BLUE FISH

Inside this issue:

Who should not receive

the flu vaccine?

What are the symptoms

of the flu?

What’s available?

When to get vaccinated?

One or two shots need-

ed?

Egg Allergy Protocol

Flu and COVID-19

When will vaccines be

available?

Payment

COVID XBB Booster

Update

Beyfortus (nirsevimab)

Fall 2023 Vaccine Chart

The flu is an illness caused by a

virus. Like a cold, it attacks the

nose, throat, and lungs. The flu

can sometimes lead to other

problems like pneumonia, ear/

sinus problems, dehydration, and

worsening of asthma. For most of

us, the flu will go away in 1-2

weeks.

2023-2024 Flu Season Newsletter

How can I catch the flu?

• The flu is easily passed from person to

person via direct contact or via airborne

pathogens (coughing and sneezing).

• A person can also get the flu by touching

something with the flu virus on it and then

touching their mouth or nose.

Everyone is at risk for getting the flu, but for some people the flu can

cause serious illness. Those most at risk include:

• All children aged 6 months to 5 years

• All persons aged older than or equal to 50 years

• Children and adolescents (aged 6 months to 18 years) who are receiving long-

term aspirin therapy

• Women who will be pregnant during the influenza season

• Adults and children who have lung (including asthma), heart (except high blood

pressure), kidney, liver, brain/nerve, blood, or metabolic disorders (including diabe-

tes mellitus)

• Adults and children who have a weak immune system either due to illness or medi-

cation

• Residents of nursing homes and other long-term-care facilities

• Health care personnel

• People exposed to at-risk people

What you need to know about the flu

Who is most at risk for getting the flu?

BLUE FISH

E D I A T R I C S

www.bluefishmd.com

It is best for everyone, including breastfeeding mothers, to receive the flu vaccine (save

those who have contraindications to receiving it, as listed below). In the event of a known flu

vaccine shortage, we may be mandated by the CDC to follow a prioritization plan.

Who should not receive the flu vaccine?

Who should NOT receive the flu vaccine?

People who SHOULD NOT get the flu vaccine:

• Children younger than 6 months of age

• People with severe, life-threatening allergies to any ingredient (ingredients may include

gelatin, antibiotics, or others) in a flu vaccine (other than egg proteins)

• People who have had a severe allergic reaction to a dose of influenza vaccine should

not get that flu vaccine again and might not be able to receive other influenza vaccines if

they have ever had Guillain-Barré Syndrome (a severe paralyzing illness, also called

GBS)

People who SHOULD NOT get the nasal spray flu vaccine:

• Children younger than 2 years old

• Adults 50 years and older

• People with a history of severe allergic reaction to any ingredient of the vaccine or to a

previous dose of any flu vaccine

• Children 2 through 17 years old who are receiving aspirin- or salicylate-containing

medications

• Children 2 through 4 years old who have asthma or who have had a history of wheezing

in the past 12 months

• People with weakened immune systems (immunosuppression) from any cause

• People who care for severely immunocompromised persons who require a protected

environment (or otherwise avoid contact with those persons for 7 days after getting the

nasal spray vaccine)

• People without a spleen, or with a non-functioning spleen

• Pregnant women

• People with an active leak between the cerebrospinal fluid and the mouth, nose, ear, or

other place within the skull

• People with cochlear implants

• People who have taken flu antiviral drugs within a certain amount of time (48 hours for

oseltamivir and zanamivir, 5 days for peramivir, and 17 days for baloxavir)

In addition, the following medical conditions are precautions to the use of the nasal

spray flu vaccine:

• Asthma in people 5 years and older

• Other underlying medical conditions that can put people at higher risk of serious flu

complications including lung disease, heart disease (except isolated hypertension),

kidney disease (like diabetes), kidney or liver disorders, neurologic/neuromuscular, or

metabolic disorders

• Moderate or severe acute illness with or without fever

• Guillain-Barré Syndrome within 6 weeks following a previous dose of flu vaccine

Page 2

2023-2024 Flu Season Newsletter

See page 4 for children under 9

years of age to see how many

doses are needed this season.

“Influenza (flu)

usually comes on

suddenly. In many

cases you can

pinpoint the hour

when symptoms

start.”

What’s available?

Note: Children 6 months to younger than 9 years of age may need to receive

the vaccine twice, separated by at least 4 weeks. See page 4 for exact details.

Page 3

2023-2024 Flu Season Newsletter

The flu shot prevents

serious complications from

the flu in 70% to 90% of

young, healthy adults.

