Influenza & Flu Shots – PediaCast 443

Show Notes


  • A simple flu shot can save your life! PediaCast and the U.S. Centers for Disease Control and Prevention team up this week to bring you the latest information regarding influenza, including what to expect this flu season, signs and symptoms of the disease, diagnosis, treatment and prevention. We hope you can join us!


  • Influenza
  • Flu Shots




Announcer 1: This is PediaCast.


Announcer 1: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello, everyone. And welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. 

It is Episode 443 for October 1st, 2019. We're calling this one "Influenza and Flu Shots." I want to welcome you to the program.

So it is that time of year again, time for the leaves on the trees to start changing color, time for apple picking and corn mazes and college football. Soon the kids will be dressing up and going trick-or-treating. 


And after a long hot humid summer, for many of us, at least here on the Midwest, this is a favorite time of the year. However, in the world of pediatrics and parenting, as we think about keeping our children and our families healthy this time of year, we also have to consider influenza because flu season will soon be upon us. 

And it turns out it could be a dozy of a flu season this year as we look at other parts of the world -- Australia, for example -- which often provides a preview of our own upcoming flu season here in the United States. Because the way the virus sort of travels around the globe, it often hits that area of the world first as it makes its way to us.

And this year in Australia, it turns out the flu hit early and hard. Health officials there, they're calling it their worst flu season on record with nearly 260,000 confirmed cases of the flu and 587 deaths.    


Now, the flu of course is contributed to many deaths in the United States in previous years, with 79,000 deaths two years ago. That's the last year with confirmed numbers of all cases. But just let that sink in -- 79,000 deaths in the United States during one flu season two years ago.

And many of these deaths are caused by a common complication of the flu, pneumonia. Kids are not spared, there were 129 pediatric deaths confirmed last year from the flu and 187 deaths the year before that. And many of these deaths occur in healthy children. You know, kids whose parents thought, "Hey, it's just the flu, no big deal. My kids are healthy. They'll fight it off." Until, of course, they do not fight it off. 

The really sad thing is that many of these deaths could have been prevented with a simple flu shot.


And so, in an effort to get the word out about this very big problem, we typically dedicate an entire episode or a part of an episode of this podcast each and every year to the flu and flu shots with the hopes that not only will we improve health literacy about the flu, helping you understand the flu disease itself and why the flu shot is so important.

But we also really hope that we'll save some lives by covering this topic. If we can save just one life, it is worth the effort of repeating this content year after year.

Of course, there's no way to know the impact that we have because parents listen to the show and take our information and warnings to heart double down on their resolve to get flu shots for every member of the family. When their kids lived, we have no idea that their child would have died if they had not received that flu vaccine.

So anyway these are the stakes, a few healthy kids will die from the flu this year and many of these deaths could have been prevented with the flu vaccine.


In a typical PediaCast fashion, we're going to take an in-depth look at influenza today including the cause, signs and symptoms, diagnosis, treatment prevention. And we'll also cover flu shots of course, including the risks. We want to be transparent as you consider risk and benefit of any decision you make as a parent. 

Turns out about 1 to 2 in a million doses of flu vaccine is associated with a severe complication. However, compare that to one 1 in 1,000 cases of flu illness resulting in death from complications of flu infection. So 1 in 1,000 deaths from flu illness compared to 1 in 1 million severe reactions from the flu shot. 

So these are the things we'll be exploring in more detail today as we move forward. 

I have a terrific guest to help us walk through influenza and flu shots. Dr. Fatimah Dawood is joining us. She is a pediatrician and medical epidemiologist with the Influenza Division at the US Centers for Disease Control and Prevention. We'll get her connected to the studio shortly. 


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So, let's take a quick break. We'll get Dr. Fatimah Dawood connected to the studio and then we will back as we explore influenza and flu shots. That's coming up, right after this.



Dr. Mike Patrick: Dr. Fatimah Dawood is a medical epidemiologist and pediatrician at the US Centers for Disease Control and Prevention. She's an expert with the CDCs Influenza Division which makes her the perfect guest for our podcast this week as we explore influenza and flu shots.

