Even though the flu season is devastating for young children, few parents see the urgency of getting their kids vaccinated.
Some don’t view flu as a killer, even though 36,000 Americans die from it in an average year and another 200,000 are hospitalized. Many hold the common misconception that you can get the flu from a flu shot, or simply dislike watching their children experience any pain.
Parents have also opposed the use of thimerosal - a mercury-containing preservative - in flu vaccines, claiming it causes childhood autism. New Jersey could become the first state to require flu shots for preschoolers, and parents have protested loudly, questioning the safety of the shots. Nonetheless, on December 10 the New Jersey Public Health Council will likely approve mandatory flu shots for children attending licensed preschools or day care centers.
But in the 49 other states where flu shots remain voluntary, there is no rush to bring children in. Using data from a number of immunization sites, the US Centers for Disease Control and Prevention recently reported that among children 6 months to 2 years of age, less than one third were fully vaccinated. Among children 2 to 5 years of age, that figure fell to one fifth.
Yet children under 5 are among those most vulnerable to the flu. Each year, approximately 100 children in the U.S. die due to influenza (flu) and more than 20,000 are hospitalized. Complications caused by the flu include bacterial pneumonia and a worsening of chronic medical conditions, such as asthma, diabetes, and congestive heart failure. Sinus problems and ear infections are also common. Still, parents are reluctant to provide their children with the seasonal protection of a flu shot.
Aside from New Jersey’s initiative, “a flu shot isn’t required for a child to go to school. If you give parents an option, they say no. They distrust vaccines,” says Dr. Jim King, a professor of pediatrics at the University of Maryland School of Medicine. “We try to tell them that if you protect your child against flu, you’re protecting your whole family.”
Indeed, studies suggest that children are the major spreaders of flu to other age groups. Two years ago, researchers at Children’s Hospital Boston and Harvard Medical School concluded that otherwise healthy 3 and 4 years olds – frequenters of daycare facilities and preschools - were driving flu epidemics. Previous studies have shown that when children are immunized, there are accompanying decreases in household flu transmission and adult flu mortality.
Dr. Marc Siegel, an associate professor in the NYU School of Medicine, says parents have not faced “the reality that children are super spreaders of the flu. Most of the deaths are in the elderly, and there’s insufficient concern that the flu will spread to the elderly from their children.” Siegel points to Japan as a model nation, noting that mandatory vaccination of school children from the 1960s to 1985 was associated with “one million fewer deaths in the general population.”
The US Centers for Disease Control and Prevention have been highlighting the importance of influenza vaccination - not just for the “super spreader” children but all age groups. But Americans may not be getting the message. Last year, about 121 million vaccine doses were produced, but close to 18 million doses were unused and went to waste. The influenza vaccine is unique because it is prepared differently each year and it only offers 3-6 months of immunity. If you received a shot during a previous year, it is useless in protecting you against this year’s strains of the virus. And doses which are not used during this flu season will have to be discarded
CDC spokesman Curtis Allen said that so far this year 108 million doses have been distributed by manufacturers, who have the capacity to produce 132 million. “We don’t know if there’s going to be a surplus of vaccine this year,” said Allen. “Most years, there winds up being more vaccine produced than distributed.”
From CDC’s vantage point, one of the challenges in vaccinating children is that first timers require two doses of the vaccine - one month apart. “You have to make two trips, so that could be a barrier to some parents,” said CDC’s Allen. “Not only that, many parents are not aware they would need two visits.” Pediatricians are overwhelmed during flu season and their staffs struggle to notify parents and make sure their children come in twice, says Dr. William Schaffner, chairman of Vanderbilt's Department of Preventive Medicine.
Another obstacle is delayed delivery of the vaccine. While private practices indicate that the flu vaccine is abundantly available, Schaffner has heard rumblings that “the vaccine that should be available under aegis of public programs is coming in more slowly.” Schaffner says CDC’s Vaccines for Children program, which provides free vaccines to many uninsured and underinsured children, has experienced delays. “The public vaccine is not getting to pediatricians as quickly and readily as the one they purchase for their patients with medical insurance,” said Schaffner.
