2014-2015 Flu Seasn Key Pints (10-31-14) Cntents Overarching Framewrk f CDC Influenza Messaging... 3 Take 3 Messages... 3 Statements fr General Audiences... 4 Disease... 4 Vaccinatin... 6 Vaccinatin Timing... 9 Vaccinatin: Wh Shuld D It, Wh Shuld Nt and Wh Shuld Take Precautins... 9 2014-2015 Influenza Vaccine Optins, Indicatins and Availability... 11 New LAIV Recmmendatin fr 2014-2015 Nasal Spray Vaccine... 13 2014-2015 Influenza Vaccine Frmulatin... 13 Statements fr Parents... 14 Vaccine Dses fr Children Aged 6 Mnths thrugh 8 Years... 16 Statements fr Pregnant Wmen... 17 Statements fr Adults (18 thrugh 64 years f age)... 18 Statements fr Adults 65 Years and Older... 18 Statements fr Adults with Certain Medical Cnditins... 20 General Messages... 20 Diabetes... 20 Asthma... 21 Heart Disease... 22 Mrbid Obesity... 22 Statements fr African Americans and Hispanics... 23 Statements fr American Indians and Alaska Natives... 23 Statements n the Imprtance f Health Care Prfessinal/Health Care Wrker Recmmendatin and Vaccinatin... 24 Flu Vaccine Safety... 25 General... 25 Thimersal... 26 Guillain-Barré Syndrme (GBS)... 27 Febrile Seizures... 27 Egg Allergy and Flu Vaccinatin... 28 Flu Vaccine Safety and Pregnancy... 29 Vaccine Cverage... 29 1
2014-2015 Flu Seasn Key Pints cntinued (10-31-14) Overall Cverage Estimates... 30 Cverage by Age... 30 Cverage by Race/Ethnicity... 30 Cverage amng Pregnant Wmen... 31 Cverage amng All Health Care Prviders (Internet Panel Survey)... 33 Influenza Vaccinatin Perfrmance Measurement Amng Acute Care Hspital-Based Health Care Persnnel... 34 Flu Vaccine Effectiveness... 36 Ways t Measure Hw Well Flu Vaccines Wrk (Study Methds)... 38 Backgrund n Flu Vaccine Effectiveness... 39 Backgrund n Waning Immunity... 42 2013-2014 Influenza Seasn: A Summary... 42 2
2014-2015 Flu Seasn Key Pints cntinued (10-31-14) Overarching Framewrk f CDC Influenza Messaging (Back t table f cntents) Take 3 Messages CDC recmmends a three-step apprach t fighting the flu: vaccinatin, everyday preventive actins, and use f antiviral drugs if yur dctr prescribes them. 1. Take time t get a flu vaccine. CDC recmmends a yearly flu vaccine as the first and mst imprtant step in prtecting against flu. Flu vaccinatin can reduce flu illnesses, dctr visits, and missed wrk and schl due t flu, as well as prevent flu-related hspitalizatins and deaths. While there are many different flu viruses, the flu vaccine prtects against the viruses that research suggests will circulate the mst this seasn. Everyne 6 mnths f age and lder shuld get a 2014-2015 flu vaccine, ideally by Octber. Hwever, as lng as flu viruses are circulating, vaccinatin shuld cntinue thrughut the flu seasn, even in January r later. Vaccinatin f peple at high risk f develping serius influenza-related cmplicatins is especially imprtant t decrease their risk f severe illness as a result f flu. Peple at high risk f serius flu cmplicatins include yung children, pregnant wmen, peple with certain chrnic health cnditins like asthma, diabetes, r heart and lung disease, and peple age 65 years and lder. The full list f high risk cnditins is available n the CDC website at http://www.cdc.gv/flu/abut/disease/high_risk.htm. Vaccinatin als is especially imprtant fr health care wrkers, and thers wh live with r care fr peple at high risk fr serius flu-related cmplicatins. Children yunger than 6 mnths are at high risk f serius flu illness, but are t yung t get a flu vaccine. If yu live with r care fr an infant yunger than 6 mnths f age, yu shuld get a flu vaccine. (See the Flu Vaccine sectin fr mre key messages related t flu vaccinatin.) 2. Take everyday preventive actins t stp the spread f germs that can cause respiratry illnesses like the flu. While these actins are helpful, remember that vaccinatin is the mst imprtant step in preventing flu. Try t avid clse cntact with sick peple. If yu are sick with flu-like illness, CDC recmmends that yu stay hme fr at least 24 hurs after yur fever is gne, except t get medical care r fr ther necessities. (Yur fever shuld be gne withut the use f a fever-reducing medicine.) While sick, limit cntact with thers as much as pssible t keep frm infecting them. Cver yur nse and muth with a tissue when yu cugh r sneeze. After using a tissue, thrw it in the trash and wash yur hands. 3
2014-2015 Flu Seasn Key Pints cntinued (10-31-14) Wash yur hands ften with sap and water fr at least 20 secnds. If sap and water are nt available, use an alchl-based hand rub. Avid tuching yur eyes, nse r muth because germs spread this way. Fr mre infrmatin, see http://www.cdc.gv/flu/prtect/habits/. 3. Take flu antiviral drugs if yur dctr prescribes them. If yu get the flu, antiviral drugs can be used t treat yur illness. Antiviral drugs are prescriptin medicines (pills, liquid r an inhaled pwder) and are nt available ver-the-cunter. Antiviral drugs are different frm antibitics. Antiviral drugs fight viruses (like flu viruses) in yur bdy; antibitics fight bacterial infectins. Antiviral drugs are nt a substitute fr getting a flu vaccine. The flu vaccine is t best way mdern medicine currently has t prtect against this serius disease. Nt everyne wh has flu symptms needs antiviral drugs. Yur dctr will decide whether antiviral drugs are right fr yu. Antiviral drugs can make flu illness milder and shrten the time yu are sick. There als are data shwing that antiviral drugs may prevent serius flu cmplicatins. Fr thse with flu wh als have a high risk medical cnditin, treatment with an antiviral drug can mean the difference between having a milder illness versus a very serius illness that culd result in a hspital stay. If yu get the flu, the earlier yu begin taking antivirals, the better. Antiviral drugs wrk best if started within tw days f symptms first appearing, but there is data t suggest they can still be beneficial even up t five days after getting sick. This wuld be especially imprtant fr a persn with a high risk medical cnditin that is very sick. Tw FDA-apprved influenza antiviral medicatins are recmmended fr use in the United States during the 2014-2015 influenza seasn: seltamivir (Tamiflu ) and zanamivir (Relenza ). Mre infrmatin abut antiviral drugs and antiviral drug resistance can be fund at http://www.cdc.gv/flu/antivirals/index.htm and http://www.cdc.gv/flu/abut/qa/antiviralresistance.htm. Fr mre infrmatin abut antiviral drugs, visit http://www.cdc.gv/flu/antivirals/index.htm. Fr mre infrmatin abut the flu r the flu vaccine, call 1-800-CDC-INFO, visit www.cdc.gv/flu. Statements fr General Audiences (Back t table f cntents) Disease 1. Influenza (the flu) can be a serius disease that can lead t hspitalizatin and smetimes even death. Anyne can get sick frm the flu. 2. While the flu can make anyne sick, certain peple are at greater risk fr serius cmplicatins frm the flu. These peple include: a) Children yunger than 5, but especially children yunger than 2 years ld 4
