Flu season is coming so it’s time to add scheduling flu vaccines to your to-do list. On The Pulse sat down with Dr. Wendy Sue Swanson, also known as Seattle Mama Doc, to get the latest flu news as the 2018-2019 flu season approaches. Spoiler alert: avoid promising a “no-poke” visit.

Q: What have we learned about last year’s flu season?

A: The Centers for Disease Control and Prevention (CDC) classified the 2017-2018 flu season as a “high severity season.” Flu activity was widespread across the country, and the season was long. There were large numbers of doctor office visits, emergency department visits, and hospitalizations related to flu. The flu season came earlier than expected and was severe, by the numbers.

Influenza can be deadly and tragic. We know that during the 2017–2018 flu season, 180 children in the United States died from flu and flu-associated illness. The CDC says about 80% of the children who died had not received a flu vaccination. Research has shown that flu vaccine reduces the likelihood of death from influenza in children.  We know that more than 80,000 Americans died from influenza-related complications and thousands more children and adults were hospitalized.

The great news is we can reduce risks from influenza causing harm as influenza is a vaccine-preventable disease. The data drives home our need to vaccinate ourselves, our own families, and ensure our patients are protected by their flu vaccine, too. The likelihood of a child being immunized goes up when their parent gets a flu shot. By improving immunization rates, we can reduce the spread of influenza in our community.

Q: Can you tell us about this year’s vaccine recommendations?

A: There are numerous choices for flu vaccine. This year, the American Academy of Pediatrics (AAP) recommends the flu shot as the best choice for flu vaccine in children during the 2018–2019 flu season. Two of the strains in this year’s vaccine are different from the flu shot from last season (Influenza H3N2 and Influenza B, Victoria lineage).

You might remember that the nasal spray flu vaccine was not available last flu season. Although it’s not recommended by the AAP, it’s back on the market this year for children age 2 years and up. The new vaccine has been redesigned because of information collected between 2013-2016 that found one strain of influenza (Influenza A H1N1) wasn’t as effective as designed. The new vaccine is expected to protect people well, but because of the lack of experience with success in children for that one strain, the AAP chose to preferentially recommend the shot this year. If your child will otherwise not get a flu shot (severe needle phobia) or if your pediatrician’s office doesn’t have supply, then getting the nasal flu spray is recommended.

For the best protection, get the flu vaccine for you and your family as soon as it’s available. Aim for being vaccinated by the end of October prior to influenza arriving in our community. Being immunized 2 weeks prior to an exposure is the best way to be protected. Getting it out of the way before flu season ramps up and the holidays arrive is good planning!

Q: Who should get the flu shot?

A: The flu vaccine is an essential, every year vaccine included on the vaccine schedule for everyone 6 months and older — babies, toddlers, kids, teens, and adults. While the flu vaccine is for everyone, it’s especially good for high risk groups like kids under 5 years who are at higher risk for complications and hospitalization, people with underlying chronic health problems, those over age 65 years, and especially pregnant mothers. When pregnant mothers get immunized they protect themselves and they create immune responses (antibodies) that they pass onto their babies. Babies born to mothers who are immunized against flu have a greater than 70% risk reduction for hospitalization for the first few months of life.

If this is your baby or child’s first time getting a flu shot they will need two doses this season. Infants and children under age 9 who’ve never had a flu shot before need two doses this season, at least 4 weeks apart. Everyone else needs just one dose this fall.

Q: Why is flu vaccine needed every year?

A: Influenza viruses are constantly changing, so flu vaccines are updated each year to better match the flu viruses that are circulating. Centers all around the world provide surveillance and scientific prediction for what specific strains will likely come to North America. For the 2018-2019 season, flu vaccines include a change to the B and A (H3N2) virus strains.

But even in years when the flu vaccine hasn’t changed, we need an annual shot so that our body is ready to fight off infection. The vaccine given each year doesn’t last a lifetime. Our body’s immunity to flu viruses, after getting the infection or after vaccination, declines over time.

Q: How effective is the flu vaccine?

A: Each year, the flu vaccine is effective at preventing influenza infections in about 50-60% of those who get it. That means in a group of 100 people, about 60 people who get the flu vaccine will be protected against an infection when someone coughs on them with influenza. That is far better than the 0% protection you get when un-immunized. Research shows that the vaccine also decreases symptoms and severity in the case that a vaccinated person does get sick. And as discussed above, influenza vaccination reduces risk of death in children. Getting the flu shot just makes sense!

Q: Where can families get the flu shot?

A: Call your pediatrician or primary care doctor to schedule an appointment to get the vaccine. Some primary care offices offer special flu clinic hours to make it more convenient for busy families to get their shots. And many pharmacies, drug stores, and grocery stores offer convenient flu vaccines throughout the season. Not all clinics provide flu vaccines to children, so call ahead to make sure if bringing your whole family.

Q: Can you share your best tips for helping kids get a shot?

A: I must start by reminding parents to never promise a “poke-free” visit to the doctor. Build up your child’s trust in you, and their doctors and nurses, by not making promises that you might not be able to keep. In the fall, a flu shot is likely to be recommended.

Next, remember that children watch their parent’s experience with shots. Know that your staying calm goes a long way. Getting your vaccines as a family can build trust with your child.

A few tips for helping your child or teen cope with the shot:

  • Offer a choice about which arm will receive the shot.
  • Teach the “cough trick.” Research shows this type of distraction can help reduce the experience of pain for some children during a shot. Tell your child or teen to cough just as the needle goes in.
  • Try other distractions, depending on your child’s age, like breastfeeding during and after, cuddling a teddy bear, watching a short video, or listening to music during the shot. Promising a treat of a special trip to the park or an ice cream cone after the shot can help too!
  • Consider using a numbing cream, like EMLA, to numb the skin before the shot. This requires planning in advance as you’ll need a prescription for the cream ahead of time.
  • Remember that fear of needles is real. Validate your child’s feelings, remind them the pain is only seconds long, and discuss options with their doctor or nurse.

Q: Besides getting the flu vaccine, what else can families do to prevent getting the flu?

A: Staying home when ill, and especially staying away from those at high-risk from influenza infections during the season are important strategies. In addition to getting the influenza vaccine, there are some other practical ways to reduce the risk of flu and the spread of infection:

  • Wash your own and your child’s hands often with soap and warm water. Use alcohol-based hand cleansers when soap and water aren’t available.
  • Avoid people who are sick. If you or your family member is sick, stay home from work or school. Stay home while sick and for at least 1 day after the fever is gone, without using fever-reducing medicine.
  • Cover noses and mouths when coughing or sneezing. Use tissue or the crook of your elbow.
  • Avoid touching your eyes, nose and mouth with unwashed hands. Remind your child to keep their hands away from their face.
  • Clean surfaces often, including toys, doorknobs, phones, keyboards and tables.
  • Avoid sharing personal items, such as forks, spoons, toothbrushes and towels.

Q: Any parting advice as this year’s flu season gets under way?

A: Influenza is a huge burden and an infection that we can work to prevent with vaccines and smart sense. Most predictable is that influenza is unpredictable. We often don’t know when a bad flu season is coming and we can prepare best by taking every step to prevent infection and spread. This year we launched a flu skill in Alexa called “Flu Doctor.” You can ask Alexa specific questions about influenza, find the pharmacy closest to your home with flu shots, and learn about flu season. Enable the skill in your Alexa – I’ll include weekly or every-other-week updates on the season and ways to protect your family.

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