Routine influenza vaccination for healthy children--old concept, new technologies

Socioeconomic impact of influenza on healthy children and their families

BACKGROUND

Recent studies indicate that influenza can be clinically important in otherwise healthy children. However, the interpretation of many studies is limited because of lack of laboratory confirmation of influenza-like illnesses. Therefore it is difficult to conclude whether the socioeconomic impact of influenza justifies vaccinating all children regardless of age or underlying chronic disorders.

METHODS

We prospectively collected data from 3771 children younger than 14 years of age presenting to emergency departments or primary care pediatricians with symptoms of respiratory tract infection during the influenza season of 2001 to 2002. Influenza infections were verified by virus culture or polymerase chain reaction. We additionally randomized 303 children age 6 months to 5 years to receive either influenza vaccine (n = 202) or no vaccination (n = 101) before the influenza season. The socioeconomic impact of influenza was assessed for both the participating children and their household contacts.

RESULTS

Influenza was documented in 352 (9.3%) of the 3771 children. Compared with influenza-negative children, children with influenza had longer durations of fever and absenteeism from day care or school (P < 0.0001). Further the numbers of medical visits, missed work or school days and the need for help at home to care for the sick children were higher among the household contacts of influenza-positive children (P < 0.0001). Influenza vaccination reduced significantly the direct and indirect influenza-related costs in healthy children and their unvaccinated family members.

CONCLUSIONS

The findings of this study support a wider use of influenza vaccine in healthy children of all ages to reduce the socioeconomic burden of influenza on the community.

Effectiveness of influenza vaccination of children with recurrent respiratory tract infections in reducing respiratory-related morbidity within the households

To evaluate the effectiveness of influenza vaccination in reducing respiratory-related morbidity among children with recurrent respiratory tract infections (RRTIs) and their household contacts, 127 children aged 6 months-9 years (78 males; median age, 3.7 years) with a history of RRTIs (>/=6 episodes per year if aged >/=3 years; >/=8 episodes per year if aged <3 years) were randomized to receive the intranasal virosomal influenza vaccine (n=64 with 176 household contacts) or a control placebo (n=63 with 173 household contacts). During influenza season, the vaccinated children had fewer respiratory infections, febrile respiratory illnesses, prescribed antibiotics and antipyretics, and missed school days than the controls, and similar benefits and a reduction in the loss of parental work were observed among their household contacts. This study shows that the benefits of influenza vaccination extend to children with RRTIs and their family members and encourages to recommend its use in such children.

Efficacy of intranasal virosomal influenza vaccine in the prevention of recurrent acute otitis media in children

To evaluate the efficacy of an intranasal, inactivated, virosomal subunit influenza vaccine for prevention of new episodes of acute otitis media (AOM) in children with recurrent AOM, 133 children aged 1-5 years were randomized to receive the vaccine (n=67) or no vaccination (n=66). During a 6-month period, 24 (35.8%) vaccine recipients had 32 episodes of AOM; 42 (63.6%) control subjects had 64 episodes. The overall efficacy of vaccination in preventing AOM was 43.7% (95% confidence interval, 18.6-61.1; P=.002). Children vaccinated before influenza season had a significantly better outcome than did those vaccinated after the onset of influenza season. The cumulative duration of middle ear effusion was significantly less in vaccinated children than in control subjects. Data suggest that the intranasal virosomal influenza vaccine might be considered among the options for the prevention of AOM in children <5 years old with recurrent AOM.

Influenza vaccination for healthy children

Influenza virus infections cause vaccine-preventable but uncontrolled epidemic disease in the United States. Population dynamics dictate that the burden of disease will increase dramatically over the next 20 years if new strategies are not implemented. New weapons for the diagnosis, treatment and prevention of influenza are now available and should be implemented immediately. The impact of disease in children has been largely overlooked. Control measures should be focused on the prevention of disease in children, who have the highest annual attack rates. The new live attenuated nasal spray influenza vaccine is particularly effective in healthy children who would benefit most from universal immunization.