Influenza Immunization

Two types of influenza vaccine are now available: inactivated (or killed) vaccine and live attenuated (or weakened) vaccine. The inactivated influenza vaccine is given as a shot and has been used in the United States for many years. The attenuated vaccine, licensed in 2003, is given as a nasal spray. It is approved for healthy children and adults from 5-49 years of age.

It is important to note that these types of vaccine are not interchangeable. Both the shot and the nasal spray are appropriate for distinct groups of children and adults.

Influenza viruses can change in two different ways. One is called "antigenic drift." These are small changes in the virus that happen continually over time. Antigenic drift produces new virus strains that may not be recognized by the body's immune system. This process works as follows: a person infected with a particular flu virus strain develops antibody against that virus. As newer virus strains appear, the antibodies against the older strains do not recognize the "newer" virus well, and reinfection can occur. This is one reason why people can get the flu more than one time. In most years, one or two of the three virus strains in the influenza vaccine are updated to keep up with the changes in the circulating flu viruses. So, people who want to be protected from flu need to get a flu vaccine every year. Also, immunity wanes after a year!

The other type of change is called "antigenic shift." Antigenic shift is an abrupt, major change in the influenza A viruses, resulting in new hemagglutinin and/or new hemagglutinin and neuraminidase proteins in influenza viruses that infect humans. Shift results in a new influenza A subtype. When shift happens, most people have little or no protection against the new virus. While influenza viruses are changing by antigenic drift all the time, antigenic shift happens only occasionally. Type A viruses undergo both kinds of changes; influenza type B viruses change only by the more gradual process of antigenic drift.

To address the drift and shift nature of the flu, the influenza vaccine is updated every year. Protection develops about 2 weeks after getting the vaccine and may last up to a year. Some people who get flu vaccine may still get the flu, but they will usually get a much milder case than those who did not get the vaccine. Flu vaccine should be given in October and may be given at the same time as other vaccines, including pneumococcal vaccine.

Some inactivated flu vaccine contains a trace amount of thimerosal, a form of mercury, as a preservative. There is no scientific evidence that thimerosal in vaccines is harmful, and the known benefits of the vaccine far outweigh any potential risk from thimerosal. If you have questions about thimerosal or reduced-thimerosal flu vaccine, ask your doctor.

Side Effects from Influenza Immunization

Serious complications from inactivated flu vaccine are very rare. The viruses in inactivated influenza vaccine have been killed, so you cannot get influenza from the vaccine. Mild problems include soreness, redness, or swelling where the shot was given; fever; and aches. If these problems occur, they usually begin soon after the shot and last 1-2 days. Life-threatening allergic reactions from vaccines are very rare. If they do occur it is within a few minutes to a few hours after the shot.

In 1976, swine flu vaccine was associated with a severe paralytic illness called Guillain-Barre Syndrome (GBS). Influenza vaccines since then have not been clearly linked to GBS. However, if there is risk of GBS from current influenza vaccines, it is estimated at 1 or 2 cases per million persons vaccinated - much less than the risk of severe influenza, which can be prevented by vaccination.

The chances of live attenuated influenza vaccine viruses spreading from person to person are very small. Even if such spread should occur, it is unlikely to cause illness. Some children and adolescents 5-17 years of age have reported mild reactions, including runny nose, nasal congestion or cough; fever; headache and muscle aches; and abdominal pain or occasional vomiting or diarrhea. Some adults 18-49 years of age have reported runny nose or nasal congestion; cough, chills, tiredness/weakness; sore throat; and headache.

Like any vaccine or medicine, influenza vaccine could theoretically trigger a serious reaction in someone who is allergic to one of its components. But severe allergic reactions to childhood vaccines are fortunately very rare (estimated at around one per million doses), and no child is ever known to have died from an allergic reaction to a vaccine.

Precautions

Inactivated Influenza Vaccine should not be given to:

  • A child who has ever had a serious allergic reaction to eggs or to a previous dose of influenza vaccine
  • A child with a history of Guillain-Barre Syndrome

Live Intranasal Influenza Vaccine is indicated only for healthy persons between 5-49 years of age and should not be given to:

  • Children younger than 5 or adults over 50 years of age or
  • People who have long term health problems with heart disease, lung disease, asthma, kidney disease, metabolic disease (such as diabetes), anemia (and other blood disorders)
  • People with a weakened immune system due to: HIV/AIDS or another disease that affects the immune system; long term treatment with drugs that weaken the immune system (such as steroids); cancer treatment with x-rays or drugs
  • Children or adolescents on long-term aspirin treatment
  • Pregnant women
  • Anyone with a history of Guillain-Barre Syndrome
  • Anyone who has ever has a serious allergic reaction to eggs or to a previous dose of influenza vaccine.

If you are severely ill at the time the shot is scheduled, you should probably wait until you recover before getting influenza vaccine. Talk to your doctor about whether to reschedule this vaccination.

After Getting Influenza Vaccine . . .
If the child has any serious or unusual problem after getting this vaccine, call a doctor or get the child to a doctor right away.

Content derived from the Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases
and American Academy of Pediatrics Policy