“About 20-50% of

the U.S. population

gets the flu each

season”

Flu viruses are constantly changing. The composition of U.S. flu vaccines is

reviewed annually by the U.S. Food and Drug Administration Vaccines and

Related Biological Products Advisory Committee and updated as needed to best

match the flu viruses research indicates will be most common during the

upcoming season. The 2023-2024 season U.S. flu vaccines will contain an

updated influenza A(H1N1)pdm09 component:

• A/Victoria/4897/2022 (H1N1)pdm09-like virus for egg-based vaccines and

• A/Wisconsin/67/2022 (H1N1)pdm09-like virus for cell-based or recombinant

vaccines.

How well flu vaccine works can depend in part on the match between the vaccine

viruses and circulating viruses. Preliminary estimates show that last season,

people who were vaccinated against flu were about 40% to 70% less likely to be

hospitalized because of flu illness or related complications.

In healthy children 2-8 years of age, the Advisory Committee on Immunization

Practices (ACIP) no longer recommends a preference for the intranasal spray flu

vaccine over the injectable flu vaccine as new data from more recent seasons

have not confirmed superior effectiveness of the intranasal vaccine. Both the

intranasal and injectable are equally recommended.

The most common signs of the flu include:

• Fever

• Headache and muscle ache

• Fatigue

• Cough

What are the symptoms of the flu?

• Sore throat

• Runny or stuffy nose

• Vomiting or diarrhea (more common

in children)

It takes about two weeks for

the flu vaccine to be

effective.

Age Dose

6 months and older (Injectable) 0.5 ml injection vaccine regardless of age

2 years and older (Intranasal)

Same dosage regardless of age; limited

supply this year

If your child is 9 years or older, regardless of what flu immunizations have been

given in the past, they will only need ONE immunization this flu season.

If your child is under 9 years of age, they may need TWO immunizations this

year. See the chart below to assist you in knowing how many shots your child

will need this flu season.

If your child needs two flu vaccines this year, they should be spaced apart by a

minimum of 4 weeks (28 days). There is no deadline by which the 2

flu vaccine

needs to be completed, but once the minimum 4 weeks has passed, the sooner

the better as your child will have optimal protection only after the 2

immunization.

The Saturday flu clinics we are hosting at multiple Blue Fish locations are each

spaced two weeks apart. Should your child need two flu vaccines, please plan

accordingly. For example, if you attend Saturday flu clinic #1, come back for the

second shot at flu clinic #3, 4, 5 or 6 (sooner is ideal). Or f you attend Saturday

flu clinic #3, come back for the second shot at flu clinic #5 or 6 (sooner is ideal).

“Seasonal” influenza vaccines are

formulated to prevent annual flu.

2023-2024 Flu Season Newsletter

Page 4

One or Two Shots Needed?

Check out our website for

updates on our flu vaccine

availability!

www.bluefishmd.com

0 flu shots

before July 2023

1 flu shot

before July 2023

2 flu shots

before July 2023

Under 9

years of age

2 flu shots

needed

2 flu shots

needed

1 flu shot needed

9 years or

older

1 flu shot

needed

1 flu shot needed 1 flu shot needed

Egg Allergy Protocol (per CDC)

All children with egg allergy of any severity can receive influenza vaccine

without any additional precautions beyond those recommended for any

vaccine.

Yearly flu vaccination should begin in September or as soon as the vaccine is

available and continue throughout the influenza season, as late as March or

beyond. The timing and duration of influenza seasons vary.

While influenza outbreaks can happen as early as October, most of the time

influenza activity peaks in February or later. About 2 weeks after vaccination,

antibodies that provide protection against influenza virus infection develop in the

body.

When to get vaccinated?

Blue Fish Pediatrics– MEMORIAL ONLY

Page 5

Flu and COVID-19 (per CDC)

Can I get the flu shot and COVID vaccine at the same time?

Yes, you can get a COVID-19 vaccine and a flu vaccine at the same time. Even though both vaccines can be given at

the same visit, people should follow the recommended schedule for either vaccine: If you haven’t gotten your currently

recommended doses of COVID-19 vaccine, get a COVID-19 vaccine as soon as you can, and ideally get a flu vaccine

by the end of October.

Can I have flu and COVID-19 at the same time?

Yes. It is possible have flu, as well as other respiratory illnesses, and COVID-19 at the same time. Health experts are

still studying how common this can be. Some of the symptoms of flu and COVID-19 are similar, making it hard to tell

the difference between them based on symptoms alone. Diagnostic testing can help determine if you are sick with flu

or COVID-19.

Will a flu vaccine protect me against COVID-19?

While getting a flu vaccine will not protect against COVID-19, flu vaccination has many other important benefits. Flu

vaccines have been shown to reduce the risk of flu illness, hospitalization and death. Getting a flu vaccine this fall will

be more important than ever, not only to reduce your risk from flu but also to help conserve potentially scarce health

care resources.

Should a flu vaccine be given to someone with suspected or confirmed COVID-19?

