Come on, folks, roll up your sleeves—and your kids’ sleeves, too. Summer’s officially over and it’s time for the flu shot.

Every year, I’m caught off guard by how many people don’t want to get a flu shot. There are lots of people who are happy to get them—anxious, even—but I’m always surprised by how much I end up being a flu shot salesman.

This puzzles me, because getting a flu shot makes abundant medical sense. Every year millions of people get influenza, and some of them get very sick; some get sick enough to die from it. It’s hard to get exact numbers on how many people die from the flu, but it can vary from just a few thousand to more than 40,000. Usually it’s the very young, the very old and people with health problems who get hit worst by the flu, but last year was different. H1N1 (called “swine flu” at the beginning, although you can’t catch it from pigs) ended up being the predominant flu virus, and it was children, young adults and pregnant women who were most affected by this strain. In fact, last season there were four times as many child deaths reported than in the previous five influenza seasons. Because of this, the Centers for Disease Control (CDC) and the American Academy of Pediatrics (AAP) are recommending that everyone over the age of 6 months (yes, everyone!) get a flu shot. Flu shots are a safe, effective way to protect yourself and your family. And when you keep yourselves healthy, you are protecting the people around you. This year, H1N1 was included in the seasonal flu vaccine, so there’s no need for two different vaccines. Seems like a straightforward decision.

But for some people, it’s not so straightforward. Here are some common reasons for balking—and my response to them.

The flu shot makes me sick. I hear this all the time, that people got the flu shot and then got sick, or had a bad winter of sickness afterward. You can certainly have side effects from the flu shot. Pain where you get the shot, aches, fever, nausea, and generally feeling yucky is entirely possible for a day or two afterward, although most people feel just fine. But the flu shot can’t give you the flu, and if you had a bad winter, it wasn’t the flu shot’s fault.

My kids and I are always healthy, so we don’t need it. Lucky you. I hope it continues to work out for you—but you should know that there is no guarantee it will. Plenty of the people who got really, really sick last year were people who were generally healthy.

I don’t trust the H1N1 vaccine, because it’s new. From the information collected last season, the H1N1 vaccine appears to be just as safe as any flu shot. Which is what it is. H1N1 is a type of influenza A, and the vaccine was made in the same way we’ve been making flu shots for years. It’s not a totally new vaccine, like many people seem to think.

I’m worried about thimerosal in flu shots, because I’ve heard it can cause autism. This has been studied really carefully, and there is really no good evidence that thimerosal (a preservative used in some immunizations) causes autism. For more information on thimerosal, visit the Food and Drug Administration page on it or the CDC’s page on thimerosal in vaccines. If you have lingering concerns, there is a thimerosal-free version.

I have (or my child has) an egg allergy. The flu shot is made using eggs, and so people who are allergic to chicken or eggs may have a reaction to it. The good news is that unless the allergy is severe, people with egg allergies usually tolerate the vaccine just fine. It may need to be given differently, or with some observation time afterward—talk to your doctor.

We got the shot last year. Yeah, well, that’s the bummer of flu shots: you have to get them every year, because every year the flu shot is slightly different, based on the strains of influenza that experts think are most likely to cause illness. Children under the age of 9 need two shots the first time they get it, and this year some may need two shots even if they got it last year, depending on how many of the seasonal and H1N1 shots they received. Your doctor will sort it out with you.

I heard that H1N1 didn’t end up being so bad last year. It’s true that H1N1 could have been much worse. Which is a good thing, given that it spread very quickly all over the world (and hasn’t gone away). But like I said before, some people got very, very sick from it—and we really don’t know what it will do this year. Better safe than sorry.

Some people will choose not to get the flu shot. I understand that. But what I hope is that people will make the decision based on real information, not misinformation or emotion. Three great places to get that real information are: the CDC’s flu web site, the new AAP health information site for parents, and the web site of the Immunization Action Coalition. And, of course, talk to your doctor—who, like you, wants you and your child to be healthy.

H1N1 and seasonal influenza beware – new heroes have arrived, ready to defend the population and fight a viral battle, via Facebook, in the form of ‘Flu Fighters!’

