumbing, sewage systems, clean water, whole foods, vitamins and minerals, etc.
Italy, with about 1/5 the population of the United States, but about equal to the size of California, has had over 600 times as many cases of measles as we have had in the United States over the last few years. To put it in perspective, that would be like having 33,000 cases of measles in the United States.
But shouldn’t folks have a choice about getting vaccinated?
Even with the new vaccine laws, parents have a choice. As with vaccine laws in the United States, Italy’s new vaccine mandates had nothing to do with forced vaccination.
That’s unlike most of the people who died of measles in Italy. Most of them didn’t have a choice about being vaccinated and getting measles. Some were immunocompromised and couldn’t be vaccinated and at least one was too young to be vaccinated.
Parents had been set a July 10th deadline to provide schools with the relevant documentation, but it will now be possible for parents to simply submit their own confirmation that the child has been vaccinated, according to Giulia Grillo, Italy’s Health Minister, who was speaking at a press conference on Thursday.
Mandatory vaccinations: Italian parents will no longer need to provide doctor’s note
And that’s why it’s unfortunate that the a newly elected government severely watered down a vaccine law that had made getting vaccinated mandatory to go to school.
And it’s unfortunate that people continue to push misinformation about vaccines and vaccine-preventable diseases.
What to Know About the Measles Deaths in Italy
A drop in vaccination rates has led to measles outbreaks and a number of measles deaths in Italy.
Dr. Taz is on a mission “to transform the way we do medicine and empower and equip you with the best tools so you can live your healthiest life.”
While that sounds very nice, it doesn’t take too long to figure out that she seems like every other anti-vaccine quack we run across these days.
Who Is Dr. Taz?
Dr. Tasneem Bhatia MD (Dr. Taz) describes herself as a nationally recognized “wellness expert” who became a “pioneer and trailblazer” after overcoming her own personal health problems.
With multiple office locations and membership packages, Dr. Taz is pleased to offer many non-evidenced based services for you and your child, and she will even file your claim forms from your insurance company, although, as expected, she doesn’t actually participate in any insurance plans.
What about vaccines?
“My journey in medicine began with pediatrics, so I am well aware of the importance of vaccines and the incredible history and success of vaccination programs in reducing infant and child mortality.
Yet as my journey continues, I have had to listen to patient after patient describe a change or a shifting in their children once vaccines were administered. I experienced this as a parent. I will never forget the day that my son received a combination vaccine. Within 24 hrs., his mild reflux became severe, his weight gain over the next few months slowed and we continue to play catch up, trying to analyze our next steps. My son, however, is not autistic. He is brilliant, hilarious, and an absolute charmer.
My patients and my own children have forced me to rethink this vaccine controversy.”
Dr. Taz on Back to School Survival Series Part Two, The Vaccine Debate Continues
And parents can get a detox screen “which will directly correlate with your child’s early ability to detox and process chemicals.” That’s probably just MTHFR testing, which you don’t need and which doesn’t correlate with much of anything, besides homocystinuria.
Now, I understand that these types of holistic docs push the idea of “pulling from conventional, integrative, holistic, functional and Chinese medicine to create the best customized treatment plans possible,” but if any of these alternative therapies worked, whether it was acupuncture or Ayurveda, or homeopathy, then why do they need to integrate them all?
So what services does Dr. Bhatia offer to bring her patients to “whole health”? It’s a veritable cornucopia of quackery. Homeopathy? Check. Acupuncture? Check. (Obviously.) IV vitamin therapy? Check. Oh, and of course Dr. Bhatia offers thermograms. She even offers mobile thermograms. Never mind that thermography remains an unvalidated test for the early detection of breast cancer, much less for all the other conditions for which Dr. Bhatia recommends it, such as arthritis, fibromyalgia, back injuries, digestive disorders, “and more…”
A commercial for acupuncture masquerading as news
And how does someone go from teaching medical students and residents at Emory University to being one of Gwyneth Paltrow’s Goop experts, along with Kelly Brogan?
They bleed into their joints, into their skin (hematoma), and from their mouth and gums. They can bleed after surgery and even after getting their vaccinations.
Vaccines and Hemophilia
Having hemophilia is certainly not a contraindication to getting vaccinated though.
“Your child should get regular immunizations with necessary precautions to prevent bleeding from the injection sites.”
There are some precautions that are recommended before giving vaccines to a child with hemophilia, including:
using a 23-gauge or smaller caliber fine-gauge needle – consider a 25- or 27-gauge needle
when possible, giving the vaccine SQ instead of IM – for example, although the IPV (polio), hepatitis A, and hepatitis B vaccines are usually given IM, studies have shown that they can be given SQ to kids with hemophilia
applying firm pressure, without rubbing, after the vaccine is given for at least two minutes and up to 5 to 10 minutes
giving acetaminophen for pain relief, if necessary, instead of ibuprofen
warning about the risk of a hematoma developing at the injection site
Most importantly, if the child with hemophilia is already getting routine prophylaxis to prevent bleeding, schedule their vaccines around the same time to decrease the risk of bleeding.
Your child’s hematologist will likely give you specific instructions to provide to your pediatrician regarding immunization precautions.
What to Know About Vaccines and Hemophilia
Kids with hemophilia should get all of their vaccines on schedule, but precautions should be taken to decrease the chance of bleeding after getting an immunization.