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Scott Webb: None of us really enjoys getting shots, especially our kids, but in light of the pandemic, it's never been more important for kids and parents to get their flu shots. And here to emphasize this point today is Dr. Katya Gerwein. She's a pediatrician with Stanford Children's Health in Berkeley.

This is HealthTalks from Stanford Children's Health. I'm Scott Webb. So doctor, thanks so much for joining me today. What are the general recommendations for flu shots in kids?

Dr. Katya Gerwein: We really recommend that all kids from the age of six months up get the flu shot every year, this year happens to be especially important. But we do think that it's a really important preventative measure every year.

Scott Webb: Yeah. And you mentioned this year, so in light of the COVID 19 pandemic, why is it so critical this year for kids to be immunized against the flu?

Dr. Katya Gerwein: The reason is twofold. One is that our hospitals are already becoming overwhelmed. And every year they have a lot of people who they need to hospitalize for the flu. And so when everybody gets their flu vaccination, it helps relieve the crush on the hospitals. And kids often are the ones who are most likely to spread the flu. So we think it's especially important for kids to get the flu shot, although we also think it's very important for adults too as well.

And the other reason is we're not really sure what's going to happen if you get COVID and the flu at the same time. It could be really bad. We just don't know. And COVID can look like the flu, which can make things more difficult in terms of diagnosis and more cases at the doctor's office that look like COVID.

Scott Webb: Yeah. We're going to come back to that, come back to how exactly, or at least, you know, roughly we can tell the difference between flu and COVID. But first let's talk about the risks of flu in children. Are they at higher risk?

Dr. Katya Gerwein: So many kids are fine with the flu. Certainly, the kids at higher risk for complications are kids with asthma, kids with pre-existing conditions. But every year, we have some kids who are totally healthy, who have severe encephalitis, which is a brain inflammation. Every year, we have kids hospitalized with pneumonia. And every year, we have healthy kids who just die in their sleep from the flu. And that's a tragedy.

Scott Webb: Yeah. Uh, to say the least as a parent, I mean, that's, um, incredibly alarming.

What if kids are to get the flu and COVID together because we believe that can happen, right? We believe you can get both as frightening as that is, is that proposition is. So what if a child gets the flu and COVID together?

Dr. Katya Gerwein: We don't know yet what that would look like or how it would be. We do know that influenza can make you more vulnerable to some other infections, but we really just don't have enough experience with flu and COVID together to really say with any sort of knowledge what that'll look like.

Scott Webb: Yeah. That's the scary thing is we've learned so much about COVID and we're on the precipice here of having multiple vaccines, perhaps, but there's still so much that we don't know about COVID. And as you say, getting the flu can make you more vulnerable, but will it make you more vulnerable for COVID-19? We just don't know yet, right?

Dr. Katya Gerwein: Right. That's exactly right. So we feel like it's better to be on the safe side and really try to immunize as many people as we can against the flu. And of course, we would like to immunize people against COVID once that's available as well.

Scott Webb: Oh gosh, you were so right, doctor. Uh, so we mentioned how do we tell the difference between the flu and COVID-19 and there are some things I've heard, uh, loss of taste and smell. Uh, that's one of the main things that I've heard from doctors is that, you know, the flu and COVID can be pretty similar, but if you have that sudden loss of taste and smell, that might be an indication that it's COVID. Is that your understanding?

Dr. Katya Gerwein: That is true. Although some people when they have some nasal congestion with the flu also have a loss of taste and smell, but if you have loss of taste and smell without nasal congestion, that makes it highly more likely to be COVID, but otherwise they look pretty similar. A lot of people just get sore throat, fever, cough, can happen with flu or COVID. Headaches, body aches.

Scott Webb: Let's go back now to the flu and let's talk about the vaccine. How protective is the flu vaccine?

Dr. Katya Gerwein: You know, of the last 20 years or so, I'd say 80% of the years, the antigenic strains match. So that is to say the shape of the flu when they're making the immunization matches what immunization they're making. And about 20% of the years, the flu virus mutates, so that it's not an exact match anymore. But even those years that people who get the flu shots still seem to be much more protected against hospitalization and death, even the years where it's not an exact match.

Scott Webb: And that's the thing about the flu vaccine, it can prevent the flu in some, but others may get the flu, but it might be a less severe case, right?

Dr. Katya Gerwein: Definitely. If you get the flu shot, it is much less likely that you will get or transmit the flu, but it can still happen, but it tends to be a much lighter case.

Scott Webb: And are there possible side effects of the flu vaccine for kids?

Dr. Katya Gerwein: Yeah. Just like anybody else, anytime you get an immunization. Your immune system can get activated and you can feel the effects of your immune system activating with fever or feeling under the weather or less energy or headaches or body aches. But I would say the vast majority of kids who get the flu shot that I know have no side effects other than a sore arm for a couple of days.

