Each year, around 20,000 American children under the age of 5 are hospitalized because of the flu, according to the Centers for Disease Control and Prevention; the CDC received reports that 86 children died of flu-related complications during the 2007-08 flu season. Accordingly, the organization recommends that all children from the age of 6 months to 19 years should be vaccinated yearly; children 9 years old and under who are being vaccinated for the first time will need two shots given a month apart. Some children are at greater risk for flu-related complications; keep reading to find out if your family falls into that category.

The more statistics you read about flu-related deaths, the scarier it gets. According to the Centers for Disease Control and Prevention, around 36,000 Americans die of the disease a year (most of them elderly) while around 226,000 people are hospitalized.

Before you decide to never leave your house again (or invest in several boxes of surgical masks and sterile gloves), know that those statistics could be interpreted as misleading. In Dr. Robert Sears’ “The Vaccine Book: Making the Right Decision for Your Child,” Sears—board-certified pediatrician and the co-author of several books—writes that the potential risks of the flu in infants and children have been “hyped by the media,” adding that the “actual number of fatalities in this age group is extremely small.”

In his book, Sears presents information from the National Center for Health Statistics (NCHS), a database popular among doctors, and the American Lung Association—and according to those groups, there are only about 100 deaths each year reportedly caused by the flu in children. When you add adults to the mix, the number goes up to around 1,500, and over 90 percent of these deaths are in people 65 years old or older. So why the marked discrepancy between 36,000 deaths cited by the CDC and 1,500 cited by the NCHS? Most of the 36,000 deaths occurred in individuals with preexisting illnesses that made them more susceptible to the flu and more likely to die as a result of complications related to the flu. Sears cites deaths caused exclusively by the flu.

The flu shot is unlike other vaccines: some doses still contain mercury, and the vaccine is not always effective. Read on to see why some parents may choose to vaccinate against the flu—or not.

Shot vs. spray: Is the flu shot effective enough to bother with it?
A recent study in Pediatrics says that over a two-year period, vaccinated children ages 6 months to 5 years had half as many flu-related medical visits.

But another recent study, published in the Archives of Pediatrics & Adolescent Medicine, says that over the past two flu seasons, vaccinations for children 5 and younger did not decrease hospitalizations or doctor’s visits linked to the flu.

A HealthDay article covering that research quotes Dr. Robert Belshe, a professor of medicine and pediatrics and director of the Center for Vaccine Development at the Saint Louis University Medical Center: “We know that the inactivated vaccine —the flu shot—doesn’t work real well in children, particularly when the virus has evolved and drifted away from the type that is put in the vaccine,” he says.

So is the problem with inactivated vaccines? There is an alternative: a nose spray that contains a weakened form of the live virus and has been shown to more effectively protect against the flu. The spray also has no mercury in it, which is another selling point (keep reading to find out more about the mercury issue). But, not everyone can get it: The CDC recommends against giving the spray to children under the age of 2; children under 5 who have asthma or episodes of wheezing; adults over 50; pregnant women; and anyone with chronic diseases. A more detailed list is available at the CDC.

The remaining problem is that it’s impossible to predict with complete accuracy which strain of the flu will be dominant in the upcoming flu season—and sometimes, vaccines fall way short.

In the aforementioned Archives of Pediatrics & Adolescent Medicine report, researchers noted that in the two flu seasons they conducted the study, there was a “suboptimal match between vaccine and circulating influenza strains, with only 11 percent and 36 percent matching in the two seasons.”

“Viral strains of the flu are so many and varied, I can’t imagine how it makes any sense to even attempt to offer a vaccine,” says Megan Cole, a registered nurse in the Athens, Ga. area who does not get the flu shot for her 10-year-old-daugher and two sons, ages 8 and 6.

Neither Janet Frick, an associate professor of psychology at the University of Georgia, nor her two children, ages 6 and 3, have had a flu shot in 3 years. The trace amounts of mercury in the shots gave her pause, but their unpredictable effectiveness also weighed on her decision.

“The kids especially get enough shots—they are fully immunized—that it seems like adding another yearly shot on top of that is more of a load on their systems than I want to have,” she says. “If I knew that it would provide 100 percent protection and a full guarantee that none of us would get the flu, then I might feel differently, but as it is, none of us are immune-compromised, and it just seems like a gamble to know whether it will even work or not.”

As Sears writes on his website, “Each year, however, the flu shots change to cover what experts predict will be the “going” strains for the coming year. Last year they guessed wrong, and the flu shot wasn’t very effective. Let’s hope they get it right this year (as they did for the few years prior to last year).”

What about mercury?
Mercury is a component of thimerosal, a preservative used in the flu shot and other vaccines to prevent contamination in multi-dose vials. It’s also a neurotoxin, and in 1999, the Public Health Service agencies, the American Academy of Pediatrics, and vaccine manufacturers declared it should reduced or altogether removed from vaccines.

Yet, while routine vaccines have no or only trace amounts of thimerosal, thimerosal-free flu vaccines are available only in limited quantities.

