4 Flu Vaccine Doses for Kids This Fall—but Where and When?

CDC and pediatricians say get the seasonal flu vaccine first, then worry about H1N1 swine flu.


This may go down in history as the most confusing flu season ever, given that a vaccine for the new H1N1 swine flu isn’t yet available, but the plain old seasonal flu vaccine is. Parents are being told that almost all children, from 6-month-old babies up to 18-year-olds, should be vaccinated against both viruses. Since a child who has never had a flu shot should have two doses, that means four doses of vaccine for some kids, should the protection against H1N1 become available.

Talk about a recipe for pandemonium at the pediatrician’s office! "It’s not going to be pretty,” David Tayloe, president of the American Academy of Pediatrics, said today at a briefing by federal health officials and other medical big guns, organized by the National Foundation for Infectious Diseases. “But if we can get the kids in now for their seasonal vaccine, then we can tackle H1N1.”

The “where and how to vaccinate” question is even more confusing because the two vaccines will be delivered in different tracks. Seasonal flu vaccine is being offered through doctors’ offices, hospitals, and retail clinics, as usual. But the H1N1 vaccine, if it passes clinical safety trials now underway and is offered later this fall, will be distributed by state health departments. Each state has its own plan. Some states will offer both seasonal and H1N1 vaccines in schools. Some will provide only seasonal flu doses, some only H1N1. Some states will not have in-school vaccinations at all. The usual rules apply in paying for seasonal flu vaccine; some insurance covers it, some doesn’t. But the H1N1 flu vaccine, if it appears, will be free. Confused enough?

So I’m going with the one-step-at-a-time approach. In our school district, seasonal flu vaccine is being offered for the first time at schools. Parents can choose to have children receive FluMist, which is delivered via nose spray. Since my daughter has never had a flu shot, she’ll need two doses about a month apart. Then I’ll stay tuned for news from the school district and my pediatrician on H1N1 vaccine, but I'll also check the federal government’s flu.gov Web site for updates on whether H1N1 vaccine will be available at all. I hope it will. So far, it seems a much safer bet than getting H1N1 flu.

Parents are understandably concerned about vaccine safety, particularly when faced with the idea of four doses of flu vaccine in one season. In 1976, when a novel swine flu shot was administered, some people came down with Guillain-Barré syndrome, a neurological disorder that can cause muscle weakness and paralysis. There’s debate over whether those cases were caused by the vaccine. Since then, the infection rate for Guillain-Barré after seasonal flu shots has been 1 case per million doses. So far this year, 25 out of every 100,000 children who have come down with H1N1 in Chicago have become so sick they had to be hospitalized because of complications such as infections. So there is risk either way. But at this point, the health risk appears to be considerably higher from H1N1 flu than the vaccine against it.

Another long-simmering safety issue: Some flu vaccines also will have trace amounts of thimerosal, a preservative with very small amounts of mercury. Parents concerned that thimerosal may be causing autism and other disorders have lobbied hard against using the preservative in vaccines, but it’s still used in multi-dose vials of flu vaccine. Thimerosal-free vaccine is being made for seasonal flu, and it should be made for H1N1, too, so if that’s important to you, call your pediatrician pronto and ask to reserve thimerosal-free vaccine.