Influenza Vaccine 2014 - Information for Parents

As pediatricians, we strongly recommend that all children receive Influenza vaccine to prevent Influenza.  Influenza (also known as the flu) is a virus that infects through the nose, throat, windpipe and lungs; the virus is highly contagious between people, as it is spread through respiratory secretions and transmitted by coughing, sneezing or talking.  Typical symptoms include fever, chills, muscle aches, congestion, cough and runny nose and difficulty breathing.  Some people who contract the flu will develop pneumonia and bronchitis, some needing hospitalization.  Unfortunately, some people who contract the flu die each year.  Over 100 children died as a result of Influenza last year.


The Influenza vaccine (flu vaccine) is recommended for everyone 6 months of age and older.  Children under 9 years old require 2 doses of vaccine separated by four weeks if they have never received a flu vaccine before.  There are two versions of the vaccine available for children: nasal and injectable.  Both versions are quadrivalent, which means they are made from 4 different strains of the Influenza virus.
The nasal vaccine (FluMist) is recommended for healthy people between the ages of 2 and 49, and has the advantage of inducing a faster and possibly longer-acting immune response without requiring a shot.  Recent studies indicate that children age 2-8 mount a better immune response to the nasal flu vaccine, so it is strongly recommended in that age group, as long as children do not have underlying lung disease.  FluMist is made from inactivated live virus and is cultured in eggs.  It is given as a nasal spray.  Side effects include mild congestion and  runny nose.
The injectable vaccine (known as a flu shot) is cultured in eggs as well, and the virus is then inactivated with the chemical formaldehyde.  The flu shot can be used in any patients, and is the only form recommended for children 6 months to 2 years old, as well as elderly patients.  Side effects from the flu shot include pain at the injection site, redness at the injection site, muscle aches or low grade fever.
Neither the FluMist or single dose vials of injectable Influenza vaccine contain Thimerosal.


Because the virus particles are completely inactivated, one cannot "get" flu from the flu vaccine.
The Influenza vaccine typically prevents about 70 of every 100 people who receive it from developing moderate to severe influenza infection.  Protection levels vary year to year, depending on which Influenza viruses are circulating, and how closely matched the Influenza vaccine is to the circulating strains.

Acute Neurologic Illness Associated with Enterovirus D-68 ..What's Going on in Colorado

The respiratory illness associated with Enterovirus D-68 has spread to many states at this point, and now a cluster of cases have been found in Colorado with limb weakness, possibly due to the same virus.
Starting in August, Colorado and the CDC have identified a cluster of children 1-18 years of age (median age of 10) with acute focal limb weakness.  At this time, there have been 9 confirmed cases.  Most of the children are in the Denver metropolitan area, and all of them have been hospitalized.  Specific testing has been done, including CSF analysis via lumbar puncture looking for meningitis.  None of the cases had bacteria or virus isolated from the CSF, though there were signs of inflammation present.  Spinal MRI scans showed lesions in the grey matter of the spinal cord, and some had brainstem lesions on MRI as well.  Most children report having a respiratory illness associated with fever in the two weeks prior to developing limb weakness.  No cases have had Enterovirus D-68 in the spinal fluid, although 6 of 8 cases did have Enterovirus D-68 isolated from nasal specimens.  Further testing is being done.
The CDC is working closely with Colorado, and they have posted a health advisory on their website at:
http://emergency.cdc.gov/HAN/han00370.asp