Flu Season 2020

Flu season is fast approaching. This year, though, the flu season has been preceded by the global COVID-19 pandemic. In this episode, we talk to two Children’s experts – pediatric infectious disease specialist Dr. Kari Neeman and pediatrician Dr. Malinda Bender – about what families should be aware of as we enter flu season and how to stay healthy during this time.

As COVID-19 vaccine development progresses into various stages of clinical trials, it’s important to remember that one key difference between COVID-19 and the influenza virus is the current availability of flu immunizations to prevent infection. Each year, flu vaccinations are a tried and true way to prevent disease. Flu shots become available annually to prevent influenza infection – and are recommended for both the young and the old.

Flu Vaccines at Children’s

Learn about flu vaccine clinics at Children’s and schedule an appointment for your child.

Topic Breakdown

1:31 – Children should get their flu shot this year
3:33 – Precautions parents can take to prepare for flu season
5:25 – Flu vaccine clinics at Children’s
6:57 – The right age for vaccination
8:24 – Side effects of the flu shot
9:52 – Convincing others to get their flu shot
10:51 – Different types of the flu
12:08 – Safety measures in flu shot clinics
12:38 – Wearing masks to prevent both COVID-19 and the flu — even after mask mandates end
13:15 – Flu vs. COVID-19
14:29 – Flu and risk of COVID-19
15:56 – COVID-19 and the impact on flu predictions
17:46 – Risk of flu may decrease due to virtual learning and social distancing
18:34 – The take-home point about this year’s flu season


Here at Children’s Nebraska in Omaha, Nebraska, it’s all kids — all day, every day. Our pediatric experts are here to answer your questions and weigh in on hot topics, helping you keep your child healthy, safe, and strong. We’re here for you. Listen in.

Flu season is fast approaching. This year, though, the flu season has been preceded by the global COVID-19 pandemic. In this episode, we talk to two Children’s experts – pediatric infectious disease specialist Dr. Kari Neeman and pediatrician Dr. Malinda Bender – about what families should be aware of as we enter flu season and how to stay healthy during this time.

Dr. Kari Neeman: I am Dr. Kari Neeman. I’m an assistant professor in adult and pediatrics, and I do infectious disease here at Children’s Hospital and the University of Nebraska Medical Center.

Dr. Malinda Bender: Hi Kari. I’m Dr. Malinda Bender. I am a general pediatrician with Children’s Physicians. I work at the Council Bluffs Children’s Physicians Clinic.

Dr. Neeman: Alright. Well today I think we’re going to be discussing the importance of influenza vaccination and how COVID-19 fits all into that. We’ve received several questions, and I think we’ll just take them one by one.

Children should get their flu shot this year

Dr. Neeman: So, the first one I have is, “Each year, the flu vaccine is available to prevent different strains of the flu. With COVID-19 infection prevalent in many communities, should my child receive the flu shot this year?”

Dr. Bender: Absolutely, the answer is yes. Every year, you should be looking to get the flu vaccine. But this year, with two significant respiratory illnesses going around, it’s particularly important to get the flu vaccine. We definitely want you to get it as early in the year as possible because we want to have that protection already in place before we start seeing the influenza vaccine even circulating. Usually, before the end of October, we would like everybody to have their flu vaccines already.

It’s going to be especially important for our most vulnerable patients, which are older adults and our young children. But to help protect them, everybody needs to get it. Especially our really young kids that are having to require — are required to get two vaccines, we want them to get it early, as well. Because those will have to be separated by 4 weeks for them to have their full protection from it. It takes about 2 weeks to build your immune response from the vaccine, so the longer we wait — if we start seeing flu, the higher chances we have that we may not have that protection in place when the flu does start circulating.

Dr. Neeman: I completely agree. Right now, most clinics throughout town have the flu vaccine available, and so start making appointments to get your child vaccinated now. We want them to have that good immunity before flu season starts, which tends to happen towards the end of November. So get it in now.

Precautions parents can take to prepare for flu season

Dr. Bender: One of the next questions that we have is, “Are there precautions that you recommend parents should take in preparing for the flu season?”