No. Vaccination should be deferred (postponed) for people with suspected or confirmed COVID-19, regardless of

whether they have symptoms, until they have met the criteria to discontinue their isolation. While mild illness is not a

contraindication to flu vaccination, vaccination visits for these people should be postponed to avoid exposing

healthcare personnel and other patients to the virus that causes COVID-19. When scheduling or confirming

appointments for vaccination, patients should be instructed to notify the provider’s office or clinic in advance if they

currently have or develop any symptoms of COVID-19. Additionally, a prior infection with suspected or confirmed

COVID-19 or flu does not protect someone from future flu infections. The best way to prevent seasonal flu is to get

vaccinated every year.

2023-2024 Flu Season Newsletter

When will the vaccines be available?

During regular office hours (starting in September), the flu vaccine will be available at well visits

for all patients of Blue Fish Pediatrics / family members living in the same household

with patients younger than 6 months old. Flu vaccines will also be administered during sick

visits at their doctor’s recommendation.

To help accommodate our busy families, we have designated Saturday flu clinics. Unlike

previous years, any patient of Blue Fish, regardless of their home office, can attend any

of our Saturday flu clinics. Any Blue Fish patient or parent is eligible to receive the flu

vaccine on these specially designated Saturdays (see below for dates). Also eligible are any

family member(s) living in the same household with patients younger than 6 months old. For

those 65yrs and older, Blue Fish does NOT carry the high dose flu vaccine. On these

specially designated Saturdays, please use our bookafy system to schedule ahead for the flu

vaccine. The scheduling link will be available on our website, and sent out to the mailing list for

newsletter recipients.

• The availability of certain flu products may be limited towards the end of the flu season.

• Please visit our website for the 2023-2024 flu information page (online booking available

for flu clinics; link on our flu information page)

• The intradermal flu vaccine will NOT be available at Blue Fish.

• The recombinant flu vaccine will NOT be available at Blue Fish.

Payment

Please read the following carefully. Regrettably, the following explanation is complicated and beyond our control.

All parents (and family members who are not Blue Fish patients) receiving the flu vaccine will pay cash prices. If you would like to

receive the flu vaccine via your insurance, please arrange for your flu vaccine through your regular doctor.

Cash paying patients: The cost is $40 for injection and $40 for nasal vaccine. If VFC eligible and VFC flu vaccine is in stock, then the cost is

$13.75 for the administration fee.

Medicaid and CHIP: The vaccine is covered by your insurance as long as we have the VFC flu vaccine in stock. If we should run out of VFC

stock, you can pay the cash price for the vaccine.

Commercial Insurance: You will need to pay your copay for your insurance. Even if your copay is higher than what we charge our cash

paying patients, we are contractually obligated by the insurance carrier to charge you the full copay amount. Insurance companies are firm

concerning this matter. We apologize for this inconvenience, but we are contractually obligated to do so. You have the option of receiving the

flu vaccine elsewhere such as a grocery store or pharmacy for their cash price (as they are not contracted with your insurance company.)

2023 Flu Clinic Dates and Locations Hours

September 9 Cypress and Katy

8:00 AM to

1:00 PM

All Clinics

Cypress and Katy October 21

September 16 Memorial

Memorial, Woodlands,

Sienna

October 28

September 23 Cypress and Katy Cypress and Katy November 4

September 30 Memorial Memorial November 11

October 7 Cypress and Katy Cypress and Katy November 18

October 14 Memorial

Memorial, Woodlands,

Sienna

December 2

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2023-2024 Flu Season Newsletter

2023 COVID XBB Booster Update

An updated COVID booster from Pfizer, Moderna, and Novavax is expected to

be available mid-to-late September. It will be targeted to protect against newer

variants which will likely provide better protection from prominent variants

now circulating, which are descendants of an omicron subvariant known as

XBB1.5.

If you’re in a low-risk category for COVID complications and you don’t have

consistent interaction with high-risk family or friends, waiting for the updated

booster is probably the best recommendation. However, it is a highly

individualized decision as there is not good data regarding this.

The updated booster expected for the fall season is showing a significant

boost in antibodies against many of the currently circulating variants.

There may be specific situations where you may want to play it safe and get

the current omicron COVID immunization now, if you have not already. If you

think you’re going to have considerable exposures, between then and now, it

is recommended to be up to date with current COVID vaccines. The best time

to get vaccinated is before you get infected. You can always do another

COVID booster when the newer version is released.

If your child is 6 months to 4 years, they will need 3 total doses of the COVID

vaccine for full protection (#1 now, three weeks later #2, eight weeks later #3).

For this age group, in order not to delay protection, we recommend to begin

with the current COVID vaccine at this time and switch to the newer booster to

complete the series should it become available.

It is safe and effective to receive both the COVID and flu vaccines at the same

visit.

