get your flu shot

I just returned from getting my flu shot and have to admire the way our employee health folks have set this up. Although the line looked long, it moved quickly. I had no actual "waiting" time, and from start to finish, spent about 8 minutes in the vicinity of the 6th floor auditorium.

I encourage all staff to get their flu shots, especially all staff who care for children.

All children who are six months old or older should also receive the flu shot--this one covers influenza A and B and H1N1. Some children less than 9 years of age need to receive two shots (4 weeks apart)--the American Academy of Pediatrics has an algorithm to help guide providers in determining how many shots should be administered to which children.  The algorithm can be accessed by clicking this link:

Recent Comments

For those parents who may be worried about the pain of the injection or the possibility of symptoms after the flu shot, I will leave a note about my experience.

I have a two year old daughter who recieved her flu shot about 2 weeks ago. She had very little reaction to the actual injection. She didn't even cry! She just grunted once and hopped down and was on her way. She also had no symptoms such as fever, runny nose etc. I think even if your child does get symptoms that they are probably going to be mild enough that it is still worth it to vaccinate.

I know as parents we don't want to do anything that inflicts pain on our children, but in this case it is far better to take them for a shot than to let them get sick.

I need to get my flu shot. Where can I go?

Becca, a good question. Flu shots are available at local retail pharmacies, and of course with your primary doctor. However, sometimes physician offices receive the flu shots later than the retail clinics. It is always wise to check with the physician's office first, before just showing up and asking for a flu shot.

I am very happy to find this year that MANY families are interested in having themselves and their children immunized. Flu vaccination for school children benefits the kids in that they are less likely to get sick and benefits parents in that research shows these families will miss less work for illness! A win for both! I have gotten mine as well by the way.

Its amazing to me that about a third of mothers say they have no intention of having their children vaccinated against the flu this year. That is according to an article in Bloomsberg Business Week yesterday.
In addition, approximately 43% of Americans DO NOT intend to have themselves immunized against influenza this year.
Although the H1N1 pandemic was not nearly as bad as we had feared, each year many people, INCLUDING CHILDREN die needlessly from this preventable disease. I know that as a pediatrician you encourage all your pediatric patients over the age of 6 months to receive the vaccine. It was encouraging to me to read in the same article that 90% of physicians ARE intending to be vaccinated this year, themselves. That means that physicians are following their own advice. It is incredibly important for ALL healthcare workers to be protected, so they are less likely to become ill themselves, but most importantly, so they are less likely to transmit the flu to any of their colleagues or patients.

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
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.

I have a 6 year old daughter and am trying decide the most appropriate way to protect her from the flu. The school system is offering a flu mist and I have not heard much about the mist this year. Is there a difference for her age group as far as efficacy and or safety and which would you prefer and why? Thank you.

Dear Curtis
Thanks for your question. For many people, doctors included, the choice of which form of immunization to obtain or offer is a personal one. However, I will try to provide you with the facts you may need to make this important decision.

The short answer is that both forms of the vaccine appear to have equivalent efficacy, so the choice depends upon a number of other factors.

As I mentioned, flu mist contains a living virus that has been treated so that it can reproduce in the nasal passages, but not to the extent of being able to cause significant disease. It hangs around just long enough to induce the immune response, and may cause some rhinorrhea (runny nose) in addition to the usual symptoms after immunization of low grade fever and muscle aches. There is obviously no area of redness or soreness as you often get with the shot. Safety is the same for both, and I can assure you that there is no mercury in the nasal spray.

Flu mist, however, cannot be given to children less than 2 years of age, or children under 5 who have had wheezing in the past year. It is also not recommended for anyone with an immune defect, or anyone who lives with someone with a SIGNIFICANT immune deficiency. This is all for the theoretical chance of transmitting the virus contained in the vaccine to the immune compromised individual. However, to my knowledge that has never actually happened. Many children less than the age of 9 will require two doses of vaccine (regardless of which form they receive) to be completely protected, so if the school is going to administer the flu mist, you need to be certain they will provide a second dose for those who need it. If in doubt as to how many doses your daughter needs, check with her pediatrician. I put the link to the algorithm in my original post, but here it is again, if you need to refer to it.
I would like to hear what you decide to do

Dr. Ackerman,
I'm a RN on Mother/Baby and I have 4 kids that I homeschool (I only add that because my kids aren't around a whole lot of kids on a regular basis). I did not vaccinate my kids or myself last year for H1N1 due to the uncertainty of the side effects of it. We all ended up getting it and had fevers of 100-102 for about 24-36 hours with no other symptoms.
What are the effects of the vaccine and how does it relate to the side effects of the flu vaccine in the past? I'm leaning toward not vaccinating this year but want to be fully informed before making the decision.

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About Dr. Ackerman

Alice Ackerman, MD, MBA, FAAP, FCCM is the Chair of the Department of Pediatrics at Carilion Clinic and Professor and Founding Chair of Pediatrics at the Virginia Tech Carilion School of Medicine. Dr. Ackerman is recognized nationally as an expert in pediatric critical care.

She has been at Carilion Clinic since June of 2007. Her primary goals are to enhance the health care of children in the Roanoke Valley and Southwest Virginia, and is actively working to do this both as physician in chief of the children's hospital, as well as through involvement with many state-wide initiatives.

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