Dr. Neeman: This year, I would say in addition to getting your child vaccinated, and like every year for every person over 6 months of age — get yourself vaccinated. Get your friends, your family members vaccinated.

This year, it’s going to be very difficult to determine the difference between influenza and COVID-19 because those symptoms overlap. We want to protect our community as a whole, and being also cognizant that there’s concern that there’s going to be a second wave of COVID-19 coming as we are more inside, indoors, as we have our directed health measures lax. And that we may see a bigger resurgence. And so we need to utilize our healthcare resources as appropriately as possible. And if we can get influenza off the table, that will give us the room to take care of those patients with COVID-19 if we need to.

Dr. Bender: I absolutely agree. The other thing I would say, too, is just to continue to practice all of those other standards of good hygiene — to wash your hands, cover your coughs — to really keep working with our kids and our family members to practice those. It’s still a good idea to wear a mask. It helps protect from COVID, both getting it and spreading it, as it would with influenza, as well.

And then just continuing to maintain your own health at a good baseline. Making sure that you’re still eating healthy and exercising. Those are all good things to help you prepare for the upcoming flu season, as well.

Flu vaccine clinics at Children’s

Dr. Neeman: So our next question: “When are Children’s Physicians office holding immunization clinics?”

Dr. Bender: Yes, we are already starting to hold the immunization clinics. This year it’s a little different. We want you to call your clinic to schedule it. We don’t have any walk-in appointments for flu vaccines.

Most of the Children’s clinics have a weekday evening flu clinic on Tuesdays, Wednesdays, and Thursdays, from 5 to 7. And then there’s going to be a couple Saturday flu clinics, as well, at Dundee Flats, and Gretna. Those will be for four Saturdays in a row — on the 26th of September, the 3rd, the 10th, and the 17th of October. And then there will be some Sunday clinics as well at the Eagle Run location.

But again, call your clinic and they can definitely help get you scheduled. Our big push this year with the flu clinics is to make sure that they’re being done during what we call our “well-visit time” to avoid any potential exposures to other sick kids when you’re coming in to get the flu vaccines.

Dr. Neeman: I would also say that if for some reason your child has an appointment at the Specialty Clinic, that we will have flu vaccines available there, as well. Feel free to ask your provider, whoever that is, if you can get one there. Because the time to get the influenza vaccine is when you are present and can get it.

The right age for vaccination

Dr. Bender: Perfect. One of the next questions that we have is about the age of vaccination. So, “At what age should a child be vaccinated? And then if my child is too young for vaccinations, do you recommend babies of a certain age remain at home as much as possible to prevent the flu?”

Dr. Neeman: Yup. And so everyone 6 months and older should be receiving the influenza vaccine. Now, the first time you receive it, if you’re between 6 months and 8 years of age, you do need to have a two-series shot that’s separated by 4 weeks. And so that’s why it’s so important to get those specific individuals in early so we can get them that second shot in.

If your baby is less than 6 months of age, then we’re going to really be pushing for moms while they’re pregnant to get their influenza vaccine so that they can make those antibodies, give them over to baby during that third trimester so that they are protected that first 6 months. And then that whole concept of cocooning. Everyone around that baby needs to be vaccinated. That includes Grandma and Grandpa, and all the naysayers. Don’t let them in the door unless they’re getting vaccinated.

Dr. Bender: Absolutely, 100% agree. I get asked that a lot from all of my new parents, and it’s so important to protect our little ones by having everybody that’s around them all already protected so they don’t bring it in.

Side effects of the flu shot

Dr. Neeman: Another question I had was, “What should I expect to see or watch for after my child receives a flu shot?”

The most common side effects of the injectable shot — which is going to be the most prevalent one out there — is just some soreness and redness, and maybe some swelling, at the injection site. These reactions are very temporary and occur in about 15 to 20% of recipients. Less than 1% of people who get the flu shot are going to have any sort of symptoms such as fever, chills, or muscle aches. It’s really kind of a sore arm or sore leg for a few hours.