“I want to avoid mercury because I do believe, even in small amounts, that it is not good for the body,” says Angela Mullis, a labor and delivery nurse in Athens whose 6-year-old daughter has received a flu shot only once. Mullis says she’s supportive of either choice when it comes to getting or not getting the flu shot, but that she doesn’t think it’s a necessary vaccination for her child.

“I guess I feel she is healthy and even if she gets the flu, she won’t have the terrible consequences it causes for some people,” she says.

One northeast Georgia mother who wished to remain anonymous, due to many years working as corporate records keeper for a major pharmaceutical and biologicals company, has chosen not to give her 3-year-old daughter flu shots, or any vaccinations at all. She made her decision after managing records of toxicity and efficacy of several vaccines.

She doesn’t get her daughter the flu shot because of concerns with “toxic chemicals, metals and viruses…that she wouldn’t have otherwise encountered naturally,” she says.  “We believe they do more harm than good, compromising her natural defense system.”

According to the National Network for Immunization Information, mercury in thimerosal-containing vaccines appears to be “rapidly excreted” soon after the dose, and “does not appear to accumulate after routine injections.”

Still, Sears advises you request a “mercury-free” vaccine, such as the Fluzone pre-filled syringe for infants 6-35 months, children 3 years and older, and adults, or the single-dose vial for children 3 years and older and adults. (The mutlti-dose vial of this brand contains mercury.) At Sears’ website, you can read more detailed information about the different brands of flu shots and their respective amounts of mercury.

What about building up immune systems?
Some parents don’t get the flu shot for their children in favor of a naturally strong and developing immune system.

“I really wanted to believe in our strong immunity system to protect us from illness,” says Stephanie Jordan, a parent and promoter of maternity events in the Athens area. While she and her husband might consider getting the flu shot as they age, their two daughters, ages 5 and 10, do not get the flu shot.  The children are home-schooled and rarely sick, she adds.

“Getting the flu once in the nine years we have not vaccinated has not caused us to reconsider our decision,” she says.

Cole’s decision to avoid the flu shot and other vaccinations came after her eldest had a severe vaccine reaction as an infant, but that’s not the only reason, she says.

“One of the reasons I decided to study nursing was because of this issue,” she says. “I learned about the intricate functions of the immune system, and it is definitely recognized that the strongest form of immunity is acquired when that child or person contracts a disease and recovers from it…to contract the illness and recover from it aids in strengthening their immune system in general. The immune system is built in exactly this way—exposure and recovery from disease. That is essentially what a vaccine aims to do: expose a child to a weakened or killed form of bacteria or virus, weak enough so that it does not actually induce symptoms, and hope that the antibodies are developed when the body recognizes those substances as foreign. Childhood is the time to build the immune system.”

Her children have gotten the flu occasionally, she says, usually recovering within a week.

“The flu is a very uncomfortable illness, but it certainly isn’t deadly to normally healthy individuals,” says Cole.

“I do feel that getting sick in the long run is good for the immune system, because it helps our immune system grow and fine-tune itself,” says Mullis. “Our bodies are amazing.”

Do you need the flu shot—are you high-risk?
“I really feel like the whole selling point with the flu shot and vaccines in general is the fact that with effective vaccination, less time is lost from work and school,” says Cole. “With parents who cannot afford the lost work, the flu shot is certainly attractive for that reason.”

According to the American Lung Association’s Faces of Influenza Initiative, the flu vaccine is recommended especially to those who have a risk of developing flu-related complications or who are most likely to spread the virus to at-risk people, such as:

• Children and adults with asthma, chronic obstructive pulmonary disease, heart disease, weakened immune system, diabetes, and other chronic medical conditions

• Children 6-59 months of age

• Children 6 months-18 years who are on long-term aspirin treatment

• Pregnant women

• Caregivers of at-risk people, including parents of children under 6 months of age, who are too young to be vaccinated

• Adults 50 years old and over 

• Residents of long-term care facilities

• Health-care professionals who work with patients

Tips on staying healthy during flu season
The CDC offers a tip sheet on how to avoid the flu, and the first thing on the list is to get a flu shot. If you choose not to get the shot, pay attention to the second item on the list: everyday preventative actions, like hand washing, using tissues to cover your mouth when you cough or sneeze, and avoiding touching your face.

Jordan relies on simple but tried-and-true methods to get her family through flu season: gargling (or nose-irrigating) with warm salt water at the first sign of a sore throat and Echinacea.

“None of us have had the flu in years,” says Frick—and her children have both been in daycare since they were four months old. “We just try to wash our hands a lot in the winter, although I know that’s not a guarantee.”

Frick also relies on a good diet to keep her family well, citing the research of Dr. Joel Fuhrman, a physician and author who specializes in disease prevention through nutrition, especially a diet that emphasizes vegetables, fruits, whole grains, legumes, nuts, and seeds.

“I believe that a healthy plant-based diet, with lots of fresh produce, makes a big difference in keeping our immune system humming along,” she says. “I think the more fruits and veggies we can get into ourselves, and into our children, the more we can build up their own ability to fight off infection and disease.”