Seasonal Influenza Vaccine

H1N1 Vaccine

Additional Information from the CDC

SEASONAL INFLUENZA VACCINE

SEBPMG currently has ALL types of the Seasonal Influenza Vaccine available:

1. Preservative-free Seasonal Flu SHOT for children under 3 years of age.
2. Seasonal Flu SHOT for children older than 3 years of age who have an underlying medical problem such as such as heart disease, lung disease, asthma, kidney disease, immune deficiency, metabolic disease, or diabetes.
3. Seasonal Flu MIST for children older than 2 years with NO underlying chronic medical problem.

H1N1 VACCINE

SEBPMG currently has the following H1N1 Vaccines available:

1. H1N1 MIST for children older than 2 years of age with NO underlying chronic medical problems.
2. H1N1 SHOT for children older than 3 years of age who have an underlying medical problem such as such as heart disease, lung disease, asthma, kidney disease, immune deficiency, metabolic disease, or diabetes.

Unfortunately, we no longer have the specifically formulated preservative-free vaccine available for our patients who are between the ages of 6 to 36 months. We do have H1N1 shots that DO contain the preservative thimerosal.

Since 2006, California law has stated that vaccines containing specific levels of mercury cannot be administered to pregnant women and young children, except under certain circumstances.  Due to delayed supplies of thimerosol-free H1N1 vaccines this year, AAP-CA and others have successfully urged the state to grant an exemption to the law.  Specifically, the Secretary of the California Health and Human Services Agency has granted an exemption to this restriction for Influenza A (H1N1) 2009 Monovalent Vaccine in children younger than 3 years of age and pregnant women from October 12, 2009 –September 30, 2010. 

This thimerosal-containing vaccine can now be given to children 6 to 36 months of age.

Because of the ongoing shortage of preservative-free vaccines, South East Bay Pediatrics is in full agreement with this decision and recommends that children under 3 years of age be vaccinated with the H1N1 Shot which does contain thimerasol.  At the present time, we do not know IF or WHEN our office will be getting additional doses of the preservative-free vaccine.

Additional Information from the CDCCC

Information from the Centers for Disease Control (CDC) and information about both vaccines can be found below, including who qualifies for each of these vaccines.

• Vaccine information sheet - Nasal Spray Vaccine ("flu mist")
• Vaccine information sheet - Injectable ("flu shot")
• CDC Questions & Answers

If you would like to schedule your child for the H1N1 Flu Mist, please download the H1N1 Questionnaire.  If the answers are “No” to all the survey questions, you can schedule a “H1N1 vaccine-only” appointment where you will be seeing a medical assistant to receive the vaccine.  Please note that you will not be seeing a physician for this “H1N1 vaccine-only” appointment. 

If you have any questions prior to receiving the vaccine or have other medical issues you would like your physician to address, or if your answer to any of the survey questions is YES, you will need to schedule an appointment with your physician prior to receiving the H1N1 Flu Mist.

No co-pay will be required for the H1N1 vaccine-only appointments.  However, if you are asked to schedule an appointment with a physician, a co-pay will be required at the time of your visit.

In addition, there is an associated charge of $42.00 per H1N1 vaccine administered which we will bill to your insurance.  Any amount not covered by insurance will be billed to and becomes the responsibility of the guarantor.  PLEASE CONTACT YOUR INSURANCE COMPANY PRIOR TO YOUR ARRIVAL TO OUR OFFICE IF YOU HAVE QUESTIONS REGARDING COVERAGE. 

AAP Releases Influenza Statement for 2009-2010

The following summary is adapted from the AAP 2009-2010 influenza policy statement.   The AAP 2009-2010 influenza policy statement, "Recommendations for Prevention and Control of Influenza in Children" is now available and can be accessed: http://www.cispimmunize.org/ill/Flu/Influenza%20Recommendations.pdf

Who should get the influenza (flu) vaccine?

The AAP currently recommends the seasonal influenza (flu) vaccine be administered to the following patients:

1. All children 6 months to 18 years of age, both healthy and those with risk factors that increase complications from influenza (i.e. high risk patients with conditions such as asthma, diabetes, immune deficiency chronic lung disease, etc…)
2. Household contacts and out-of-home care providers of:
   1. All children with high-risk conditions
   2. Healthy children younger than 5 years of age
3. Health care professionals
4. Pregnant women

When can the influenza (flu) vaccine be administered?