Dr. Bender: One of the other questions I get asked a lot in my clinic is, “Should we give Tylenol before or after the flu shot?” In general now, we are not using Tylenol because there’s some concerns that it may help — or may reduce your ability to build an immune response to the vaccine. That being said, if your child is extremely fussy after the flu shot, or is running high fevers after the flu shot, you can give a dose. But otherwise, for just low-grade fevers and a little bit of achiness, generally we try to use the warm packs and just some soothing techniques otherwise for kids that have some discomfort with the flu shot.

Convincing others to get their flu shot

Dr. Neeman: Our next question — “As a parent, I know I should recommend those around my child receive the flu shot. What are some techniques to approach this topic?” Well, we can let them know what the CDC guidelines are and recommend that it’s not only for their child’s protection — but for their protection, as well.

But I think this year with COVID-19 and the pandemic going on, why not do anything we can do to decrease the transmission of respiratory illnesses and conserve our healthcare resources? I think that this should be an easy sell this year.

Dr. Bender: I 100% agree. It kind of goes back to that cocooning, as well. If you really have to kind of set the expectations that you want your little ones to be — have to have less exposure — then to really encourage the family members around them to get it. You can use that as another reason.

Different types of the flu

One of the next questions that we have is, “Many times, a region may have a higher prevalence of a specific strain of influenza. What are the differences between type A and type B of the flu?”

Kari: So, there are actually four different types of influenza. Type A, B, C, and D. But Type A and B are what we primarily see in humans. Type A is the strain that can cause pandemic illness. But both strains can definitely cause symptomatic disease in humans and can result in hospitalization, and have that equal mortality associated with them.

Every spring, we decide what is going to be in our influenza vaccination by looking at what’s circulating in the opposite hemisphere. Based on that, we choose the four strains and that is what we have to go by. Type A strain — the one that can cause pandemic illness — can have a little bit more of what we call “antigenic shift,” and so we may not have an exact match. And that’s why some years, the flu vaccine doesn’t seem to be quite as effective. The type B is a little bit more stable and usually is a fairly good match.

Safety measures in flu shot clinics

Dr. Bender: Next question is, “What precautions will it take in hosting flu clinics this year as opposed to past years?” We just touched on that a little bit earlier regarding that we’re doing it during the well-visit times. Or if you’re in the office for another reason, to do the vaccine while you’re in there to prevent you having to come back into the clinic a second time.

Wearing masks to prevent both COVID-19 and the flu — even after mask mandates end

Dr. Neeman: The next one we’ll go to is, “When the local mask mandate ends, would it be best to continue masks for children of the recommended age to prevent flu?”

This is easy. Yes. When the mask mandate ends, COVID-19 infection will not be gone. Influenza will not be gone. And so, we’re going to need to continue doing this mask until who knows when at this period. But we will not have herd immunity or have a vaccine readily available throughout this influenza season. So plan on wearing your mask.

Flu vs. COVID-19

Dr. Bender: So one of the big questions we get is, “Is it COVID, or is it flu?” And what symptoms are the most effective to pay attention to in distinguishing between flu and COVID-19?” So, they definitely have a lot of overlapping symptoms: Fever, cough, shortness of breath, fatigue, sore throat, runny nose, muscle aches, some headaches, vomiting, and diarrhea. We can definitely see that, especially more in kids with COVID, but we also see it with flu.

But the other big difference is that we’ve kind of been able to differentiate slightly is, if the loss of taste or loss of smell — more often, that should be associated with a COVID infection.

Dr. Neeman: I would also just reiterate that COVID-19 — upwards of 45% of patients are going to be completely asymptomatic. And that’s why we need the mask mandate and our directed health measures with good hand hygiene and keeping that social distancing.

Dr. Bender: And like we said before, both of them are spread by droplets, so that mask definitely helps with the spread of both of those viruses.

Flu and risk of COVID-19

Dr. Bender: One of the other questions I’ve had is, “Does contracting the flu increase your child’s risk of contracting COVID-19?”

Dr. Neeman: No, it does not. These are two separate viruses. While they’re both spread by respiratory droplets, they are a little bit different, although they do have some overlapping symptoms.