So let's give a warm PediaCast welcome to Dr. Dawood. Thanks so much for joining us today.

Dr. Fatimah Dawood: Thank you for having me.

Dr. Mike Patrick: We really appreciate you taking time out of your busy day. 

So what exactly is the flu? I think sometimes doctors and patients and families have a little bit of a different definition. What's the real definition of the flu when we use that term?

Dr. Fatimah Dawood: Well, the flu is a contagious respiratory illness caused by influenza viruses. And it can cause mild to severe illness.

Dr. Mike Patrick: So we really see runny nose, congestion, cough. This is not necessarily the vomiting diarrhea that sometimes folks will call the flu. This is really respiratory in nature, correct?

Dr. Fatimah Dawood: That's correct. Although in children, the flu can also occasionally cause vomiting and diarrhea. But usually the children will also have those other respiratory symptoms that you mentioned.


Dr. Mike Patrick: Yeah, absolutely. And this is something that we see seasonally. We don't usually talk about the flu in the middle of summer. Why is it this time of year we start talking about it again and encouraging folks to get flu shots?

Dr. Fatimah Dawood: Well, the flu season is typically considered October through the Spring. It could be as late as April or May sometimes. So we really encourage people to get their flu shot by the end of October, at the latest. So that they are protected for the duration of the flu season. 

Every year is a bit unpredictable as to when the flu will start to circulate and that's why we want people to get vaccinated by the end of October.

Dr. Mike Patrick: Why do you think that is that we see it in the winter time and then other hemisphere, we see it during their summer, right? 

I'm sorry, during their winter. During their fall and winter and then during our fall and winter. So just at the seasonal kind of ebb and flow, right?

Dr. Fatimah Dawood: That's right. In many places globally, there is a season for influenza as you mentioned and in the US that's typically October through May.


I think Scientists are still trying to understand the reasons why the fu circulates only during those colder periods in some parts of the world. 

Dr. Mike Patrick: Absolutely. And probably to some degree, just from a hypothetical standpoint, if we had to sort of guess, folks when it's cold outside are indoors and schools in session, then it's easier to pass viruses back and forth, right?

Dr. Fatimah Dawood: That's certainly one of the leading hypotheses.

Dr. Mike Patrick: So, tell us in terms of numbers, how many folks get the flu and what is... Ultimately, we're talking about the flu because it can cause deaths, so how many people does the flu affects and then actually kill each year?

Dr. Fatimah Dawood: Well, every flu season is different but what we do know is that on average flu can cause millions of illnesses every season, hundreds of thousands of hospitalizations, and tens of thousands of deaths.


Dr. Mike Patrick: Yeah, so lots. And if you look at numbers since 2015 reported by the CDC, in terms of symptomatic illness since 2015, it kind of ranges between 25 to 49 million cases of the flu. And in terms of deaths of all ages, between 25,000 and 79,000 deaths each year. So, that's comes out about 1 death per 1,000 symptomatic cases. So if you figure, 1 in 1,000 folks with the flu ended up dying from the flu, those are pretty significant numbers.

Dr. Fatimah Dawood: The flu certainly can cause very severe illness, that's right.

Dr. Mike Patrick: And then, who is most at risk as we think about especially severe flu disease and the deaths that possibly can be associated with that?

Dr. Fatimah Dawood: Most people who get sick with the flu will have mild illness and more typically recover in less than two weeks. But as you said, the flu can cause very severe illness and complications as well. It's really important for parents and other listeners to know that even healthy young children can get very sick from the flu.


But as you mentioned, there are some groups that are at higher risk for flu complications. These include our youngest children, those younger than two years of age, as well as older adults who are 65 years of age and older, pregnant women, and people with certain chronic diseases like heart disease, asthma, or diabetes.

People with compromised immune systems are also at high risk for flu complications. 

Dr. Mike Patrick: And so, especially if you're a young child, if you're elderly, if you have a chronic medical condition, you definitely want to think about flu vaccine and talking to your medical provider about how you can best protect yourself from the flu, right?

