September 2016 Bulletin

Needles and Noses: A Flu Vaccine Q&A With Dr. Wendy Sue Swanson

Wendy Sue Swanson Digital HealthDr. Wendy Sue Swanson, a pediatrician at The Everett Clinic in Mill Creek, a member of Seattle Children’s medical staff and executive director of Digital Health, and author of the Seattle Mama Doc blog, addresses questions about the nasal flu vaccine and what you need to know for this year’s flu season.

What is the CDC’s recommendation about flu vaccines this year, specifically about nasal flu vaccine?

Like years past, flu vaccination is recommended for all children over the age of 6 months. The flu vaccine is an essential and safe vaccine that should be given every year.

One thing that’s new this year: the American Academy of Pediatrics (AAP) recently endorsed recommendations by the Advisory Committee on Immunization Practices (ACIP) to avoid use of flu mist vaccine this coming flu season.

The Centers for Disease Control (CDC) will review the recommendations shortly. If the CDC accepts the recommendation it will become official U.S. policy for the 2016–2017 season to recommend flu vaccination to all children over 6 months of age with a shot only.

What does this mean for those who have used the nasal flu vaccine in years past?

To be clear, those who received the nasal flu vaccine were given a safe vaccine and are in no danger.

However, the effectiveness has varied and was, unfortunately, very low. Last year, for example, the 2015–2016 nasal flu vaccine is estimated to have been only 3% effective in protecting against any strain of flu. The injected flu vaccine has an estimated 63% effectiveness.

What should providers tell parents who may already be wary of vaccinations?

I think we have the opportunity to build trust in the flu vaccine. The reality is that the best way to protect a child or high-risk individual from getting influenza and/or complications from the infection is to get immunized. The flu vaccine is safe and offers added protection for children and their families outside of avoiding those who are ill during the flu season.

How can providers reassure parents that the vaccine is effective?

Flu vaccines are different from most other vaccines because the influenza virus shifts and drifts from one strain to the next each year. The vaccine is prepared annually to improve the likelihood of it working against the type of flu that eventually arrives and causes infection.

Because it’s prepared annually based on predictions for circulating strains, and because the strains shift and change, flu vaccine effectiveness varies from year to year. However, vaccines aren’t 100% effective in all who get them. The influenza vaccine typically has an effectiveness rate between 50% and 60%, but it’s the best way to protect high-risk groups, which includes young children.

The science behind flu vaccine effectiveness is always changing because of the nature of the infection and ongoing vaccine development. Close tabs are kept on vaccine effectiveness to help us know the best ways to protect our patients.

What tips can you offer providers to help vaccinate kids with severe needle phobia?

  • Don’t promise no-needle visits ever! A nasal flu vaccine will likely be back, but there is no certainty when. We’ll likely get to offer it in upcoming seasons, but this year we’re back to offering just the shot.
  • Acknowledge and recognize that needle phobia is real. We have to treat the anxiety that children and their families feel with respect and work with the care team to minimize anxiety with shots.
  • Consider teaching children and teens the “cough trick.” It’s a distraction technique where a child or teen coughs just as the needle goes in. Ask your patient to cough as the shot is being administered. Studies have shown that kids feel less pain when using this trick.
  • Children watch their parent’s experience with shots and we all clearly know a nervous parent makes a nervous child at times. We can remind families how far their reactions go to build calm and trust in their child at flu shot visits. In addition, I recommend family flu shot visits where everyone gets immunized at once!
  • Treats (ice cream, special snack, time at a special park or restaurant) after shot visits are awesome incentives!

Why is it still important for children – and everyone – to get the flu vaccine?

Clearly influenza and complications from the infection are hardest on infants and young children, pregnant women, the elderly and those with underlying health conditions that make it harder to deal with the infection (e.g., diabetes, asthma, neurologic conditions and problems with the immune system).

Depending on the season, influenza can cause anywhere from 4,000 to 50,000 deaths per year in the United States. Thankfully, only a couple hundred of those deaths each year are children. But children are exposed to infections more than adults because of the nature of their play, interactions and school settings.

The flu vaccine is recommended for all infants and children ages 6 months and older to protect them from the infection, their community, and severe complications.

