The dreaded flu season is almost upon us again. Over the last year there have been many articles harping on the importance of the influenza vaccine, especially in high risk patients such as asthmatics. I have several articles on my desk showing only a 10-25% influenza vaccination rate in children with moderate-severe asthma. Influenza vaccination has been shown to reduce asthma related exacerbation to the influenza infection in both adults and children. Some reasons that are suggested for the poor vaccination rate include deferral of vaccination in asthmatic patients who are symptomatic and/or who are on steroids. Another barrier appears to be a perception of the public that the flu vaccine is associated with local and systemic side effects. Because the availability of the vaccine occurs just a short time before the onset of the flu in our community there is only a small window in time when vaccination will result in timely titers. To help answer the questions about safety and efficacy of the vaccine during an asthma exacerbation (which is an all too common occurrence in the fall), Park et al. studied 50 children in the midst of an asthma exacerbation and who were on prednisone versus a controlled group of 50 children without asthma. The study showed that the vaccine was well tolerated by all participants in the study and those patients on a short term prednisone dose acquired protective titers. This study does not generalize to patients on chronic prednisone therapy. This study emphasizes the importance of giving the vaccine and suggests vaccination even during an illness. The authors even suggest that Emergency Rooms may wish to immunize patients when they are seen there. A study sponsored by the CDC noted that asthmatic children who receive the vaccine were 40% less likely to have an asthma exacerbation during the flu season.

Another study by Nichol et.al. looked at healthy working adults who received the vaccine. They discovered that most of the systemic adverse effects were a result of coincidental illness or a heightened somatic awareness after vaccination.

Contraindications to the vaccine include egg and chicken allergy and a prior hypersensitivity reaction to vaccine. The influenza vaccine is produced in embryonated eggs. There are several preparations which include inactivated whole-virus and the subvirion which is commonly called "spilt-virus". Children under 13 years old should receive the split-virus due to less adverse effects. Adults can safely receive either preparation. The dosing of the influenza vaccine is clearly written in the Red Book and often clearly laid out in the inserts. For those 3yrs and less - 0.25cc IM and for those 3yrs and older - 0.5cc IM. For anyone under nine who is receiving influenza vaccine for the first time, two doses given one month apart are required.

There is an intranasal vaccine currently being studied and it is looking promising.

As the summer is coming to an end we need to start reminding our patients to get vaccinated for the flu season.