Dr. Fatimah Dawood: That's right. The flu vaccine is actually recommended for everyone six months of age and older. But if you're one of those higher risk groups that we just talked about, it's especially important to get vaccinated against the flu.

Dr. Mike Patrick: So putting on your scientist hat here again, in terms of flu virus and making people sick, how does that work? What exactly is the flu doing inside of the body that makes it so dangerous?


Dr. Fatimah Dawood: Well, adults and children with the flu can spread it to other people up to about six feet away. And most experts think that the flu viruses spread mainly by droplets. So those droplets are made when people with flu cough, sneeze, or talk. And then, the droplets can land in the mouths or noses of other people or even be inhaled into their lungs. 

Less often, a person might also get the flu by touching a surface or object that has flu virus on it and then touching their own mouth or nose. Then, once the virus enters the body, it then infects or invades cells in the respiratory tract and that causes inflammation. 

In most cases, the flu viruses will infect and cause inflammation in our upper respiratory tracts which includes our noses, our throats and our voice boxes. But sometimes, the flu can also affect the lower respiratory tract down in the lungs, for example.

Dr. Mike Patrick: And when we say it affects it, it really invades those cells and turns them into virus making factories, right? So the cells that normally have a job to do, their job is being transformed into making more flu virus. And ultimately, that destroys the cells in the process. 

Dr. Fatimah Dawood: That's right. 


Dr. Mike Patrick: And then, what sort of signs and symptoms? We talked about it being upper respiratory, runny nose, congestion, cough, sometimes can go down into the lungs. And then, what are the common symptoms that are often seen that would make us think hey this could be the flu that's going on?

Dr. Fatimah Dawood: Well, typically, flu signs and symptoms usually come on suddenly. And as you mentioned, people can have fever or just feel fever. She'll have chills, cough, and sore throat are also common, runny nose, muscle aches, headaches, and often people feel very fatigue or very tired. 

And then, as we talked about earlier, in children particularly, sometimes children will have vomiting and diarrhea with the flu as well. 

Dr. Mike Patrick: And the muscle aches and fever, sore throat, right? In terms of what this looks like. 

Dr. Fatimah Dawood: That's right.

Dr. Mike Patrick: There are other viruses that can cause similar signs and symptoms, so how can we differentiate virus that's not the flu with one that is the flu?


Dr. Fatimah Dawood: Well, flu symptoms can be very similar to the symptoms of the common cold that are caused by other respiratory viruses. Sometimes, flu symptoms come on more suddenly than your average cold symptoms. But really, it's not possible to have for sure if you have the flu or the common cold based on symptoms alone. 

So if your doctor or your child's doctor needs to know for sure whether you or your child has the flu, they need to order a laboratory test. There are several laboratory tests than can be done to detect the flu.

Dr. Mike Patrick: Perfect. And we'll talk more about those in just a few minutes. 

What about getting the flu more than one time and in particular, during the specific flu season? So if you have a child with a high fever, runny nose, cough, you see the doctor, they say you have the flu. Can you get it again later that same season? 

Dr. Fatimah Dawood: Well, there are multiple different types of flu viruses that circulate each season. And so, it's certainly possible, although less common to get the flu more than once. So even if you think you've had the flu, one time during a season and you haven't got vaccinated yet, it's still worthwhile to get vaccinated so you are protected for the rest of the flu season.


Dr. Mike Patrick: Great. A lot of the folks in our audience are kind of sciencey and would like to know details. So there are proteins on the outside of the flu virus that our bodies make antibodies against, correct?

Dr. Fatimah Dawood: That's correct. 

Dr. Mike Patrick: Okay. And so, we've heard like influenza A and influenza B and you hear things like H1N1 and others. And these just really describe the mix of proteins on the outside of the virus. Am I still on the right track here? 

Dr. Fatimah Dawood: That's right. So there are two proteins on the outside of the virus, the hemagglutinin protein and the neuraminidase. And so, when you hear H1N1, the H is referring to the type of the hemagglutinin and the N is referring to the neuraminidase protein. Our flu vaccines are designed primarily to boost our immunoresponse against the hemagglutinin protein.