2014-2015 Flu Seasn Key Pints cntinued (10-31-14) b) Adults 65 years f age and lder c) Pregnant wmen d) American Indians and Alaskan Natives seem t be at higher risk f flu cmplicatins e) Peple wh have medical cnditins including: Asthma Neurlgical and neurdevelpmental cnditins [including disrders f the brain, spinal crd, peripheral nerve, and muscle such as cerebral palsy, epilepsy (seizure disrders), strke, intellectual disability (mental retardatin), mderate t severe develpmental delay, muscular dystrphy, r spinal crd injury]. Chrnic lung disease (such as chrnic bstructive pulmnary disease [COPD] and cystic fibrsis) Heart disease such as cngenital heart disease, cngestive heart failure and crnary artery disease) Bld disrders (such as sickle cell disease) Endcrine disrders (such as diabetes mellitus) Kidney disrders Liver disrders Metablic disrders (such as inherited metablic disrders and mitchndrial disrders) Weakened immune system due t disease r medicatin (such as peple with HIV r AIDS, r cancer, r thse n chrnic sterids) Peple yunger than 19 years f age wh are receiving lng-term aspirin therapy Peple wh are mrbidly bese (Bdy Mass Index, r BMI, f 40 r greater) 3. Fr mre infrmatin abut peple at high risk f serius flu-related cmplicatins visit: http://www.cdc.gv/flu/abut/disease/high_risk.htm. 4. Much f the U.S. ppulatin is at increased risk frm serius flu cmplicatins, either because f their age r because they have a medical cnditin like asthma, diabetes (type 1 and 2), r heart cnditins; r because they are pregnant. Fr example, mre than 30 percent f peple 50 thrugh 64 years f age have ne r mre chrnic medical cnditins that put them at increased risk f serius cmplicatins frm flu. 5. Symptms f the flu can include fever, cugh, sre thrat, runny r stuffy nse, bdy aches, headache, chills and fatigue. Sme peple may als have vmiting and diarrhea. 6. Peple may als be infected with the flu and have n symptms at all, r have nly respiratry symptms withut a fever. 7. Flu viruses are cnstantly changing. Each flu seasn, different flu viruses can spread, and they can affect peple differently based n differences in their immune systems. Even healthy children and adults can get very sick frm the flu. 8. In the United States, thusands f healthy adults and children see a dctr r are hspitalized frm flu cmplicatins each year. Flu vaccinatin can help prtect yu and yur family frm the flu and its cmplicatins. 9. Flu seasns are unpredictable. The severity f flu seasns can differ substantially frm year t year. 10. Over a perid f 30 years, between 1976 and 2006, estimates f yearly flu-assciated deaths in the United States ranged frm a lw f abut 3,000 t a high f abut 49,000 peple during the mst severe seasn. 5
2014-2015 Flu Seasn Key Pints cntinued (10-31-14) a) Each year in the United States n average, an estimated 5 t 20 percent f the ppulatin can be infected with the flu, and mre than 200,000 peple may be hspitalized during a flu seasn. b) The 2009 H1N1 pandemic is an example frm recent years f hw unpredictable the flu can be. Fr mre infrmatin abut the 2009 H1N1 pandemic, see http://www.cdc.gv/h1n1flu/. 11. Since 2004-2005, flu-related deaths in children reprted t CDC during regular flu seasns have ranged frm 37 deaths (during 2011-2012) t mre than 170 deaths (during 2012-2013). During the 2009 H1N1 flu pandemic, (April 15, 2009 t Octber 2, 2010), 348 pediatric deaths were reprted t CDC. a) Mre infrmatin abut pediatric deaths since the 2004-2005 flu seasn is available in the interactive pediatric death web applicatin at http://gis.cdc.gv/grasp/fluview/pedfludeath.html. 12. Mst flu-related pediatric deaths ccurred in children wh were nt vaccinated against flu. 13. During mst flu seasns, it is estimated that 90 percent f seasnal flu-related deaths and between 50 and 60 percent f seasnal flu-related hspitalizatins in the United States ccur in peple age 65 years and lder (Kstva/Reed mdels). Hwever, this pattern can change depending n which influenza viruses are circulating. 14. Influenza seasns where H3N2 influenza viruses are predminant can be particularly hard n lder adults. During the 2012-2013 flu seasn, when H3N2 viruses were mst cmmn, hspitalizatin rates were three t twelve times higher amng adults aged 65 years and lder than hspitalizatin rates amng yunger age grups. 15. It is nt pssible t predict hw mild r severe the 2014-2015 flu seasn will be, r which influenza viruses will predminate. Vaccinatin (Back t table f cntents) 1. The first and mst imprtant step in prtecting against the flu is t get a flu vaccine each seasn. a) Everyne 6 mnths f age and lder is recmmended t get the 2014-2015 flu vaccine, with rare exceptins. 2. Flu vaccinatin can reduce flu illnesses, dctrs visits, and missed wrk and schl due t flu, as well as prevent flu-related hspitalizatins and deaths. 3. While hw well the flu vaccine wrks can vary frm year t year, there are many reasns t get a flu vaccine each year. a) Flu vaccinatin can keep yu frm getting sick frm flu. Prtecting yurself frm flu als prtects the peple arund yu wh are mre vulnerable t serius flu illness. b) Flu vaccinatin can help prtect peple wh are at greater risk f getting seriusly ill frm flu, like lder adults, peple with chrnic medical cnditins and yung children (especially infants yunger than 6 mnths ld wh are t yung t get vaccinated). c) Flu vaccinatin als may make yur illness milder if yu d get sick. 6
