From Vincent Iannelli, M.D.,
Your Guide to Pediatrics.
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About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

This year's flu season is getting started, but it is not to late to get your kids a flu vaccine if you can find one. Unfortunately, we have encountered shortages like we had last year, and there are some other factors that may make it difficult for you to get your kids a flu shot.

The announcement that Chiron Corporation, one of the big manufacturers of flu vaccine, would not be able to distribute any of its flu vaccine, has cut in half the amount of flu vaccine available in the United States. If your doctor ordered their flu vaccine from Chiron, then they simply may not have any flu vaccine to give your child. However, since the Chiron flu vaccine, called Fluvirin, is only approved for adults and children over age 4 years, it is likely that your Pediatrician has at least some supply of flu vaccine from Aventis, the other major flu vaccine supplier, whose flu vaccine is called Fluzone.

Even if your doctor has flu vaccine, because of new recommendations issued by the CDC and ACIP in response the Chiron situation, unless you or your child is in a high risk or priority group (see below), you will likely be 'informed about the urgent vaccine supply situation and asked to forego or defer vaccination' this year.

Another big factor is that this year's recommendations have changed so that all children between the ages of 6 and 23 months should get a flu shot. In addition, close contacts of infants under 6 months old should also get a flu shot.

That means that your Pediatrician's office is going to have to give a lot of flu shots this year, which may cause logistical problems, even if they don't run out of flu shots. It takes time to give all of these children flu shots, especially when you add in all of the other high risk children with diabetes, asthma, and other medical problems who also need a flu shot. So get started early and make sure that you have some place to get a flu shot, whether it is from your Pediatrician, the health department, or any place else you can get one.

When should your kids get their flu shots?

Younger kids and those with health problems should get their flu vaccine early, during October or November. If your child is under 9 years old and is getting the flu vaccine for the first time, then he should get started in October because he will need two flu vaccines one month apart to get full coverage and protection. If your younger child doesn't already have a well child checkup scheduled in October, you might call your Pediatrician to see when you can get his flu vaccine. Many doctors are setting up 'flu clinics' where you just see a nurse and get your flu vaccine, either during or after office hours.

Who Should Be Vaccinated With the Flu Shot This Season

Priority groups for vaccination with inactivated influenza vaccine this season are:

• all children aged 6 to 23 months,
• adults aged 65 years or older,
• persons aged 2 to 64 years with underlying chronic medical conditions,
• all women who will be pregnant during influenza season,
• residents of nursing homes and long-term care facilities,
• children 6 months to 18 years of age on chronic aspirin therapy,
• health-care workers with direct patient care, and
• out-of-home caregivers and household contacts of children aged less than 6 months.

Other Vaccination Recommendations

• Healthy persons who are 5-49 years of age and not pregnant, including health-care workers (except those who care for severely immunocompromised patients in special care units) and persons caring for children aged less than 6 months should be encouraged to be vaccinated with intranasally administered live, attenuated influenza vaccine (Flumist).
• Persons in priority groups identified above should be encouraged to search locally for vaccine if their usual health-care provider does not have vaccine available.
• Many children aged less than 9 years require two doses of vaccine if they have not previously been vaccinated. All children at high risk of complications from influenza, including those aged 6-23 months, who present for vaccination should be vaccinated with a first or second dose, depending on vaccination status. However, doses should not be held in reserve to ensure that two doses will be available. Rather, available vaccine should be used to vaccinate persons in priority groups on a first come first serve basis.

Vaccination of Persons in Non Priority Groups

• Persons who are not included in one of the priority groups above should be informed about the urgent vaccine supply situation and asked to forego or defer vaccination. Keep in mind that where flu vaccine supply is sufficient, additional priority groups have been added, including all adults aged 50-64 and out-of-home caregivers and household contacts of persons in high-risk groups.