Dr. Mike Patrick: And each strain, this protein is a little different which is why we have to sort of decide what's going to go into a flu vaccine each year, sort of trying to predict which viruses, which have those specific proteins are going to be circulating. And I imagine that's a kind of a tough job figuring that out. 


Dr. Fatimah Dawood: That's right. Every year, the flu virus changes. And so, every year, we have to develop a new flu vaccine based on the viruses that we think are most likely to circulate that season. 

Dr. Mike Patrick: Is there research going on to try to figure out a universal flu vaccine that might target a protein that is on all strains of flu virus regardless?

Dr. Fatimah Dawood: That is an ongoing area of research and I think our goal for the future. As of now though, we have annual flu vaccines and so everybody does have to get their vaccine each year to be best protected for the viruses that are likely to circulate that season. 

Dr. Mike Patrick: So dreaming ahead, maybe someday, we'll have just one flu shot that everyone can get and it will last for a long time, but that's definitely not in the immediate future. Still lots more science needs to happen before we're there, correct? 

Dr. Fatimah Dawood: That's right.

Dr. Mike Patrick: So you did talk about the only way to know for sure if it is the flu is through testing. What sorts of tests are available to try to figure out if the child has the flu or not?


Dr. Fatimah Dawood: Well, there are several different tests available to detect flu. One of the most common tests is the rapid influenza diagnostic test. And these tests work by detecting parts of the virus, namely, the antigens that stimulate an immune response. 

These tests can provide the results as quickly as 10 to 15 minutes, but they're not as accurate as some of our other flu tests. So one thing to know is that if your child has a negative rapid flu test, but it is flu season, they could still potentially have the flu. 

Other flu tests are called rapid molecular assays and these detect genetic material of the virus. And these rapid molecular assays are more accurate than the rapid influenza diagnostic test that I first mentioned. 

And then, we also have several more accurate and sensitive flu tests. But these are highly specialized and are typically performed in hospital or state public health laboratories. For any of these tests to be done, your healthcare provider has to take a sample from inside your nose or the back of the throat. And so it's usually a swab that's taken and sent off for testing. 


Dr. Mike Patrick: So the genetic tests that are more accurate, those are also I would imagine more expensive and take longer to come back and are usually used more in the hospital setting when someone is sick enough to be in the hospital from the flu. And less likely to be used quickly in the course of an office visit, correct?

Dr. Fatimah Dawood: That's correct. 

Dr. Mike Patrick: And now, I want to just kind of focus in on the rapid flu test that you had mentioned. So the one that most folks would have done in the doctor's office, you mentioned that those are always accurate. What sort of numbers are we looking at in terms of false positives and false negatives, that kind of thing?

Dr. Fatimah Dawood: Well, it really varies depending on how much flu is out there. So I think the most important thing to know is that if you're in the middle of flu season and you have a positive rapid diagnostic test, then you're very likely to be positive. But if you have a negative a rapid diagnostic test, there is still a possibility that you do have the flu. 

And so, when healthcare personnel order these tests, they have to take those statistics into consideration, as well as where we are in the flu season. 


Dr. Mike Patrick: Now, correct me if I'm wrong about this, but if you look at the package insert from a lot of these rapid flu tests, they'll give you a fairly low false negative rate. So you feel like, oh, if it comes back negative, I really feel like this child does not have the flu. But those are done in a very controlled setting.

And then the CDC have done some sort of real world tests of these rapid flu test and found that they weren't quite as accurate as the package inserts might suggest. Have you heard of that or no? 

Dr. Fatimah Dawood: There are a good number of studies looking at the accuracy of these tests in the real world setting. Really, the findings are consistent with what I mentioned, that it really depends on where we are in the flu season. And so, the performance of the test in part is really just the context in which the test is being done. 


Dr. Mike Patrick: So in the middle of flu season, if it's positive, you're definitely likely to have the flu, but if it's negative, there's still a good chance if you have flu symptoms that it could be the flu even with the negative tests. 