2014-2015 Flu Seasn Key Pints cntinued (10-31-14) d) Flu vaccinatin can reduce the risk f mre serius flu utcmes, like hspitalizatins and deaths. 4. CDC recmmends an annual flu vaccine as the first and best way t prtect against the flu. There are tw imprtant reasns t get a flu vaccine every year: a) The first reasn is that because flu viruses are cnstantly changing, flu vaccines may be updated frm ne seasn t the next t prtect against the viruses that research indicates will be mst cmmn during the upcming flu seasn. b) The secnd reasn that annual vaccinatin is recmmended is that a persn s immune prtectin frm the vaccine declines ver time. Annual vaccinatin is needed fr best prtectin. 5. Flu vaccinatin prevented an estimated 13.6 millin flu cases, 5.8 millin medical visits and nearly 113,000 flu-related hspitalizatins in the United States ver a six-year perid (frm 2005 t 2011) accrding t a study by CDC experts. 6. The cmpsitin f the flu vaccine is reviewed each year. If needed, the vaccine is updated t prtect against the influenza viruses that research indicates will be the mst cmmn during the upcming seasn. Even in years when the vaccine cmpsitin des nt change, new flu vaccine is manufactured every seasn. (All seasnal flu vaccine expires by the end f June.) 7. Prtect yur family frm the flu by getting yurself and yur family members vaccinated. 8. Getting a yearly flu vaccine is especially imprtant fr peple at high risk f serius flurelated health cmplicatins and their clse cntacts. Peple at high risk f serius flu cmplicatins include: 9. While the flu can make anyne sick, certain peple are at greater risk fr serius cmplicatins frm the flu. These peple include: a) Children yunger than 5, but especially children yunger than 2 years ld b) Adults 65 years f age and lder c) Pregnant wmen d) American Indians and Alaskan Natives seem t be at higher risk f flu cmplicatins e) Peple wh have medical cnditins including: Asthma Neurlgical and neurdevelpmental cnditins [including disrders f the brain, spinal crd, peripheral nerve, and muscle such as cerebral palsy, epilepsy (seizure disrders), strke, intellectual disability (mental retardatin), mderate t severe develpmental delay, muscular dystrphy, r spinal crd injury]. Chrnic lung disease (such as chrnic bstructive pulmnary disease [COPD] and cystic fibrsis) Heart disease such as cngenital heart disease, cngestive heart failure and crnary artery disease) Bld disrders (such as sickle cell disease) Endcrine disrders (such as diabetes mellitus) Kidney disrders Liver disrders Metablic disrders (such as inherited metablic disrders and mitchndrial disrders) 7
2014-2015 Flu Seasn Key Pints cntinued (10-31-14) Weakened immune system due t disease r medicatin (such as peple with HIV r AIDS, r cancer, r thse n chrnic sterids) Peple yunger than 19 years f age wh are receiving lng-term aspirin therapy Peple wh are mrbidly bese (Bdy Mass Index, r BMI, f 40 r greater) 10. Fr mre infrmatin abut peple at high risk f serius flu-related cmplicatins visit: http://www.cdc.gv/flu/abut/disease/high_risk.htm. 11. Flu vaccines cannt cause flu infectin r illness. a) The mst cmmn side effects frm a flu sht are a sre arm and maybe a lw fever r achiness. The nasal spray flu vaccine might cause cngestin, runny nse, sre thrat, r cugh as side effects. If yu d experience them at all, these side effects are mild and shrt-lived. 12. The flu vaccine is used t prevent flu illness, nt t treat it. (Influenza antiviral drugs may be prescribed t treat flu. See Antiviral Drug messages fr mre infrmatin.) 13. A flu vaccine prtects against influenza viruses. It will nt prtect against ther respiratry viruses that may cause symptms that are similar t thse seen with flu infectin. 14. In additin t flu vaccine, ther vaccines are recmmended fr adults that prevent serius diseases such as shingles, pneumnia caused by pneumcccal bacteria, hepatitis, meningitis and whping cugh. 15. Unfrtunately, few adults are aware that they need ther vaccines, leaving themselves and their lved nes unnecessarily vulnerable t serius diseases. 16. Adults shuld talk with their dctrs r ther health care prfessinals t learn which ther vaccines are recmmended fr them and take steps t stay up-t-date t ensure that they have the best prtectin. 17. Medicare Part B cvers flu, pneumcccal, and hepatitis B vaccines fr high risk persns and tetanus vaccine as part f wund management. 18. Mst health insurance plans cver the cst f recmmended vaccines. Check with yur insurance prvider fr details f cverage. If yu d nt currently have health insurance, visit www.healthcare.gv t learn mre abut affrdable health cverage ptins. 19. Fr mre infrmatin abut the seriusness f the flu and the benefits f flu vaccinatin, talk t yur dctr r ther health care prfessinal, visit www.cdc.gv/flu, r call CDC at 1-800-CDC-INFO. 20. Visit CDC s website n adult vaccinatin fr mre infrmatin: http://www.cdc.gv/vaccines/adults. 21. Flu and ther adult vaccines are ffered in many lcatins, including: dctr s ffices, clinics, health departments, retail stres, pharmacies, health centers, as well as by many emplyers and schls. 22. Even if yu dn t have a regular dctr r ther health care prfessinal yu can get a flu vaccine and ther adult vaccines in ther lcatins, like health departments r pharmacies. Vaccines may als be ffered at yur schl, cllege health center r wrkplace. 23. Find a place near yu t get flu and ther vaccines at http://vaccine.healthmap.rg/. 24. Take the CDC quiz t find ut which vaccines might be right fr yu: http://www2.cdc.gv/nip/adultimmsched 8
2014-2015 Flu Seasn Key Pints cntinued (10-31-14) Vaccinatin Timing 1. Yu shuld get a flu vaccine sn after it becmes available, ideally by Octber, t ensure that yu are prtected befre flu seasn begins. Hwever, as lng as flu viruses are circulating, vaccinatin shuld cntinue thrughut the flu seasn, even in January r later. 2. It is nt pssible t knw exactly when the flu seasn will start each year. It is best t get vaccinated befre influenza viruses start t spread in yur cmmunity. 3. The timing f flu utbreaks is unpredictable. While seasnal flu utbreaks can happen as early as Octber, mst f the time flu activity peaks between December and February, althugh activity can last as late as May. Smetimes mre than ne flu virus type r subtype will cause utbreaks in a cmmunity in a single seasn. As lng as flu activity is nging, it s nt t late t get vaccinated, even in January r later. 4. When yu get yur flu vaccine, yur bdy starts t make antibdies that help prtect yu frm influenza virus infectin. It takes abut tw weeks after vaccinatin fr the immune system t fully respnd and fr these antibdies t prvide prtectin. 5. Since it takes abut tw weeks after flu vaccinatin fr antibdies t develp in the bdy that prtect against flu virus infectin, it is best that peple get vaccinated s they are prtected befre flu begins spreading in their cmmunity. Vaccinatin: Wh Shuld D It, Wh Shuld Nt and Wh Shuld Take Precautins (Back t table f cntents) The Flu Sht Peple wh can get the flu sht: Different flu shts are apprved fr peple f different ages, (see Nte), but there are flu shts that are apprved fr use in peple as yung as 6 mnths f age and up. Flu shts are apprved fr use in pregnant wmen and peple with chrnic health cnditins. Peple wh can't get the flu sht: Children yunger than 6 mnths are t yung t get a flu sht Peple with severe, life-threatening allergies t flu vaccine r any ingredient in the The Nasal Spray Vaccine Peple wh can get the nasal spray vaccine: The nasal spray vaccine is apprved fr use in peple 2 years thrugh 49 years f age. Peple wh cannt get the nasal spray vaccine: Children yunger than 2 years Adults 50 years and lder Peple with a histry f severe allergic reactin t any cmpnent f the vaccine r t a previus dse f any influenza vaccine Peple wh are allergic t eggs Children r adlescents (2 years thrugh 17 9