Developed by researchers at Children’s Hospital Boston, in collaboration with the Department of Health and Human Services (HHS), a new Facebook application called “I’m a Flu Fighter!” gives you the opportunity to mobilize and take action against the threat of influenza – by telling your friends that you got the H1N1/seasonal flu vaccine and encouraging them to do the same. Launching as part of National Influenza Vaccination Week, the app also provides information on influenza – including a flu vaccine locator – courtesy of HHS’s Flu.gov.

The app is garnering high profile attention and was even plugged on the White House blog on Saturday by Secretary of Health and Human Services, Kathleen Sebelius.

The application is part of the HealthySocial project, founded two years ago by Ben Reis, PhD, of the Children’s Hospital Informatics Program (CHIP). CHIP has been instrumental in connecting the public with health care issues through technology. Reis and his team are working on a range of free social apps that allow users to collaborate with their friends to encourage better health.

“Social networks have tremendous potential to do good in the world,” says Reis. “By leveraging existing social connections, people can spread positive health behaviors and attitudes amongst their friends and loved ones.”

This isn’t the first social media tool that tracks flu to come out of CHIP. In September, they released a free iPhone app called “Outbreaks Near Me,” which tracks disease outbreaks in real time. The app got a lot of press coverage, including articles in the Wall Street Journal, Time, ABC News, USA Today and Scientific American.

Third on the list of the Huffington Post’s Top 10 Medical Research Trends to Watch in 2010, is “the Health Internet,” the brain child of Isaac Kohane and Ken Mandl, from Children’s Hospital Informatics Program (CHIP).

Last fall, a group of leading thinkers and entrepreneurs from a variety of sectors gathered to discuss an idea that originated with Harvard’s Isaac Kohane and Ken Mandl — the development of an “iPhone-like platform” for health information technology (HIT), a more open and flexible approach than the architecture currently being contemplated, and one that holds greater promise for creating a consumer-oriented “Health Internet.” Obama Administration officials pledged at the meeting to have a pilot effort launched that could have real-time patient data accessible online this year.

The Children’s Hospital Informatics Program (CHIP) has been instrumental in connecting the public with health care issues through technology. CHIP created HealthMap, a website, blog and an iPhone app that tracks disease outbreaks in real-time. We featured their weekly H1N1 tracking updates over the last several months here on Thrive.

What a whirlwind of a year. Since launching this blog in July, we’ve had more than 230,000 visitors, many of whom have left thought-provoking comments on our posts.

We’ve enjoyed bringing you personal stories and expert insight about current pediatric health topics, and we hope you continue reading us in 2010.

What were our readers most interested in this year? Our most widely read stories range from a video series about defeating a milk allergy to a news report about the discredited Baby Einstein videos. Did you miss any of our most popular posts? We revisit them below.

• H1N1 was by far the most popular topic on Thrive. We posted 44 different articles on the subject. Our most read H1N1 blog asked the question, “Should my child get the swine flu (H1N1) shot?” This post triggered an outpouring of reader comments, from both hesitant parents weighing the pros and cons, and vocal vaccine proponents. To see a complete list of Thrive’s H1N1 stories, click here.

• This heartbreaking story written by a mother about her daughter and shaken baby syndrome was a wake-up call for us all. Readers were both sympathetic to her plight and also outraged; a sensitive topic, this post received a lot of passionate feedback.

• Brett Nasuti, an 11-year-old Children’s patient, was born allergic to 15 foods. Thrive readers got to tag along as he went through a milk exposure desensitization trial to cure his milk allergy—the first of its kind in the country— by watching this video series. Will Brett ever get to eat pizza and drink milk with his cookies? Watch the first of Brett’s video series here.

• Children’s media expert, Michael Rich, MD, MPH, addresses Disney’s precedent-setting move offering refunds on the Baby Einstein DVDs they claimed promoted better brain development in infants. A media expert, Rich contributes a weekly post about children and media.

• The Twilight phenomenon has hit teens and pre-teens worldwide. Claire McCarthy, MD, gives suggestions for how parents should address the main themes of this book series with their children. McCarthy, a pediatrician, writes regular posts for Thrive about everything from BPA to childhood stress.

