5 Questions: Maldonado on vaccines for influenza, pertussis

Yvonne Maldonado

Yvonne Maldonado, MD, professor of pediatrics and chief of pediatric infectious diseases and medical director of infection control at Lucile Packard Children’s Hospital, spoke recently about this year’s influenza vaccine and the outbreak of pertussis in California with Robert Dicks, the hospital’s senior manager of media relations. The Q&A below is adapted from the interview that is posted on YouTube at http://www.youtube.com/watch?v=5ZhIxC2KWos.

Q: How will this year’s flu season compare with last year’s? 

Maldonado: There’s now one vaccine for this year’s different influenza strains, as compared with last year when you needed to get a vaccine for the pandemic H1N1 and another vaccine for the seasonal flu strains.

So hopefully, we’re not going to have what we had last year. We will expect H1N1 to show up again this year. It is already showing up around the world in the southern hemisphere, where we expect it to be. But we are also probably going to see some of the other strains of influenza, which are included in the current vaccine. So we are going to see what’s called H3N2 and B in different parts of the world and possibly in the United States as well.

Still, we don’t expect the severity that we saw last year.

Q: What would be your vaccination recommendation for families this year?

Maldonado: We always recommend annual influenza vaccinations for children. This year in particular, it is important to remember that the recommendation for influenza vaccination is for universal use, that is for everyone 6 months of age and older, including older adults.

Q: We have heard some children need more than one dose of seasonal flu vaccine this year. Can you explain that?

Maldonado: Yes. In general, influenza vaccines are dosed differently for children 9 years of age and younger versus those over 9 years of age, and that is not different this year; however, there are differences in whether a child should receive one or two doses of vaccine if they are under 9 years of age based on whether or not they got one or two doses of H1N1 vaccine or seasonal flu vaccine last winter. The reason is that children under 9 may not have a complete immune response to the new H1N1 strain after just one dose.

Parents of children 6 months to 9 years of age are encouraged to talk to their providers who will help them make the decision to get one or two doses of this year’s seasonal flu vaccine.

Q: When should people get vaccinated for influenza?

Maldonado: It depends where you live in the United States. Generally flu season can start as early as December or January, so we recommend vaccination as soon as possible, and I understand that vaccines are already available in most parts of the country at this point. So the earlier the better. September is a good time to start, but you can be vaccinated even through December and still have an impact on protection when the flu is circulating, sometimes as late as February or March.

Q: Tell us about the pertussis vaccine. Why is it needed?

Maldonado: Pertussis is always recommended for children. It is a routine immunization for children. There is also a new vaccine called Tdap, which includes the new acellular pertussis vaccine, and it’s included as a booster for older children and adults. The reason it is particularly important right now for us is that there is an epidemic in California in which thousands of people have become infected, notably causing several infant deaths. Since very young infants do not generally get the full dose of pertussis vaccines, those around them must be vaccinated, including health-care workers.

So we need everyone to get vaccinated with the Tdap vaccine if they are over 7 years of age and for all children 7 and under to get their routine pertussis vaccine.