2014-2015 Flu Seasn Key Pints cntinued (10-31-14) vaccine. This might include gelatin, antibitics, r ther ingredients. See Special Cnsideratins Regarding Egg Allergy fr mre infrmatin abut egg allergies and flu vaccine. Nte: There are certain flu shts that have different age indicatins. Fr example peple yunger than 65 years f age shuld nt get the high-dse flu sht and peple wh are yunger than 18 years ld r lder than 64 years ld shuld nt get the intradermal flu sht. Peple wh shuld talk t their dctr befre getting the flu sht: If yu have an allergy t eggs r any f the ingredients in the vaccine. Talk t yur dctr abut yur allergy. If yu ever had Guillain-Barré Syndrme (a severe paralyzing illness, als called GBS). Sme peple with a histry f GBS shuld nt get this vaccine. Talk t yur dctr abut yur GBS histry. If yu are nt feeling well. Talk t yur dctr abut yur symptms. years f age) n lng-term aspirin treatment. Pregnant wmen Peple with weakened immune systems (immunsuppressin) Children 2 years thrugh 4 years wh have asthma r wh have had a histry f wheezing in the past 12 mnths. Peple wh have taken influenza antiviral drugs within the previus 48 hurs. Peple wh care fr severely immuncmprmised persns wh require a prtective envirnment (r therwise avid cntact with thse persns fr 7 days after getting the nasal spray vaccine). Peple wh shuld talk t their dctr befre getting nasal spray vaccine: There are als ther warnings and precautins fr the nasal spray flu vaccine. Yu shuld talk t yur dctr if yu have any f these: Asthma: Peple f any age with asthma might be at increased risk fr wheezing after getting the nasal spray vaccine. A chrnic cnditin like lung disease, heart disease, kidney r liver disrders, neurlgic/neurmuscular, r metablic disrders. The safety f the nasal spray vaccine has nt been established in peple with underlying medical cnditins that place them at high risk f serius flu cmplicatins. See Peple at High Risk f 10
2014-2015 Flu Seasn Key Pints cntinued (10-31-14) Develping Flu Related Cmplicatins. If yu ever had Guillain-Barré Syndrme (a severe paralyzing illness, als called GBS). Sme peple with a histry f GBS shuld nt get this vaccine. Talk t yur dctr abut yur GBS histry. If yu have gtten any ther vaccines in the past 4 weeks, r if yu are nt feeling well. 2014-2015 Influenza Vaccine Optins, Indicatins and Availability (Back t table f cntents) 1. There are several flu vaccine ptins available fr the 2014-2015 flu seasn. 2. Flu vaccines made t prtect against three different flu viruses (called trivalent vaccines) will be available this seasn. In additin, flu vaccines made t prtect against fur different flu viruses (called quadrivalent vaccines) als are available. a) Trivalent flu vaccines prtect against tw influenza A viruses (an H1N1 and an H3N2) and an influenza B virus. The fllwing trivalent flu vaccines are available: A standard-dse trivalent sht (IIV3) that is manufactured using virus grwn in eggs. Different flu shts are apprved fr peple f different ages, but there are flu shts that are apprved fr use in peple as yung as 6 mnths f age and up. Mst flu shts are given with a needle. One flu vaccine als can be given with a jet injectr.) An intradermal trivalent sht, which is injected int the skin instead f the muscle and uses a much smaller needle than the regular flu sht. It is apprved fr peple 18 thrugh 64 years f age. A high-dse trivalent sht, apprved fr peple aged 65 years and lder. A trivalent sht cntaining virus grwn in cell culture, which is apprved fr peple 18 and lder. A recmbinant trivalent sht that is egg-free (RIV3), apprved fr peple 18 thrugh 49 years f age. b) The quadrivalent flu vaccine prtects against tw influenza A viruses and tw influenza B viruses. The fllwing quadrivalent flu vaccines are available: A quadrivalent flu sht (IIV4) apprved fr different ages, but there is a quadrivalent flu sht that can be given t children as yung as 6 mnths f age. A quadrivalent nasal spray vaccine, apprved fr peple 2 years thrugh 49 years f age (recmmended preferentially fr healthy* children age 2 years thrugh 8 years ld when immediately available and there are n cntraindicatins r precautins). 11
2014-2015 Flu Seasn Key Pints cntinued (10-31-14) 3. Fr anyne 9 years and lder, CDC des nt recmmend ne flu vaccine ver the ther. The imprtant thing is t get vaccinated every year. 4. Flu vaccines can be given in tw ways, as a sht r as a nasal spray. a) The flu sht is an inactivated vaccine that is made with killed flu virus. The age indicatins fr the different flu shts vary, but all may be given t peple with chrnic medical cnditins. b) The nasal spray flu vaccine is made with live, weakened flu viruses. The nasal spray vaccine is apprved fr use in peple 2 years thrugh 49 years f age See http://www.cdc.gv/flu/abut/qa/nasalspray.htm fr a cmplete list f peple wh can and cannt receive the nasal spray flu vaccine. All nasal spray flu vaccine fr the 2014-2015 flu seasn will be quadrivalent (made t prtect against fur flu viruses). 5. Fr healthy* children 2 thrugh 8 years f age, CDC recmmends the nasal spray flu vaccine when it is available. While the flu sht and the nasal spray vaccine bth can prtect yur child frm getting the flu, there is evidence t suggest that the nasal spray vaccine may wrk better in yunger children than a regular flu sht. (See sectin n Nasal Spray Vaccine). 