Even when the vaccine is available, some parents believe it causes more harm than the flu itself. As long as the majority of influenza vaccines distributed in the United States contain thimerosal – 90 percent do - as a preservative, parents will distrust them. Used to prevent contamination in multi-dose vials of vaccines, thimerosal is feared because it contains ethylmercury. While there is little belief in the scientific community that the low doses of thimerosal in vaccines have caused harm, many parents have linked mercury in shots to autism and other neurological disorders in children.
“We have heard concern from a lot of parents about thimerosal in the vaccines,” said CDC’s Allen, acknowledging that the influenza vaccine is the only recommended one still containing thimerosal. “If they have concerns, they should talk to their healthcare provider and see if they have thimerosal-free vaccines.”
Sidebar: Nasal Spray May Make Vaccination Easier
Parents who don’t like watching their children cry while receiving flu shots may now have a solution. In September, the U.S. Food and Drug Administration approved FluMist, a nasal spray flu vaccine, for children aged 2 to 5. “One of the deterrents to vaccination for parents is they hate to see their child stuck,” says CDC spokesman Curtis Allen. “FluMist is an excellent alternative to a flu shot for those 2 to 5 years of age, unless they have episodes of wheezing or asthma.”
The spray vaccine, initially approved for healthy people between the ages of 5 and 49, is a pain free alternative which may hold benefits over other vaccines on the market. “The influenza virus changes a little from time to time. There’s now quite good data suggesting the nasal spray vaccine gives better protection against drifted influenza,” says Vanderbilt’s Schaffner. “The nasal spray vaccine is better protection against those aberrant strains.”
When FluMist first hit the market, its manufacturer MedImmune blundered in placing a premium price on the vaccine. “Individuals weren’t willing to pay and third party payers said no way,” says Schaffner. However, the cost of the vaccine has since declined and a refrigerator-stable version has been introduced, making it easier to stock for pediatricians. FluMist now costs around $20 a dose, versus $12-15 for other vaccines on the market, says Maryland ’s King, who was involved with early research studies involving FluMist and children.
Both King and Schaffner, who has no involvement with FluMist, agree that the nasal spray could allow for speedier vaccination of children in clinic settings. King says schools using the spray can vaccinate 100-200 children an hour. “It’s easier to use (FluMist) if you’re vaccinating a lot of kids. Much easier than a needle and syringe program as you can imagine,” notes Schaffner.
Since the FDA’s Advisory Committee on Immunization Practices approved FluMist for children 2 to 5, insurance companies will likely cover its usage from this point forward. “Now that it’s a recommended population, insurers are kind of forced to cover that,” says King. “However, if you’re ten years old, an insurer may not pay for it.”
Some don’t view flu as a killer, even though 36,000 Americans die from it in an average year and another 200,000 are hospitalized. Many hold the common misconception that you can get the flu from a flu shot, or simply dislike watching their children experience any pain.
Parents have also opposed the use of thimerosal - a mercury-containing preservative - in flu vaccines, claiming it causes childhood autism. New Jersey could become the first state to require flu shots for preschoolers, and parents have protested loudly, questioning the safety of the shots. Nonetheless, on December 10 the New Jersey Public Health Council will likely approve mandatory flu shots for children attending licensed preschools or day care centers.
But in the 49 other states where flu shots remain voluntary, there is no rush to bring children in. Using data from a number of immunization sites, the US Centers for Disease Control and Prevention recently reported that among children 6 months to 2 years of age, less than one third were fully vaccinated. Among children 2 to 5 years of age, that figure fell to one fifth.
