School started a month ago, which means that your child has already caught at least one cold. Viruses love classrooms like my kid loves ice cream, so with flu season right around the corner, it’s smart to get your child a flu shot. Or is it? We all know people who, after dutifully getting jabbed, wound up chained to a bed for a week anyway. And there was also that 2009 Atlantic article arguing that perhaps “everything we think we know about fighting influenza is wrong,” including the notion that flu vaccines help. So is it really worth dragging your kid to the doctor to get an inoculation this year?
Yes—but research suggests that not all ages benefit equally, and some flu vaccines do seem to work better than others. If you’re the parent of a 2- to 7-year-old, you should call your pediatrician now and make an appointment to give your kid FluMist, the flu vaccine nasal spray (yup—no needles), which is actually quite effective, much more so than the flu shot in this age group. Kids older than 7 also seem to benefit more from the nasal spray than the shot, but the vaccine’s protection isn’t quite as pronounced. The toughest decision falls on the parents of wee ones between the ages of 6 months and 2 years, because the only approved vaccine for them is the shot—yet very little research has been conducted on its safety and efficacy in babies and young toddlers.
I’ll admit that over the years, I’ve had my doubts about the flu vaccine. I was shocked to learn from that Atlantic piece—which, by the way, many experts have problems with—how ineffective the flu vaccine is compared to other vaccines. Then, when my son was an infant, I couldn’t believe how little research had been done on the effects of the flu vaccine in babies, especially since the Centers for Disease Control and Prevention now recommends that all babies over the age of 6 months get vaccinated. But now, as the mother of a 2-year-old, I am much more pro-flu vaccine, because the research on older kids suggests that the vaccine really does protect them (not just from the flu, but also from ear infections). True, the flu vaccine may not be as effective as other vaccines, but that doesn’t mean it doesn’t provide enough benefit to make it worthwhile, particularly in light of the minuscule vaccination risks. Moreover, since senior citizens don’t derive nearly as much protection from the shot—their aging immune systems are, well, lazier—it’s nice to know that by protecting my son, I may also be protecting his grandparents, who are at a much increased risk for deadly flu complications like pneumonia. (That the flu can be dangerous is not just a myth propagated by the U.S. government in collusion with Big Pharma; if you don’t believe me, read this Slate article from last year.)
First, let me explain the different flu vaccines. There are many, but they can be lumped into two main types: shots and nasal sprays. The shot contains either whole killed viruses or a mixture of viral proteins. The nasal spray is a live attenuated vaccine, which means that the viruses in it are alive, albeit weakened. They are also “cold-adapted,” which means they’re engineered so that they can replicate in your nose, where temperatures are low; they can’t, however, thrive in the warmer environment of your lungs, where flu infections usually set up shop and do damage. It’s important to note that neither the shot nor the nasal spray can actually give your kid the flu, but both can cause mild reactions such as runny noses, coughs, headaches, and tenderness at the injection site.
If you’ve got a kid between the ages of 2 and 7, the nasal spray is definitely the way to go. According to a 2012 systematic review of the scientific literature, among kids this age, the spray has an efficacy of 83 percent. This is very high—by comparison, the flu shot, among kids this age, has only about 48 percent efficacy. But what does “83 percent efficacy” actually mean? What it doesn’t mean is that, for every 100 kids who get the inoculation, 83 are spared of the flu. Instead, it’s a relative risk comparison, which means that kids who get the vaccine are 83 percent less likely to get the flu than kids who don’t get the vaccine. If you average the data from the 10 trials included in the 2012 systematic review, 16 percent of unvaccinated kids caught the flu, whereas only 3.4 percent of those who got the nasal vaccine did. (I know it seems like a higher percentage of kids get the flu each year. But keep in mind there are many, many flu-like viruses out there that aren’t actually influenza. Flu vaccines only prevent those that are influenza, a point that some vaccine skeptics, such as Dr. Mercola, seem to miss when they argue that the flu vaccine doesn’t prevent illness in general. No—it does not.)
For some unknown reason, the benefits of the nasal spray seem to wane in older kids and adolescents, at which point the shot has an edge. In a 2009 clinical trial, researchers gave either the intranasal vaccine, the flu shot, or a placebo to a population comprised mostly of college students during the 2007–2008 flu season. They found that 10.7 percent of unvaccinated students caught the flu, whereas 6.9 percent of those who got the nasal vaccine did and only 3.4 percent of those who got the shot did. (Same goes for older adults: The shot seems to work better.)