• One mother tells the shocking story of how strep throat attacked her child’s brain, causing symptoms of obsessive compulsive disorder.  Many other parents wrote in to Thrive, saying they had experienced the same thing. It’s a scary story, but by sharing, this family helped others feel like they weren’t so alone.
• We also talked a lot about epilepsy this year. We recently shared the video and first-person story of a young woman whose seizures are being controlled by a novel brain stimulation technique. We also heard from neurologist Frances Jensen, whose work studying the causes and potential treatments of epilepsy was featured in a 60 Minutes story.

Is there anything we didn’t cover this year that you’d like us to? Please let us know!

In case you missed it, Margaret Chan, MD, the director-general of the World Health Organization (WHO), yesterday cautioned the world that the H1N1 pandemic is not over, even though you’re not hearing as much about it in the media or around the watercooler. “It is too premature and too early for us to say we have come to an end of the pandemic influenza worldwide,” Dr. Chan said at a press conference.

With much less attention being paid to H1N1 these days, Thrive asked Claire McCarthy, MD, a pediatrician and the medical director of Children’s Martha Eliot Health Center, if she thought families could stop worrying about the virus—and whether people should still get vaccinated if they haven’t already. Here’s what she had to say:

“I completely agree with the WHO. It’s true that we are seeing fewer cases and hearing less worry about it among patients and families. But while there are fewer cases, people are still getting very sick from H1N1, especially young people—and this virus is just too new for us to really know what it’s going to do. I am nowhere near ready to tell anyone that the pandemic is over. I’m still telling everyone to wash their hands (I sure am!)—and encouraging everyone to get vaccinated.”

In addition to H1N1 and the regular seasonal flu, which should be starting up in earnest pretty soon, Children’s researcher Florence Bourgeois, MD, MPH, recently published a study that said we should also be on the lookout for RSV this winter, since those infected with it had more than twice as many emergency department visits and six times more hospitalizations than those with seasonal flu.

In other H1N1 news, Children’s Adrienne Randolph, MD, MSc, is quoted in The Boston Globe’s article linking severe H1N1 cases with asthma. The decision about whether to vaccinate kids with asthma for H1N1 is something we wrote about on Thrive not long ago. Also check out Dr. Randolph’s very popular post on why you should get your child the H1N1 vaccine. The Boston Globe also reports that the H1N1 flu may be less contagious than we originally feared.

From swine flu to obesity to dangerous plastics, many issues that affect children’s health garnered media attention in the year 2009. Here’s a rundown of the some of the biggest and most important stories:

H1N1

This is the story that caught the most attention—for good reason. Not only is the H1N1 influenza virus very contagious, it appears to particularly affect young people. H1N1 caused more pediatric hospitalizations and deaths than we usually see with the seasonal influenza virus, which is very scary for parents (and pediatricians!). The virus led to countless school closings—sometimes to control the spread, and sometimes because there weren’t enough teachers left to teach!

We’ve had some good news recently: The vaccine, which appears to be effective and safe, is now plentiful. While there was some concern about resistance, H1N1 is still generally treatable with medication (although it’s rarely necessary). And the number of new cases is steadily dropping—but it’s important not to let our guard down completely, because nobody knows for sure what this new virus will do next.

Bottom line: Keep washing your hands, and get vaccinated.

Health Care Reform

We all know that our health care system costs too much money, and doesn’t reach everyone. But how do we fix it? That’s the question President Obama and others have been struggling with. There are no easy answers, and lots of competing stakeholders. It’s very clear that the response will need to be multifaceted and built on compromise.

Children’s Hospital Boston has been doing its part not only to help, such as by working with insurers to cut costs and improve care, but to make sure that the needs of children aren’t lost in the debate. Dr. Judy Palfrey, the current president of the American Academy of Pediatrics and a staff member of Children’s since 1974, has spoken and written eloquently about the health care needs of children.

Bottom line: This is an important issue that will affect each one of us. Stay informed—and talk to your elected officials!

