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What to do about the flu vaccine?

With winter fast approaching many parents are asking “What should we do about the flu vaccine?” The flu vaccine has been around since the 1950’s and for as long as it has been around there have been questions and differing opinions on its value. From my perspective, as a paediatrician, I think it is best to consider current literature and the recommendations being made by the various professional bodies. This will enable us to make informed decisions.

What is flu?

Flu, or influenza is a viral infection and is predominantly experienced during the winter months. Because it is viral, anti-biotic treatment is of no benefit what-so-ever. Having said this, influenza can lead to more serious, secondary bacterial infections such as bronchitis and pneumonia. Under such circumstances anti-biotic treatment would be required.

Typically flu begins with muscle aches and pains. Symptoms such as excessive tiredness, fever, sinus, sore throat and a cough are typical as the flu virus usually infects the upper airways. It lasts for anything between four and seven days.

People often mistake a common cold for flu. Colds are also viruses and also cause nasal congestion, sore throats and a mild cough. Muscle aches and pains are not usually experienced with a common cold.  The common cold doesn’t usually last longer than four days and would not usually develop into anything more serious.

What are the similarities between flu and COVID-19?

Both influenza (flu) and COVID-19 are respiratory diseases that spread easily from one person to another. They also share a lot of symptoms such as fever, cough, body pains, headaches and so on but they are caused by different viruses. From the data that we do have on COVID-19 it would seem that COVID-19 has a longer incubation period than flu and a person suffering from COVID-19 can spread the illness to others for longer.

Will COVID19 and flu circulate at the same time?

COVID-19 first showed its face during the winter months in Europe. South Africa’s first case was diagnosed in March 2020. Since then the world has seen various waves so the likelihood of the influenza virus and COVID-19 circulating together are highly likely.

How is it spread?

Much like COVID-19, the flu virus spreads easily from person to person. An individual with flu is contagious from a day before their symptoms begin and certainly for as long as the symptoms are present. This is usually seven days. The virus is spread by the ill person coughing or sneezing around others. The particles are small and light so often remain in the air for some time. Even if you are not present when the person sneezes or coughs you may be susceptible for about an hour after the occurrence because you could breathe in the airborne particles. The virus can contaminate surfaces, be spread from hand to hand or by coming into contact with a facial tissue after the ill person has blown their nose.

So who should get the flu vaccine?

child getting vaccineIn the past certain groups were identified as definitely needing the flu vaccine. This year however The Centre for Disease Control (CDC) now recommends that anyone older than 6 months should receive the flu vaccine.  From my perspective I am pleased that this recommendation has been made. While it is known that children usually recover well from flu we can never be certain if the ill child is going to come into contact with someone who is high risk or an individual who may subsequently develop more serious illnesses. Given that the third wave is expected to hit harder than the other waves we need to do all we can to conserve potentially scarce health care resources.

In a nursery school or crèche situation, the flu virus spreads easily since children are in close proximity to one another. Toddlers have not yet learnt the etiquette of coughing away from others and also have little immunity to the viruses because of a lack of previous exposure. These children may well bounce back easily after the illness but may in the meantime have spread the virus to those more at risk like Granny and Grandpa, an asthmatic or an immune compromised individual.

Since I typically deal with families with children of all ages I am concerned about those babies younger than six months. They cannot receive the flu vaccine but are at high risk if they get ill. I would thus highly recommend that parents, siblings and caregivers have the flu vaccine to protect these little ones.

Pregnant ladies who receive the flu vaccine pass the immunity onto their babies for the first 8 weeks of life. This is a huge advantage for newborns who are being born during the winter months. Mom’s immunity protects them when they are too little to receive the vaccine themselves.

How does the flu vaccine work?

Extensive research goes into establishing the various strains of viruses expected to circulate in the community in the forthcoming influenza season.  The vaccine is produced using these viruses but in an inactivated (killed) form. This means that you cannot get sick from the vaccination. Four strains of the flu virus are included into the vaccine each year.

