To do or not to do...The Flu Shot

We all remember the 1918-20 flu epidemic that killed between 3-6% of the world's population, or 50-100 million people, right? No we don't or else we'd all be running to get the flu vaccine, willing to stop at nothing until at least our children were vaccinated.

The annual morbidity and mortality associated with seasonal influenza annually is much less thanks to advances in medicine and healthcare in the last century that have allowed us to lead healthier lives and live longer. Although there is antiviral treatment for the flu if one becomes ill, the first line of defense is to prevent the flu in the first place, or vaccination against the flu. Last season, 90% of children who died from the flu were not vaccinated. Forty percent of these children had no preexisting condition. According to the Centers for Disease Control and Prevention (CDC), 20,000 children under the age of 5 were hospitalized last year due to complications from the flu.

The American Academy of Pediatrics (AAP) and the CDC, two well-respected organizations that continually develop and promote guidelines based on current scientific data, both recommend that people over the age of 6 months get immunized against the flu via injection or nasal spray every year.

So why are some people wavering on whether to get vaccinated? I'll list the most common concerns I hear and respond to them based on the research I have done. This is by all means not a comprehensive list. Two notes: The research conducted for this article was based on data and comments from the CDC, FDA, AAP, well-respected medical journals, and experts in medicine, it is not based on panic-blogs such as "mom with gut instinct"; and 2. My public health training, at Johns Hopkins and other academic institutions, has enabled me to analyze both scientific and non-scientific data, and I used these skills to perform my research for this article.

• "There are all sorts of horrible additives in vaccines. Aluminum, formaldehyde, mercury...I'm not putting this stuff into my child." Before the use of preservatives, it was much more common for children to have adverse events from contaminated vaccines. Additives that help vaccines work better have helped to prevent millions of vaccine-preventable deaths. All substances are poison; it's the dose and not just the presence that counts. The most common exposure to aluminum is food and water. Make up and anti-perspirant have aluminum in them as well. Formaldehyde is naturally produced and processed by the human body. The amount of naturally occurring formaldehyde in a newborn is 50-70 times the upper limit they could receive in a vaccine. Have you gotten new curtains or replaced the cabinets in your kitchen lately? The highest risk of cancer attributed to formaldehyde is from the air we breathe, including indoor air. The amount of mercury in the influenza vaccine (called thimerisol) is also nominal compared to our mercury exposure from other sources, but high-profile activists like Jenny McCarthy have done such a "good" job of scaring parents about mercury in a panic-driven, unsubstantiated way that it is no longer present in many brands of the flu vaccine. Large clinical studies have shown no link between thimerisol and autism, a false claim Ms. McCarthy continues to drive as truth. (More on where to get thimerisol-free flu shots if you're still so inclined later.)
  
  
• "My kids are 4 and 6. They've never gotten the flu and they've never gotten the flu shot. We take vitamin C during the winter and eat kale powder every day." It may be in part because so many other kids around them have been vaccinated. The school nurse at Fox Meadow said that almost all children there get vaccinated and there were only about 5 cases of the flu last year, a number she recalled was surprisingly low and attributed to high vaccination rates. We put our kids in car seats up to a certain age. We do this because data shows that kids are more likely to survive an accident if properly restrained in a car. If your child ate kale powder the morning of a car accident and walked away injury-free, you may attribute that to the kale powder instead of the car seat, but there is no scientific data to support kale powder being the life saver, yet there is solid data to show that car seats save lives and reduce injuries. Flu vaccines have years of data backing their safety and effectiveness in preventing and attenuating the flu. Our own personal experiences influence our decision making every day. I witnessed a college student who was perfectly healthy develop septic shock and die of complications from the flu. This traumatic event resonated with me and I, personally, will not put my children at risk of getting seriously ill from vaccine-preventable illness.
  
  
•  "Flu vaccines don't work for every strain of the flu. I got the flu even though I got the flu shot." Using the same example of car seats, car seats are not 100% effective. A child can still be hurt or killed in a car crash, but the odds of these outcomes are less when a child is in a car seat. Flu shots are also not 100% effective. Each year, epidemiologists and virologists work to predict the strains of the seasonal flu that will be most prevalent. It is certainly possible to get the flu even if you received a flu shot, however, it may be an attenuated version of the flu.
  
