It’s Flu “shot” season but thankfully not every vaccine hurts going in. This year your child may be offered either the “flu shot” or the flu nasal spray vaccine (ouchless!). This year most nurses and docs will encourage young children to get a nasal flu spray over the shot as recent data has found the nasal flu vaccine protects younger children better. Every year the flu vaccine is created to protect against influenza viruses predicted to spread and circulate in North America. We need the shot every year for two main reasons:
- Typically, different influenza virus circulate around the world from year to year. Over 100 international centers maintain year-round surveillance to determine and predict which strain will cause human infections. The information is used to forecast the recipe for the vaccine here at home. This year the strains (types) of influenza in the shot and nasal spray are the same as last year (2013-2014).
- Protection Fades. When you get a flu vaccine you stimulate the immune system to create protection against the strains of the virus in the vaccine. That immunity (the antibodies that are created) tends to fade and wane in your bloodstream after about 6-12 months. Therefore, even if you got the flu vaccine last year you really want your family to have it again this year so it protects you through the winter influenza season which can continue late into the springtime but tends to peak in February or March.
The flu vaccine contains either three (trivalent) or four (quadrivalent) strains of influenza. There is no official recommendation for one over the other. Flu vaccine is recommended for all children over 6 months of age who have no contraindication to the vaccine.
Worth noting: If the thought of needles deters you from getting the vaccine for your child or your family, Live Attenuated Influenza Vaccine (LAIV), a nasal spray, is a great option for those age 2 to 49 years. In fact, there’s data to suggest the nasal flu vaccine is more effective in protecting children from influenza in young childhood. Recommendations this year include a push to have children between 2 and 8 years of age immunized with the nasal spray whenever possible. If the nasal isn’t available, the shot should be given — no reason to wait.
About 20,000 children younger than 5 years old are hospitalized from flu every year — form CDC “Which Flu Vaccine Should Children 2 to 8 Years Old Get?”
Who Can Get The Nasal Flu Vaccine?
If your child is prone to wheezing or has a history of asthma, we want them to get immunized because their risk of severe infection from flu is higher. In the past, recommendations to avoid nasal spray with a history of wheezing predominated our counseling on which one we recommended. This is changing as more data demonstrates superior protection from nasal flu spray over the shot in young children. Even though the nasal spray can increase the risk of wheezing, many providers will counsel families to consider it if their child is young and hasn’t had serious wheezing and has had no asthma in the last 1 year. This year, talk with your doctor or nurse if your child has had wheezing or asthma in the last 12 months — if so, you’ll need to weigh the benefits of the vaccine protection against the potential risk that the nasal spray can cause a wheezing event.
- Age 2 and up: Children without serious stuffed up noses and no contraindications (see below) to nasal flu vaccine can get it.
- Age 2 to 8: Especially recommended to have nasal flu spray if available, because it’s been found to be more protective.
- Age 8 & Up: Children over age 8 years of age without contraindication can also get a nasal flu spray but there is no official recommendation for the nasal spray over the shot.
- Kids Who Can’t: Children are recommended NOT to get nasal flu spray when on aspirin, history of egg allergy, weakened immune system, have contact with an immunocompromised family member or close contact, or have had serious wheezing or persistent asthma in last year if age 2 to 4 years.
What is Influenza Infection?
Influenza virus causes infections that typically involve the upper respiratory tract. It causes cough, high fever, body aches, and even pneumonia. Rarely it can cause more severe respiratory challenges or serious infections outside the lungs. Children with asthma or underlying lung, neurologic, or immune deficiencies are at higher risk for more severe infection.
Influenza is unpredictable from year to year. Last year (2013-2014) we had a relatively mild flu season. Unfortunately it’s difficult to predict if this year will be the same. Children are at higher risk for serious infections, especially children under 5 years. In addition, high-risk individuals include infants, pregnant women, elderly & people with chronic disease.
Flu Vaccine, The Numbers:
Recommended for ALL infants/children 6 months and up.
Nasal spray can be use on ages 2-49, but is especially recommended for children age 2 to 8 years.
The flu shot is made of of dead viral particles, the nasal spray is made up of weakened virus. Neither can cause flu illness.
What Parents Need To Know About Flu Shots
- Flu vaccine (shot or spray) won’t give you the flu. The effectiveness varies on a number of things, including how old the child is getting it, if the viral strains included are the ones circulating, and the number of shots you’ve had in the past. The flu shot is the best way to prevent influenza infections!
- Children with underlying lung problems need to get a flu shot. However, if they have wheezed in the last year, talk with your child’s doctor or nurse to see if they can have a nasal flu spray.
- Children under 9 may need a 2nd dose, especially if an infant or if this is the first season ever getting the flu vaccine. Talk with your child’s care team for more.
- Protection lasts several months to a year — now’s the time for flu protection.
Nancy Swank says
Both of my kids had the nasal flu vaccine a few years back and although it didn’t hurt like a shot, they both found it unpleasant. In fact, my older son requested to get the shot in the future. Younger son still prefers nasal vaccine.
Wendy Sue Swanson, MD, MBE says
Not uncommon. Lots of us don’t like things pushed up our noses! In the past few years since we’ve been offering nasal spray flu vaccine, I’ve heard this dozens of times. That’s why it’s important to know that the nasal may be more effective….when a child asks for the shot—imagine (!!) –and they are between age 2 and 8, in particular– you’re going to have to coach them into that nasal spray!
My son just turned 2 so I am wondering what it is about the nasal spray that makes it unsafe/not recommended for the under 2 set?
Wendy Sue Swanson, MD, MBE says
It’s likely not “unsafe” in that age range, but the data doesn’t exist to know. It just wasn’t tested in that age range (I presume, in part, because of how difficult it would be to get a 15 month-old to “sniff” on command).
Are there any concerns about kiddos with Type 1 Diabetes getting the nasal vs. shot?
Wendy Sue Swanson, MD, MBE says
Hi Jamie, Talk specifically with your child’s care team for individual recs.
In general, flu shots are highly recommended for patients over 6 months of age who have a diagnosis of insulin-dependent diabetes (IDDM) as children and adults are at increased risk for complications of influenza when they have IDDM. Here’s more information about nasal flu spray and recs for people with IDDM from the Centers For Disease Control:
Carol Weber says
My son, 12, got the FluMist Tues. when we got to the clinic because they said there were no shots available for children. Nobody warned us of the side effects. My son got sick the next day and is getting worse–his 4th day now. I am pissed. We usually have done shots in the past.
My 6 year old daughter is going to have her flu vaccine for the first time next week.
She just recovered today from croup after one time steroid pill was given. (1st question) Can she get her flu vaccine despite taking that one time dose steroids (decadron for croup)? (Second question): We prefer nasal flu spray for her very 1st time dose, does the second dose after 4 weeks also applies for nasal vaccine for first timers? Would appreciate the clarification.