I made sure to get my flu shot well before the start of flu season.
You want some time for it to start working, so that you can be sure that you are protected.
So while some folks talk about getting a flu vaccine too early, you do want to make sure that you get it in time to get protection before flu is active in your area. Still, it is never too late to get a flu vaccine. It is better to get a flu vaccine late in the flu season than to skip it all together.
What about younger kids getting their flu vaccine for the first time and who need 2 doses? When do they start getting protection?
“The first dose “primes” the immune system; the second dose provides immune protection.”
Study Looks at Flu Vaccine Dosing in Children
Although they likely have some protection after that first dose, the best protection will begin 10 to 14 days after their second dose.
We know that pregnant women are supposed to get a flu vaccine.
Although recommendations on exactly when to get it have changed over the years, it has been a universal recommendation since at least the 1994-95 flu season.
But why?
How Does a Mother’s Flu Shot Protect a Newborn Baby?
One obvious way that a flu shot provides protection during pregnancy is that it reduces your risk of getting the flu while you are pregnant.
A flu shot during your pregnancy protects both you and your baby.
That’s good, as having the flu while you are pregnant can lead to preterm labor, a premature birth, birth defects, or a miscarriage. And of course, the flu can be life-threatening for pregnant women.
Getting a flu shot while you are pregnant can also help to make sure that you don’t get the flu after your baby is born, which not only keeps you healthy, but decreases the chance that your baby will be exposed to the flu. After all, if you get the flu, no matter how much you try to cover your cough and wash your hands, there is a good chance that you will give it to your baby.
And since babies can’t get flu shots of their own until they are at least six months old, a flu shot during pregnancy helps to make sure that your baby gets some of antibodies to protect them from the flu.
“When you get a flu shot, your body makes antibodies that also pass to your fetus. This means your baby has protection against the flu after birth. This is important because infants less than 6 months of age are too young to get the flu shot.”
Frequently Asked Questions for Patients Concerning Influenza (Flu) Vaccination During Pregnancy
Do you have to wait until late in your pregnancy to make sure that the most antibodies get passed to your baby?
While that might seem like a good idea, especially since that’s what we do for the Tdap vaccine and protection against pertussis, there are several reasons that we don’t do that with the flu vaccine, including that:
pregnant mothers need the protection before flu season hits, so waiting would not be safe and could mean that you get sick with the flu before getting your shot
protection from the flu vaccine shouldn’t wane or wear off so quickly that you need to get it later, after all, the earliest that you can get vaccinated is when flu vaccines first become available in August or September and that should provide good protection past the peak of flu season
When you get your flu shot while pregnant is going to have more to do with when you got pregnant in relation to the start of flu season more than anything else.
“The flu shot can be safely given during any trimester. Pregnant women can get the flu shot at any point during the flu season (typically October through May). Pregnant women should get the shot as soon as possible when it becomes available. If you are pregnant, talk with your obstetrician–gynecologist (ob-gyn) or other health care provider about getting the flu shot.”
Frequently Asked Questions for Patients Concerning Influenza (Flu) Vaccination During Pregnancy
Most importantly, remember that flu shots are considered an “essential component of prenatal care.”
While everyone should get a flu vaccine each year, since pregnant women are in a high risk group for flu complications, you should especially make sure that you get vaccinated and protected if you are pregnant. Everyone around you should get vaccinated too!
There is a very good reason why people with HIV and hepatitis B don’t have to wear distinctive badges.
Have you ever thought that people with HIV should wear badges???
And whether or not they work in a hospital, it has nothing to do with the fact that they don’t pose a risk to others, and it has nothing to do with health care workers who refuse to get a flu shot and have to wear a mask.
Confidentiality Rules and Civil Rights
Hopefully we have gotten over a lot of the misinformation and stigma that once kept kids with HIV and hepatitis B out of schools and teens and adults out of work.
“Ryan White confidentiality guidelines have helped allay the fears that many people living with HIV have around unwanted disclosure and HIV discrimination.”
Building Trust: Confidentiality and the Ryan White HIV/AIDS Program
And of course, that’s why people with HIV and hepatitis B don’t have to “wear any distinctive badges or clothing.”
The Americans with Disabilities Act (ADA) is the most powerful law safeguarding the rights of children in public and private schools and daycare centers. The law also prevents any organization or business from discriminating against a person because of a real or perceived disability, such as an infectious disease.
A second law, Section 504 of the Rehabilitation Act, bars schools, colleges and other organizations receiving federal funding from discriminating against children with disabilities. Section 504 identifies chronic liver disease as a “hidden disability.”
Legal Protections for Children with Viral Hepatitis
In fact, laws protect people with HIV/AIDS and other conditions, so that no one would try and make them “wear any distinctive badges or clothing.”