  
•  "There are so many side effects from the flu vaccine." Dr. Fred Bomback, a pediatrician with Westchester Pediatrics who has been in practice for over 40 years and keeps abreast of current guidelines and clinical studies, has yet to see any serious adverse events resulting from a flu vaccine; however, he has seen very serious complications from the flu itself. "It's a risk benefit ratio with the flu vaccine and the data is clearly way on the side of the flu vaccine. What scares me is that kids with no underlying conditions die of the flu each year," said Dr. Bomback. He and his colleagues work hard to educate parents about the benefits as well as the small risks of the flu vaccine. Each year, his practice hears of children who end up in the ICU on ventilators at Westchester Medical Center due to complications from the flu. He feels very, very lucky that he has yet to see a patient death from the virus. "We've seen many kids have complications from the flu, yet not the flu vaccine," said Dr. Bomback. "Parents who don't give a child a flu vaccine often have irrational reasons for not doing so." If a parent has a concern about the risks of a flu vaccine, they should certainly discuss it with their pediatrician; however, they should also be sure to discuss the risks of not getting their child immunized, or "the price of inaction." Dr. Dan Weiser, a pediatric oncologist at Montefiore/Albert Einstein School of Medicine, stresses that the importance of vaccination extends beyond oneself. "By being immunized against the flu, you also protect those around you who may be more vulnerable to infection," said Dr. Weiser. "This includes the elderly, infants and anyone who is immunocompromised, like those undergoing treatment for cancer. Not only do we insist that all of our pediatric cancer patients get the flu vaccine, we have a responsibility to our patients to ensure that all healthcare providers are vaccinated as well. The more people in the community who are immunized, the safer we all are because there's a lower chance that infection will spread." In fact, many medical institutions now require that employees get vaccinated and at no personal cost to them. In New York, institutions cannot fire an employee for refusing the flu vaccine, but they can require that the employee wear a mask during the flu season.
  
  
• "I don't want my kids to get the flu shot. It's traumatizing for all of us!" You can say that again. On my way to getting my own children vaccinated, my 5- year-old attempted to "pre-traumatize" my 3-year-old by telling him over and over again that he was getting a shot, it was going to hurt, and he might cry. When it came time for the vaccination, he hopped up on the table and he received his shot with little drama. Next it was my daughter's turn. She became hysterical and wouldn't get up on the table to get her shot. She eventually did it, and has been telling all of her friends at the bus stop and at school how brave she is and how the flu shot only hurts for a second. For children who do not do well with shots, there are several options: 1. FluMist is available for children over the age of 2 years and is a nasal spray. Although some parents don't like the idea of a live, attenuated virus, which the nasal spray is, Dr. Bomback reminds parents that the side effects are still minimal and both the MMR and varicella vaccines are live, attenuated, and injectable vaccines; 2. A numbing ointment such as Emla may be applied to the upper arm area of your child if you discuss this with your pediatrician and fill the prescription ahead of time. 3. Bring an ice pack to the appointment and hold it on your child's are immediately before the injection for a few minutes. Some pediatricians may even have ice packs available for use if you request it; 4. If your child responds well to rewards, bring them a token gift for their bravery.
  

So, where can you go to get vaccinated against the flu? Your primary care physician, pulmonologist, allergist, OB/GYN, and pediatrician should all have the flu shot available, and your pediatrician may have the nasal spray in stock. Most major supermarkets, superstores like Target and Walmart, and all chain pharmacies offer the flu shot. If you want the whole family to bond over being vaccinated, the CVS Minute Clinic in Eastchester has flu shots in stock for those ages 3 and up. The pediatric vaccine is thimerisol and preservative free, the clinic is walk-in, and a Nurse Practitioner administers the shot. Insurance covers it in most cases, but it's usually never more than $25-30 for the shot. We were in and out in less than 15 minutes and my kids wore their bandaids like badges of honor. For that matter, so did their mom.

Resources:

http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/Children-Should-be-Vaccinated-Against-Influenza-as-Soon-as-Possible.aspx

http://www.cdc.gov/flu/protect/children.htm