So, with influenza, symptoms are generally going to develop 1-4 days after you’ve been infected, and you’re infectious from about 1 day prior to symptom onset to about 7 days of illness.

Where with COVID-19, symptoms are generally going to develop about 5 days after you’ve been infected, but can be anywhere from 2 to 14 days, and that’s where we’re getting that quarantine period recommendation. You are then infectious from about 2 days before you have symptoms to 10 days following symptom onset. That’s why if you have a positive test or symptoms consistent with COVID, we’re recommending isolation for 10 days.

Again, just remember, COVID-19 can be asymptomatic, and has been more associated with the super-spreading events that we don’t necessarily see with influenza. Again, wearing our mask and those hand hygiene and directed health measures.

COVID-19 and the impact on flu predictions

Dr. Neeman: Let’s see. Our next question is, “Does COVID-19 impact the expected flu predictions for this year?” And I’ll say no. I don’t think that one has any relation to the other. Let’s hope we have a mild flu season, but we will see.

Dr. Bender: Absolutely. I think one of the big things though that we’re worried about is with the COVID potentially impacting hospitalizations, and then flu potentially impacting hospitalizations, that we may be in a situation that if we aren’t getting vaccinated, and we’re not practicing good hygiene and wearing masks and social distancing to a degree — the hospitals may become overwhelmed again at some point.

So I think that’s part of our big outlook for this year, is making sure that our resources are still available, and to do as much as we can in preventing spread and preventing the illnesses by immunizations.

Dr. Neeman: Yup. And I would just reiterate that influenza is more than just a cold. Influenza, as it’s been described to me, it feels like you’ve been hit by a bus and you’re down for a good week with this illness. But there can be lots of complications from it that can result in hospitalization. Pneumonia, sepsis, multi-organ failure. And while that doesn’t occur in the majority of patients that get infected, that it is a possibility and so we need to make sure — especially this year with potential limited resources — that we are protecting those most vulnerable.

Risk of flu may decrease due to virtual learning and social distancing

Dr. Neeman: “Do you expect to see a decrease in flu due to the limited interaction of children, due to virtual learning and social distancing?”

Dr. Bender: So I think this is a possibility because it is spread by droplets. That’s why a lot of the schools did go to the social distanced — or the virtual learning with the social distancing practices in the schools. Because both are spread by droplets, if we can slow the spread of COVID that way, I think we could also potentially slow the spread of influenza that way.

But, the vaccine is still very important to help the prevention with the influenza, as well. The social distancing will not be enough for the prevention of flu.

Dr. Neeman: I completely agree.

The take-home point about this year’s flu season

Dr. Neeman: Lastly, “As a parent, what take-home point is most important for me to remember this flu season?” I guess my message would be get your child vaccinated and encourage everyone you know to be vaccinated. Continue to do the directed health measures — the masks, the social distancing, and good hand hygiene.

This year, more so than most, influenza seasons, vaccination is critical. With the concern for that second wave, we just need to ensure that we have as many people vaccinated as possible so that we can prevent those hospitalizations. And while vaccines aren’t 100% effective, they often decrease the severity of the disease and prevent those hospitalizations. The influenza vaccine is not perfect, but it is better than nothing, and we really need it this year.

Every year, children die from complications of influenza. In the US, it’s generally between 100 and 200 kids a year. This year, let’s try to do better, despite the fact that there’s a pandemic going on.

Dr. Bender: Absolutely. Absolutely agree. Prevention is our #1 tool that we have. And don’t forget — it can take a couple weeks to build immunity to influenza, so don’t wait until it’s here to get vaccinated. Start getting vaccinated now through whatever means you need to. Through our clinics or the specialty clinics when you’re in for a visit. Get the vaccine now.

Dr. Neeman: Alright, well I think that is all for us today. I hope that you found this conversation valuable and that you will take some of these points to heart. And have a wonderful day!

Dr. Bender: Thank you Dr. Neeman for joining me. I enjoyed talking to you with this today, too. Have a great day!


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