“Almost 30 years after the onset of the epidemic, HIV stigma and discrimination—fed largely by ignorance and animus—persist and continue to have a forceful impact on people living with HIV.”
HIV Stigma and Discrimination Persist, Even in Health Care
Or at least you would hope no one would try and make them wear a badge…
Wearing a surgical mask is very common when people are sick and want to avoid spreading their germs to others. They are also commonly worn when people are healthy and are just afraid of getting sick.
Why Do Some Folks Wear a Mask During Flu Season?
Is that why you see some folks wearing masks during flu season?
If you were worried about your privacy, would you talk about it on Facebook?
Maybe, but some folks actually have to wear a mask during flu season.
Well, they have to because they decide they don’t want to get a flu vaccine, but still want to keep their job that could put others at risk if they got sick with the flu. So basically, it is unvaccinated health care personal and others who work around sick and vulnerable people who might have to wear a mask when they are at work.
Why don’t they just get vaccinated and protected against the flu?
That’s a good question…
Some other questions to consider as you think about flu vaccine mandates include:
Do unvaccinated health care workers pose a risk to others in the course of their jobs? Of course they do. Health care personal are at high risk to get the flu, since they are often around people who are sick with the flu, and are at higher risk to get the flu if they are unvaccinated.
Does wearing a mask protect anyone? – Yes, they actually do and recent studies have concluded that “surgical face masks worn by infected persons are potentially an effective means of limiting the spread of influenza.”
Does getting a flu shot prevent you from catching the flu? – Flu shots aren’t the most effective vaccine we have, but they are the best way to avoid catching the flu, being 10 to 60% effective since 2004.
Does getting a flu shot prevent you from spreading the flu to others? Yes, and several studies have shown lower rates of nosocomial cases among hospitalized patients as more health care personal get vaccinated!
Does getting a flu shot just cause you to have milder symptoms? The flu vaccine does has many benefits besides preventing the flu, but it is certainly not limited to just causing milder symptoms.
Does wearing a mask violate your HIPAA rights? No. Unless you announce it, no one knows why you are wearing a face mask. Maybe you have herpes or a cold or are just afraid of getting sick. And the Health Insurance Portability and Accountability Act only protects patients, not employees.
So why don’t all health care personal get a flu vaccine each year?
Most do.
And while some people seem to be against the idea of mandates for health care workers getting flu shots, most think it is a great idea.
“I support this requirement. I think it is a good idea. Ethically, it makes total sense. First, every doctor, nurse, and HCW knows that they are supposed to put patient interests ahead of their own interests. Whatever you think about flu shots, it is good for patients that their healthcare providers are vaccinated against the flu, particularly among patients who cannot themselves be vaccinated, such as some of the elderly, babies, people with immune diseases, and people who just received transplants or are getting cancer treatment. Vaccination does not help them. They are all immunosuppressed.”
Art Caplan on The Law: Get a Flu Shot or Wear a Mask, Healthcare Workers!
In fact, most think that there is both an ethical and a legal rationale for flu vaccine mandates for health care workers.
“Doctors and other healthcare providers have an ethical obligation to make decisions and take actions that protect patients from preventable harm. 5 Many patients are highly vulnerable to flu, so choosing not to be vaccinated is choosing to do harm—a choice that has no place in healthcare.”
Doctors choosing not to be vaccinated is choosing to do harm
It is hard to imagine that some doctors and nurses not only skip getting vaccinated, putting others at risk, but then don’t even want to wear a mask.
How many doses of flu vaccine will your kids under age 9 years need this year?
That’s right, some kids actually need two doses of the flu vaccine to get the best protection – a priming dose and a booster dose.
How Many Doses of Flu Vaccines Do My Kids Need?
You child might need two doses of flu vaccine, separated by at least 4 weeks, if they are 8 years old or younger and:
this is the first year that they are getting a flu vaccine, or
they have not received two or more total doses of flu vaccine before
That second part is a little confusing.
That’s because the two doses do not have to have been in the same season or even in consecutive seasons. As long as a child has had at least 2 or more doses of flu vaccine in the past, then they only need one dose this year.
And even if they have never had a flu vaccine before, kids who are already 9 years old, only get one dose.
“Evidence from several studies indicates that children aged 6 months through 8 years require 2 doses of influenza vaccine administered a minimum of 4 weeks apart during their first season of vaccination for optimal protection”
Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season
Why do they get 2 doses?
“The first dose “primes” the immune system; the second dose provides immune protection.”
Study Looks at Flu Vaccine Dosing in Children
Because studies show that getting 2 doses of flu vaccine like this works best!
Study – Effectiveness of the 2003-2004 influenza vaccine among children 6 months to 8 years of age, with 1 vs 2 doses.