Dr. Fatimah Dawood: That's right, there's still a fair chance that you could have the flu. And so, it's always a discussion that you should have with your doctor in determining what to infer from the test results.

Dr. Mike Patrick: So there's going to be a lot of doctors who then don't necessarily do flu tests in the middle of flu season. When you're trying to decide the flu's in my community or not, it may be more useful to do those tests. 


And I only mentioned this because one family may go see their doctor and their child gets a flu test, and then the next-door neighbor, their family goes to see a different doctor who's like, "No, we don't need to do flu test at all if we know the flu is here. And it looks like the flu and acts like the flu, we can call it the flu." 

And both of those are okay, would you agree with that? Those are both ways in which doctors may look at diagnosing the flu in a given flu year. 

Dr. Fatimah Dawood: That's right. A flu test isn't necessarily always a part of deciding how best to treat a person for the flu. It's a decision that's made with your doctor and can depend on the circumstances how sick the person is with the flu, whether they have other underlying conditions, how much we know about what flu is circulating in the community. A variety of factors can go into whether to order a flu test or not.

Dr. Mike Patrick: So your mileage may differ depending on which medical provider you are seeing in the course of the flu season. 

Dr. Fatimah Dawood: That's right. 


Dr. Mike Patrick: So let's say that your child does go see the doctor, maybe gets a flu test, maybe not, but gets diagnosed with the flu. What are next steps then in terms of treating this illness?

Dr. Fatimah Dawood: Well, again, it really depends on each individual case but there are antiviral medications that are available to treat the flu. These are different from antibiotics which fight against bacterial infections. These antiviral drugs fight specifically against the flu and they do come in a variety of forms, pills or liquid medication. There's an inhaled powder, even an intravenous solution. 

These medications are available by prescription though. So you need a prescription for your doctor, healthcare provider to get an antiviral medication.

As I mentioned earlier, most people with the flu have mild illness and they may not necessarily need an antiviral drug. But depending on how sick you or your child are and whether or not you have other underlying conditions that might place you at higher risk for flu complications, you and your doctor will make the decision together about whether an antiviral drug is appropriate.


Dr. Mike Patrick: Is there a best time to start antiviral drugs? Like with an antibiotic, if you have a bacterial infection, even if you've had it  a few days, you can get the antibiotic started and it's going to hopefully work. With the antiviral drug, is there more time sensitivity to getting that started. 

Dr. Fatimah Dawood: Well, we do know that antiviral drugs work best when you start it early. And so, if you think you have the flu and you're sick, you should talk with your doctor as soon as possible to see whether an antiviral drug is appropriate for you or not. 

Dr. Mike Patrick: And certainly, though, if it does have the best likelihood of working, the sooner you get it started. That also means that as soon as you think your child may have flu symptoms, that you get in and have that conversation with your medical provider to see if it would be beneficial to start it, since it's going to work best if you start it early. 

Dr. Fatimah Dawood: That's right. 


Dr. Mike Patrick: What about resistance to antiviral medicines. Is that something that happens like it occurs with the antibiotics and bacterial infections?

Dr. Fatimah Dawood: Antiviral resistance can occur. And every year, CDC actually monitors circulating influence of viruses for resistance to the antiviral drugs that we have available. Unlike antibiotics, for the most part, antiviral resistance isn't associated so much with overuse but occurs more in specific populations. For example, people with immunocompromising conditions where they may shed virus far longer. 

Dr. Mike Patrick: And then, do we see many side effects from the antiviral medications themselves. So as parents are deciding do we just let the flu ride out or do we treat this with an antiviral medication? Are there specific side effects that can happen with the medicine that we ought to consider in making that decision? 

Dr. Fatimah Dawood: Well, like with all medications, antiviral medications do have some side effects as well, but they are for the most part very well tolerated. And most side effects are mild and self-resolving. 


Oseltamivir, our most common antiviral medication, sometimes is associated with some vomiting or nausea. But again, in the studies that they've done, those are typically been mild and self-resolving.