6. Thse wh care fr r are in cntact with persns wh have severely impaired immune functin (i.e., immune functin is impaired t a level that requires a prtective envirnment) shuld receive the flu sht rather than the nasal spray vaccine. 7. Flu vaccine is available in dctr s ffices, pharmacies, public health clinics and ther lcatins. 8. Of the verall flu vaccine supply prjected fr the 2014-2015 seasn, manufacturers estimate that 77 millin dses will be available as quadrivalent flu vaccines. Of the ttal quadrivalent flu vaccine supply, as many as 18 millin dses f the nasal spray influenza vaccine (LAIV) have been prjected by the manufacturer t be available. 9. Fr the latest infrmatin n flu vaccine supply, including prjectins and dses distributed, visit http://www.cdc.gv/flu/prfessinals/vaccinatin/vaccinesupply.htm. Althugh flu vaccines are available fr purchase frm manufacturers and distributrs, individual health care prfessinals may receive their vaccine shipments at different times because f prductin and delivery schedules fr different prducts. 10. While sme flu vaccine became available late July and August, the vaccine supply is usually mst abundant in September and Octber and thereafter. (Fr infrmatin abut the recmmended timing f flu vaccinatin, see Timing f Vaccinatin sectin.) 11. Sme pints t keep in mind: a) All nasal spray flu vaccine ffered during the 2014-2015 seasn will be quadrivalent vaccine. b) Bth quadrivalent and trivalent flu shts will be available. c) Dn t delay getting a flu vaccine if yu want a quadrivalent vaccine and it isn t available. Mst f the flu vaccine ffered this year will be trivalent. The imprtant thing is t get vaccinated against the flu. 12
2014-2015 Flu Seasn Key Pints cntinued (10-31-14) d) Mre quadrivalent flu vaccine is expected t be available during future seasns. 12. Every flu vaccine is frmulated t ffer imprtant prtectin frm influenza viruses. (* Healthy in this instance refers t children 2 years thrugh 8 years ld wh d nt have an underlying medical cnditin that predispses them t influenza cmplicatins.) New LAIV Recmmendatin fr 2014-2015 Nasal Spray Vaccine (Back t table f cntents) 1. Recent studies suggest that the nasal spray flu vaccine may wrk better than the flu sht in yunger children. Specifically in these studies, the nasal spray flu vaccine prevented abut thirty t fifty percent mre cases f flu than the flu sht in yung children. 2. Starting in 2014-2015, CDC and its Advisry Cmmittee n Immunizatin Practices (ACIP) recmmend use f the nasal spray vaccine fr healthy* children 2 years thrugh 8 years f age when it is immediately available and if the child has n cntraindicatins r precautins t that vaccine. 3. If the nasal spray vaccine is nt immediately available, these children shuld get the flu sht (IIV). Vaccinatin shuld nt be delayed in rder t btain the nasal spray flu vaccine when the flu sht is available. (Typically, nasal spray vaccine makes up a smaller prtin f ttal available vaccine each year.) 4. There is n preferential recmmendatin between the trivalent r quadrivalent flu sht. 5. Sme peple shuld NOT receive the nasal spray vaccine and may be able t get a flu sht instead. There are als precautins fr the nasal spray vaccine. (See the sectin abve n nasal spray vaccine r refer t Vaccinatin: Wh Shuld D It, Wh Shuld Nt and Wh Shuld Take Precautins n the CDC website.) 6. Sme children 8 years ld and yunger will need tw dses f vaccine t be prtected against flu. (See the sectin Vaccine Dses fr Children Aged 6 Mnths thrugh 8 Years.) 7. Fr the cmplete list f flu vaccines apprved fr use during the 2014-2015 seasn, visit http://www.cdc.gv/flu/prtect/vaccine/vaccines.htm. (*Healthy in this instance refers t children 2 years thrugh 8 years ld wh d nt have an underlying medical cnditin that predispses them t influenza cmplicatins.) 2014-2015 Influenza Vaccine Frmulatin (Back t table f cntents) 1. Each year, experts must select which flu viruses the flu vaccine shuld prtect against many mnths in advance f the flu seasn in rder fr vaccine t be prduced and delivered n time. 2. Because influenza (flu) viruses are cnstantly changing and the cmpsitin f the flu vaccine must be determined s far in advance, selecting the right influenza viruses fr the flu vaccine t prtect against is a challenging task. 3. In 2012, the Fd and Drug Administratin (FDA) apprved flu vaccines that prtect against fur viruses (called quadrivalent flu vaccines) fr use in the United States. These vaccines are available as bth a nasal spray and a sht during the 2014-2015 flu seasn. 13
2014-2015 Flu Seasn Key Pints cntinued (10-31-14) 4. Trivalent and quadrivalent flu vaccines are available during the 2014-2015 seasn. a) Trivalent flu vaccines prtect against three flu viruses: an influenza A (H1N1) virus, an influenza A (H3N2) virus and an influenza B virus. b) Quadrivalent flu vaccines prtect against fur flu viruses: an influenza A (H1N1) virus, an influenza A (H3N2) virus and tw influenza B viruses (frm Yamagata and Victria lineages). 5. Quadrivalent vaccines are intended t prvide brader prtectin against influenza B viruses by adding anther B virus t the vaccine. 6. The specific viruses fr the 2014-2015 flu seasn vaccines were recmmended by the U.S. Fd and Drug Administratin s Vaccines and Related Bilgical Prducts Advisry Cmmittee (VRBPAC) n February 28, 2014. 7. Internatinal surveillance indicated that these viruses wuld be the nes mst likely t cause illness in the United States during the 2014-2015 seasn. 8. Fr mre infrmatin abut the cmpsitin f this year s flu vaccine and hw viruses fr the seasnal flu vaccine are selected, g t http://www.cdc.gv/flu/abut/seasn/vaccine-selectin.htm. Statements fr Parents (Back t table f cntents) 1. Flu can be a serius disease fr children f all ages and can lead t hspitalizatin r, in rare cases, even death. a) [Alternative] Flu can be a serius disease fr children f all ages, causing them t miss schl, activities, r even be hspitalized. 2. Vaccinatin is especially imprtant fr certain peple wh are at high risk fr serius cmplicatins frm flu r wh are in clse cntact with peple at high risk, including the fllwing grups: a) Children yunger than 5 years f age, and especially thse yunger than 2 years f age. b) Children f any age with a lng-term health cnditin like asthma, diabetes r disrders f the brain r nervus system. These children are at higher risk f serius flu cmplicatins (like pneumnia). Fr the cmplete list f thse at high risk, visit http://www.cdc.gv/flu/abut/disease/high_risk.htm. c) Adults wh meet any f the fllwing criteria: Are clse cntacts f, r live with, children yunger than 5 years ld. Are ut-f-hme caregivers (nannies, daycare prviders, etc.) f children yunger than 5 years ld. Live with r have ther clse cntact with children f any age with a chrnic health cnditin, i.e., asthma, diabetes, etc. Are health care wrkers. 3. Every year in the United States, therwise healthy children are hspitalized r die frm flu cmplicatins. 14