Study – Vaccine effectiveness against laboratory-confirmed influenza in children 6 to 59 months of age during the 2003-2004 and 2004-2005 influenza seasons.
Are you still worried about your child’s egg allergy and getting them a flu vaccine?
Everyone needs a flu shot. Even kids with egg allergies. Photo by Gabriel Saldana (CC BY-SA 2.0)
That’s not surprising, as we once warned people about residual egg proteins in flu vaccines and the possibility of immediate hypersensitivity reactions in those with severe egg allergies.
“Recent studies have shown that even individuals with confirmed egg allergy can safely receive the flu vaccine. The Joint Task Force on Practice Parameters of the American Academy of Allergy Asthma and Immunology and the American College of Allergy Asthma and Immunology as well as the American Academy of Pediatrics state that no special precautions are required for the administration of influenza vaccine to egg-allergic patients no matter how severe the egg allergy.”
Egg Allergy and the Flu Vaccine
In fact, it began to change in 2011, when we got the recommendation that it was okay to give flu shots to people with egg allergies, if they only get hives as their reaction. It was still recommended that those with more severe allergic reactions to eggs “be referred to a physician with expertise in the management of allergic conditions for further risk assessment before receipt of vaccine.”
Before that, we would sometimes do skin testing on high risk egg allergic kids, desensitization, or regular chemoprophylaxis.
In 2013, the recommendation changed so that those with severe allergic reactions to eggs should get their flu shot “by a physician with experience in the recognition and management of severe allergic conditions.”
The recommendations were again modified in 2016, removing the recommendation that egg-allergic flu vaccine recipients be observed for 30 minutes and that those with severe egg allergies “should be vaccinated in an inpatient or outpatient medical setting (including but not necessarily limited to hospitals, clinics, health departments, and physician offices), under the supervision of a health care provider who is able to recognize and manage severe allergic conditions.”
Why the changing advice?
It’s because severe allergic reactions to vaccine are rare (in a million doses rare). And even in the flu vaccines that still use eggs, almost all of the egg protein is removed from the final vaccine. So that residual amount of egg protein is unlikely to trigger an allergic reaction. And that’s what we saw as the recommendations were slowly changed year after year.
Getting a Flu Shot When You Are Allergic to Eggs
And that’s why we have our current recommendations:
Those with a history of egg allergy who only get hives can get any age-appropriate flu vaccine.
Those with a history of egg allergy who have severe reactions, including angioedema, respiratory distress, lightheadedness, recurrent emesis, or who required epinephrine or another emergency medical interventions, can still get any age-appropriate flu vaccine, but they should get it in an inpatient or outpatient medical setting (such as a hospital, clinic, health department, or physician’s office). And the vaccine administration should be supervised by a health care provider who is able to recognize and manage severe allergic reactions.
Those who can eat eggs without reaction can get any age-appropriate flu vaccine.
Do you still have to be observed after getting your flu vaccine if you have an egg allergy?
No postvaccination observation period is recommended specifically for egg-allergic persons.
Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season
Nope. But that’s likely because although they are rare, reactions might not occur right away.
So yes, you can and you should get a flu vaccine if you are allergic to eggs.
After decades with a single type of flu vaccine – the flu shot – there are now many different kinds of flu vaccines that many of us can choose from. And your choices are not just between the nasal spray flu vaccine vs a flu shot. There are also a lot of different kinds of flu shots available now.
Everyone needs a flu shot. When will you get yours? Photo by Gabriel Saldana (CC BY-SA 2.0)
Having choices is nice.
It would be also be nice to have a little more guidance on what to do with these choices.
It is actually easy to start by asking which one you should get for your kids, as many of these flu vaccine options are only available for adults and seniors.
Flu Vaccine Options
Before you start thinking too long and hard about potential options, keep in mind that you might not have as many options as you think.
“Not all products are likely to be uniformly available in any practice setting or locality. Vaccination should not be delayed in order to obtain a specific product when an appropriate one is already available.”
Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season
Doctors and clinics might not stock multiple brands or types of flu vaccines, so you might have to get whatever flu vaccine that they have available.
“Within these guidelines and approved indications, where more than one type of vaccine is appropriate and available, no preferential recommendation is made for use of any influenza vaccine product over another.”
Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season
And that’s okay. In most cases, there haven’t been head to head studies showing that one flu vaccine is better than another.
Flu Vaccine Options for Kids
Still, since these options might be available to you, it is good to know about them.
This year, younger kids, between the ages of 6 months and 3 years, can either get:
FluLaval Quadrilvalent
Fluarix Quadrivalent
Fluzone Quadrivalent Pediatric
While you are unlikely to notice a difference, both FluLaval and Fluarix are given at a 0.5ml dose containing 15 µg of HA per vaccine virus, while Fluzone is given at a 0.25ml dose containing 7.5 µg of HA per vaccine virus. Why the difference? “Safety and reactogenicity were similar between the two vaccines,” even at the different doses.
