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Dear Jen,
Thank you so much for writing in and asking your question. I am sure that many parents who have been reading this blog have similar questions and concerns, but may have been reluctant to ask. I am impressed that you have four children whom you home school, work as an RN, and still have time to read this blog. You must run on everlasting batteries!

First I will state the bottom line of my opinion, which is that everyone over 6 months of age needs to be vaccinated. For a moment I will talk just about the children, and forget the fact that you are a health care provider, but I will come back to that point later.

Although in most people under most circumstances, influenza appears to be a relatively mild illness, it can cause a number of significant complications, such as bacterial pneumonia, sinus infections, ear infections and dehydration. In some people the pneumonia caused by influenza can be so severe as to require oxygen therapy or even mechanical ventilation. Although we used to think that the flu was only dangerous in people over age 65, in recent years we have identified increasing numbers of deaths in children due to influenza A or B. Clearly, with the H1N1 virus that circulated last winter, children were hit harder than older people, and there were proportionately more hospitalizations and deaths in kids than in adults. During my years in Baltimore I witnessed a number of otherwise healthy children die from complications of their influenza infection. The flu seems to interfere with the immune system, and can make your child more susceptible to bacterial infections in the days following recovery from the virus itself.

I am not sure how you know for sure you had H1N1 last year. I believe you had a flu-like illness, but unless you had specific testing done, it is not possible to know "for sure" what virus was causing your fever. It is unusual for influenza to occur without muscle aches. H1N1 last winter also was generally accompanied by some degree of gastrointestinal distress. Howver, even if you did have H1N1 you would still be susceptible to the other flu viruses anticipated to cirulate this year.

Certainly it is conceivable that if you keep your children isolated all winter, and they do not attend parties, go to the library, church or other places where a large number of people are gathered, you may be able to keep them safe from influenza. However, I believe you should not risk it. Also, people tend to shed virus particles before they develop significant symptoms, and so you cannot easily avoid everyone who may be infected.

The immunizations available for influenza prevention include a shot and a nasal spray. The shot contains a killed virus, and the nasal spray ("flu mist") contains a "live attenuated virus". In general the response rates and side effects of the two are similar and mild. There may be a low grade fever, mild muscle aches, and in the case of the shot, soreness at the site of the injection. See my reply to Curtis (below) for a more in depth description of the flu mist.

Now, we have to address the fact that you are a nurse caring for a very vulnerable population. You may not know this, but the American Academy of Pediatrics has published a policy statement calling for universal and MANDATORY yearly immunization of all health care workers who have patient contact. The policy statement can be accessed by clicking the following link
http://pediatrics.aappublications.org/cgi/content/abstract/peds.2010-2376v1
The American Academy of Pediatrics has issued this policy statement because of the devasting effects on patients--especially neonates and immunocompromised patients of contracting influenza. They point to a number of hospitals and organizations who have already instituted such a policy to protect their patients. I would urge you to review it. I suspect that by next winter, a majority of health care organizations will have mandatory immunization in place.

I obviously cannot tell you what you should do for yourself or your children, but my strong recommendation is to obtain the immunization this year and every year. If you have specific questions about any of your children, I would urge you to speak with your child's primary care provider.

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