Maggie McKay (Host): Welcome to Total Health Talks, your Cook County Health podcast where we empower your journey to better health. I'm your host, Maggie McKay. And today, we're going to talk with Dr. Jonathan Mannheim, a pediatric infectious diseases physician, about flu facts for families. Thank you so much for joining us.

Jonathan Mannheim, MD: My pleasure. Thanks for having me

Host: So, let's start off with why is influenza more than just a bad cold, especially for children?

Jonathan Mannheim, MD: That's a really good question. It can certainly seem like a bad cold, but it really has the potential to be much more serious. You know, with a cold, you're going to feel crummy for a few days. You're going to have a runny nose and a cough and a sore throat, but you're not going to usually be hospitalized. But with the flu, kids can be hospitalized, and a lot of kids are hospitalized every year with pneumonia, with dehydration, with asthma exacerbations, and some children even die from influenza every year.

Even before COVID, we were very scared of the flu because the flu was the virus that would really hurt kids. And so, we can't predict which kids are going to get sick, so that's why it's pretty scary if kids are not vaccinated and ready for it.

Host: I'm so glad I never knew that when my son was little, that you could die from the flu as a child.

Jonathan Mannheim, MD: Yeah. I mean, every year, there's dozens, maybe, you know, a few more can die from the flu. And it's usually the youngest kids, those under the age of one. But they're the ones who have sort of the least reserve, who are hit the hardest, have the smallest lungs, get the most plugged up. So yeah, it can hit them pretty hard.

Host: Wow. So who should receive a flu vaccine? And at what age should children start getting vaccinated?

Jonathan Mannheim, MD: Good question. Anytime after six months of age. So if you're six months old and you're coming in for your routine six-month vaccinations, like your tetanus shot and your pneumonia shot, you can also get your flu shot. And we recommend it to anyone. There's really no reason not to get it. And yeah, six months of age.

Host: I got mine this season. When is the best time to get vaccinated? And is there ever a point in the season when it's too late? Because, you know, you talk to people and you're like, "Did you get your flu shot?" And they're like, "No, it was, it's too late."

Jonathan Mannheim, MD: It's never too late. Maybe, you know, I guess in July and August when there's absolutely no flu, there's low risk of flu, but there's always flu going around the Cook County and City of Chicago. It's highest, as everyone knows, in November, December, January, February. So, getting your flu shot in September and October is an ideal time. But really, there's no wrong time. If a child, for example, is born in November and can't get their first flu shot until April, great. They should get it, because it gives them some protection for the next incoming year.

Host: And why, especially for children, is it important to get a flu vaccine every year instead of just once?

Jonathan Mannheim, MD: It's another good question. There's really two reasons. First, our immune system protection from the vaccine, that goes down over time. So, influenza viruses are constantly changing. Every year, they go west to east, sort of like the jet stream, and they hit Asia, and then they come east, and then they hit us. And so, we're trying to match our flu vaccine to what is happening already in other parts of the world. So, it's sort of an educated guess, but it's changing every year. And you're not going to have exactly the same flu as theprevious year, and that's why we give a new vaccine every year.

Host: Oh, okay. So, it's different ingredients.

Jonathan Mannheim, MD: Yeah, sort of, I'd say it's the same ingredients in sort of a different genetic signature for exactly the type of flu vaccine that we have on any given year. So, it might be exactly the same outfit with a different handkerchief or something like that.

Host: And so, which children are at greatest risk for serious illness and complications or even hospitalization from influenza?

Jonathan Mannheim, MD: Anyone under the age of five and certainly under anyone under the age of two and definitely under the age of one. And any children with chronic medical conditions or if they're immunocompromised. And so, this means things like asthma, any lung diseases, neurological diseases, heart diseases, diabetes. But it's an important point that unfortunately we can have severe influenza, really bad flu in completely healthy children with no history of any of those.

Host: You were mentioning how, you know, it's circulating around the world and you try to match that. So, how effective is the flu vaccine, especially during years when it is not a perfect match for the circulating strains?

Jonathan Mannheim, MD: I think that's the most hard question to answer as both a doctor and a parent, right? So when we think effective, I guess the question is, what does it mean to be effective? I would love it if no one got the flu because getting the flu really stinks. You feel awful. You don't go to school. You don't go to work. You just want to lie in bed all day.

And so in preventing anyone getting the flu, it's never 100% effective. Because even with vaccination for most things in the world, you can still get the virus or the bacteria that you're vaccinated against. But even when vaccination doesn't prevent infection, it still reduces by a lot the likelihood that you're going to be hospitalized or have severe complications. And so, it's very effective at preventing severe complications. It's not always 100% effective at preventing any symptoms at all.

