Wednesday, September 23, 2009

Timing your (and your child's) flu and H1N1 vaccines

When getting your seasonal flu and H1NI flu vaccines this fall, you may need to do a bit of research and planning. While the Centers for Disease Control is saying that vaccines for the seasonal flu and the H1N1 strain can be provided simultaneously or within close timing of one another, a "live" H1N1 vaccine cannot be given at the same time, or within four weeks of, receiving a "live" seasonal flu preventive, such as the popular FluMist vaccine.

Of the four H1N1 vaccines approved by the CDC, three are deactivated (or "killed" vaccines). These will be administered by injection. One of the H1N1 vaccines is a "live" (also referred to as attenuated, which means weakened, or LAIV) vaccine that will be given via a nasal spray. This form will likely be the first H1N1 vaccine released for distribution. (Immunizations for the seasonal flu are available now, and people are being advised to get their flu shots as soon as possible. Live H1N1 (spray) vaccines are expected to be available by October 5.)

The official CDC language about all this is pasted at the bottom of this post, but to translate the talk into a real life application:

I know that with my grade schoolers, the FluMist nasal spray is much preferred over getting an injection. Where I live, the county is administering FluMist to elementary school students for free starting in October. Any person receiving the FluMist will need to wait four weeks before receiving a live H1N1 vaccine. It's now believed that all children age 9 or younger will need a second H1N1 vaccine, which would be administered three or four weeks after the first.

So, for instance, a child receiving a FluMist vaccine at school on October 15 will need to wait until about November 15 before receiving a live H1N1 vaccine, which would be followed in mid-December by the H1N1 booster.

An alternative scenario, and the more likely one since most of the available H1N1 doses won't be live, would be to get the FluMist, or any other "live" flu vaccine, and then receive an inactivated (i.e. "not live") H1N1 vaccine at the same time or later. A concern raised about the all-at-once option, especially by parents, is whether or not two vaccines at the same time might be too much for a child's body to handle. After all, the H1N1 vaccine is brand new and its full impact is still an unknown.

So this flu season, it's important to pay attention to what type of vaccine you and your children are being given—live attenuated vs. inactivated—and then plan accordingly. Low-cost and even free vaccines will be widely available (at schools, clinics, drug stores, supermarkets) in order to prevent an epidemic or pandemic. Unless you and your children receive the flu vaccinations from your family doctor, you'll be the only one keeping track of who in your household got what shot when.

For more information, visit:,,

And check out this AP story: "Flu shot better than nasal spray in adults"

Answers from the CDC Website (posted September 21-22, 2009, purple type is my emphasis)

Can seasonal influenza vaccine and 2009 H1N1 vaccine be given at the same visit?

Both seasonal and 2009 H1N1 vaccines are available as inactivated and live attenuated (LAIV) formulations.... existing recommendations are that two inactivated vaccines can be administered at any time before, after, or at the same visit as each other .... Existing recommendations also state that an inactivated and live vaccine may be administered at any time before, after or at the same visit as each other. Consequently, providers can administer seasonal and 2009 H1N1 inactivated vaccines, seasonal inactivated vaccine and 2009 H1N1 LAIV, or seasonal LAIV and inactivated 2009 H1N1 at the same visit, or at any time before or after each other. Live attenuated seasonal and live 2009 H1N1 vaccines should NOT be administered at the same visit until further studies are done. If a person is eligible and prefers the LAIV formulation of seasonal and 2009 H1N1 vaccine, these vaccines should be separated by a minimum of four weeks.

Can 2009 H1N1 vaccine be administered at the same visit as other vaccines?

Inactivated 2009 H1N1 vaccine can be administered at the same visit as any other vaccine, including pneumococcal polysaccharide vaccine. Live 2009 H1N1 vaccine can be administered at the same visit as any other live or inactivated vaccine EXCEPT seasonal live attenuated influenza vaccine.

Will two doses of vaccine be required?

The U.S. Food and Drug Administration (FDA) has approved the use of one dose of 2009 H1N1 flu vaccine for persons 10 years of age and older.... At this time, FDA has approved two doses for children 9 years of age and younger. Immunogenicity data for the 2009 flu H1N1 vaccine among adults is similar to that for seasonal influenza vaccines. If this is also the case among children, then it is likely that younger children will require two doses and older children will require one dose, as licensed. As with seasonal vaccine, children ages 6 months through 35 months get two doses of 2009 H1N1 flu vaccine that contains one-half the dose used for older children and adults.

What will be the recommended interval between the first and second dose for children 9 years of age and under?

This will not be known until clinical trials are complete. For planning purposes, planners should assume 21-28 days between the first and second vaccination.

1 comment:

Lil said...

Thanks. I never understood what attenuated meant. I didn't realize that there's a significant difference between the flumist and a shot. So much to be aware of.


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