Editor's note: This article was sponsored by the Washington State Department of Health.
Flu season is always unpredictable, but it’s even more uncertain during a pandemic.
Despite worrisome predictions, last year’s influenza numbers plummeted, largely due to physical distancing, school closures and other COVID-19 precautions people were taking. With some of those restrictions easing and kids back in classrooms, this year could be quite a different story, health officials warn.
“We can’t let our guard down just because we had fewer cases last season,” says Annika Mai Hofstetter, M.D., Ph.D., MPH, a Seattle Children’s pediatrician whose research focuses on vaccination. “There is potential for a severe flu season ahead.”
That potential underscores why it’s so important for children and adults to get vaccinated, which is the best way to prevent flu, she says. Health officials strongly recommend influenza vaccination for everyone ages 6 months and older, including pregnant people, as soon as possible. The flu season runs October–May, typically peaking between December and February. Since it takes the body about two weeks to build immunity after receiving the vaccine, it’s best to prepare now.
“Vaccination is the best preventative measure we have,” says Hofstetter.
What will this flu season be like?
Pediatric deaths caused by flu reached a tragic new high during the 2019–2020 flu season: Nationally, about 200 children died — historically, that’s the highest recorded number of child deaths during a regular flu season. But last year, those figures plunged to one child death, according to the Centers for Disease Control and Prevention (CDC).
That dramatic difference was likely a result of the mitigation and distancing measures taken to prevent the more contagious novel coronavirus.
“In addition to vaccination, we were on top of those other preventative measures,” notes Hofstetter, referring to washing hands, staying home when sick and wearing face masks.
But what happens now, with kids back in school and some of the precautions relaxed? This past summer might offer some unsettling clues. When mitigation efforts were greatly eased this summer, some parts of the country experienced a spike in childhood respiratory diseases, such as respiratory syncytial virus, or RSV. That disease, a common cause of bronchiolitis and pneumonia in children, usually surges in the winter. But like the flu, the illness did not circulate widely last year.
“[This unseasonal surge in RSV cases] could be indicative of what might come over the course of this upcoming flu season, with kids back in school,” says Hofstetter.
Still, some behavioral changes could help. Parents are now more diligent about keeping sick kids home from school, even if it’s “just a cold.” And perhaps the delay in COVID-19 vaccinations for younger children has resulted in a greater appreciation of the widely available flu vaccine.
“Certainly, some parents have seen the downsides of not having a COVID-19 vaccine available,” Hofstetter notes. “But thankfully, children as young as 6 months can receive a flu vaccine for best protection.”
How well do flu vaccines work?
Each year, scientists predict which flu strains will be circulating in the coming season. When vaccines are well matched to the circulating flu, that protection can reduce the risk of contracting influenza by 40–60 percent on average, according to the CDC.
Only time will tell how accurate this year’s predictions turn out to be. But even imperfect flu vaccines are effective in terms of reducing the severe infections that can lead to hospitalization and death, Hofstetter says.
In fact, a recent study published in the journal Vaccine found that vaccinated adults with breakthrough flu cases had lower risks of being admitted to the intensive care unit and death as compared to unvaccinated patients. Children who have been vaccinated against flu were 45 percent less likely to get a fever if they became infected, the same study found.
Where to go?
Along with the pediatrician’s office, there are other vaccination location options for children ages 3 and older, such as area pharmacies and vaccination events. For example, in the Seattle area, grocery store pharmacies, such as QFC and Safeway, offer the flu vaccine, as do drugstore chains such as Rite Aid and CVS Pharmacy.
In Washington state, children ages 18 and younger can get a flu vaccine at no cost, and most insurance plans cover this preventive care for adults.
College students have “strikingly low” flu vaccination rates, according to the National Foundation for Infectious Diseases. Student health services, flu fairs and mobile clinics can play an important service in vaccination outreach to this undervaccinated population, says Hofstetter.
Preparing for the visit
The flu vaccine comes in several forms, such as a standard shot that’s approved for kids 6 months and older, and a nasal mist for children ages 2 and older. Parents can consult with a provider about which flu vaccine formulation is available and the right choice for their child.
The best way to address a child’s concerns about vaccination depends on their age. For older children, it’s often useful to explain why and how vaccination works in preventing illness, says Hofstetter.
For younger children, it’s helpful to address their fears directly. Try saying something like: “The flu shot is just a poke, and the pain quickly disappears. You’ll just have a little soreness at that spot, and you’ll feel better very soon.”
Creating a choice — however small it might seem — also gives the child a sense of control. That control can come in the form of choosing which arm receives the vaccine or which kind of cartoon-themed bandage to pick afterward. For younger children, incentives like stickers can also be helpful.
Last year, pediatricians reported a drop in regular childhood vaccines, a result of some parents’ apprehension about taking their children into a health-care setting. But more than 18 months into the pandemic, health-care providers have taken measures to mitigate caregivers’ fears. Many pediatric practices maintain different waiting rooms for sick and healthy kids. Masking recommendations are strictly enforced, and surfaces are regularly sanitized.
“All of these things have made going to health-care settings quite safe from the risk of exposure to COVID-19, in my opinion,” says Hofstetter.
For those with children who qualify to receive a COVID-19 vaccine, it’s reasonable to get both shots at the same time, Hofstetter notes. Parents often have questions when children are scheduled for more than one vaccine. This practice has been studied and found to be safe and effective for a child’s immune response, according to Hofstetter. But no matter your child’s eligibility to receive the COVID-19 vaccination, Hofstetter urges families not to delay in getting a flu vaccine for the most effective protection heading into the flu season.
Ultimately, among all the unknowns confronting us this year, the best thing parents can do to protect their children is use the tools available to them, Hofstetter advises, adding, “The best time to get vaccinated is now.”
For more information about the influenza vaccine, visit the Washington State Department of Health website.