Since we have a series about the flu, I want to share a really frustrating situation regarding flu shots. Despite assurances that this year’s supply would be plenty, our office is having trouble getting them. We have had zero shipments from the state, meaning kids on Medicaid and the state HMO programs haven’t yet been vaccinated–and that includes young kids with chronic diseases such as asthma. They’re the ones who REALLY need flu vaccine.The private insurance patients aren’t fairing much better. We had infant flu shots last week, but ran out quickly since the recommendation this year calls for all kids ages 6 months to 5 years to get the shot.Now we only have one type of injectable flu vaccine in our office, but here is where the real frustration lies. This flu vaccine is made by a British company who tells us their product is only licensed for children 4 and older.The infant flu shots (the ones we ran out of) are licensed for ages 2 and under only.So what about the 3 year olds?We have nothing for them, even though the CDC and AAP recommend they get vaccinated. We do have an order pending for flu vaccine from an American company that is licensed for ages 3 and up, but haven’t seen hide nor hair of it.As best we can tell, the British flu vaccine is identical to the American vaccine. But since the Brits only tested it in the 4 and over crowd, they don’t want to say we can use it for 3 year-olds.It gets worse. As doctors, we use drugs “off label” all the time, without fear of malpractice as long as that off-label use is the “standard of care.” So, with informed consent, we could use the British vaccine in 3 year-olds, as long as parents know the entire story. I feel comfortable doing this, because there appears to be no difference between the British flu vaccine and the American one.BUT, if we do that, and a kid has a severe allergic reaction or some other adverse event, you can bet the lawyers will say, “but that shot was only for 4 and older.” And they’ll say this despite our getting informed consent from the parent, claiming we shouldn’t have asked.On the other hand, if we don’t offer the British vaccine, and a kid gets pneumonia and dies, then we are faulted for not offering what we have. Now the lawyers argue giving the flu vaccine to a 3 year-old is the standard of care and we should have let the parents make the choice.The crazy thing is that the same lawyer will argue either way, depending on if the vaccine or the pneumonia injured the kid. I guess it’s just the nature of the lawyer’s job.Just as it’s my job to figure out what to do for 3 year-olds with regard to flu vaccine this year.What would you do?

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