2014-2015 Flu Seasn Key Pints cntinued (10-31-14) 4. In the United States, each year an average f 20,000 children yunger than 5 years ld are hspitalized due t flu cmplicatins. 5. Children yunger than 5 years ld and especially thse yunger than 2 years ld, are at higher risk f serius flu cmplicatins, including hspitalizatin and death, cmpared t lder children. 6. The risk f serius flu cmplicatins requiring hspitalizatin is highest amng children yunger than 6 mnths f age, but they are t yung t be vaccinated. The best way t prtect them is t ensure peple arund them get vaccinated. 7. It is als imprtant fr pregnant wmen t get vaccinated t prtect their unbrn babies. Studies have shwn that getting a flu sht during pregnancy can decrease yur baby s chance f getting the flu fr up t 6 mnths after birth. 8. Getting vaccinated during pregnancy is safe and can prtect the mther and the baby fr up t 6 mnths after birth. 9. Children have been significantly impacted by the 2009 H1N1 virus. This virus is expected t cntinue circulating during the 2014-2015 flu seasn, alng with ther influenza viruses. 10. During the 2013-2014 flu seasn a flu seasn when 2009 H1N1 influenza viruses predminated mre than 100 flu-related pediatric deaths were reprted. a) During the 2009-2010 flu seasn (April 15, 2009-September 30, 2010), 348 fluassciated pediatric deaths were reprted t CDC as a result f the 2009 H1N1 pandemic. b) During the 2011-2012 seasn, 35 flu-assciated pediatric deaths were reprted t CDC, representing the lwest number f pediatric deaths recrded since this kind f recrd-keeping began. 11. Amng children 6 mnths and lder, 80 t 85 percent f flu-related pediatric deaths ccurred in children wh had nt received a flu vaccine. 12. Infrmatin abut pediatric deaths since the 2004-2005 flu seasn is available in the interactive pediatric death web applicatin at http://gis.cdc.gv/grasp/fluview/pedfludeath.html. 13. Vaccinatin is the first and mst imprtant step in prtecting yur family against the flu. 14. Children 6 mnths and lder are recmmended t get a yearly flu vaccine. 15. Vaccinatin is especially imprtant fr children with asthma, diabetes (type 1 and 2), r certain ther lng-term medical cnditins because they are at increased risk fr serius cmplicatins frm flu if they get sick. a) The flu can make sme medical cnditins wrse. Fr example, children with asthma (even if it s mild r cntrlled by medicatin) are mre likely t develp serius cmplicatins frm the flu (like pneumnia) and/r a wrsening f their chrnic cnditin (fr example, asthma attacks) cmpared t children withut asthma. b) Children with asthma (even if the asthma is mild r cntrlled by medicatin) are mre likely t be hspitalized fr flu-related cmplicatins than children wh dn t have asthma. 15
2014-2015 Flu Seasn Key Pints cntinued (10-31-14) 16. If yu live with r care fr a child wh is at high risk f serius cmplicatins frm flu, it is particularly imprtant fr yu and yur children 6 mnths f age and lder t get vaccinated. a) If yur child is at high risk f serius flu cmplicatins and gets sick with the flu, yur dctr may recmmend treatment with flu antiviral drugs. (See Antiviral Drugs messages.) b) Fr the full list f age factrs and medical cnditins that put smene at high risk, see http://www.cdc.gv/flu/abut/disease/high_risk.htm. 17. Be sure t let the dctr knw if yur child has a severe allergy t eggs r has any medical cnditins like asthma, ther heart r lung cnditins, neurlgic cnditins, r ther medical prblems. (See Egg Allergy messages.) 18. Be sure t let the dctr knw if yur child has ever experienced a reactin t the flu vaccine. 19. Children als shuld be current n ther vaccines, including thse that can help prevent pneumnia, like pneumcccal and Hib vaccines. 20. Talk t yur child s dctr r ther health care prfessinal abut getting a flu vaccine. 21. CDC als recmmends that parents and children take everyday preventive actins t stp the spread f germs. (See Everyday Preventive Actins messages.) 22. The Flu Guide fr Parents (http://www.cdc.gv/flu/freeresurces/print-family.htm) prvides detailed infrmatin fr parents n the seriusness f flu illness in children, hw t prtect them, and hw t care fr children with flu illness. Vaccine Dses fr Children Aged 6 Mnths thrugh 8 Years (Back t table f cntents) 1. Sme children 6 mnths thrugh 8 years f age will require tw dses f flu vaccine fr adequate prtectin frm flu. Children in this age grup wh are getting vaccinated fr the first time will need tw dses f flu vaccine, spaced at least 28 days apart. Sme children wh have received flu vaccine previusly als may need tw dses. Yur child s dctr r ther health care prfessinal can tell yu if yur child needs tw dses. 2. The current recmmendatin is that children 6 mnths thrugh 8 years f age need nly ne dse f 2014-2015 seasnal influenza vaccine: (1) if the child has received at least ne dse f the 2013-2014 seasnal vaccine, r (2) if the child is knwn t have received at least tw seasnal flu vaccines since the 2010-2011 seasn. If the vaccinatin status is unknwn any child in this age grup, that child shuld be given tw dses f seasnal flu vaccine. The 2009 H1N1 virus cntinues t circulate and cause illness. Seasnal flu vaccine was nt frmulated t prtect against the 2009 H1N1 virus until the 2010-2011 flu seasn. This means that children wh did nt get either the mnvalent 2009 H1N1 flu vaccine during the 2009-2010 seasn r wh have nt had a seasnal flu vaccine since the 2010-2011 seasn will nt be fully prtected frm the 2009 H1N1 flu virus until they have received tw dses f the 2014-2015 flu vaccine. 3. Children 6 mnths thrugh 8 years f age wh require tw dses f flu vaccine d nt need t receive matching flu vaccines; the flu sht r the nasal spray vaccine can be used fr either dse. 16