Host: And can children still get the flu after they've been vaccinated? And if so, what benefits does vaccination provide?

Jonathan Mannheim, MD: And that's a good follow-up question. It's probably the most common question I get asked by parents. And unfortunately, the answer is yes, anyone can still get the flu after being vaccinated because no vaccine is perfect. We're trying to match up the exact genetic signature of the flu with the one that we're getting as a vaccination in our arms, but it's not always perfect.

And even if it is perfect, your immune system still doesn't always work exactly as you want to. Maybe you haven't slept as well or, you know, your kid had a different cold, or who knows? There's a lot of reasons that kids can just be a little out of whack, right? And so, I can tell you that vaccinated children who get the flu are much less likely to experience severe outcomes, and that's the reason we vaccinate kids, so that they're not in the hospital, they're not, you know, on a ventilator or something worse.

Host: So, it's better than nothing.

Jonathan Mannheim, MD: It's certainly better than nothing. And, you know, you might not get the flu. Maybe you'll just have a tiny little cold. You won't feel like, you know, awful.

Host: So, Dr. Mannheim, let's talk about side effects. What are the most common ones for the flu vaccine? And can the vaccine give someone the flu?

Jonathan Mannheim, MD: You know, I take it back. That's the most common question I get asked. The flu shot cannot give you influenza. And so, influenza's a virus, and the vaccine does not contain—the one that you're getting injected into your arm does not contain live influenza virus. So, it can't cause an infection. But what does happen after you get any vaccine is your immune system wakes up. And so, the flu vaccine doesn't contain live virus, but it contains sort of the signatures of the virus, so your body recognizes what the flu virus would look like if you got it. And so, your body sort of does a trial run. Your immune system turns on. You get a very sore, achy arm. Some people feel kind of crummy for a day or two, feel tired or achy, and even have a very small fever.

But that's it. And then, it goes away because your immune system realizes, "Oh, this is not actually the flu. I don't need to be sick." So really, the most common side effects are a sore arm, and you feel a bit tired or achy for a day or so. But you can't get the flu from the virus.

Host: Good to know, Because, you know, I've heard a lot of people say that, and I think, I don't think that's correct."

Jonathan Mannheim, MD: Right. And I think, you know, the reason is it's intuitive why people think that because you get the shot in November, you feel kind of bad for a day, and then you get another cold, right? The flu vaccine takes a week or two, pretty much up to two weeks to be fully protective. And a lot of people, especially around children, I have two boys who are under the age of three. I've been sick for three years straight. You get a lot of colds. And when you get a cold a few days after getting the flu shot, you put two and two together, but they're actually not related.

Host: Right. Okay. Now, this is a crazy question. But what if you can't remember whether or not you got the flu? Do they keep track of that, like say at CVS, for example,

Jonathan Mannheim, MD: If you've gotten the flu shot or not?

Host: Yeah.

Jonathan Mannheim, MD: CVS will keep track of their own flu shots. Walgreens will keep track of their own flu shots. That's as an adult, but it's good to know that if you go to any doctor's office in Cook County, all of your child's vaccines are getting put on a centralized database by the state of Illinois called iCare. So, we can track year by year, month by month, any vaccines, including the flu vaccine that your child has got. So, we'll be able to keep track. It doesn't matter if you've gone to 20 different clinics, we can keep track.

Host: And if you forgot and you went and you got it, let's say twice in one year, is that harmful?

Jonathan Mannheim, MD: No harm at all.

Host: Do you tell parents who believe that influenza is usually a mild illness and that their healthy child doesn't need the vaccine?

Jonathan Mannheim, MD: It's, you know, it's not an incorrect perception because the vast majority of children with influenza will be okay. The problem is we don't have a reliable way of knowing which kid will be the exception. And so, children with asthma certainly at higher risk, with neurological problems, with immunocompromising problems at higher risk.

But like I said, healthy kids can also get really sick. And I can't tell you, and no one can really tell you who that's going to be. So, it's sort of like the seatbelt analogy. You wear a seatbelt when you go drive in a car, you go to work, you go to school. Ninety-nine percent of the time you're not going to get in a car accident, but if you get in a car accident that day, that's why you want a seatbelt. And it's the same thing with the flu. Vast majority of children are going to be completely okay. They're going to feel really terrible for a week, but they're going to be okay. But I can't tell you which kid's going to be in the hospital. And so, that's why we give you the flu shot.

Host: Great analogy on the seatbelt. Beyond vaccination, what other steps can families take to help prevent the spread of flu during the school year?

