Flu shots

With all the controversy surrounding vaccines, they can be scary. When you are talking about the flu shot, there are many issues surrounding them, especially considering that last year's shot was not particularly effective. You want to keep your child from getting sick, but you don't want him exposed to unnecessary chemicals, and if it's not going to work well, then what is the point? Still I feel that vaccines are very important for us and for public health in general. So I looked to see what Dr. Sears had to say on the matter:

Flu Vaccine Update for the 2008/2009 Season

12:31 PM PDT, October 15, 2008

It’s flu season again, and people are already lining up for their flu shot. Each year, however, the flu shots change to cover what experts predict will be the “going” strains for the coming year. Last year they guessed wrong, and the flu shot wasn’t very effective. Let’s hope they get it right this year (as they did for the few years prior to last year). The available brands are virtually identical to what they were last year as far as manufacturing and ingredients go (including mercury).

The most important thing for infants, children, and pregnant women is to MAKE SURE YOU ARE GETTING A MERCURY-FREE FLU VACCINE. Here are all the flu vaccines for the 2008/2009 flu season:

FLUZONE Shot
This is the only brand approved for all age ranges, from young infants to adults. It comes in four different formulations:

Pre-filled syringe for infants 6 through 35 months – NO mercury.
Pre-filled syringe for children 3 years and older and adults – NO mercury.
Single-dose vial for children 3 years and older and adults – NO mercury.
Multi-dose vial for infants 6 months and older, children and adults – contains the full dose of mercury.

FLUZONE is the only brand of flu shot approved for young infants and toddlers. BEWARE – the multi-dose vial has the full dose of mercury. You have to make sure you are getting a single-dose pre-filled syringe or vial, NOT the multi-dose vial.

FLUMIST Nasal Spray
An alternative to the flu SHOT for young children is the FLUMIST nasal spray. There is no mercury in this formulation. It is approved for children 2 years and older and adults through age 49.

FLUVIRIN Shot
This shot is approved for children 4 years and older and adults. It comes in two formulations:

Pre-filled syringe – has a trace of mercury (see below)
Multi-dose vial – has the full dose of mercury


FLUARIX Shot
This is only for adults 18 years and older. It only comes as a pre-filled syringe with a trace amount of mercury.

FLULAVAL Shot
This is only for adults 18 years and older. It only comes as a multi-dose vial with the full dose of mercury.

AFLURIA Shot
This is only for adults 18 years and older. It has two formulations:

Pre-filled syringe with no mercury
Multi-dose vial with the full dose of mercury

Nasal Spray Versus the Shot?
Overall I have no preference between the two. The nasal spray is a great alternative for anyone who wanted the shot, but can’t find a mercury-free version. It seems that the nasal spray works a little better, but causes flu-like side effects more often. It also shouldn’t be used in anyone with asthma or a history of wheezing. The shot seems to not quite work as well, but may cause fewer side effects.

What is the Difference Between Trace and Full-Dose Mercury?
In trace mercury vaccines, mercury is added to the manufacturing process as a preservative, but is then filtered out at the end before being put into single-dose syringes or vials. A full preservative isn’t needed because this vial or syringe is only opened and used once, and then discarded. The amount of mercury in vaccines that are labeled “trace” is less than 1 microgram. I believe that this amount is completely harmless (as opposed to the full dose).

In full-dose mercury vaccines, the mercury is not filtered out. The preservative is needed for these large 10-dose vials because many doses are drawn out, and the solution needs to stay sterile during that process. The amount of mercury in these large vials is 25 micrograms per dose (any infants through age 3 getting a Fluzone shot from the multi-dose vial with mercury would only be getting a half dose, so each shot would be 12.g micrograms).

Why Not Just Make All Flu Shots Without Mercury?
The challenge is space and money. The five different companies that make the flu shot have to scramble every year to make enough. It costs more money and takes up more manufacturing time and space to put single doses of the flu shot into syringes or single-dose vials, compared to putting 10 doses into larger vials. In order to accommodate the demand, manufacturers have to make most of their product “in bulk” this way. In the future I hope that more companies will change over to mercury-free formulations, or the almost-as-good trace mercury formulations.

Infants and Pregnant Women – Just Say No To Mercury
The debate over whether or not mercury in the flu shot is enough to cause harm continues to rage on, with no clear resolution yet. I believe it is prudent in the mean time to avoid giving any full-dose mercury shots to children under 3 and to pregnant women. What should you do if all you can find is a full-dose version? Just say no, and tell your doctor why. Maybe if enough patients do this, doctors will order and demand more of the mercury-free version for next year. For kids 2 years and older, get the nasal spray instead (this can’t be given to pregnant women).

New Flu Shot Recommendations for This Year?
The ACIP, AAP and CDC have decided that it would be beneficial for all children to get a flu shot every year until age 18. Previously the recommendation was for all children until age 5. They don’t know whether or not to push this new policy for THIS year, or wait until next year, because they don’t know if there will be enough flu vaccine to go around to cover all children and teenagers. They don’t want to make a new policy unless they have enough vaccine to cover it. But whether it goes into effect this year or next, it is now believed by medical experts that it’s best to get a flu vaccine for all children and teens every year.

ALL OF THE INFORMATION IN THE VACCINE BOOK REGARDING FLU SHOTS FOR LAST YEAR IS STILL THE SAME FOR THIS YEAR (with the one exception that in the book I state that Fluvirin brand only has trace mercury, and this they also make a full-dose mercury version). FOR MORE INFORMATION ON DECIDING WHETHER OR NOT TO GET A FLU VACCINE, VISIT www.TheVaccineBook.com

YOU CAN VIEW THE PRODUCT INSERTS FOR THIS YEAR’S FLU VACCINES YOURSELF AT www.fda.gov/cber/flu/flu2008.htm