2014-2015 Flu Seasn Key Pints cntinued (10-31-14) 4. Everyne 9 years f age and lder needs nly ne dse f 2014-2015 flu vaccine t be prtected. 5. T view a chart (algrithm) that shws influenza vaccine dsing recmmendatins fr children aged 6 mnths thrugh 8 years, visit http://www.cdc.gv/mmwr/preview/mmwrhtml/figures/m6332a3f1.gif Statements fr Pregnant Wmen (Back t table f cntents) 1. Getting a flu sht prtects pregnant wmen frm the flu. Studies als have shwn that getting a flu sht while yu are pregnant can decrease yur baby s risk f getting the flu fr up t 6 mnths after birth. a) Flu shts are a safe way t prtect the mther and her unbrn child frm serius illness and cmplicatins f flu. The flu sht has been given t millins f pregnant wmen ver many years. Flu shts have nt been shwn t cause harm t pregnant wmen r their babies. b) Pregnant wmen can receive the flu sht at any time, during any trimester, while pregnant. c) Pregnant wmen are mre likely t becme severely ill with the flu than wmen wh are nt pregnant. d) Pregnant wmen with the flu have a greater chance fr serius prblems fr their unbrn baby, including premature labr and delivery. e) Getting a flu sht is the best way t prtect yu frm the flu and prevent pssible flu-assciated pregnancy cmplicatins. f) When pregnant wmen get flu shts, they and their babies (after birth) get the flu less ften. 2. If yu have additinal questins, talk t yur dctr abut flu vaccinatin during pregnancy. 3. Pregnant wmen are at high risk f serius flu cmplicatins. If yu get sick with the flu, call yur dctr right away. Yur dctr may recmmend treatment with influenza antiviral drugs (see Antiviral Drugs messages). 4. Babies yunger than 6 mnths f age are t yung t get a flu vaccine. T prtect infants yunger than 6 mnths frm getting the flu, their mther shuld get a flu sht during her pregnancy. 5. If yu have yur baby befre getting the flu sht, yu still need t get vaccinated. If yu breastfeed yur infant, antibdies that help prtect the baby frm flu may be passed in breast milk. 6. An additinal way t prtect the baby is fr all f the baby s caregivers and clse cntacts (including parents, brthers and sisters, grandparents and babysitters) t get vaccinated against the flu. 17
2014-2015 Flu Seasn Key Pints cntinued (10-31-14) Statements fr Adults (18 thrugh 64 years f age) (Back t table f cntents) 1. All peple 6 mnths f age and lder, including adults 18 thrugh 64 years f age, are recmmended t receive the seasnal flu vaccine annually. 2. Getting sick with the flu can result in missed schl, wrk, and extracurricular activities. 3. Nearly 60 percent f influenza-related hspitalizatins reprted t CDC s influenza surveillance system were amng adults 18-64 years ld during the 2013-2014 seasn. 4. A similar increase in hspitalizatins amng nn-elderly adults was als seen during the 2009 H1N1 pandemic, especially amng adults between the ages f 18 and 49 years ld. 5. Studies have shwn that adults yunger than 65 years ld experience mre severe flurelated illness during flu seasns when H1N1 influenza viruses predminate. 6. While the percentage f influenza-related hspitalizatins amng adults 65 years and lder remained the highest amng all age grups, hspitalizatins amng yung and middle-age adults were higher during the 2013-2014 seasn than in the past three influenza seasns. Mre deaths than usual als ccurred in this yunger age grup last seasn. 7. H1N1 influenza virus is expected t cntinue circulating during the 2014-2015 flu seasn, alng with ther influenza viruses. The H1N1 virus is cvered by the 2014-2015 flu vaccine. 8. It is nt pssible t predict which influenza viruses will predminate this seasn, but it is imprtant fr all adults age 18-64 t be vaccinated this seasn. 9. Vaccinatin is particularly imprtant fr adults with certain lng-term medical cnditins because they are at high risk f serius illness if they get the flu. This grup includes, fr example, peple with asthma (even if mild r cntrlled) and diabetes (types 1 and 2). 10. By getting a flu vaccine, adults can help prevent spreading flu t friends and family wh are at high risk fr flu cmplicatins such as grandparents, yunger siblings, and peple with certain medical cnditins like asthma r diabetes. 11. CDC recmmends adults 18-64 years f age als fllw everyday preventive actins t help stp the spread f germs. (See Everyday Preventive Actins messages.) 12. Fr the full list f age factrs and medical cnditins that put smene at high risk f flu cmplicatins, see http://www.cdc.gv/flu/abut/disease/high_risk.htm. 13. If yu are at high risk f serius flu cmplicatins and get sick with the flu, yur dctr may recmmend treatment with antiviral drugs. (See Antiviral Drugs messages.) Statements fr Adults 65 Years and Older (Back t table f cntents) 1. Human immune defenses becme weaker with age, which places sme peple 65 and lder at greater risk f flu-related cmplicatins. 2. While annual flu vaccinatin is recmmended fr all peple 6 mnths and lder, vaccinatin is especially imprtant fr thse 65 and lder because peple in this age grup are at high risk f getting seriusly ill frm the flu. 18
2014-2015 Flu Seasn Key Pints cntinued (10-31-14) 3. On average, nearly 90 percent f flu-related deaths and between 50 and 60 percent f seasnal flu-related hspitalizatins in the United States ccur amng peple 65 years and lder; hwever, this pattern can change depending n which flu viruses are circulating. Vaccinatin is the best prtectin against the flu and flu-related cmplicatins. 4. Prtectin prvided by flu vaccinatin can vary depending n a number f factrs. (http://www.cdc.gv/flu/abut/qa/vaccineeffect.htm.) a) Sme studies have indicated that immunity may last fr shrter perids f time in sme peple (fr example, in peple with weaker immune systems, which may include thse aged 65 years and lder); ther studies have indicated that antibdy levels (which are an indicatr f immune prtectin) last thrugh ne flu seasn. b) Cnsistent with CDC and Advisry Cmmittee n Immunizatin Practices (ACIP) general recmmendatin, peple with weakened immune systems and peple 65 years f age and lder shuld ideally be vaccinated by Octber. Given the variability f existing study results and the uncertainty and unpredictability f when flu activity will begin in a given cmmunity, CDC and ACIP d nt recmmend delaying vaccinatin fr peple in these grups. c) As lng as flu viruses are circulating, vaccinatin shuld cntinue thrughut the flu seasn, even in January r later. 