2021/2022 Flu Season: Stay Safe, Informed, and Healthy

With all of the attention on COVID-19, we don’t want to lose track of the need to protect against the flu. The flu isn’t going away, and as flu season approaches, we want to help you and your family stay safe, healthy, and informed. New “models” of flu appear each year. The Center for Disease Control and Prevention (CDC) examines the influenza strains that have affected Australia during its flu season and, from this research, evaluates which strains are likely to be most prevalent in the U.S. during the coming year. Admittedly, there has been varying degrees of accuracy in the CDC’s predictions over the past few years. However, their recommended vaccines have led to milder and shorter illnesses as well as fewer cases of influenza overall.

The SARS-CoV-2 (coronavirus) pandemic will continue to complicate flu season, making it particularly important to protect ourselves and our families against viral illness. It’s necessary to understand the differences between the flu and COVID-19. Different viruses cause each respective respiratory illness. Similar symptoms of the flu and COVID-19 mean that testing may be the only way to distinguish them, and prevention is key. Click here to learn more about the similarities and differences between COVID-19 and the flu.

Currently, it is impossible to predict the effectiveness of the 2021 – 2022 flu vaccine, but it is recommended that everyone, six months and older, get vaccinated to protect against the flu. It takes between 10-14 days for the flu vaccine to take effect. We recommend getting vaccinated by the end of October if possible. Even if you cannot make this deadline, get vaccinated at your earliest opportunity. It is better to have some immunity than none.

It’s especially crucial to protect people living with Duchenne. A 2005 CDC study found that children with neuromuscular disease are at a six-times greater risk of flu-related respiratory failure. Please get yourself, your child, and all your family members vaccinated as early as possible.

What’s new for the flu in 2021/2022

CDC Recommendations:

The influenza vaccine or “flu shot” is recommended and available for people living with Duchenne.
The nasal spray (live virus) is available again for people ages 2 – 49 years old. It should be as effective as the vaccine. This is a live virus vaccine and is NOT recommended for people living with Duchenne.

The 2021/22 trivalent influenza vaccine will include protection against:

Egg-Based Vaccine

An A/V Victoria/2570/2019 (H1N1) PFM 09-like virus
An A/Cambodia/30826360/2020 (H3N2)-like virus
A B/Phuket/3073/2013-like virus (B/Yamagata lineage)
A/B/Washington/02/2019-like virus (B/Victoria lineage)

Cell- Or Recombinant-Based Vaccine

An A/Wisconsin/588/2019 (H1N1) pdm09-like virus
An A/Cambodia/e0826360/2020 (H3N2)-like virus
A B/Washington/02/2019-like virus (B/Victoria lineage)
A B/Phuket/3073/2013-like virus (B/Yamagata lineage)

Additional information:

There are several types of influenza vaccines available. Your medical provider will tell you which is most appropriate for you and/or your child.
Pregnant women should receive the influenza vaccine.
Some children, 6 months old – 8 years old, will need 2 doses of the influenza vaccine.
- Children in this age group who previously received ≥2 doses of trivalent or quadrivalent influenza vaccine ≥4 weeks apart before July 1, 2021 need 1 dose of 2021-22 influenza vaccine. The two previous doses need not have been received in the same or consecutive influenza seasons.
- Children in this age group who have not previously received ≥2 doses of trivalent or quadrivalent influenza vaccine ≥4 weeks apart before July 1, 2021 or whose vaccination history is unknown need 2 doses of 2021-22 influenza vaccine, given ≥4 weeks apart.
Details for healthcare providers can be found here.
People 65 years and older should receive the FLUAD Quadrivalent or High Dose Quadrivalent vaccine. This vaccine includes an ingredient intended to help improve the immune response helpful for our older generation.
For additional information on the 2020-2021 influenza season and vaccine, please visit CDC’s Frequently Asked Flu Questions 2020-2021 Influenza Season page, as well as CDC’s Information for Schools & Childcare Providers page.

WHAT SHOULD I DO IF I THINK MY CHILD HAS THE FLU?

The influenza vaccine protects against certain types of the flu. Even against those certain types, it is not always 100% effective. People living with Duchenne are particularly vulnerable to the effects of the flu—especially the pulmonary effects.

Call your primary health care provider immediately if your child has flu symptoms. Rapid diagnostic testing checks secretions in the throat for the influenza virus and is 50-70% accurate for diagnosing influenza. Note: Most providers will send a negative specimen for culture, just to be sure that there is no virus present.

If the test is positive, a course of antiviral medication is recommended. The medication should be started as soon as possible after diagnosis and continued for 5 days. Ideally, the medication should be administered within 48 hours of the onset of symptoms. However, the treatment has been shown to have some benefit if begun later, especially for patients who are experiencing a longer or more complicated course.

ANTIVIRAL MEDICATIONS

Antiviral medications can lessen symptoms of the flu and shorten the time of illness by 1-2 days. They can also prevent serious complications of the flu, such as pneumonia.

There are two antiviral drugs recommended by the CDC:

Tamiflu (Oseltamivir, pill or liquid)
Relenza (Zanamivir, inhaled powder, not recommended for patients with pulmonary issues)

Side effects of antivirals may include: nausea, vomiting, dizziness, runny/stuffy nose, cough, diarrhea, headache, and some behavioral side effects; there are rare occurrences of neuropsychiatric events associated with Tamiflu.

There are other factors considered in a clinical decision to use an antiviral course of treatment. They include: the severity of the disease for the patient, the progression of the disease, underlying medical conditions, the likelihood of influenza, and time since onset of symptoms.

CDC RECOMMENDATIONS

The CDC recognizes that people living with neuromuscular disease are at higher risk for developing more serious complications from influenza. For that reason, prophylaxis (antiviral medication) may be suggested for people with Duchenne who are living with household members who have also been diagnosed with influenza.

If antiviral medication is the recommended course, antivirals should begin on the day the household member is diagnosed. Again, factors that impact a clinical decision to treat higher-risk outpatients with antivirals include: the severity of the disease for the patient, the progression of the disease, any underlying medical conditions, and the likelihood of developing influenza.

WHAT IF MY CHILD MISSED THEIR CORTICOSTEROID DOSE?

If you/your child is taking corticosteroids regularly (daily or every other day), it is very important NOT to miss doses.

If you/your child has missed 24 hours of corticosteroids—it is critical to contact your primary care/neuromuscular provider for IV corticosteroid dosing.

Missing 24 hours or more of corticosteroids can result in acute adrenal insufficiency, which can be a life threatening condition. For questions or concerns, please refer to the PJ Nicholoff Steroid Protocol (download).

BESIDES ANTIVIRAL MEDICATION, WHAT OTHER “OVER THE COUNTER” MEDICATIONS ARE SAFE TO GIVE A PERSON WITH DUCHENNE?

You should always check with your primary health care provider and/or your neuromuscular provider regarding the safety and dosing of any medications.

PPMD’s Safe and Unsafe Medications Resource (download) lists medications that are frequently used in the management of Duchenne, as well as both over-the-counter and prescription medications used for other conditions not specific to Duchenne that you may encounter. Included in this resource are cautions that should be observed that are specific to patients living with Duchenne.

What Can I Do TO HELP MY COUGHING/BREATHING?

Caring for your child’s lungs when they have the flu is critical. Visit the PPMD website to find information on caring for the lungs, the understanding the importance of cough, and assisting cough during an illness.

Please share these resources with others so that we can work together to keep each other and our families safe, healthy, and active all season long.