Dr. Mike Patrick: It's sort of hard because if the child has the flu and then they have what you think might be a reaction to the medicine, was it the medicine or was it the flu that caused the vomiting?

Dr. Fatimah Dawood: That's right. That's an important point as well because oftentimes the virus itself can cause those very same symptoms that you might think of as a side effect of a medication.

Dr. Mike Patrick: So I want to move on to talk about complications from the flu. So when we think about the flu infection itself, most common is going to be that sudden onset of high fever, runny nose, congestion, cough, sore throat, muscle aches. But what we really worry about is pneumonia, right, as a complication of the flu? Tell us how that happens and why that's dangerous.

Dr. Fatimah Dawood: Well, pneumonia certainly is one of the more serious complications of the flu and it can occur as we talk about earlier when the influenza virus actually infects cells in the lower respiratory tract in the lungs and results in inflammation.


We know that pneumonia from the flu can result from either influenza virus infection alone or sometimes from infection with the flu virus and the bacteria at the same time. 

Dr. Mike Patrick: So it's really the patient's own mouth bacteria that while your body's fighting the flu virus off can sort of migrate down in the lungs and cause a bacterial pneumonia. And those can be life threatening. 

Dr. Fatimah Dawood: Pneumonia from the flu virus certainly can be life threatening. 

Dr. Mike Patrick: In fact, when you look at those flu death, when we say 1 death per 1,000 cases of flu, a lot of those end up being pneumonia that was the ultimate cause of death, correct? 

Dr. Fatimah Dawood: Pneumonia certainly is one cause of death for influenza. With those deaths, with the estimated deaths from the CDC, one way of estimating deaths is to look at pneumonia and influenza coded deaths from death certificates. And so, in that sense, pneumonia is one of the leading causes of influenza deaths. 


Dr. Mike Patrick: What are some other causes?

Dr. Fatimah Dawood: Well, pneumonia can result in a variety of complications. So we talked about pneumonia as one of the more serious complications. In rare cases, it can also cause inflammation on the heart, myocarditis, inflammation on the brain, encephalitis. In very severe cases, it can even cause multi-organ failures. So for example, respiratory and kidney failure together. So there are  a variety of ways in which the flu virus can cause severe illness that ultimately leads to death. 

Dr. Mike Patrick: And just like bacteria from your mouth can go down in the lungs, they can also go up into the sinuses and up into the middle ear. And so, sinus infections and ear infections are other complications of the flu. 

And then, folks with asthma, it can cause their asthma to get a  lot worse and then that can become life threatening, too, right? 

Dr. Fatimah Dawood: That's right. That's an important thing for people to know. The flu virus can make underlying medical conditions worse for people.


So as you said, for adults or children with asthma, if they have the flu, they may experience an asthma attack that's precipitated by that flu infection. 

Dr. Mike Patrick: One of the other terms that folks hear is swine flu. We heard that in particular a few years back. And the bird flu is another one that we sometimes hear. What do these terms mean? 

Dr. Fatimah Dawood: Swine flu is a respiratory disease that is fairly common in pigs in the winter time. It's caused by influenza A viruses and it typically causes outbreaks of influenza in pigs in the winter just as we see outbreaks of human influenza in humans every year. 

Avian flu viruses or bird flu viruses are diseases caused by infection with influenza A viruses as well. And these viruses are naturally occurring in wild aquatic birds globally. But they can also infect our domestic culture and other bird and animal species. It's important for people to know that avian flu viruses don't normally infect humans but there had been occasional cases reported. 


Dr. Mike Patrick: Yes, it's unusual but it can happen in terms of sort of making that jump between the animal in question whether it's pigs or birds and humans. And then, why is that particularly scary if it does make that jump? 

Dr. Fatimah Dawood: Well, in certain cases, not always, but in certain case, avian flu viruses can cause more severe illness than our typical seasonal influenza viruses. And so, they can result in some of those more severe complications that we talked about earlier such as pneumonia.

Dr. Mike Patrick: And because our bodies have not seen those particular flu viruses before, we really don't have any natural immunity against them, right?

