Flu Shots are Important; Especially for Kids with Asthma

by Carole Jackson, Bottom Line Health

Here comes flu season — so let’s not beat around the bush. Children with asthma can be extremely vulnerable to serious — even life-threatening — complications from the flu. So with rare exceptions, they should receive the flu vaccine, according to the CDC. (Yes, it’s true that a meta-analysis published in The Lancet Infectious Diseases on October 26, 2011, showed that the vaccine was only 59% effective in people ages 18 to 64, but some protection is still better than none.)

You’re probably thinking: But my child’s asthma is under control, so why does it matter? Sure, the better-controlled a child’s asthma is, the better he/she can defend against the flu and withstand respiratory infections. But even when asthma is well-controlled, there still is extra danger when flu season starts, because a flu infection could trigger an asthma attack.

Why am I bringing this up right now? Because, according to a new survey of families with asthmatic children, a surprising one-third of parents say that they will not have their asthmatic child vaccinated against the flu. Heading up the research was Toby Lewis, MD, a pediatric lung specialist at C.S. Mott Children’s Hospital in Ann Arbor, Michigan. She worries that families may be making their decisions without having all the facts.

In the survey, the reasons that parents list for not giving their child the flu vaccine include the belief that flu is not an important trigger of asthma… the belief that the vaccine can actually cause flu… the belief that the vaccine doesn’t help prevent flu… and the belief that the flu vaccine isn’t safe. But these are incorrect.

Obviously, this is extremely frustrating news for medical professionals, but Dr. Lewis says that the purpose of the research was to better understand parents’ concerns so doctors could address them directly. Dr. Lewis has debunked each misconception, one-by-one…

Myth #1: Flu isn’t an asthma trigger.

Most people are familiar with the general misery that an influenza infection can cause — such as fever, aches and pains, severe cough and chest congestion. But for people with asthma, all of those symptoms can be accompanied by an asthma attack. At a minimum, this might mean that your child has to miss an extra day of school or take more breathing medications. But in severe cases, the asthma attack can literally “take his/her breath away” — making it difficult for your child to inhale and requiring care in an emergency room or even hospitalization.

In fact, the majority of hospitalizations for asthma are presumed to be brought on by viral infections, which include flu and nonflu infections, said Dr. Lewis. Looking at it another way, people with asthma were among those at highest risk of being hospitalized from influenza during the recent 2009 outbreak, according to a study reported in BMJ (formerly British Medical Journal), because the virus caused inflammation in the airways, triggering spasms and wheezing. A flu vaccination could keep an asthmatic child out of the hospital.

Myth #2: The flu vaccine can cause flu.

Parental anxiety on this topic comes from a misunderstanding about the way vaccines establish protection in the body, Dr. Lewis said. She describes the vaccination as a “training exercise” that teaches the body’s immune system to recognize and fight off particular germs. In the process, though, the stimulation of the immune system can sometimes create a low-grade fever and “blah” feelings for a day or two — but this is not nearly as bad as having a natural infection with the flu. The ultimate payoff for this brief response to vaccination is that when the real flu virus comes along, the immune system knows right away how to fight off the germ. (Of course, if a child’s immune system isn’t functioning well for some reason, even a vaccine might not allow it to beat back the flu.)

Myth #3: The flu vaccine doesn’t actually prevent flu.

The flu vaccine is not perfect — each season, a vaccine is produced to combat the particular strains of flu believed to be headed our way. This year’s vaccine protects against three strains of flu that are holdovers from last year (the H1N1 “swine flu” virus and two other strains that are anticipated to be going around during this flu season). But even if a brand new strain were to make a surprise appearance this year, Dr. Lewis noted, the current vaccine may still enable the body to put up greater resistance to it, making any sickness milder and, even more importantly, reducing the chance for dangerous asthma episodes.

Myth #4: The flu vaccine isn’t safe.

Some parents also express worry about the vaccine’s safety or wonder if the vaccine is right for their children. Dr. Lewis notes that there is a large body of scientific evidence supporting the safety of influenza vaccines and also encourages families who may have these sorts of concerns to talk directly with their children’s doctors.

If you’re looking for something to worry about, there is one real — but extremely rare — risk worth noting. Two studies, according to the CDC, have suggested that approximately one person out of one million vaccinated people may be at risk for Guillain-Barré Syndrome (a severe paralytic illness) associated with the seasonal flu vaccine, though doctors aren’t sure why.

While it’s safe for most kids to get the flu vaccine, there are exceptions to the rule. These are some general guidelines from the CDC as to specific medical situations that should be discussed with a doctor before getting the flu shot…

  • Children who have hepatitis or another chronic illness or who are on certain drugs, including some types of immunosuppressive therapy, should be evaluated by specialists in these areas. Then the decision about getting a flu vaccination should be made on a case-by-case basis.
  • Children who have a severe allergy to chicken eggs, as the vaccine may contain traces of egg protein.
  • Children who have had a severe reaction to an influenza vaccination or any of its ingredients, such as the preservative thimerosal. (Thimerosal-free versions of the vaccine are available for those who need it.)
  • Children younger than six months of age (influenza vaccine is not approved for this age group).
  • Children who have a moderate-to-severe illness with a fever (they should wait until they recover to get vaccinated).
  • Children with a history of Guillain-Barré Syndrome.

Doctor’s Orders

 The flu vaccine can be administered either as a shot or, for healthy children over the age of two, as a nasal spray. While many parents would prefer to choose the spray to spare their children the shot, this is not advised for children with asthma. The reason: When the vaccine is delivered through a shot, it contains only dead viruses, but the nasal vaccine contains weakened though still live viruses. Children with asthma have sensitive respiratory systems and might react to the live viruses with a runny nose and other minor cold-type symptoms.

Dr. Lewis acknowledges that even parents who don’t get their asthmatic kids vaccinated are trying to do what is best for the children. Unfortunately, she says, the decision not to vaccinate against the flu is usually based on misunderstandings of what the risks truly are. “The flu is not just a regular cold,” she said. It is a difficult sickness to go through, and the risk of having a bad asthma attack from the flu, according to Dr. Lewis, “is many times worse than the risks usually associated with the vaccine.”


Toby Lewis, MD, MPH, associate professor, department of pediatrics and communicable diseases, C.S. Mott Children’s Hospital, Ann Arbor, Michigan, and lead author of a study on asthmatic children and flu vaccine.