- MOST RECENT FLU SHOT UPDATE FROM TORONTO PUBLIC HEALTH OCTOBER 11, 2016 FROM DR. VINITA DUBEY, AN EXCELLENT PUBLIC HEALTH OFFICIAL: I agree with your concerns about vaccine hesitancy regarding the flu vaccine, especially in the midst of different recommendations for flu vaccination between the US and Canada. We know it is very confusing for parents, and even for clinicians who are not as up-to-date with the recommendations from various bodies.
At Toronto Public Health we support the Canadian National Advisory Committee on Immunization’s (NACI) recommendations before our American counterparts (ACIP). There are always different recommendations between the two groups. For example, ACIP has not yet gone to a 2-dose adolescent HPV vaccination program while we have in Canada.
With the help of Public Health Ontario, we had the opportunity to understand where the NACI recommendation got its evidence and how it was able to make a different recommendation for the same vaccine. On Wednesday October 11th, Public Health Ontario presented rounds on the data. The slides and audio will be available but are not yet up. They will be available here. In summary, based on some RCTs from Canada, and even studies from Europe, Flumist was not less effective than injection vaccine, but it was equivalent. Also, Flumist is a live attenuated cold adapted temperature sensitive vaccine. The H1N1 vaccine component used the A/California strain in previous vaccines; it was very labile and temperature sensitive. The vaccine was distributed in the summer months. There is some question as to whether this caused the H1N1 component of the vaccine to be less effective as we know that perfect cold chain procedures are not always adhered to. In the current Flumist vaccine, the A/Bolivia strain is used for the H1N1 component which is seen to be more temperature stable. In Canada, UK and Finland, the reduced vaccine effectiveness for the H1N1 strain was not seen.
The recommendation from Canada is that either vaccine-nasal spray or injection, can be used in children 2 to 17 years of age. Some parents and children may prefer the nasal spray. We know that the rates of needle phobia can be about 10%. If you do not feel comfortable recommending the nasal spray vaccine, you can certainly give the injectable vaccine for children. NACI has said they are equally efficacious.
As for the issue of vaccine hesitancy, I think the response to parents is that our surveillance of vaccines is working. NACI has previously had Flumist as a preferential recommendation, which it downgraded. The US based their decision on US only data and did not look at other European or Canadian data.
In summary, the issue is complex. Different studies show different things for different strains.
- Up-date for Flu-shot recommendations for the 2016/2017 Season: We recommend the yearly flu shot for all our patients once they are older than six months. You may request flu shots for your children, once the shots are available in early October, whenever you see your doctor for a visit (unless your child is too ill for an immunization), or you can make an appointment with our nurse Jane Marie Swain if your child is between six months and five years old. Once your child is five years old, flu shots can be given in your local drug store by the pharmacist (ask the pharmacist for availability). As well, flu shots for the whole family are available in your local Toronto Public Health Flu Clinic. You can use the intranasal flu vaccine FLUMIST® available in the local drug store for children older than two years.
- For the latest on Zika virus information, please go to the following resources:
CDC Zika website, http://www.cdc.gov/zika
AAP Zika website, www.aap.org/zika
Information for clinicians from the CDC, http://1.usa.gov/1PNfhuC
Information for parents, http://bit.ly/1SUbiTi
Pan American Health Organization Zika website, http://bit.ly/1WYeZqt
- Please note that Toronto Public Health has updated their recommendation for Hepatitis A prophylaxis after exposure to Costco “Nature’s Touch Organic Berry Blend” products as of April 22, 2016: Toronto Public Health now recommends that individuals 6 months of age and older should be offered Hepatitis A vaccine as soon as possible and within two weeks of exposure. This recommendation is different from the recommendation I have provided to patients until now, which was based on telephone consultations with Toronto Public Health and on the latest edition of the American Academy of Pediatrics “Red Book”, which is to generally not immunize contacts in Community Outbreaks. Different authorities give different recommendations, and for different reasons (not only scientific ones); thus it is often confusing for both us and patients to be given different recommendations and in the end one has to weigh the circumstances to one’s best ability (likelihood of infection, likelihood of complications, side effects of treatment, motivation for industry and agencies to protect patients’ – but also their own – interests).
- For the newest developments regarding Zika virus, please refer here.
- Many patients are unaware of the significant medication shortages in different areas of pharmacology; a recent article can be found here.
- An excellent article on “The Coddling of the American Mind” appeared in the Atlantic and is hyperlinked for you here. By early 2016, there were several important antibiotics we had used extensively for our patients in the past that were no longer available, such as Ceclor, Pediazole, Suprax and, most recenlty, Clavulin. Even Penicillin suspension is unavailable.
- as of February 10, 2015, there have been reports of a small number of Measles cases in Toronto (11 cases as of February 22, 2015) and in Quebec. Our patients are receiving measles shots (in the form of MMR) just after their first birthday and at 18 months and do not need a third shot between four and six years (please refer to my immunization hand-out): the MMR shot is only needed between four and six years if a child has not received the MMR at 1 year and again at 18 months.
- For an excellent overview on the vaccination debate, see: Seth Mnookin: “The Panic Virus”, Simon & Schuster, 2011
- Reminder: when treating fever, please remember that there is no medical reason to treat the fever (as fever is not the problem but rather one of the body’s ways to respond to an infection) but that the only reason to treat is to make the child feel more comfortable (which is important). I recommend using acetaminophen (Tempra® or Tylenol®) rather than ibuprofen(Advil®) as ibuprofen can – albeit rarely – cause kidney problems.
- Reminder: children should be in their car seats up to an age of 4 years; between 4 and 8 they should be in a booster seat unless they are taller than 4’9″.
- If you are interested in new thoughts on children and screen time, you may be interested in a National Pubic Radio Blog on the issue 😉
- Please note the new information on Flu shots and on Bexsero (a new immunization against Meningococcus Type B meningitis) in the immunization hand-out.
- For the latest news on Ebola patients treated outside of Africa (as per January 5, 2015), you can go here.
- An excellent article on immunizations from the Globe and Mail can be found here (February 2015)
- A superb resource to find Mental Health Services in Toronto can be found here.