Jonathan Mannheim, MD: It's all those things that you, know already to do and that are really hard to do Because you're around little kids. And kids are, you know, gross, and they eat things they shouldn't, they lick things they shouldn't, they don't wash their hands. And so those are the things you should be doing.

You know, wash your hands. If you're sneezing or coughing, try to cover your cough. And having everyone in the house vaccinated is helpful because, you know, if you're under six months of age, you can't get a flu shot. And so, everyone else getting a flu shot protects that little kid.

And it spreads pretty fast within households. So, you know, if another person in your house gets the flu and/or if you get the flu, there are medications we can give to prevent it from getting worse, but they're not as good as preventing the flu in the first place.

Host: I was recently sick and I thought, "Oh, it's just a cold. It'll go away." And then, I thought, "Wait, is this the flu? Is this RSV?" I mean, like COVID you can take a test for and find out. But how can parents tell the difference between flu, RSV, COVID-19, and just a common cold? And when should they contact their child's healthcare provider?

Jonathan Mannheim, MD: It's a really good question. The truth is you can't reliably tell always because RSV and COVID and even the common cold, which is caused by a lot of different viruses, can be pretty severe at times. And so, there's no one thing I could say that's going to make it clear that it's the, it's influenza versus not. Typically with the flu, it tends to come on pretty quickly, and you get a high fever, you get body aches, and you can have throwing up, you can have diarrhea. But the truth is, you can get those with all of these other viruses we've talked about.

Now, you can actually get at Walgreens and CVS and any pharmacy today, you can get a flu test that you buy over the counter, the same as the COVID test you're talking about, and they're often combined as COVID flu tests. And so, you can get one of the at-home tests, and those are pretty reliable. But of course, any doctor's office, any pediatrics office you go into, any at Cook County, we can do a flu test as well.

Host: That's so interesting. I've never heard of that. Have they been around for a long time?

Jonathan Mannheim, MD: I think a few years now mass-marketed maybe the last five years since COVID. They're expensive though. And they're like $25, $30 for one test or two tests. So, it may be more economical, probably safer anyway, just go to the. Doctor if your kid's really sick.

Host: Right. What should parents do if their child develops flu symptoms? Are antiviral treatments available, and who maybe would benefit most from those?

Jonathan Mannheim, MD: If your child definitely has the flu or flu-like symptoms and you think they have the flu and you go to the doctor and we tell you have the flu, we can give your child an antiviral medication called Tamiflu. And that's probably the one most people are familiar with, and that is an oral medication. It can be a tablet or a liquid that we give to children to prevent severe or progressive illness, especially amongst those children who are at the highest risk. And so really, that's for the youngest kids under the age of two, and certainly babies under the age of one. And so, they work best when they're started quickly, within the first 48 hours ideally of the symptoms.

If you think your kid has the flu, if they test positive for flu on a home test, you know, bring them in, talk to your pediatrician, and we can give these medications. But like I said, it's sort of a Band-Aid versus prevention. And so, it's always better to try to get the flu shot, prevent these from happening than trying to deal with it after the fact.

Host: And as a pediatric infectious diseases physician, what is the one thing you wish more parents understood about influenza and flu vaccination?

Jonathan Mannheim, MD: It's really just that it can be so severe. And I can remember as a resident in Chicago seeing children in the pediatric ICU, children who were intubated on a breathing machine, on a ventilator from the flu. And almost invariably these are the children who are unvaccinated. And so, you know, this is a very safe vaccine outside of a sore arm and feeling a bit achy, that's it. And the plus side is you're going to have peace of mind that your kid is going to be protected against really severe complications

Host: Well, in closing, is there anything else you'd like to add that you think parents need to know?

Jonathan Mannheim, MD: Just to reiterate, you can't get the flu from the vaccine. You probably can get another cold in November, December, January. I'd be surprised if you didn't, but it's not going to be from the vaccine

Host: Okay. Thank you so much for sharing your expertise. This information has been so helpful. We really appreciate your time.

Jonathan Mannheim, MD: My pleasure. Thanks for having me.

Host: Again, that's Dr. Jonathan Mannheim. To find out more, please visit cookcountyhealth.org/podcast. And if you'd like to schedule an appointment with Dr. Mannheim, please contact Cook County Health at 312-864-0200. As we wrap up another insightful episode of Total Health Talks, make sure to visit cookcountyhealth.org/podcast again and subscribe to our podcast. Share and connect with us on social media. Stay tuned for more engaging discussions. This is Maggie McKay signing off from Total Health Talks. Stay well.