Vol. 99 October 16, 2013 Flu Vaccine Update

hubSeasonal flu vaccine is effective and should be offered to everyone over 6 months old
who does not have a specific medical contraindication. (1)

Remember how excited we got about swine flu?
And then how concerned we became about the swine flu vaccine?
We began calling it H1N1 flu in hopes of reducing some of the stigma attached to its name.
We thought it might cause much more illness and deaths than seasonal flu, H1N2.
It didn’t.
That was in 2009 and 2010.

There is no such flu excitement this time around, but there are a lot more flu vaccines. There are 20 flu vaccine preparations made by 9 different pharmaceutical companies for prices ranging from $9.50 to $32.00.  (The highest priced one is for people with egg allergy.)

The “flu shot” delivers inactivated (or killed) virus, provides protection against three strains of flu (“trivalent”), and most preparations, but not all, are suitable for any one over 3 yo.

The nasal spray, “Flumist”, delivers live virus providing protection against four strains of flu (“quadrivalent”) and gives excellent protection to children over 2 yo. It can not be given to people over 42 yo. This live virus vaccine may cause shedding of the virus from the vaccinee for a few days, but serious illness from such person-to-person transmission has not been reported.

Children from 6 months to 8 years old receiving a flu vaccine for the first time or who have NOT received at least 2 doses since July 2010 need a SECOND vaccine administration at least 4 weeks later.

The trivalent vaccines protect against influenza A (California strain) which is “H1N1-like”, influenza A (Victoria strain) which is “H3N2-like”, and influenza B (Massachusetts strain) which is “2012-like”. Influenza virus strains are named after their site of origin, and, yes, Massachusetts can now proudly claim a place along other locales that gave their name to diseases; like Coxsackie, N.Y. for hand-foot-and mouth disease and Lyme, Connecticut for…you know. The quadrivalent vaccine adds an influenza B (Brisbane strain) which is “2008-like”.

The trivalent vaccine is the most readily available (at both your physician’s office or a retail store) and there is no compelling reason to seek out the quadrivalent vaccine. The vaccine’s effectiveness in preventing the flu depends on which flu strain is circulating in your area. Effectiveness may be as high as 80% in young adults, but is almost always lower in the elderly. A high dose vaccine that allegedly delivers four times the usual prod to your immune system is being marketed for the over 65ers , but it is not recommended since there is no independent study of its success.

In Massachusetts last year there were 5 flu deaths in children under 17 yo.  None of the five had been adequately vaccinated. Two of the five had no pre-existing health problems. Nationally there were 146 pediatric deaths from the flu last year compared to 34 the previous year.  40% of those deaths were in children who were otherwise very healthy.  90% of them were unvaccinated. (2)

So, don’t be flu-ish, get your flu shot …or spritz in the nose.


1. The Medical Letter, Volume 55, Issue 1425, September 16, 2013
2. Massachusetts Department of Public Health, October 16, 2013

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