All children need flu vaccine, panel says

Wants coverage expanded by 30 million

Email|Print| Text size + By Mike Stobbe
Associated Press / February 28, 2008

ATLANTA - All children - not just those under 5 - should get vaccinated against the flu, a federal advisory panel said yesterday.

The panel voted to expand annual flu shots to virtually all children except infants younger than 6 months and those with serious egg allergies.

If heeded, the decision could bring about one of the largest expansions in flu vaccination coverage in US history, with about 30 million more children vaccinated. The flu vaccine has been available since the 1940s.

Flu shots were already recommended for people considered to be at highest risk of death or serious illness from the flu, including children ages 6 months to 5 years, adults 50 and older, and people with weakened immune systems. The panel said that should be expanded to include children up to age 18.

Top disease trackers in Massachusetts hailed the federal recommendation, saying that if widely implemented, it could yield two major benefits: fewer seriously ill children and less transmission of the potentially lethal illness to adults.

"I think it's a great idea because we know that young children are often the first to introduce influenza into a community," said Dr. Anita Barry, director of communicable disease control for the Boston Public Health Commission. An expanding body of scientific research, including landmark studies by scientists at Children's Hospital Boston, indicates that when children fall ill with the flu, it often foreshadows more widespread outbreaks among adults.

Specialists at the US Centers for Disease Control and Prevention, which is expected to approve the recommendation from the advisory panel, estimate that 36,000 Americans die annually from the flu. Most of those deaths are among the elderly, but in recent years, doctors and parents have become increasingly concerned about the toll exacted by the virus on children. In the fall of 2003, unusual clusters of flu-related deaths were reported among children in Colorado and Texas.

Children ages 5 to 18 get flu at higher rates than other age groups, but they tend not to get as sick. Only 25 to 50 of the annual flu-related deaths occur in children in that age bracket, CDC officials said.

But there are more garden-variety problems associated with the flu in youngsters, too. "There's the missed school, the parent missing work," said Dr. Alfred DeMaria, director of communicable disease control for the Massachusetts Department of Public Health. "There's a lot of impact from influenza on children."

One of DeMaria's associates - Dr. Susan Lett, director of the state's immunization program - is a member of the Advisory Committee on Immunization Practices, which voted in favor of the childhood vaccinations. Another Boston-area physician, Dr. Tracy Lieu of Harvard Medical School, also sits on the panel.

DeMaria said state health authorities have not decided whether to increase the amount of flu vaccine they buy as a result of today's recommendation. This year, the state purchased 708,000 doses, placing it among the biggest governmental purchasers of vaccine in the nation. The state of Massachusetts pays $10 to $20 for each vaccine dose.

"Will this be so fantastically successful that it will warrant making it mandatory for schools?" DeMaria said. "We're going to have to wait and see."

The advisory committee said all children should get vaccinated starting this fall, but acknowledged that many doctors have already ordered their vaccine for the 2008-2009 season and may not be able to give the shots until late 2009. The flu season generally starts in the fall and continues through spring.

Children can receive the vaccine through either a shot or a spray. Side effects are mostly minor, including low-grade fever, aches, and soreness where the shot was given.

Panel members waffled a bit on whether to make the recommendations kick in immediately. Some public health professionals pushed for the clearest endorsement possible of the flu vaccine, out of concern that the public is losing faith in flu shots because this year's vaccine was not well matched to circulating viruses.

A few members argued that the committee should recommend flu shots for every healthy person, rather than adding another set of children now and maybe young adults in a few years.

"Creeping incrementalism, I believe, continues to foster confusion" about who should get the shot and how important it is, said Dr. Gregory Poland, a Mayo Clinic specialist in infectious diseases.

The head of the panel, Dr. Dale Morse, asked for a report on universal vaccination of adults.

Vaccine makers said they expect to be able to produce enough doses next season to accommodate an additional 30 million children, but panel members had concerns about how the doses would be given to so many.

No other vaccine is given to nearly all youngsters every year. Most schools aren't set up to administer the doses, and physician groups were unsure doctors could take on the task.

Stephen Smith of the Globe staff contributed to this report.

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