Within two weeks of the flu vaccine being given, the body forms an immune response to the killed virus. That means that should an immunised person come into contact with one of the viruses their bodies will recognise the virus and respond accordingly. Since there are many, many different types of flu viruses and only three strains are included in the flu vaccine each year, it is possible for an immunized person to still get sick from a strain not included. This is why the flu vaccine is recommended each year. As time goes by an individual who has been immunized annually will have immunity to a much larger number of these viruses.https://www.news24.com/life/wellness/body/condition-centres/flu/news/getting-the-annual-flu-shot-wont-weaken-your-immune-system-20171128-2 Pregnant woman can receive the vaccination at any time of the pregnancy. Those in their second and third trimesters are at risk of developing severe reactions to flu. Pregnant woman should therefore receive the flu vaccine as a priority.

What is the recommended dose?

If your child is younger than 9 years of age AND HAS NEVER HAD THE FLU VACCINE then two doses of the vaccine will be given. These two doses are given one month apart.

If your child is younger than 9 years but has previously had two doses of the flu vaccine then only one dose will be given.

Those older than 9 years of age only require a single dose of the flu vaccine.

Which children should not receive the flu vaccine?

Currently there are two situations where the vaccine should not be give

  • If the child previously had a severe reaction to the vaccine.
  • If the child has suffered from Guillain-Barre syndrome ( This is a condition which affects the nerves and immune system)
  • Children who are sick with COVID-19 should defer the flu vaccine until they are better.

Common misconceptions about the flu vaccine

As I said at the beginning of this blog, the flu vaccine often gets a bad rap. In fact there are so many old wives tales and misconceptions about the flu vaccine that I sometimes have to smile. These misconceptions are not based on fact and are often the root of a lot of confusion.

The most common misconceptions about the flu vaccine:

  • You cannot have a flu vaccine if you are allergic to egg.

People with egg allergies can definitely receive the flu vaccine. Studies have shown in fact that there is no higher risk to a person who is allergic to eggs than those that are not. Health experts conclude that the amount of egg in the vaccine is so tiny that even those with severe egg allergies are safe to have the vaccine.

If there is a severe allergy to eggs and you are concerned then it is recommended that the vaccine be done where there is a medical practitioner available to deal with an allergic reaction if it does occur. In such a case rather have the vaccine done at your doctor’s rooms than in a shopping centre or in a work environment.

  • The year I had the flu vaccine was the year I got the worst dose of flu!

As explained previously the flu vaccine generally contains four strains of flu viruses. If you are exposed to a different virus you will get ill. It’s not the vaccine that made you ill but the virus you were exposed to.

  • I shouldn’t breastfeed if I have flu.

It is really important that a mother continues to breastfeed even if she has flu. The virus is not transmitted through the breastmilk. The anti-bodies which the mother develops will be transmitted through the breastmilk and will help to protect the baby from infection. If you are concerned about coughing or sneezing over the baby you may wear a mask.

  • It is not necessary to get the flu vaccine every year.

As already explained the flu circulating in our community’s changes from year to year. Because of this scientists develop a flu vaccine each year to protect against the current flu strains. A vaccine against those particular strains annually is therefore important.

  • You can get flu from the vaccine.

The vaccine does not contain any live virus so you cannot get flu from the vaccine. The side effects of the vaccine are swelling at the site of the injection, some redness at the site, a headache or mild fever. Most of these side effects are as a result of the immune response to the vaccine and indicates that body is fighting the illness already.

  • The flu vaccine weakens the immune system.

The flu vaccine causes anti-bodies to be formed in response to the virus. That means that immunity is actually improved. *****

In conclusion

With all the current information and the recommendations made by The American Paediatric Society, The Centre for Disease Control and other important medical bodies it is recommended that all patients six months an older receive the flu vaccine. Under normal conditions, South Africa usually has between 6000 and 11 000 deaths each year from influenza. While many of these deaths are among the elderly and those with compromised immune systems, it also includes children under the age of 5 years. Globally influenza levels have been lower than in previous years and this is most likely due to the fact that people are isolating and wearing masks. Despite this phenomenon, flu has debilitating side effects and results in many hours being lost in the work place for parents.

Influenza is not something to be taken lightly as it impacts our society from the tiniest of individuals up to our precious and often frail elderly. Currently the flu vaccine is the most effective way of combating the influenza virus. As a paediatrician I would thus recommend that all children from the age of six months receive the vaccine.

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