COVID-19 and Influenza: A Q&A with Drs. Roshni Mathew and Katya Gerwein

With the ongoing COVID-19 pandemic, public health officials say it’s more important than ever for children to be vaccinated now against the flu. For parents with questions about the flu vaccine, two Lucile Packard Children’s Hospital Stanford experts provide some answers. Roshni Mathew, MD, is a pediatric infectious diseases physician and the associate medical director for infection prevention and control at Packard Children’s. Katya Gerwein, MD, is a Berkeley pediatrician with Stanford Children’s Health.

What are the general recommendations for flu shots in kids?

Roshni Mathew, MD: Every child 6 months or older should receive his or her annual influenza vaccine unless there is a contraindication (such as a severe allergic reaction to a previous flu vaccine). Children 6 months through 8 years should get two doses of influenza vaccine at least four weeks apart in their first season of vaccination. After that, they should receive a single annual vaccine.

Why is it especially important this year, with the COVID pandemic, for kids to be immunized against the flu?

Mathew: The influenza vaccine not only protects individuals from acquiring influenza but also protects them from getting severe disease. If all individuals get the vaccine, we can potentially reduce the occurrence of influenza in the community and thereby reduce the number of people coming in with flu symptoms, which could be very similar to COVID-19. If we are able to prevent influenza-related outpatient visits or influenza-related hospitalizations, that also can help reduce the burden on the health care system.

What are the risks of flu in children?

Katya Gerwein, MD: There are serious risks, including pneumonia, encephalitis, and sudden death, in healthy children. Most kids do fine with the flu, but not everybody. We know there are some kids who are more vulnerable because they have asthma and other preexisting conditions, but every year there are healthy children who die from the flu unexpectedly.

What if you were to have flu and COVID together?

Mathew: There have been a few published reports of influenza and COVID at the same time. But it’s not common, and so we don’t actually know the impact of having both infections at once.

If a child were to get the flu, might that make him or her more vulnerable to COVID?

Mathew: We don’t really have any indication that having influenza makes you more likely to get COVID. But if flu has caused you to have severe illness, then having another respiratory virus on top of the infection could certainly be difficult on the body.

Is there any way to distinguish flu symptoms from COVID symptoms?

Gerwein: The only difference is that COVID may cause loss of taste and smell. But other than that, most of the other symptoms overlap very closely.

How protective is the vaccine?

Gerwein: It seems to cut in half the risk of hospitalization or death in kids. Even when it’s only 50 percent protective, it seems the people who are vaccinated get a much milder case. I had a mom who didn’t believe in the vaccine but had to get it for work. She got the flu, which hit her very hard, but then she was much better the next day. Her partner, who was not vaccinated, had complications, and it took him weeks to get back to normal.

What are the possible side effects of the vaccine that may concern people?

Gerwein: I think most people don’t have side effects at all, but some have that immune system activation—that achy feeling and mild fever or fatigue the next day. But you cannot get the flu from the flu vaccine, as some people think.

What about the option of a nasal spray vaccine for kids?

Mathew: The nasal spray is a live attenuated (weakened) vaccine. This would only be an option for someone over 2 years of age who is healthy and doesn’t have specific conditions that preclude them from getting a live vaccine, such as being immunocompromised.

Given the ease of transmitting both flu and COVID, what steps is Packard Children’s Hospital taking to control infection?

Mathew: The steps to reduce transmission of influenza are similar to COVID in terms of physical distancing, mask wearing, and staying home when sick. The additional measure we have for influenza is the vaccination. So the health care worker vaccination program is up and running. This happens every year. Also, as health care providers, we make sure there is an opportunity for both inpatients and outpatients to get vaccinated.

Is there anyone who shouldn’t get the shot?

Mathew: Infants less than 6 months would not qualify. The other group that should not get the vaccine are individuals who have a history of severe allergic reaction to a prior influenza vaccine. While many vaccines have trace amounts of egg protein, egg allergy is not considered a contraindication.

When is the best time to get a flu shot?

Mathew: The immunity you get from the influenza vaccination can wane over the course of the season. So, getting the vaccine around the end of October is a consideration, since the peak of flu season is often January or February. However, the timing of onset of the flu season can vary, and vaccines are available now, and any opportunity to get vaccinated should be used, since we do not want anyone to miss their opportunity.

Where do you recommend parents take their children for a flu shot?

Gerwein: Your local pediatrician’s office is the best place to get a flu shot. They know you, and they know your medical history.

Flu shots are offered by your Stanford Children’s Health provider and at select clinic locations.

View more information at flushots.stanfordchildrens.org

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