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Children, the Flu, and the Flu Vaccine

Influenza is dangerous for children

Influenza (“the flu”) is more dangerous than the common cold for children. Each year, many children get sick with seasonal influenza; some of those illnesses result in death.

  • Children commonly need medical care because of influenza, especially before they turn 5 years old.
  • Severe influenza complications are most common in children younger than 2 years old.
  • Children with chronic health problems like asthma, diabetes and disorders of the brain or nervous system are at especially high risk of developing serious flu complications.
  • Each year an average of 20,000 children under the age of 5 are hospitalized because of influenza complications.
  • Flu seasons vary in severity, however some children die from flu each year. During the 2013-2014 influenza season, more than 100 flu-related pediatric deaths were reported. More information about pediatric deaths since the 2004-2005 flu season is available in the interactive pediatric death web application.

The single best way to protect your children from the flu is to get them vaccinated each year.

The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season. Traditional flu vaccines (called trivalent vaccines) are made to protect against three flu viruses; an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus. In addition, there are flu vaccines made to protect against four flu viruses (called “quadrivalent” vaccines). These vaccines protect against the same three viruses as the trivalent vaccine and an additional B virus.

What kinds of flu vaccines are available for children?

  • The trivalent flu vaccine protects against three flu viruses; two influenza A viruses and an influenza B virus. The following trivalent flu vaccines will be available:
    • standard dose trivalent shots that are manufactured using virus grown in eggs. These are approved for people ages 6 months and older. There are different brands of this type of vaccine, and each is approved for different ages.
  • The quadrivalent flu vaccine protects against four flu viruses; two influenza A viruses and two influenza B viruses. The following quadrivalent flu vaccines will be available:
    • a standard dose quadrivalent shot. One brand is approved for people 6 months and older while others are approved for those 3 years and older.
    • a standard dose quadrivalent nasal spray, approved for healthy* non-pregnant people 2 through 49 years of age (recommended preferentially for healthy children 2 to 8 years old when immediately available and there are no contraindications or precautions).

Starting in 2014-2015, CDC recommends use of the nasal spray vaccine (LAIV) for healthy* children 2 through 8 years of age, when it is immediately available and if the child has no contraindications or precautions to that vaccine. Recent studies suggest that the nasal spray flu vaccine may work better than the flu shot in younger children. However, if the nasal spray vaccine is not immediately available and the flu shot is, children 2 years through 8 years old should get the flu shot. Don’t delay vaccination to find the nasal spray flu vaccine. For more information about the new CDC recommendation, see Nasal Spray Flu Vaccine in Children 2 through 8 Years Old or the 2014-2015 MMWR Influenza Vaccine Recommendations.

(*“Healthy” in this instance refers to children 2 years through 8 years old who do not have an underlying medical condition that predisposes them to influenza complications.)

A complete list of influenza vaccines that are available for the 2014-15 season can be found on CDC’s influenza website.

Your child’s health care provider will know which vaccines are right for your child.

  • CDC recommends that everyone 6 months of age and older get a seasonal flu vaccine.
    Keep in mind that vaccination is especially important for certain people who are high risk or who are in close contact with high risk persons. This includes children at high risk for developing complications from influenza illness, and adults who are close contacts of those children.

For the complete list of those at high risk, visit People at High Risk of Developing Flu–Related Complications.

There are special vaccination instructions for children aged 6 months through 8 years of age

Some children 6 months through 8 years of age require two doses of influenza vaccine. Children in this age group who are getting vaccinated for the first time, as well as some who have been vaccinated previously, will need two doses. Your child’s health care provider can tell you whether two doses are recommended for your child.

The 2009 H1N1 virus that caused the 2009 H1N1 influenza pandemic continues to circulate. A 2009 H1N1-like virus wasn’t added to the seasonal vaccine until the 2010-2011 flu season. This means that children who did not get the 2009 H1N1 vaccine in 2009-2010, or a seasonal flu vaccine in 2010-2011 or later, will not be fully protected from the 2009 H1N1 virus until they receive two doses of the 2014-2015 flu vaccine.

The first dose should be given as soon as vaccine becomes available.

The second dose should be given at least 28 days after the first dose. The first dose “primes” the immune system; the second dose provides immune protection. Children who only get one dose but need two doses can have reduced or no protection from a single dose of flu vaccine.

If your child needs the two doses, begin the process early. This will ensure that your child is protected before influenza starts circulating in your community.

Be sure to get your child a second dose if he or she needs one. It usually takes about two weeks after the second dose for protection to begin.

Recommendations on the control and prevention of influenza are published annually, in late summer or early fall. Existing recommendations are available at Seasonal Influenza Vaccination Resources for Health Professionals. Updated recommendations for the 2014-2015 season, including the current recommendation regarding the preferential use of nasal spray vaccine in healthy children 2 to 8 years old, is available on the CDC website.

Some children are at especially high risk

Children at greatest risk of serious flu-related complications include the following:

  1. Children younger than 6 months old
    These children are too young to be vaccinated. The best way to protect them is to make sure people around them are vaccinated
  2. Children aged 6 months up to their 5th birthday
    It is estimated that each year in the United States, there are more than 20,000 children1 younger than 5 years old who are hospitalized due to flu. Even children in this age group who are otherwise healthy are at risk simply because of their age. In addition, children 2 years of age up to their 5th birthday are more likely than healthy older children to be taken to a doctor, an urgent care center, or the emergency room because of flu. To protect their health, all children 6 months and older should be vaccinated against the flu each year. Vaccinating young children, their families, and other caregivers can also help protect them from getting sick.

    1Thompson W, Shay D, J, Weintraub E, et al. Influenza-Associated Hospitalization in the United States. JAMA 2004; 292 (11):1333-1340.

  3. American Indian and Alaskan Native children
    These children are more likely to have severe flu illness that results in hospitalization or death.2,3

    2CDC. Deaths Related to 2009 Pandemic Influenza A (H1N1) Among American Indian/Alaskan Natives --- 12 States, 2009. MMWR. 2009;58(48);1341-1344.
    3CDC. Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR. 2010; 59(No.RR-8).

  4. Children aged 6 months through 18 years with chronic health problems, including:
    • Asthma
    • Neurological and neurodevelopmental conditions [including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy (seizure disorders), stroke, intellectual disability (mental retardation), moderate to severe developmental delay, muscular dystrophy, or spinal cord injury].
    • Chronic lung disease (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis)
    • Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)
    • Blood disorders (such as sickle cell disease)
    • Endocrine disorders (such as diabetes mellitus)
    • Kidney disorders
    • Liver disorders
    • Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)
    • Weakened immune system due to disease or medication (such as people with HIV or AIDS, or cancer, or those on chronic steroids), and
    • Children who are receiving long-term aspirin therapy

Children should be vaccinated every flu season

Children should be vaccinated every flu season for the best protection against flu. For children who will need two doses of flu vaccine, the first dose should be given as early in the season as possible. For other children, it is good practice to get them vaccinated soon after flu vaccine becomes available, ideally by October. However, getting vaccinated even later can be protective, as long as flu viruses are circulating. While seasonal influenza outbreaks can happen as early as October, most of the time influenza activity peaks in January or later. Since it takes about two weeks after vaccination for antibodies to develop in the body that protect against influenza virus infection, it is best that people get vaccinated so they are protected before influenza begins spreading in their community.

*"Healthy" indicates persons who do not have an underlying medical condition that predisposes them to influenza complications.

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