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Flu vaccine menu expands: Nasal mist back; some vaccinations age-specific

Jason Hill, nurse manager at the Chris Jensen Health & Rehabilitation Center in Duluth, administers the more powerful flu shot to residents Pat Wick (center) and Lyle Burke Friday, Oct. 5. Both have been getting flu shots since the practice started. Bob King / Forum News Service1 / 2
Jason Hill, nurse manager at Chris Jensen Health & Rehabilitation Center in Duluth, draws flu vaccine into a syringe to administer it to one of the center's residents. Bob King / Forum News Service2 / 2

DULUTH — When it comes to flu shots, one size doesn't fit all.

As in past years, a souped-up vaccination is given to people ages 65 and older in preparation for the 2018-19 flu season, infectious-disease specialists at Essentia Health and St. Luke's in Duluth say.

For the first time, though, St. Luke's also is providing a specific vaccination to a slightly younger crowd, those ages 50-64.

Known as Flublok, or technically as recombinant influenza vaccine, it's the vaccine that used to be given to people who have egg allergies, said Sherry Johnson, a nurse practitioner with St. Luke's Infectious Disease Associates. It turned out that even though the normal vaccine is made in an egg-based culture, people who are allergic to eggs aren't allergic to the vaccine, she said.

But in what she called a small study — around 10,000 people — published last year in the New England Journal of Medicine, those in the 50-64 age group fared better with Flublok than with the traditional vaccine, Johnson said.

"So St. Luke's has adopted that; we're going to try it," she said. "We'll see what the outcome is at the end of the flu season. But we're hopeful that we're going to see maybe fewer people with influenza in that age group."

Essentia Health is going with the regular vaccine for the 50-64 set, said Dr. Rajesh Prabhu, Essentia's infectious disease specialist. He was cautious about the possible advantage with Flublok.

"I don't think there's enough information to say that for sure," Prabhu said. "It's hard to compare vaccines, because every year the flu changes. ... Maybe (one year) it was a good year for the recombinant vaccine, but maybe the next year it's no better than the regular."

The U.S. Centers for Disease Control and Prevention doesn't recommend one over the other, he added.

The corporate offices for Walgreens and CVS, both of which offer flu shots, didn't respond to a query about the specific vaccinations they provide.

Both Essentia and St. Luke's give those who are 65 and older the high-dose vaccine.

"All that means is they put more of the flu particles or antigens in the vaccine compared to the standard dose," Prabhu said.

The 65-and-older version has been shown to be four times more powerful than the regular version, Johnson said.

Why not give it to everyone?

"Because they probably don't need it," Johnson said. "In older people, we're looking at that declining immune system. Younger people have a more robust immune system."

Adults who are younger than 65 but have weakened immune systems sometimes ask for the higher-dose shot, she said. But because that's not recommended by the CDC, it might not be covered by insurance.

For those younger than 50, nasal spray vaccination is back.

For a few years it wasn't available because it wasn't found to be effective enough, Johnson said. But it has been improved and now is recommended by the CDC for those 49 and younger. However, the American Academy of Pediatrics still said it prefers an injectable vaccination for children.

"They're worried about past failures," Johnson said. "Still, I would say flu mist vaccine for somebody that would not receive any vaccine (otherwise) would be a great idea."

The CDC recommends getting a flu shot by the end of October, and both health systems as well as pharmacists, nursing facilities and many workplaces are making vaccinations readily available. The shots are covered by most insurance plans. They're recommended by everyone from 6 months old and up.

This year's flu preparation comes after the worst flu season in decades. CDC data estimate 80,000 people died due to influenza during the 2017-18 season, the Washington Post reported last week. The previous high, in an analysis extending more than 30 years, was 56,000.

The number included 180 pediatric deaths in 2017-18, the most since those numbers started to be collected in 2004. About four out of five of the children who died last flu season hadn't been vaccinated, the CDC reported.

Five children in Minnesota died from influenza during the past season, the state Department of Health reported. The vaccination rate for children in the state was 62 percent, slightly better than the previous two years and better than the national rate of just under 58 percent.

Overall, the vaccine was estimated to be 40 percent effective for both the A and B flu viruses in the past flu season, the CDC reported.

That's not great, Johnson said, but it's better than nothing.

"You have to remember that even in the flu season last year where we were really disappointed in the performance of the flu vaccine, it still did save lives," she said. "Even though we still see flu with people who are vaccinated, it's likely to be less severe."

She experienced that herself, Johnson said. She got a flu shot ahead of last year's influenza season and still came down with the flu. But the symptoms only lasted for a day.

There's no sure way to predict what this flu season will be like, both Prabhu and Johnson said, but there's at least one hopeful sign.

"If things hold true, last year we were all focusing on Australia, 'Oh look, they're having a bad flu season, it's going to be a bad flu season for us,'" Prabhu said. "And they're having a mild season (this year). That's the thing with influenza. Not every year is going to be a high-severity flu season."

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