Media, Technology and Kids

The media and technology are playing an increasing role in the lives of US children, and researchers are raising some red flags. Here are just a few of them:
•    Children who spend more than two hours a day in front of screens are more likely to be obese
•    Exposure to sexual content on TV has been linked to early initiation of sex—and multiple studies have shown that media exposure leads to more sexualized behavior in girls, and more dissatisfaction with their bodies
•    The more children are exposed to violence in the media, the more likely they are to have aggressive behavior
•    Excessive TV viewing is associated with poorer grades—and attentional problems
•    Some studies have linked early TV viewing (before age 3) with lower developmental scores
•    Teens who are addicted to the Internet are more likely to harm themselves
•    According to a Pew study, half of teens 16 and 17 have talked on a cell phone while driving, and a third of them have texted behind the wheel

The ramifications of all this for our children are tremendous—and scary.

Bottom line: Pay attention to the media and technology use of your child. Set limits—and enforce them.

Obesity and kids

Since 1980, childhood obesity rates have tripled. Right now, a third of US children are overweight or obese—and numbers are steadily rising. That’s an awful lot of kids destined to have heart disease and diabetes and all the other health (and social!) consequences of obesity.

Legislators and advocates are taking action, and we are seeing progress. More restaurants list calories, soda is coming out of more school lunchrooms, some companies are decreasing the sugar content of their foods and awareness is rising about the effect of ads for junk food and soda on children.

It’s a start, but it’s not enough; we’re going to need a grass-roots, comprehensive strategy to save our kids. That strategy needs to start at home; with two-thirds of U.S. adults either obese or overweight, grownups are hardly setting a good example.

Bottom line: Don’t ignore that “baby fat” or assume your child will slim down when he’s older.  Make exercise and healthy eating part of your family’s everyday life—now.

Dangerous plastics

This year, many states raised concern about Bisphenol-A (BPA), a chemical used in many plastics, including baby bottles. Scientists have been concerned for years about possible health effects, especially for infants and pregnant women. In fact, Canada and the European Union have banned the use of BPA in products used by infants and small children.

To avoid BPA, look for the number 7 inside a triangle on the product; if you see that, don’t use it. While you’re at it, avoid 3 and 6; they contain phthalates, which are also possibly dangerous. 1, 2, 4 and 5 are better. Try not to use plastic containers when you heat things in the microwave, and wash them by hand instead of putting them in the dishwasher, as heat releases more chemicals.

Bottom line: As we figure out which plastics are dangerous and just how dangerous they are, try to use less plastic in general. Use glass, ceramic, and metal instead. Buy fewer plastic toys.

What pediatric health issues were you talking about this year? Are there any pediatric health issues (or general health issues) that people weren’t talking enough about in 2009? Look into your crystal ball: What do you see as the big health stories of 2010?

While you’re here, check out U.S.News & World Report’s listing of the top 10 health stories from 2009.

In case you missed it, the CDC today recalled 800,000 H1N1 vaccine doses meant for children, age 6 months to nearly 3 years old because they lost some of their strength after being released to the public. The good news is that there are no risks to any child who was vaccinated and you don’t need to get your child re-vaccinated if he or she got doses from the recalled batch; it just may be that your child isn’t quite as protected from H1N1 as you originally thought.

Check out the CDC’s Q&A on the topic.

Here are this week’s H1N1 updates from the HealthMap team of the Children’s Hospital Informatics Program.

• The World Health Organization (WHO) reports that “Disease activity has peaked and is declining in North America and has either recently peaked or is currently peaking in much of western and northern Europe.” In other good news, WHO also reports no signs of widespread resistance to Tamiflu.
• Nevertheless, the WHO has clearly stated it is too soon to call the pandemic over. The global death toll from H1N1 rose to 8,768 as Cyprus, Albania, and the Gaza Strip recorded their 1st H1N1 deaths. The Netherlands saw their first Tamiflu-resistant death.
• In the United States, only half of all states reported widespread flu activity, down from 43 states only two weeks ago. England reported new cases were half of the previous week’s number.

* Please note that this post will conclude our weekly H1N1 blogs. While the pandemic is far from over, reports of first cases and deaths are less common as H1N1 has spread throughout much of the globe. Numerous H1N1 vaccines have been developed in countries all over the world, and the vaccine shortages seen earlier this year have abated.

HealthMap continues to track H1N1 and all other infectious diseases at http://www.healthmap.org. For the latest disease alerts, you can also follow us on twitter. We hope the H1N1 blogs have been informative and helpful.

For more information from Children’s Hospital Boston on the seasonal and H1N1 flus, visit our Flu Information Center.