Updated June 07, 2015.

Each flu season seems to have some kind of surprise in store for parents and pediatricians.

The big surprise this year was the announcement of flu vaccine delays. Although they were only delayed by weeks to months, and many pediatricians still got partial shipments of flu vaccine, this was indeed a surprise after so many years of having such a plentiful supply of flu vaccine. Fortunately, over 147 million doses of flu vaccine have now been distributed and any delays should have been resolved.

Another surprise has been the announcement that the nasal spray flu vaccine was found to be ineffective against the H1N1 flu virus, at least among children during last year's flu season. And then news that influenza A (H3N2) viruses have drifted, and so are different than the H3N2 flu virus strain that is in this year's flu vaccine, came as a big surprise to most people. Although it is not uncommon for flu viruses to drift (it is one of the reasons we need new flu vaccines each year), when they do, it can make the flu vaccine less effective.

And what will hopefully be the last big surprise - the announcement from the CDC that "early data suggests that the current 2014-2015 flu season could be severe."

Flu Season

Especially with the bad flu season we faced a few years ago, parents should take steps to help avoid the flu and to keep their family from getting sick. In addition to getting a flu vaccine, this can include frequent hand washing, avoiding close contact with people who are sick with the flu, disinfecting contaminated surfaces, including toys and kitchen counter-tops.

Flu vaccine recommendations for the 2014-15 flu season didn't change from last year. Experts still recommend the vaccination of all people who are at least six months old. The availability of 151 to 156 million doses should make that easy too.

Also remember that children who are less than nine years of age, still need two doses of the flu vaccine if this will be the first time that they are getting vaccinated. Your kids might also need two doses if they are less than nine years of age and haven't had at least two doses of seasonal flu vaccine since July 1, 2010.

If your own pediatrician doesn't have flu shots, you might check with your local health department, hospital, or pharmacies, and find a flu shot wherever you can.

Flu Season Activity Reports

The weekly flu reports from the CDC tin May have stated that flu activity "is drawing to a close."

Google's Flu Trends, which relates flu searches in an area to how many people are actually sick with the flu, continues to report a low level of flu activity in the United States. Google Flu Trends is supposed to 'estimate flu activity faster than traditional systems.' It is a good complement for the CDC surveillance system, but is by no means a replacement, as we saw during the 2013-14 flu season, in which Google's Flu Trends greatly overestimated peak flu levels.

Knowing where there is flu activity can be helpful though, because if you have classic flu symptoms in an area where there are a lot of flu infections, especially widespread or intense flu infections, then you likely have the flu and should see your doctor right away if your child is a candidate for one of the flu medications, such as Tamiflu (oseltamivir) or Relenza.

Keep in mind that the FDA  expanded the approved use of Tamiflu in 2012, at a dose of 3 milligrams per kilogram twice daily for five days, to treat children as young as 2 weeks old. As with older children and adults, Tamiflu is for those infants who have flu symptoms for no longer than two days. But unlike older children and adults, Tamiflu can not be used to prevent flu in infants.

Children under age two to five years and those with chronic medical problems, such as asthma, diabetes, or heart problems, etc., are considered to be high risk for flu complications and should be considered for antiviral flu medications.

Because of the increased demand for the oral suspension form of Tamiflu, as in past years, it is sometimes on back order may be hard to find in many areas. Your pharmacist should be able to compound the 75mg Tamiflu capsules into a suspension for your child though in the event of a Tamiflu shortage, as we are now seeing. The CDC also states that "for those patients who cannot swallow capsules, the capsules can be opened and the contents may be mixed with chocolate syrup or some other thick, sweet liquid, as directed by a healthcare professional" who can figure out an age-appropriate dose for your child, perhaps by using the 30mg or 45mg Tamiflu capsules.

Flu Deaths

Each year, the flu is reported to be responsible for almost 36,000 deaths, including about 85 deaths in children. In the 2009-10 flu season, 281 deaths in children were reported to the National Notifiable Diseases Surveillance System.

There were 112 pediatric flu deaths during the 2013-2014 flu season.

There have been 142 pediatric flu deaths during the 2014-2015 flu season.

Most of these children were eligible to get a flu vaccine, but few were fully vaccinated against the flu.

The CDC has also reported that during last year's flu season:

• 90% of pediatric flu deaths were in children who had not received a flu vaccine
• 40% of the flu deaths were in children who had no underlying chronic health problems
• 40% of children had received a flu vaccine by mid-November
• flu vaccination prevented an estimated 6.6 million influenza illnesses, 3.2 million medically attended influenza illnesses, and 79,260 hospitalizations

Unfortunately, in a new report, "Early Estimates of Seasonal Influenza Vaccine Effectiveness — United States, January 2015," the CDC has estimated the effectiveness of this year's seasonal flu vaccine to prevent "influenza-associated, medically attended acute respiratory illness" at about 24% in children between the ages of 6 months and 17 years.

While the flu vaccine isn't as effective this year, it is important to keep in mind that in a year with a drifted virus strain, like during the 2007-08 flu season, the "the vaccine can still prevent some infections with the circulating A (H3N2) viruses and might also prevent serious complications requiring hospitalization. Also, vaccine might protect against other influenza viruses that can circulate later."

<sub>Sources:

CDC. FluView. 2014-2015 Influenza Season Week 21 ending May 31, 2015

CDC. Early Estimates of Seasonal Influenza Vaccine Effectiveness — United States, January 2013. MMWR. January 11, 2013 / 62(Early Release);1-4.

CDC. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices – United States, 2013-14, MMWR 2013, September 20, 2013 / 62(RR07);1-43</sub>