Learn more

To learn more, read Swanson’s blog post, No Nasal Flu Vaccine This Year: Flu Shot for All Over 6 Months.


Seattle Children’s Offers Consultation Line for Suspected Child Abuse and Neglect

Are you concerned that a child you treat may be abused or neglected? Help is only a phone call away.

Seattle Children’s Suspected Child Abuse and Neglect (SCAN) Team provides a 24-hour consultation service for healthcare providers who suspect a patient is being mistreated or have questions about whether a situation warrants further action.

Our SCAN team includes physicians who are board-certified in child abuse pediatrics and social workers with expertise in child abuse and neglect as well as intimate partner violence.

You can reach our team Monday through Friday from 8 a.m. to 4:30 p.m. by calling 206-987-2194 or toll-free at 866-987-2000. After hours, call 206-987-2000 and ask for the SCAN or child abuse doctor on call.

Visit Seattle Children’s Protection Program for more information.


Provider Grand Rounds (CME Credit Available)

Upcoming Grand Rounds

For Provider Grand Rounds information, visit our website.

Watch Past Grand Rounds Online

  • Autism and the Molecular Biology of the Social Brain
  • Kids These Days… Novel Ways to Get High
  • Enhancing Patient Safety Through Simulation-Based Teamwork Training

For all past grand rounds, visit our video library.


Register Now for Recognizing, Preventing and Reporting: A Guide to Child Abuse for Primary Care Providers

October 15, Wright Auditorium, Seattle Children's

This course is designed to improve your clinical practice by providing tools for identifying and evaluating behaviors and injuries related to child abuse, accessing support from local and regional resources and making referrals to Child Protection Services.

Course fee (includes catering, instructional materials and CME credit)

  • Before Sept. 15: $100
  • Sept. 16 to Oct. 12: $125

View the course brochure (PDF) for more information, then register online. All registrations must be received by noon on Wednesday, Oct. 12.


New Medical Staff and Allied Health Professionals for September 2016

Medical Staff

  • Emily Antoon-Walsh, MD, MA, Seattle Children's, Hospital Medicine
  • Pearl Chang, MD, Seattle Children's, Hospital Medicine
  • Yewlin Chee, MD, Harborview Medical Center, Ophthalmology
  • Jennifer Chiem, MD, Seattle Children's, Anesthesiology and Pain Medicine
  • Laura Duling, MD, Seattle Children's, Anesthesiology and Pain Medicine
  • Aimee Foord, DO, Seattle Children's, Hospital Medicine
  • Megan Frye, PhD, Odessa Brown Children's Clinic, Psychiatry and Behavioral Medicine
  • Michelle Gern, MD, Seattle Children's, Hospital Medicine
  • Christopher Johnson, DO, Seattle Children's, Orthopedics and Sports Medicine
  • Uma Khazanie, MD, Seattle Children's, Hospital Medicine
  • Navita Kumar, MD, Seattle Children's, Hospital Medicine
  • Tao Sheng Kwan-Gett, MD, Seattle Children's, Emergency Medicine
  • David Lin, MD, MHA, Bloodworks Northwest, Laboratory Medicine/Pathology
  • Anoop Patel, MD, Harborview Medical Center, Neurosurgery
  • Daniel Petroni, MD, PhD, Northwest Asthma & Allergy Center, PS, Allergy
  • Stephanie Randle, MD, MS, Seattle Children's, Neurology
  • Aditi Sharma, MD, Seattle Children's, Pediatrics
  • Anita Thomas, MD, MPH, Harborview Medical Center, Emergency Medicine
  • Matthew Thompson, MD, Seattle Children's, Orthopedics and Sports Medicine
  • Amy Trowbridge, MD, Seattle Children's, Hospital Medicine
  • Anna Villavicencio, PhD, Seattle Children's, Psychiatry and Behavioral Medicine
  • Nicholas Vitanza, MD, Seattle Children's, Hematology-Oncology
  • David Werny, MD, MPH, Seattle Children's, Endocrinology

Allied Health Professional

  • Krista Miller, CRNA, Seattle Children's, Anesthesiology and Pain Medicine