What do new flu shot recommendations mean for your family?

We just got kids back into school. Is it too early to think about the flu shot?

Not really.

Dr. Leighton Ellis, pediatric department chair for St. David's Children's Hospital in Austin, Texas, says the idea is to get it by Halloween to have good immunity when peak flu season arrives in winter. You can remember the timing by the Centers for Disease Control and Prevention's campaign slogan: "Say Boo to the Flu." You can even take a pledge on sayboototheflu.com and find fun activities for kids.

The CDC hasn't made its predictions yet about what kind of a flu season we can expect. (Let's hope it's not like the 2017-2018 season, which was particularly bad because of the number of cases and deaths as well as the lower effectiveness of the vaccine.)

The CDC did release its vaccination recommendations for the 2019-2020 flu season, and there are some changes, especially for the youngest shot receivers.

What's different? There are two manufacturers of the shot that have lowered how old you have to be to use that flu shot and/or changed the dosing levels.

The Afluria Quadrivalent shot was previously only for people who are 5 years or older. Now it can be used for anyone age 6 months or older. Kids who are age 6 months to 3 get a smaller dose (0.25 milliliter). At age 3 and up, it's the standard dose (0.5 milliliter).

The Fluzone Quadrivalent can now be given to children ages 6 months and older at the full dose (0.5 milliliter). Previously it was given as a half dose until age 3.

What does this mean for flu shot providers and patients? It means that there's less of a chance clinics will run out of shots for the youngest recipients because these kiddos have more flu shot options and can even take a full dose of the Fluzone.

Flu shots are recommended for most people ages 6 months and older, but especially for anyone for whom getting the flu would be more likely to become life-threatening. That includes the elderly, anyone who has asthma, diabetes or an immune deficiency, pregnant women, anyone who is morbidly obese, as well as anyone who is caring for someone with these conditions. If there is a vaccine shortage, these are the people who will be given priority to receive the vaccine, Ellis says.

The CDC continues to recommend that kids younger than age 9 receive two shots to build up their immunity. Once they have had two shots, they don't need to get a second shot, even if one shot was given in one season and a second in a different season. People ages 9 and up don't need to get two shots even if they've never had a flu shot before, Ellis says, because the CDC assumes that at some point they've been exposed to the flu and have some natural immunity to it if they've made it to age 9.

What about the FluMist? It went away for a few seasons when it was found to not be as effective as the flu shot but was back last year. Ellis reserves it for patients who absolutely won't do a shot, but sometimes getting a kid to let someone squirt something in their nose can be more difficult for the nurses than giving the shot. FluMist is not for kids younger than age 2 or anyone 50 or older, anyone pregnant or with asthma or a compromised immune system.

Ellis doesn't recommend the FluMist for teens and adults because what she's noticed is that anecdotally it doesn't work as well for them as it does for kids. The advantage of the FluMist is it could potentially keep you from getting the flu, she says, because it stops the virus from spreading past the nose.

With a flu shot, you can still get the flu, but it will be a shorter period of illness, and it will be less severe.

A flu shot can make you feel bad or give you a fever, but you won't get the flu from just getting the shot. If you get a cold with a flu shot, Ellis says, "You probably got it in line waiting for the flu shot."

You can get a cold with the FluMist with symptoms like a sore throat and a running or stuffy nose and a fever.

Just like there are special recommendations for flu shots for young kids, there are special recommendations for seniors. People ages 65 or older should get the high-dose version of the flu shot to increase their immunity. The reason? Their immunity starts to wane quicker, usually around six months. Kids' immunity lasts 12 to 18 months, and typical adults usually have about 18 months of immunity. (That doesn't mean adults should skip the shot one flu season because strains of the flu change each year and the shot is for that year's strains.)

Ellis says there aren't many reasons a person couldn't get a flu shot. Even people who are allergic to eggs can get one, but they'll want to do it in their doctor's office and wait 15 minutes to make sure there isn't a reaction. If you're not sure whether you should get a flu shot, ask your doctor.

What about the people who just hate shots?

Ellis shares a few of her tips:

• Use a cold spray or a numbing spray on the area.

• Use the Buzzy Bee (a cold, buzzing device that distracts from the area where pain is being felt) on the arm.

• Blow a breath out at the same time the shot is going in.

• Use electronic devices to distract such as playing games on a phone.

• Engage in an unrelated conversation during the shot.

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