Dr. Fatimah Dawood: That's right. That can certainly be the case. 

Dr. Mike Patrick: When folks do have the flu, we treat it. We'd rather prevent it. What are some of the best ways to prevent getting infection with influenza to begin with? 

Dr. Fatimah Dawood: Well, we know the best way to prevent seasonal flu is to get vaccinated every year. Flu vaccines are recommended for all people six months of age and older. And we now know from a variety of studies that flu vaccines can reduce not just flu illnesses but the doctor's visits, hospitalizations from the flu, and even death from the flu. 


It's really important for parents and other listeners to know that infants younger than six months of age are at very high risk of serious complications from the flu, but they're too young to get vaccinated. 

And so, another strategy for protecting those youngest and most vulnerable infants is actually to provide flu vaccination to pregnant women. There are now a lot of studies that show that vaccinating pregnant moms actually results in antibody transfer from the mom to the developing baby and then protects the young infants during their first few months of life. 

Dr. Mike Patrick: So flu vaccine's for everyone. Six months and older, also pregnant women to protect those who are six months and under. And really, that's the biggest way to prevent the flu, correct?

Dr. Fatimah Dawood: That's right.

Dr. Mike Patrick: And then, what are some things that you can do otherwise during the flu season to help prevent transfer of the virus? 


Dr. Fatimah Dawood: Well, in addition to getting a flu vaccine, there are other everyday preventive actions that people can take and this include avoiding contact with people who are sick or if you yourself or your child is sick staying home or keeping your child home while they're sick. And then, covering your mouth and nose with a tissue if you cough or sneeze. 

Dr. Mike Patrick: So the ways that you prevent all viral infections, correct? 

Dr. Fatimah Dawood: That's right.

Dr. Mike Patrick: As we look at the flu, there are various forms of flu vaccine that's available. What are the choices in terms of the type of vaccine that we can give our kids and give ourselves, too. 

Dr. Fatimah Dawood: There are a number of different flu vaccines available this upcoming season. So this include standard dose flu shots, high-dose flu shots, flu shots with adjuvants which are substances that enhance the body's immune response to the vaccine. And then, even a flu vaccine nasal spray this season. 

For children six months of age and older, they can receive either an age-appropriate flu shot. Or if they're at least two years of age, they can also get the flu vaccine nasal spray in most cases. The high-dose flu shot and the flu shots with adjuvants that I mentioned are licensed specifically for older adults, those 65 years of age and older. 


Dr. Mike Patrick: And really, just talking with your medical  provider, they'll be able to guide you on which is going to be the best form of flu vaccine for you or your children.

Dr. Fatimah Dawood: That's right. 

Dr. Mike Patrick: Then question I think that a lot of folks have then is are flu shots safe? 

Dr. Fatimah Dawood: Yes, flu shots are very safe and they have a good safety record. Hundreds of millions of Americans have safely received flu vaccine over the past 50 years. And so, it's important for parents and other listeners to know that there's been extensive research around the safety of flu vaccines.

Dr. Mike Patrick: And they're not a 100% safe. Really nothing is 100% safe. Even walking outside, driving your car in the highway is not 100% safe. It ends up being that there's about 1 to 2 severe complications from flu vaccine per million doses that are given. 


Dr. Fatimah Dawood: Every year, the CDC monitors for adverse effects from all vaccines. And so, it's an ongoing area of surveillance that CDC works on. 

Dr. Mike Patrick: The numbers that I've seen from the CDC are about 1 to 2 cases per million doses of flu vaccine given. But when we compare that to 1 death per 1,000 cases of flu disease, if we're looking at a risk benefit sort of way, the benefit of the flu vaccine definitely outweighs any risk that would be associated with it. Would you agree with that?

Dr. Fatimah Dawood: I would agree with that. 

Dr. Mike Patrick: And then, what about egg allergy? That's another one in the past. We've heard "Well, if I had an allergy to egg, I can't get a yearly flu vaccine." Is that still true?