Basically, these are just different brands of the same type of flu shot.
There are even more options as your kids get older though, including Fluzone Quadrivalent (age three and above), Afluria Quadrivalent or Trivalent (age five and above), Flucelvax Quadrivalent (age four and above), FluLaval and Fluarix.
Of these, some folks wonder if Flucelvax, since it isn’t made in chicken eggs, might be more effective than the others. Remember, one of the things that are thought to make the flu vaccine less effective than most other vaccines is that they are made in eggs, leading to mutations. And there is actually some evidence that those flu vaccines that are not made in eggs might be more effective.
“And the University of Pittsburgh Medical Center is taking that a step further, saying it will only be buying the two egg-free vaccines on the market: Flucelvax and FluBlok. That’s because there is some evidence these two formulations may work better than the older vaccines grown in eggs, said Dr. Richard Zimmerman, who advises the UPMC Influenza Committee.”
Guidance on which flu vaccine to get: Shots for kids, maybe go egg-free
Again, remember that the CDC has made “no preferential recommendation” for one flu vaccine over another. Why not? We don’t have enough information to make that kind of recommendation.
Should parents only ask for Flucelvax? That would only work if they made enough doses for every kid to get vaccinated, which they didn’t. Should you hold out until you can find FluceIvax for your kids? No, since doing that might leave them unvaccinated once flu season hits.
What else should you know about your flu vaccine options? While over 80% of flu vaccines are now thimerosal free, most of these flu vaccines are still available in multi-dose vials with thimerosal.
Also thimerosal free, this year, Flumist is back as an option. It is available for healthy kids who are at least two years old. Although the AAP has issued a preference for flu shots this year, the ACIP says that kids can get either Flumist or a flu shot.
What about if your kids are allergic to eggs?
“Persons who report having had reactions to egg involving symptoms other than urticaria (hives), such as angioedema, respiratory distress, lightheadedness, or recurrent emesis; or who required epinephrine or another emergency medical intervention, may similarly receive any licensed, recommended, and age-appropriate influenza vaccine (i.e., any IIV, RIV4, or LAIV4) that is otherwise appropriate for their health status.”
Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season
Unless they had a severe allergic reaction to a previous flu vaccine, they can get any available flu vaccine, especially if the previous reaction was only hives or they are able to eat eggs.
What if you want a flu vaccine without aluminum? Take your pick. While it would be safe it was, aluminum is not an ingredient in flu vaccines.
Flu Vaccine Options for Adults
In addition to all of the flu vaccines available for older kids, adults have a few more options:
Afluria Quadrivalent or Trivalent can be given by jet injector to those between the ages of 18 and 64 years
Flublok Quadrivalent – a recombinant flu shot that can be given to those who are at least 18 years old
Fluzone High-Dose – a trivalent flu shot with a higher dose of flu virus antigens (4 times the amount of antigen as a regular flu shot) that is available for seniors who are at least 65 years old
Fluad – a trivalent flu shot with an adjuvant that is available for seniors who are at least 65 years old
Why get a flu vaccine with a jet injector instead of a standard needle? High-pressure jet injectors don’t use needles!
Like FluceIvax, Flublok is not made in chicken eggs. The recombinant hemagglutinin(HA) proteins are made in insect cell lines. Does Flublok work better than egg based flu vaccines? That’s the theory, but again, there is no preference for one of these vaccines over another.
Seniors have even more choices.
Should they get Fluzone High-Dose, Fluad, or one of the other flu vaccines? Both have been shown to be more effective than standard flu vaccines in seniors, but they have not been compared against each other.
“In a Canadian observational study of 282 people aged 65 years and older conducted during the 2011-12 season, Fluad was 63% more effective than regular-dose unadjuvanted flu shots.”
CDC on People 65 Years and Older & Influenza
But neither Fluzone High-Dose nor Fluad are quadrivalent, so only protect against three flu virus strains.
Is there a quadrivalent flu shot for older adults that might work better than standard flu shots?
Yes. FluceIvax and Flublok are non-egg based quadrivalent flu shots that might be more effective than standard flu vaccines.
So are you more confused now that you know you have so many options? Just remember that for most people, the mistake isn’t about choosing the right flu vaccine, it is about not getting vaccinated.
What to Know About Your Flu Vaccine Options
While it might seem like you have a lot more options in a flu vaccine this year and that some might be more effective than others, keep in mind that availability will likely greatly limit these “options.”
And the best flu vaccine is the one that you actually get, as it will be the one that reduces your risk of getting the flu. Missing your chance to get vaccinated and protected because you are waiting for a specific brand or type of flu vaccine isn’t going to help keep the flu away.
