Expert Advice -- The Flu Vaccine

My three-year-old son's pediatrician recommends he receive the flu shot, due to his chronic problems with asthmatic bronchitis. Further, he recommends the shot provided by his office at a much higher cost than those given by my company. My insurance does not pay for the flu shot. Should my son get the shot, are there differences between the shots being offered, and does it matter which one he receives?


Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

The flu shot is an important immunization for many people, both young and old. Although current recommendations specifically target certain people as ideal candidates for the vaccine, anyone who receives it has the potential of deriving significant health benefits. This is the major reason many companies and communities offer free or low-cost flu shots.

The vaccine itself is interesting because its contents change from year to year. In fact, it is somewhat of a gamble whether or not the vaccine will contain the correct components by the time the flu hits the United States. There are many strains of flu that circulate the globe, but to be effective, the vaccine can only hold components against three of those strains. And it takes several months for the manufacturers to produce enough vaccine for the population. Therefore, the decision of what to put in the vaccine is made in the spring prior to the next winter's flu season. In other words, a guess is made nine months in advance about which three strains will most likely infect people of the U.S. If the guess is wrong, people vaccinated for the flu may still get it. Luckily, the folks at the Centers for Disease Control in Atlanta have gotten pretty good at predicting this.

Next page: Is there a difference in the vaccines?

Based on the CDC predictions, the manufacturers of the flu vaccine, Connaught, Evans Medical and Wyeth-Ayerst, all make the same kind of vaccine, containing the same components. The only difference between vaccines for any given year is that they come in two forms: split and whole. The split form contains parts of the virus, while the whole form contain the whole, inactivated virus. Both work equally well, but the split form is often recommended for children because it tends to cause less fever than the whole form.

The vaccines provided by your company and your pediatrician work equally well, but the split form is recommended for children. I suspect your pediatrician is recommending his office's vaccine because your company may be offering only the whole form. However, I would definitely check on this. If your company is offering the vaccine to its employees and their family members, there's a good chance they're offering both forms. If that's true, I would certainly recommend getting the free split form over the expensive split form. But keep one thing in mind: A child under nine years of age who has never had the flu vaccine requires two shots, spaced one month apart. So, you'll need your child to get two shots if he fits in this category.

As for recommendations on which children should receive the vaccine, they include:

• Residents of any chronic-care facility that houses those with chronic medical illnesses

• Anyone who has a chronic disorder of the lungs or heart, including children with asthma

• Those who require medical follow-up of metabolic diseases, kidney problems, diabetes, red blood-cell problems such as sickle cell disease or immune-suppressed children.

• Those on long-term aspirin therapy

• Those with a history of multiple ear infections

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