Dr. Fatimah Dawood: The flu vaccine is actually recommended for people with egg allergy. So there are a variety of flu vaccines available as I mentioned. The most important thing is to talk with your health care provider about the most appropriate flu vaccine for you.


Dr. Mike Patrick: And especially if you have a history of anaphylaxis, so very severe allergic reaction to eggs, you definitely want to talk to your medical provider and perhaps an allergist. But if you didn't have the severe kind of reaction, then it is okay to get a flu vaccine. But talk to your medical provider about that. 

So another question I think a lot of folks have -- and we kind of touch upon this already but I just want to sort of drive it home -- is that you really do have to get a flu shot every year. So last year's flu shot is not good for this flu season. Why do we have to get one every year? 

Dr. Fatimah Dawood: Well, the flu vaccine is designed to protect against three or four flu viruses that research indicates are most likely to spread and cause illness in the upcoming season. And flu viruses are constantly changing. So that's why the vaccine composition is reviewed every year and updated.

And the updates are based on several factors. They're based on looking at which flu viruses are most likely to make people sick, the extent to which the viruses are spreading, and how well the previous season's vaccine protected it against those viruses.  


Dr. Mike Patrick: Great. And then, tell us one more time, who should get a flu vaccine?

Dr. Fatimah Dawood: Everyone six months of age and older should get a flu vaccine, but especially those people in certain high risk groups. Children who are younger than two years of age, so six months through under two years of age, people older than 65 years of age, pregnant women, and people with underlying chronic medical conditions. 

Dr. Mike Patrick: Great. And where can folks go to get a flu shot? 

Dr. Fatimah Dawood: There are a variety of places now where people can get a flu shot. Your doctor's office is one place but flu shots are now available in pharmacies, grocery stores, sometimes in schools, around the workplace. So, there are a variety of places where you can get a flu shot this upcoming season. 

Dr. Mike Patrick: And one more caveat, if it's your first year ever getting a flu shot and you're under the age of eight, then you're going to need two flu vaccines at least 28 days apart, correct? 

Dr. Fatimah Dawood: That is correct. 


Dr. Mike Patrick: So something to think about. And really, it's time now, right? Time to get those flu shots right now because they take a couple of weeks before we have maximum immunity and it's really working for us. And in a couple of weeks, we could start to see flu activity in the United States, we just don't know.

Dr. Fatimah Dawood: That's right. That's why everyone should go out and get their flu vaccine. Now is the perfect time and we recommended getting vaccinated by the end of October at the latest.

Dr. Mike Patrick: Great. And I had my flu shot. So I'm protected. I actually got a little fever after getting the flu vaccine that evening. That's fairly common, right?

Dr. Fatimah Dawood: Some fever after getting the flu vaccine is common. It's usually mild and self-resolving, but it's actually a sign that your immune system is doing what it should and creating a response to the vaccine so you'll be protected later on.  

Dr. Mike Patrick: And muscle aches and maybe a mild headache and just sort of feeling blah can happen along with that fever. But as you said, it's short lived and that's just our body's immune system doing what it's supposed to do. 

Dr. Fatimah Dawood: That's right. 


Dr. Mike Patrick: We really appreciate you taking time to chat with us about the flu and flu vaccines. There is a terrific information at the CDC website. We'll put a link to that in the show notes for this episode, 443, over at if you're interested in where flu is active in the United States at any given time this upcoming flu season. 

You want more hints on preventions, symptoms, diagnosis, treatment, all of that's at and again, we'll put links to that in the show notes. 

So Dr. Fatimah Dawood, medical epidemiologist and pediatrician with the Influenza Division of the Centers for Disease Control and Prevention, thanks again for joining us today. 

Dr. Fatimah Dawood: Thanks for having me. 



Dr. Mike Patrick: We are back with just enough time to  say thanks to all of you for taking time out  of your day and making PediaCast a part of it. Really do appreciate that. 

Also, thanks again to our guest, Dr. Fatimah Dawood, medical epidemiologist and pediatrician with the Influenza Division at the Centers for Disease Control and Prevention.

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Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.



Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.

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