The  influenza vaccine should be offered to all children as soon as it is available, even as early as August or September.  This should continue throughout the entire flu season up to May 1. 

What are the types of influenza (flu) vaccines available?

There are 2 types of influenza (flu) vaccine:

1. Trivalent inactivated influenza vaccine (TIV) – the typical “flu shot.”
2. Live-attenuated influenza vaccine (LAIV) – the “flu mist.”

Healthy children ages 2 through 8 years can receive either TIV or LAIV.

How many influenza (flu) vaccinations are required for optimal immunity?

• Children 9 years of age and older should receive only one dose for the season even if they have not received the vaccine before.
• Children <9 years receiving the flu vaccine first time need a second dose during the same season at least 4 weeks after the first shot is given.
• Children <9 years who received only one dose in the first season they were vaccinated should receive a second dose during the same season at least 4 weeks after the first shot is given.  This applies only to the first year that the child receives the flu vaccine.   
• Only one dose will then be needed in following seasons. seasons.

What are the side-effects of the TIV influenza (flu) shot?

The most common symptoms associated with the flu shot are soreness at the injection site and fever. Fever typically occurs within 24 hours of the shot and  is more common in children younger than 2 years of age.  Other milder symptoms can include nausea, lethargy, headache, muscle aches, and chills. You cannot get the flu from the flu shot since it contains viral protein but no live virus. 

More detailed information can be obtained from the “CDC Influenza VIS 2009-2010” once it is published.  In the meantime, the 2008-2009 version is available at http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-flu.pdf.

Who should not be vaccinated with the TIV “flu shot?”

• Infants less than 6 months of age
• Those who have a moderate to severe febrile illness
• Those who have a history of significant allergies to eggs or a reaction to any previous influenza vaccine dose or vaccine component
• Those who are known to have experienced Guillain-Barre syndrome (GBS) within 6 weeks after a previous influenza vaccination

What is the “flu mist?” Who can receive it?

The “flu mist” is a live-attenuated influenza vaccine ( is administered intranasally and is licensed by the FDA for healthy people 2 through 49 years of age. More detailed information can be obtained from the “CDC Influenza VIS 2009-2010” once it is published.  In the meantime, the 2008-2009 LAIV version is available at http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-flulive.pdf.

Who cannot receive the “flu mist?”

Since the safety and effectiveness in individuals with underlying medical conditions that are associated with an increase risk of complications from influenza have not been established, the “flu mist” cannot be administered to these individuals. 

• Children less than 2 years of age
• Those who have a moderate to severe febrile illness
• Those who have a history of significant allergies to eggs or a reaction to any previous influenza vaccine dose or vaccine component
• Those who have received other live vaccines within the last 4 weeks (however other live vaccines can be given on the same day as LAIV.)
• Those with asthma, reactive airway disease, or other chronic disorders of the pulmonary or cardiovascular systems
• Those with underlying medical conditions, including metabolic disease, diabetes, renal dysfunction, and hemoglobinopathies
• Those who have known or suspected immunodeficiency or who are receiving immunosuppressive therapies
• Those who are receiving aspirin or other  salicylates
• Those who are known to have experienced Guillain-Barre syndrome (GBS) within 6 weeks after a previous influenza vaccination
• Pregnant adolescents
• Those with any condition that can compromise respiratory function or handling of secretions or can increase the risk for aspiration, such as cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders.
• Children younger than 5 years with recurrent wheezing or a wheezing episode in the past 12 months

What about mercury or thimerosal in the vaccines?

Some formulations of the inactivated flu vaccine contain minute amounts of thimerosal. 

From the CDC:

Concerns about the minute amounts of vaccines continue to be raised by some. There is no evidence that the incidence of autism spectrum disorders is higher among children who receive thimerosal-containing vaccines than among children who do not. The benefits of protecting children against the known risks of influenza are clear. Therefore, children should receive the formulation of TIV available rather than have immunization delayed because of the thimerosal content of the available vaccine; this includes high-risk children with underlying central nervous system disorders.  LAIV does not contain thimerosal.