Most kids should get flu shots, panel says

Almost all children under 18 should get annual flu vaccinations, a federal advisory panel recommended yesterday - the first time the vaccine is being suggested for groups who do not have the highest risk of death from the disease.

The recommendation to vaccinate 30 million additional school-age children is based on more than a desire to keep youngsters healthy and in class. Doctors hope it will protect their parents and grandparents, too.


"Kids are not just transmitters, they're amplifiers," said Dr. James King, a professor of pediatrics at the University of Maryland School of Medicine. "If you're going to catch the flu, you're much more likely to get it from a child."

If the Centers for Disease Control and Prevention takes the advisory panel's advice - and it usually does - the CDC would set in motion one of the largest expansions of flu vaccine coverage since the United States began giving the shots to the elderly after World War II.


In the future, the Advisory Committee on Immunization Practices will consider making the recommendation universal for everyone over the age of 6 months.

Yesterday's proposal, covering all children 6 months through 17 years except for those with serious egg allergies, would not take effect until 2009. Officials said they held off a year because many doctors have already placed vaccine orders for the next flu season and might be unprepared for the logistical challenges that could come with administering so many more shots so soon.

The vaccination must be given from October through January every year - a period when children don't regularly see their pediatricians. "This poses a challenge," said CDC spokesman Curtis Allen. "But it's doable. It's important."

The CDC panel's recommendation would not make flu vaccination a requirement for attending school. Only state and local health officials have that authority. (New Jersey, for example, requires vaccinations for all children in day care or preschool.)

Instead, the CDC is asking pediatricians to make flu shots or nasal vaccine part of standard care for nearly all children, just as it has been for children ages 6 months through 5 years.

Flu shots are already recommended for the 218 million Americans at highest risk of death or serious illness, including young children, adults 50 and older, and people with weakened immune systems.

The recommendation to add more youngsters didn't come sooner, several doctors said, because vaccine shortages have been an issue over the past few years.

Officials now say they believe there will be plenty of doses available to immunize the additional patients. But not everyone is sure.


"Is there even enough vaccine?" asked Dr. Joshua M. Sharfstein, Baltimore's health commissioner.

"The recommendations outstrip the ability of manufacturers to make the vaccine," said Dr. Daniel Levy, an Owings Mills pediatrician and president of the Maryland chapter of the American Academy of Pediatrics.

The proposal marks a shift in a strategy that focused on those at highest risk of death from flu - a tactic that many doctors say hasn't worked.

While the proportion of the elderly population vaccinated has remained steady at about 65 percent for the past decade, the rate of flu death and hospitalization in that group has been rising, said Dr. W. Paul Glezen, a professor of microbiology and pediatrics at Baylor College of Medicine in Houston.

Although young people ages 5 to 18 are at least twice as likely as adults to get the disease, they rarely get as sick. An estimated 36,000 people in the United states die of the flu each year, but school-age children typically account for fewer than 50 of those.

"It's not a big cause of death," said King, the Maryland professor of pediatrics. "It's a big cause of medical visits."


Keeping children healthy and in school is expected to blunt the spread of flu to everyone. Flu epidemics tend to start in classrooms and spread outward, several doctors said. Children tend to stay contagious longer, have poor hygiene and occupy small spaces together.

"The main reason [to give shots to more children] is to protect those children from influenza," said Allen, the CDC spokesman. But he added, "We know that schools are a repository of germs - and many times children do bring home the disease to their parents."

One indicator that an epidemic is beginning is school absenteeism data, said Dr. Roger Baxter, co-director of the Kaiser Permanente Vaccine Study Center. "We notice that every year, when it picks up, it first picks up in the school-age kids," he said.

A 2001 study in The New England Journal of Medicine showed that when flu vaccines were mandated in Japan, flu deaths in the elderly plummeted. When flu vaccines were no longer required, flu deaths among the elderly rose.

The vaccine is also known to work more reliably in children than in the elderly.

Members of the CDC panel said they would like doctors to start administering more shots for the coming flu season if possible.


Dr. Susan Moriarty, a pediatrician in Columbia, said she has long recommended vaccines to all of her patients - and their parents.

"The more people [vaccinated] the better," she said. "We make a big push from October through December and even into January. Anyone who comes into the office for anything, we offer the flu vaccine."

One issue: how to administer shots to so many more patients. Most doctors don't have time for one-on-one inoculation visits. Some experts suggest that pediatricians hold evening and weekend clinics, while others think schools might be the best place.

Levy, the American Academy of Pediatrics chapter president, said there are financial questions, too. Pediatricians lay out the money for vaccine ahead of time, and they're often stuck with the surplus at the end of the season. He said a better compensation system must be worked out.

Otherwise, most doctors see few downsides to administering more flu shots. "They're unbelievably safe," Baxter said.

But Rita Shreffler, executive director of the National Autism Association, said she isn't convinced of that. Even though some flu vaccine is available as a nasal spray that does not contain mercury preservatives, most traditional flu vaccine does, she said.


Shreffler is convinced that the metals in vaccine preservatives caused her two children to become autistic, although no major studies have found a link between the preservative thimerosal and autism.

"Parents need to be very careful about this," she said.

King said it's about time that flu vaccine be given to all school-age children - for their sake and everyone else's.

"You hate to vaccinate kids just to protect us [adults]," he said. "But as a public health tool, I think it's phenomenal."

At a glance


VACCINE DECISION: A government advisory panel recommends that virtually all children, ages 6 months through 17 years, get an annual flu vaccination.

WHO GETS IT NOW: The shot was previously recommended for children ages 6 months through 5 years, adults 50 and older, and people with weakened immune systems.

WHAT'S NEXT: Doctors and school officials will discuss how to organize services so they can give shots to 30 million or more new children.

[Source: Associated Press]

The flu in Maryland

2,400 Cases of flu reported by Maryland doctors this season.


397 Maryland flu patients hospitalized

147 Children hospitalized

0 Flu deaths in Maryland this season

SOURCE: Maryland Department of Health and Mental Hygiene