Our initial Saturday Flu Clinics will only offer the flu vaccine. However,

when the newest COVID booster becomes available we will offer it

alongside the flu vaccine at all remaining Saturday Flu Clinics and

at all Well Child Checks.

Blue Fish will likely only offer the Pfizer brand COVID booster.

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2023-2024 Flu Season Newsletter

What is Beyfortus (nirsevimab)?

Beyfortus™ (nirsevimab) is a new prescription long-acting monoclonal antibody product used to help prevent a serious

lung disease caused by Respiratory Syncytial Virus (RSV). Nirsevimab is not a vaccine.

• Nirsevimab was approved by the US Food and Drug Administration (FDA) on July 17, 2023.

• On August 3, 2023, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease

Control and Prevention (CDC) voted unanimously in favor of recommending use of nirsevimab.

• The American Academy of Pediatrics recommends that all infants -- and especially those at high risk -- receive

the new preventive antibody, nirsevimab, to protect against severe disease caused by respiratory syncytial virus

(RSV), which is common, highly contagious and sometimes deadly.

RSV is one of the most common causes of childhood respiratory illness and results in annual outbreaks of respiratory

illnesses in all age groups. An estimated 58,000 to 80,000 children under 5 years of age, most of them infants, are

hospitalized each year nationwide due to RSV infection, with some requiring oxygen, intravenous (IV) fluids, or

mechanical ventilation (a machine to help with breathing). Each year, an estimated 100 to 300 children younger than

5 years of age die due to RSV.

Who should get Beyfortus (nirsevimab)?

Nirsevimab is recommended for:

1. All infants younger than 8 months born during or entering their first RSV season, including those recommended by

the American Academy of Pediatrics (AAP) to receive Synagis (palivizumab).

2. Infants and children aged 8 through 19 months who are at increased risk of severe RSV disease (see below) and

entering their second RSV season, including those recommended by the AAP to receive Synagis (palivizumab).

Per the FDA label, children who have received nirsevimab should not receive palivizumab for the same RSV season.

Who should not get nirsevimab?

Nirseveimab is contraindicated in individuals with a history of serious hypersensitivity reactions, including anaphylaxis, to

nirsevimab-alip or to any of the excipients.

Hypersensitivity including Anaphylaxis:

Serious hypersensitivity reactions, including anaphylaxis, have been observed rarely with other human IgG1 monoclonal

antibodies. If signs and symptoms of a clinically significant hypersensitivity reaction or anaphylaxis occur, initiate

appropriate medicinal products and/or supportive therapy.

Use in Individuals with Clinically Significant Bleeding Disorders:

As with any other IM injections, Beyfortus should be given with caution to individuals with thrombocytopenia, any

coagulation disorder or to individuals on anticoagulation therapy.

Nirsevimab is not recommended if there is a previous history of RSV infection.

Administration:

Prefilled syringe given IM in the thigh.

Reactions:

Most common adverse reactions with nirsevimab were rash (0.9%) and injection site reactions (0.3%).

Beyfortus (nirsevimab)

Page 8

2023-2024 Flu Season Newsletter

Pricing:

Estimated to be approximately $495 out of pocket. As soon as nirsevimab is available, Blue Fish hopes to have it in

stock. It will likely not be covered by insurances initially, but we will offer it for those families who qualify medically.

Parents can opt to pay for the treatment up front. (Insurances will be billed and reimbursement will be given should your

insurance later pay.)

For qualifying families, Beyfortus should be added to the VFC program sometime this fall, hopefully by October.

Timing of nirsevimab:

On the basis of pre-pandemic RSV infection patterns, nirsevimab may be administered in most of the continental United

States from October through the end of March.

Children 8 through 19 months of age who are recommended to receive nirsevimab when entering their SECOND

RSV season because of increased risk of severe disease:

1. Children with chronic lung disease of prematurity who required medical support (chronic corticosteroid therapy,

diuretic therapy, or supplemental oxygen) any time during the 6-month period before the start of the second RSV

season

2. Children who are severely immunocompromised

3. Children with cystic fibrosis who have manifestations of severe lung disease (previous hospitalization for pulmonary

exacerbation in the first year of life or abnormalities on chest imaging that persist when stable) or have weight-for-

length that is <10th percentile

Coadministration with routine childhood vaccines:

In accordance with the CDC’s general best practices for immunizations, simultaneous administration of nirsevimab with

age-appropriate vaccines is recommended. In clinical trials, when nirsevimab was administered concomitantly with

routine childhood vaccines, the safety and reactogenicity profile of the concomitantly administered regimen was similar

to the childhood vaccines administered alone. When concomitantly administered, nirsevimab is not expected to interfere

with the immune response to other vaccines.

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Beyfortus (nirsevimab) continued

2023-2024 Flu Season Newsletter

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2023-2024 Flu Season Newsletter