Tamalpais Pediatrics

Influenza Vaccine Overview:

The Flu Vaccine for this winter contains three strains of Influenza, as it always does. One of the strains is the H1N1 strain that was in the past two years' flu vaccine. The other two strains are new this year – an H3N2 strain and a B strain of Influenza. The decision on which three strains are included in the vaccine is made by Influenza and Public Health experts who monitor the Influenza activity around the world over time and make predictions for which strains will cause disease in the United States this winter.

We follow the CDC and AAP guidelines and recommend that all children 6 months and up receive the Flu Vaccine. Please see the Flu Shot Recommendations tab for details.

Because healthy school-aged children are so likely to get Influenza, we strongly encourage them to get the Flu Vaccine. Influenza outbreaks often center around schools, and by immunizing these kids we can protect them, their families and the entire community.

Some children will need two doses of the Flu Vaccine this winter, depending on whether they have ever received the flu vaccine in the past. Check the "One vs. Two Doses" tab to see if your child will need one or two doses. The staff at Tamalpais Pediatrics will let you know how many doses your child needs when you come to our office.

We received our flu vaccine shipment very early this year and have been vaccinating against the flu since late August. As usual, we have both the injection and intranasal vaccines. Take a look at the Injectable vs. Nose Spray tab to get information on these two versions of the Flu Vaccine.

We're sorry to say that this year we will not be able to vaccinate parents. In the past we have offered this, but because of issues with the insurance companies we contract with, we cannot offer vaccines for parents.

The Flu Vaccine for children over 3 is available with and without the preservative Thimerosal. We have ordered both types for our office, to ensure that we have enough vaccine for all of our patients who want it. The doctors at Tamalpais Pediatrics recommend that you get whatever Flu Vaccine is available, and feel that it is safe. Check the Thimerosal Fact Sheet tab for more information. The intranasal version of the Flu Vaccine is Thimerosal free.

Please take a look at the CDC Flu Website for more information on Influenza and this year's Influenza Vaccine.

Flu Shot Recommendations:

Influenza vaccine is recommended for all children from age 6 months up to their 19th birthday.

A flu shot is strongly recommended for children and adults in the following groups:

• Children with asthma or any lung disease, including any child who has had wheezing, pneumonia, bronchitis or has used an inhaler or nebulizer.
• Children with a chronic disease that puts them at risk of getting seriously ill with Influenza, such as diabetes, cerebral palsy, heart or kidney disease, or any type of immunodeficiency.
• Family members or those living in the same home as children in any of the above groups, or a child under five.
• Parents, siblings and others living with infants under six months.

If your child is 6 months to 8 years of age, and this is the first year they are getting a flu shot, they will need two doses of the Influenza Vaccine. Please ask about this when you come in for your flu shot.

If your child is 6 months to 8 years of age, and they did not receive a flu shot in 2010/2011 or 2011/2012, they may need two flu shots this year, even if they have received flu vaccine prior to last year. Please check with us and we will help you figure out if your child needs one or two doses of vaccine.

In addition, flu shots are recommended for adults over age 50, pregnant women and some other groups. Please see the CDC website at www.cdc.gov for full recommendations.

Injection vs. Nose spray:

We will be offering both the injectable flu vaccine (the “shot”) and the intranasal (nose spray) flu vaccine. We can give the intranasal version to children as young as 2 years old, as long as they have not had wheezing, asthma or other lung problems.

Both vaccines are effective in preventing Influenza in children. The intranasal vaccine is a live virus that has been weakened so that it doesn't cause the flu; the virus grows in your nose and throat and gives protection there as well making antibodies that circulate in the bloodstream. In children, some studies have shown that it's a little more effective than the injection – and the biggest benefit is no shot! The injectable vaccine is also very effective, and for children who have had wheezing, it's the only option. This is not a live virus vaccine, it contains parts of the flu virus (antigens) that your immune system reacts to in order to make antibodies which protect you against the flu. Both of these vaccines may contain some egg protein, since eggs are used to grow the virus that goes into the vaccine. If your child has an egg allergy, please talk to your doctor – they can and should still receive the Flu Vaccine but may have to do it at the Allergist's office or using a special protocol at our office.

