Thursday, September 25, 2008

2008 Center for Diseases Control and Prevention (C.D.C.) Influenza Vaccine Recommendations

The Centers for Disease Control and Prevention have released their guidelines for 2008. The major change is the recommendation that children from age 5 years old to 18 years old should also get the flu vaccine, unless they have serious egg allergy. Previously, only children from age 6 months to 5 years old were recommended to receive the flu vaccine. Research has shown that school age children have higher rates of flu than the vaccinated people older and younger than they are plus these children are likely to spread flu to the general population. The new recommendation plugs this hole in our general protection wall.

Why should I be concerned about influenza? A viral infection initially of the respiratory tract which can cause severe illness in some people. The people prone to this outcome include the very young, elderly, those with respiratory or heart diseases, and those with compromised immune systems, such as with cancer. About 200,000 people are hospitalized and about 36,000 people die each year from flu infection.

When do influenza infections occur? The season may range from October until May, based on historical records. Typically the peak is in February.

When should I get vaccinated? As soon as possible. Some facts: after vaccination, it may take up to two weeks for protective levels of antibodies to be generated. Epidemics take time to be detected and it could be too late to protect you because of the time delay. Once an epidemic is detected, there is inevitably a rush for vaccinations, resulting in a local shortage, and once again no protection. Our office just got our shipment of the trivalent flu vaccine (FYI $25 - the same price as everywhere else - which you must prepay because most insurances do NOT cover this. (Bad preventative medicine.) Personal advice: check with your employer. They may subsidize this price, because they are practicing good preventative medicine for their employees. Our office provides the flu vaccination free to our employees. We're a medical office focusing on respiratory diseases. Make sense?) I plan on getting vaccinated and by this weekend ALL of my family will be vaccinated, except my 11-year-old daughter. She gets hysterical from injections, so we have compromised and will get her the nasal vaccination. This is officially called the live, intranasal influenza vaccine. It is a nasal spray. This is significantly more expensive, (I was quoted prices from $40-70 for FluMist by local providers), and not covered by insurance either. (More bad preventative medicine.) The trivalent vaccine, which most people will receive, is a live vaccine and given as an injection into the muscle, usually of the deltoid, which covers your shoulder. People may have soreness in their arm for 1-2 days. I usually have this, but it's a small price to pay for not getting an influenza infection. I had been vaccinated for flu each year since 1984, when I entered medical school. So far, there are no long-term adverse effects. Here is the CDC's information sheet on the inactivated vaccine.

Here's a tangent, mercury-free trivalent vaccine costs about $35 and is given by injection. Mercury can be and usually is used in the preparation process. People have speculated that mercury causes autism in children. There is no evidence that this is true. Otherwise we would ban mercury use altogether.

By the way, what IS a "serious egg allergy"? As an allergist, I define this as a life-threatening allergic reaction after touching or eating a food product containing egg. Life-threatening means: throat closing, trouble breathing in the chest, and/or lightheadedness or fainting. Historical information eliminates the vast majority of concerns, because it turns out it was not an allergic reaction or they have eaten eggs without any reaction. If patients have a concern, then we can skin test patients for egg allergy or the flu vaccine. It takes about 60 minutes, most of which is waiting and watching. If you have a question about this, ask your doctor before proceeding.

Age of patientDose of vaccineFrequency
Children 6 months old - 35 months old, first time0.25 ml IMtwice, 4 weeks apart
Children 6 months old - 35 months old, second or more time0.25 ml IMonce
Children 36 months old - 8 years old, first time0.50 ml IMtwice, 4 weeks apart
Children 36 months old - 8 years old, second or more time0.50 ml IMonce
Children >9 years old and adults, any time0.50 ml IMonce

This information comes from the package insert of the Fluzone vaccine, which is the only approved vaccine by injection for children.

SUMMARY: every one 6 months and older should proceed in a calm and orderly fashion to get a influenza vacation, unless they have a serious egg allergy (Cut to scene of a riot in the streets because a shipment of Wii have arrived on Christmas Eve at Toys'R Us).

More facts at

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