As another school year starts, so does preparation for the 2022-2023 flu season. While COVID-19 continues to present in our communities, flu season is upon us and we don’t want to forget to protect ourselves and our families against the flu.

Each year, the FDA and CDC work together to understand which strains of flu are most likely to circulate, and use that information to guide the season’s vaccine makeup so that it can provide as much protection as possible. Because our flu season often looks like the flu season seen in Australia the year prior, studying their prior season’s strains of flu helps guide scientists who create North America’s flu vaccine. While efficacy (how well a vaccine works) may vary from season to season, getting vaccinated against flu is the best way to support milder and shorter illness, or prevent infection with flu altogether.

The Flu & COVID-19

The SARS-CoV-2 (coronavirus) pandemic will continue to complicate flu season, making it very important to protect ourselves and our families against any viral illness. It’s important to understand the differences between the flu and COVID-19. Different viruses cause different types of respiratory illnesses. However, because symptoms of the flu and COVID-19 can be similar, testing may be the only way to distinguish them. Prevention is key. Click here to learn more about the similarities and differences between COVID-19 and the flu.

Who Should Get the Flu Vaccine?

Currently, it is impossible to predict the effectiveness of the 2022 – 2023 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, so it’s important to stay away from anyone who is sick during that time to avoid the risk of a flu infection. While the flu vaccine is available as early as July and August, vaccination in the summer months is generally not recommended. This is because protection may wear off before the end of flu season, leaving people vulnerable to infection with flu. PPMD agrees with the recommendation of the CDC to get vaccinated by the end of October, if possible, to help provide coverage through the peak of flu season. Even if you cannot make this deadline, you should get vaccinated as early as possible. It is better to have some immunity than none, and getting vaccinated later in the season may still provide coverage during peak flu season.

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 vaccinate yourself, your child, and all your family members as early as possible to reduce risk to people living with Duchenne and those around them. If you have questions or concerns about getting you or your child vaccinated, reach out to your neuromuscular team who can talk you through the risks and benefits of the flu vaccine.

WHAT’S NEW FOR THE FLU VACCINE IN 2022/2023?

CDC RECOMMENDATIONS:

• The influenza vaccine or “flu shot” is recommended for anyone ages 6 months and older (with rare exceptions) and is available for people living with Duchenne.
• The nasal spray (live virus) is available again for people ages 2 – 49 years old, however is NOT recommended for people living with Duchenne. While the nasal spray should be as effective as the vaccine, this should only be an option for family members and friends of individuals with Duchenne. 
• Pregnant women should receive the influenza vaccine.
• Some children, 6 months old – 8 years old, will need 2 doses of the influenza vaccine. This includes:
  • Children in this age group who are being vaccinated for the first time 
  • Children who have previously only received one dose of vaccine 
  • If your child needs two doses of vaccine, the second dose should be given at least four weeks after the first dose Because of this, the CDC recommends being vaccinated early  to provide maximum protection.
  • If you are unsure if your child needs two doses of the flu vaccine, talk to your child’s doctor to make a plan for vaccination. 
• People 65 years and older should receive one of three preferential vaccines for their age group. These include Fluzone High-Dose Quadrivalent vaccine, Flublok Quadrivalent recombinant flu vaccine, and Fluad Quadrivalent adjuvanted flu vaccine. Of these, there is not one that is preferred over the others. These vaccines are recommended over other standard-dose unadjuvanted flu vaccines based on studies that showed that these vaccines are potentially more effective for this age group. There is no preferential recommendation for people younger than 65 years.
• For additional information on the 2022-20223 influenza season and vaccine, please visit CDC’s Frequently Asked Flu Questions 2022-2023 Influenza Season page, as well as CDC’s Information for Schools & Childcare Providers page.
• Additional details for healthcare providers can be found here.

ADDITIONAL INFORMATION:

• There are several types of influenza vaccines available:
  • Standard-dose flu shots
  • Cell-based flu shots
  • Recombinant flu shots
  • High-dose flu shots
  • Egg-based high-dose flu shots
  • Egg-based adjuvanted flu shots
  • Egg-based live attenuated flu nasal spray vaccine 

THE 2022/23 INFLUENZA VACCINES WILL INCLUDE PROTECTION AGAINST:

Egg-Based Vaccine

• An A/V Victoria/2570/2019 (H1N1) PFM 09-like virus
• An A/Darwin/9/2021 (H3N2)-like virus (updated)
• A B/Austria/1359417/2021-like virus (B/Victoria lineage) (updated)
• A B/Phuket/3073/2013-like virus (B/Yamagata lineage)

Cell- Or Recombinant-Based Vaccine

• An A/Wisconsin/588/2019 (H1N1) pdm09-like virus
• An A/Darwin/6/2021 (H3N2)-like virus (updated)
• A B/Austria/1359417/2021-like virus (B/Victoria lineage) (updated)
• A B/Phuket/3073/2013-like virus (B/Yamagata lineage)

Your medical provider will tell you which vaccine is most appropriate for you and/or your child.

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 nasopharynx (the upper part of the throat, behind the nose) for the influenza virus and is 50-70% accurate for diagnosing influenza. Note: If the results come back negative, most providers will send the specimen for culture (further testing), 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 started 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.

Be sure to talk to both your child’s primary care physician AND neuromuscular team if your child has the flu. Your child’s neuromuscular team may have additional recommendations for treatment support.

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 four approved antiviral drugs recommended by the CDC that may potentially be recommended (Note: Some of these medications may be applicable to your child with Duchenne):

• Tamiflu (oseltamivir, pill or liquid for those 14 days of age and older)
• Relenza (zanamivir, inhaled powder for those 7 years and older, not recommended for patients with pulmonary issues)
• Rapivab (peramivir, given once intravenously for those six months and older)
• Xofluza (baloxavir marboxil, single-dose pill for those aged 5-12  years who do not have chronic medical conditions, and all people age 12 and older)

Common 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 the 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.  It’s important to work with your doctor to come up with a plan that makes the most sense for you and/or your child. 

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 (taking antiviral medication before symptoms start) may be suggested for people with Duchenne who are living with a household member who has also been diagnosed with influenza.

If antiviral medication is recommended for prevention, the person with Duchenne should start taking the medication the same day the household member is diagnosed with influenza. Again, different factors may impact a doctor’s decision to treat higher-risk outpatients with prophylactic antivirals. The severity of the disease for the patient, the progression of the disease, any underlying medical conditions, and the likelihood of developing influenza will all help your doctor decide if taking these medications is right for you and/or your child.

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, understanding the importance of cough, and assisting cough during an illness. Your child’s pulmonologist can also work with you to develop a plan to keep your child’s lungs healthy during an illness. 

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 as soon as possible 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 more information for you or your doctor, 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 over-the-counter and prescription medications that are frequently used in both the management of Duchenne, as well as 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.

Preventing influenza through vaccination, good hand hygiene, and avoiding others who are sick is the best way to protect yourself and your loved ones with Duchenne and Becker. Be sure to talk to your doctor about any questions or concerns you may have about influenza or the vaccine. PPMD is here to help work together to keep each other and our families safe, healthy, and active all season long.