Flu Shot Clinics:

Your child can get a flu shot at any visit to our office this winter. For your convenience, we are also doing walk in Flu Shot Clinics. In order to accommodate as many families as possible, only flu shots will be given at these clinics- we will not be updating other immunizations. If your child needs more than just a flu shot, please call the office to schedule a visit with the nurses during regular weekday hours.

You will not need an appointment for the Flu Shot Clinics – please come anytime between 9am and Noon. The clinics will be walk-in, first come, first served. We are hoping that this will be an efficient and easy way to offer Flu Vaccine to our patients.

The flu shot clinic dates are:

Flu information online:

For the most current information on Influenza and the Influenza Vaccine, please visit the following sites:

• AAP healthychildren.org Flu page
• CA Department of Public Healthy Flu Information Page
• CDC Influenza Information Page
• Find a Flu Shot
• Google Flu Trends

Remember that the best way to keep yourself or your children from getting the Flu or any other viral illness is to get immunized, wash your hands frequently, cough or sneeze into your elbow, stay away from those who are sick and get plenty of rest and exercise.

Thimerosal Fact Sheet

What is thimerosal?

It is a preservative used in 30 types of vaccines for 60 years.

Used in multi-dose vials, it prevents bacterial and fungal contamination.

It contains ethylmercury, a form of mercury that is probably less toxic and cleared faster from the body than methylmercury, the type of mercury found in some fish (swordfish, tuna).

Does the Influenza vaccine contain thimerosal?

The Influenza vaccine is being manufactured in both single doses that do not contain thimerosol and multi-dose vials that do contain thimerosol. The nasal version of the vaccine does not contain thimerosal.

When was thimerosal removed from childhood vaccines and why?

In 1999, when the presence of thimerosal in vaccines was highlighted in a report by the U.S. Food and Drug Administration. It was felt that if children received thimerosol in multiple different vaccines, the total amount of mercury they would be exposed to would be more than the amount recommended for their age.

Back when the initial concerns were raised, the studies disproving the association between thimerosal and autism had not been performed.

Since 2002, all recommended childhood vaccines have been thimerosal-free except for influenza vaccine for children over 3.

Isn’t it against California Law to give a child under 3 a vaccine containing thimerosal?

Thimerosal-containing vaccines may be unavoidable in epidemics and in other situations where multi-dose vials are needed.

Since 2004, when AB 2942 was signed into law, pregnant women and children under the age of three have only received thimerosal free vaccines. When the supply of a vaccine is limited, the Secretary of the California Health and Human Services Agency can grant an exemption to AB 2942 allowing pregnant women and young children to be given thimerosal containing vaccines. This happened last year, for example, during the H1N1 Influenza Epidemic.

Is Thimerosal Associated with Autism?

Thimerosal was removed from all pediatric vaccines in 2001 and since 2004 no pregnant woman in California has received a thimerosal containing vaccine, yet the rate of autism remains unchanged.

The original studies that raised questions about the thimerosal-autism link have since been discredited and ten convincing studies have been published in leading medical journals indicating there is no link between vaccines and autism.

Where Can I Find Additional Information?

CDC Website

FDA Website

There are no known risks of Thimerosal when given in vaccines, but there ARE risks of not vaccinating.

One Dose or Two?:

Because this year's Flu Vaccine contains the H1N1 strain, some children will need two doses to make sure that they are really protected against Influenza.

We will be following the recommendations of the Centers for Disease Control and the American Academy of Pediatrics, and will let you know when your child gets their flu shot whether they need to return for a second.

If your child does need two doses of Flu Vaccine this year, the second dose should be given at least 4 weeks after the first. Longer than 4 weeks is OK, but it should not be less.

If your child is age 6 months to 8 years and has never received any Flu Vaccine, they need two doses this year.

If your child is age 6 months to 8 years, and received Flu vaccine in the past 2 years they only need one Flu Vaccine this year.

If your child is age 6 months to 8 years and did not receive a Flu Vaccine last year or the year before, they need two doses of Flu Vaccine this year.

If your child is age 9 years or older, they only need one Flu Vaccine this year.

These recommendations were designed to be simple, but there may be exceptions and you and your doctor may decide to give only one dose instead of two in certain circumstances – we will help you decide when your child is here for their Flu Vaccine.