Scott Webb: Yeah. Both of my kids got the flu shot this year. And of course they were mad at me for a bit. And my son is convinced as many people are that the flu shot gives you the flu. Could you clear that up for my son and everybody else?

Dr. Katya Gerwein: Sure. The flu shot can absolutely not give you the flu. It's not a live virus. It just activates your immune system and says, "Hey, this is the shape. Can you make a shape to match it in your immune system?" And when your immune system gets activated, you can feel that in the same way you do when you're ill, but it didn't give you the flu. And most people don't even have that side effect at all. Most people just don't feel anything afterwards.

Scott Webb: Exactly. Yeah. You're so right. So when we talk about nasal sprays, is that an option for kids?

Dr. Katya Gerwein: Well, theoretically, yes, but since we're trying not to get near anybody's nose or mouth, and because when we give the nasal spray, kids often tend to excrete more respiratory droplets, we're not doing it this season because of COVID. Some places maybe. People can order it, but we are not just because it feels more risky to the staff.

And I just want to say there are ways to make shots, so they don't bother you. There's something called a shot blocker, which is just a piece of plastic with bumps on it that distracts your nerves into saying, "Oh look, interesting, bumpy plastic" instead of shot. And if you do something on the opposite arm like I have a ball with whizzing lights to distract, and I tell kids, "It's just like when you're reading a book or watching a movie and somebody talks to you and you don't even hear them. Your ears heard the sound, but your brain didn't hear it. So it didn't happen for you." So same thing, if you're distracted, when you got the shot, it just doesn't bother you.

Scott Webb: Oh, that's really cool. And I wonder, does that work for adults as well?

Dr. Katya Gerwein: Oh, totally.

Scott Webb: Is there anyone who shouldn't get the flu shot?

Dr. Katya Gerwein: Anybody under the age of six months? So very young babies, it's just not effective. It wouldn't be dangerous, but it wouldn't be effective. So it's not approved for their age group. And theoretically, anybody who's had an anaphylactic reaction to flu vaccine in the past. I've never met or heard of anybody who that's actually happened to, but that would be theoretically a reason not to.

Scott Webb: And when's the best time to get a flu shot?

Dr. Katya Gerwein: Usually October is the best time, but at this point better, late than never.

Scott Webb: As we get close to wrapping up here, doctor, where do you recommend parents take their children for the flu shots? We're talking about that. Do you recommend going to stores or providers' offices or the hospital? What's your best recommendation?

Dr. Katya Gerwein: We always love it when they get their flu vaccine at the pediatrician, because we know them well, and we tend to do things that make it more fun or better tolerated for kids. But that said, it's the same vaccine everywhere. So if it's a lot easier for parents just to haul the whole family over to CVS on a Saturday or Sunday, that's fine too. We do have a lot of drive-thru flu options at Stanford as well. So, better to get it at the place that's easiest and fastest, but if you can get it at your pediatrician, that's the absolute best

Scott Webb: Yeah, that sounds right. And I didn't know about the drive-thru options, but that's good to know. So doctor, anything else you want to tell people about the flu vaccine, mixing it with COVID and all of that? What else can we tell people today?

Dr. Katya Gerwein: One other thing that I hear a lot from people is, "Well, I'm not seeing anybody, I'm not going anywhere. I just have a mask on, so I couldn't get the flu anyway." And I just want to say that even with shelter in place, I am still hearing people, "My kid got a fever. I have a runny nose and a sore throat." And, you know, we test them and it's not COVID. People are still getting sick much less, but they are still catching things, even though they feel like they are still being so careful with shelter in place. They are still catching them. You can still get the flu, even if you're being really careful. So not to feel like, "Oh, well, I wouldn't get it this season anyway," it's still important to get the flu shot.

Scott Webb: Yeah. That's a great way to end. And I think you're so right. I mean, I mask up, I keep my distance. I use hand sanitizer, like it's my job, and I still have gotten a couple of minor colds along the way. And I think to myself, "How is that even possible?" You know, I'm doing every possible thing I can to protect myself and yet I've still gotten some colds and it's same thing with the flu. You may think that because you're not going out as much and you're not around people as much, it's still important to get the flu shot, right?

Dr. Katya Gerwein: Yes. And we're hoping that if enough people immunized and people are careful with masking and sanitizer and distancing, we're hoping not to see the flu much this season. And we are already seeing it somewhat. It is already here, but we're hoping not to have a lot of people get it.

Scott Webb: Thank you so much for your time and your expertise today. Really great having you on and you stay well.

Dr. Katya Gerwein: Thank you.

Scott Webb: That's pediatrician Dr. Katya Gerwein. For more information, visit StanfordChildren's,org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you.

This is HealthTalks from Stanford Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.