Parents advised for first time to vaccinate 6- to 23-month-olds

Sunday, October 06, 2002

By Virginia Linn, Post-Gazette Staff Writer

Parents already daunted by the array of vaccines their babies get during their first two years can add one more to the list -- flu shots.

Penny Williams of Squirrel Hill plans to get her 15-month-old son, Jack, a flu vaccination before the four-year-old twins, Bailey, left, and Emilie, bring home any germs from school. (Martha Rial, Post-Gazette)

For the first time, the federal Centers for Disease Control and Prevention is urging healthy babies age 6 months to 23 months to line up with the elderly and infirm for an annual influenza shot.

And here's the kicker: Because they've never received a flu shot before, they'll need two, timed a month apart, to build up proper immunity.

Health authorities are asking parents to bring in their babies as soon as the vaccine is available this month so they are protected by the time the flu arrives, usually in mid-November or December. But even if a baby doesn't reach his 6-month mark until January, that's not too late to get started.

"We do see the flu well into March and April," said Guillermo Cole, spokesman for the Allegheny County Health Department. "The child will be vulnerable until he's vaccinated."

He estimated that there are about 23,000 children in Allegheny County in this age group.

Dr. Scott Harper, a CDC influenza expert, emphasized the advice for babies was not a formal recommendation, but an "encouragement" based on recent data that shows babies are just as likely as those over 65 to land in the hospital with flu complications such as pneumonia or severe dehydration.

Where are the flu shots With three manufacturers producing a record 94 million doses of influenza vaccine for the United States, no shortages or delays are expected this flu season. The bulk of the supplies is expected to be shipped by the end of this month. St. Barnabas Medical Center in Richland has its 700 doses. The retirement and health care community ordered extra doses this year because of supply problems last year, so it's offering shots immediately to the public. Flu clinics operated by the Allegheny County Health Department and Visiting Nurse Foundation also will open to the general public. Last year, the Health Department had to limit early doses to high-risk groups such as the elderly. The Health Department opens its Oakland flu clinic Oct. 21. Shots cost $15, (including each of the two inoculations for babies or for anyone under 9 who has never had a flu shot) but will be free to anyone covered by Medicare Part B who is not in an HMO. Hours will be 9 a.m. to 3 p.m. Mondays, Tuesdays, Wednesdays and Fridays, and 9 a.m. to 7 p.m. Thursdays at the clinic, 3441 Forbes Ave. No appointments are necessary. Only the Health Department and pediatricians' offices will carry vaccines available for babies, which come in 0.25-milliliter doses. Anyone over 3 gets a 0.5-milliliter dose. The Visiting Nurse Foundation community flu program at Giant Eagle and Shop 'n Save stores, Pittsburgh International Airport, local malls and some churches will provide the vaccine to those 9 and older. That program kicks off next Sunday. The foundation charges $20 per shot; there's no charge for those covered by Medicare Part B or Highmark's SecurityBlue program. Pneumonia shots ($35, except Medicare Part B, no HMO) also are available at all sites. Shots at St. Barnabas, 5830 Meridian Road, cost $15 (except for Medicare Part B and SecurityBlue) and are available from 8:30 a.m. to 6 p.m. Mondays through Thursdays and 8:30 to 5 p.m. Fridays. Walk-ins are welcome or people may call 724-443-7231 for appointments. This year's vaccine protects against the Panama and New Caledonia Type A strains and Hong Kong Type B strain. Since the county began tracking flu cases in 1991, it experienced its worst season in 1999-2000, when a record 158 cases were confirmed. Your Health will publish a comprehensive list of public flu vaccine clinics scheduled throughout the region on Oct. 15.   -- Virginia Linn

Many fewer die. In 2000, one baby was listed among the 365 influenza/pneumonia deaths in Allegheny County, which involved mostly older people. But babies do get very ill.

Babies are particularly vulnerable because many are no longer protected by the mother's antibodies, and their own immune systems are still immature and their bodies react with higher fevers and more severe symptoms.

Of last season's 130 confirmed influenza cases in Allegheny County, which was just a fraction of actual cases, 25 were diagnosed in children 2 years or younger.

"That's nearly one out of five," Cole said. "They can get hospitalized at a higher rate than older children."

The vaccine is beneficial because it cuts down on the spread of disease and eases symptoms even if the child is infected, said Dr. Bradley Bradford, chair of the Department of Pediatrics at Mercy Hospital. He said pediatric practices should be able to fit in these extra shots without problems.

Dr. Mary Goessler, vice chair of pediatrics at Allegheny General Hospital, said the vaccine was particularly important for babies in day care or in families with other children who are exposed to illnesses at school or day care.

That sums up Penny Williams' family. The Squirrel Hill mother has 4-year-old twins, Emilie and Bailey, in preschool and Jack, 1, at home. And Emilie recently developed asthma.

An adult infectious disease doctor who is now a stay-at-home mom, Williams, 49, is an advocate for the vaccine for all of her children -- not just to protect her family, but as a public health effort.

"It's a wicked virus," she said, recalling how she was flattened with the flu as an intern with a 104-degree fever that made her skin hurt.

"When you go to preschool or day care or the Carnegie Museum on a Saturday afternoon, there are sick kids everywhere," she said. "Anything you can do to prevent your kids from getting sick from these enclosed environments, you should do it."

Williams often hears resistance from other parents who don't want to hassle with the doctor visits or put their children through the pain of the shots. "Your kid may cry for five minutes from the shot, but it's worth it," she said.

A concern among some parents is a mercury-preservative called thimerosal in flu vaccine. The drug maker Aventis is making a version without thimerosal, which will be available later this season.

Some parents have said thimerosal is responsible for the increase in diagnoses of autism, a neurological disorder. An Institute of Medicine study has found insufficient evidence to prove any link. Nevertheless, the CDC has been pushing vaccine manufacturers to stop using the preservative, which is added to some vaccines to prevent the growth of dangerous bacteria or fungi.

Although the cost of the flu shots is not included this year in the federal Vaccines for Children Program (a CDC program that provides free vaccine to doctors and clinics for needy children), they are covered for any child 6 months or older enrolled in the state's Children's Health Insurance Program, or CHIP. That covers 11,400 children in Allegheny County.

Families covered by Highmark Blue Cross Blue Shield, the region's largest insurer, can expect the same coverage for babies for the flu vaccine as they receive for other childhood immunizations, such as hepatitis B, said Dr. Donald Fischer, Highmark medical director.

In fact, Highmark also will cover the shots for older, healthy children if doctors deem it necessary. That would be encouraged, for example, if a person over 65 lives with the family.

The vaccine isn't given to those younger than 6 months because infants don't develop an immunogenic response, said Dr. Marian Michaels, an infectious disease specialist at Children's Hospital.

All first-timers between 6 months and 9 years need two flu shots to develop sufficient protection.

Babies receiving their first shot may develop a mild reaction from the antigen exposure that could result in fatigue, slight fever or achiness lasting one or two days.

"It's not the flu," Michaels emphasized, dispelling a common myth that she's quizzed about repeatedly.

"The vaccine does not cause influenza. There's nothing live in it," she said. "That's hard for people to understand."

Virginia Linn can be reached at vlinn@post-gazette.com or 412-263-1662.