5. Adults 65 years and lder are ften mst impacted by serius flu disease each year that can result in hspitalizatin r death. A recent study cnducted by CDC experts shws that flu vaccines prevent flu-assciated hspitalizatins in peple 65 years and lder, even during seasns when verall flu vaccine effectiveness is lw. 6. Peple 65 years and lder have a vaccine ptin available t them designed specifically fr peple in this age grup. This high dse flu vaccine (Fluzne High-Dse) cntains mre antigen (the part f the vaccine that helps yur bdy build up prtectin against flu viruses) than standard flu shts, and is intended t prmte a better immune respnse in this age grup. a) Data frm studies cmparing trivalent Fluzne vaccines, high dse and standard dse, amng peple aged 65 years r lder indicate that a strnger immune respnse (i.e. higher antibdy levels) ccurs after vaccinatin with Fluzne High- Dse. Results frm a clinical trial f mre than 30,000 participants shwed that adults lder than 65 years f age wh received the high dse vaccine had 24.2% fewer influenza infectins as cmpared t thse wh received the standard dse flu vaccine. Nte: CDC and the Advisry Cmmittee n Immunizatin Practices (ACIP) have nt expressed a preference fr the high dse vaccine ver the standard-dse flu sht fr peple 65 years f age and lder. 7. The higher dse flu vaccine may result in mre f the mild side effects that can ccur with standard-dse seasnal shts. Mild side effects can include pain, redness r swelling at the injectin site, headache, muscle ache and fever. 8. Talk t yur dctr r ther healthcare prfessinal abut the best vaccine ptin fr yu. 9. Peple 65 years f age and lder shuld nt get the nasal spray flu vaccine r the intradermal flu sht. 19
2014-2015 Flu Seasn Key Pints cntinued (10-31-14) 10. If yu get sick with the flu, yur dctr may recmmend treatment with antiviral drugs. (See Antiviral Drugs messages.) 11. Pneumcccal disease can be a cmplicatin f influenza infectin and includes pneumnia, meningitis and bld infectins. 12. Learn mre abut when pneumcccal vaccines are needed fr adults: http://www.cdc.gv/features/adult-pneumcccal. CDC recmmends all adults 65 years r lder receive 2 types f pneumcccal vaccines. One dse f PCV13 first, fllwed 6 t 12 mnths later by ne dse f PPSV23. 13. It is safe t get either f the pneumcccal vaccines at the same time as the influenza (flu) vaccine, but yu need t get the tw pneumcccal vaccines at different times. 14. While yu dn t need a pneumcccal vaccine every year, it is imprtant t get a flu vaccine each flu seasn. Flu can be serius, even fr therwise healthy peple. And having the flu increases yur chances f getting pneumcccal disease. Statements fr Adults with Certain Medical Cnditins (Back t table f cntents) General Messages 1. Mst peple wh get the flu will have mild illness, will nt need medical care r antiviral drugs, and will recver in less than tw weeks. Sme peple, hwever, are mre likely t have serius flu-related cmplicatins that may result in being hspitalized and ccasinally result in death. 2. Diabetes, asthma, and heart disease (even if well managed) are amng the mst cmmn lng-term medical cnditins that place peple at higher risk fr serius flu cmplicatins. a) The flu als can make lng-term health prblems wrse, even if they are well managed. b) It is particularly imprtant that all adults with chrnic medical cnditins like asthma, diabetes (types 1 and 2), and heart disease, receive a flu vaccine every year. c) Stay in cntrl f yur health by getting yur flu vaccine. 3. Yur dctr may prescribe antiviral drugs as treatment fr flu infectin. (See Antiviral Drug messages.) 4. Fr the full list f medical cnditins that put yu at a higher risk fr serius flu cmplicatins, see http://www.cdc.gv/flu/abut/disease/high_risk.htm. Diabetes (Back t table f cntents) 20
2014-2015 Flu Seasn Key Pints cntinued (10-31-14) 1. While CDC recmmends everyne 6 mnths and lder t get vaccinated against the flu, it is especially imprtant t get a flu sht if yu have diabetes (type 1 and 2). 2. Even if yur diabetes is well managed, yu can get the flu and have serius cmplicatins. It s imprtant that yu knw the signs and symptms f flu and make a plan with yur dctr abut what t d in case yu get sick. 3. If yu have diabetes, getting the flu can make yu very sick even if yur diabetes is well managed. 4. Fr example, flu illness can cause bld glucse (sugar) levels t rise and fall (r g up and dwn), making it harder t manage diabetes. 5. It is als pssible fr bld glucse (sugar) levels t decrease, fr example, when peple experience a decreased appetite r nausea frm flu illness. 6. Peple with diabetes smetimes have a harder time fighting infectins. 7. A study shwed that peple with diabetes were mre than tw times mre likely t be hspitalized with a flu-related illness. (Everyne with diabetes, including bth type 1 and type 2 diabetes, shuld be prtected frm flu with an annual flu sht.) 8. Peple with diabetes shuld ask their family and friends t als get a flu vaccine; this can als help reduce their chances f getting sick frm flu illness. 9. Flu shts are apprved fr use in peple with diabetes and ther health cnditins. There is a precautin against giving nasal spray flu vaccine t peple with diabetes because the safety f the nasal spray vaccine in peple with diabetes and sme ther high risk cnditins has nt been established. 10. If yu have flu-like symptms, call a dctr, nurse, r clinic right away even if yu have had a flu sht. A dctr r clinic can prescribe medicine t treat the flu and reduce yur chance f serius illness. It s imprtant t start taking this medicine as sn as pssible. The medicine wrks best if taken within the first 48 hurs after yur symptms start. Visit: http://www.cdc.gv/flu/antivirals/index.htm and http://www.cdc.gv/flu/abut/disease/symptms.htm. 11. Take everyday steps t prtect yur health. Visit: http://www.cdc.gv/flu/prtect/habits/index.htm. 12. Fr mre infrmatin abut flu and diabetes, visit: http://www.cdc.gv/flu/diabetes/. Asthma (Back t table f cntents) 1. Althugh peple with asthma are nt mre likely t get flu, flu is mre serius fr peple with asthma, even when asthma is mild r the symptms are well managed. 2. Peple with asthma are mre likely t have breathing prblems if they get the flu. 3. The flu can als trigger asthma attacks r cause pneumnia and ther acute respiratry diseases. Adults and children with asthma are mre likely t develp pneumnia after getting sick with the flu. 4. Asthma is the mst cmmn chrnic medical cnditin amng children hspitalized with the flu. 5. Flu shts are apprved fr use in peple with asthma. 6. The nasal spray vaccine is apprved fr use in peple 2 thrugh 49 years f age. 21