Yet children under 5 are among those most vulnerable to the flu. Each year, approximately 100 children in the U.S. die due to influenza (flu) and more than 20,000 are hospitalized. Complications caused by the flu include bacterial pneumonia and a worsening of chronic medical conditions, such as asthma, diabetes, and congestive heart failure. Sinus problems and ear infections are also common. Still, parents are reluctant to provide their children with the seasonal protection of a flu shot.
Aside from New Jersey’s initiative, “a flu shot isn’t required for a child to go to school. If you give parents an option, they say no. They distrust vaccines,” says Dr. Jim King, a professor of pediatrics at the University of Maryland School of Medicine. “We try to tell them that if you protect your child against flu, you’re protecting your whole family.”
Indeed, studies suggest that children are the major spreaders of flu to other age groups. Two years ago, researchers at Children’s Hospital Boston and Harvard Medical School concluded that otherwise healthy 3 and 4 years olds – frequenters of daycare facilities and preschools - were driving flu epidemics. Previous studies have shown that when children are immunized, there are accompanying decreases in household flu transmission and adult flu mortality.
Dr. Marc Siegel, an associate professor in the NYU School of Medicine, says parents have not faced “the reality that children are super spreaders of the flu. Most of the deaths are in the elderly, and there’s insufficient concern that the flu will spread to the elderly from their children.” Siegel points to Japan as a model nation, noting that mandatory vaccination of school children from the 1960s to 1985 was associated with “one million fewer deaths in the general population.”
The US Centers for Disease Control and Prevention have been highlighting the importance of influenza vaccination - not just for the “super spreader” children but all age groups. But Americans may not be getting the message. Last year, about 121 million vaccine doses were produced, but close to 18 million doses were unused and went to waste. The influenza vaccine is unique because it is prepared differently each year and it only offers 3-6 months of immunity. If you received a shot during a previous year, it is useless in protecting you against this year’s strains of the virus. And doses which are not used during this flu season will have to be discarded
CDC spokesman Curtis Allen said that so far this year 108 million doses have been distributed by manufacturers, who have the capacity to produce 132 million. “We don’t know if there’s going to be a surplus of vaccine this year,” said Allen. “Most years, there winds up being more vaccine produced than distributed.”
From CDC’s vantage point, one of the challenges in vaccinating children is that first timers require two doses of the vaccine - one month apart. “You have to make two trips, so that could be a barrier to some parents,” said CDC’s Allen. “Not only that, many parents are not aware they would need two visits.” Pediatricians are overwhelmed during flu season and their staffs struggle to notify parents and make sure their children come in twice, says Dr. William Schaffner, chairman of Vanderbilt's Department of Preventive Medicine.
Another obstacle is delayed delivery of the vaccine. While private practices indicate that the flu vaccine is abundantly available, Schaffner has heard rumblings that “the vaccine that should be available under aegis of public programs is coming in more slowly.” Schaffner says CDC’s Vaccines for Children program, which provides free vaccines to many uninsured and underinsured children, has experienced delays. “The public vaccine is not getting to pediatricians as quickly and readily as the one they purchase for their patients with medical insurance,” said Schaffner.
Even when the vaccine is available, some parents believe it causes more harm than the flu itself. As long as the majority of influenza vaccines distributed in the United States contain thimerosal – 90 percent do - as a preservative, parents will distrust them. Used to prevent contamination in multi-dose vials of vaccines, thimerosal is feared because it contains ethylmercury. While there is little belief in the scientific community that the low doses of thimerosal in vaccines have caused harm, many parents have linked mercury in shots to autism and other neurological disorders in children.
“We have heard concern from a lot of parents about thimerosal in the vaccines,” said CDC’s Allen, acknowledging that the influenza vaccine is the only recommended one still containing thimerosal. “If they have concerns, they should talk to their healthcare provider and see if they have thimerosal-free vaccines.”
Sidebar: Nasal Spray May Make Vaccination Easier
Parents who don’t like watching their children cry while receiving flu shots may now have a solution. In September, the U.S. Food and Drug Administration approved FluMist, a nasal spray flu vaccine, for children aged 2 to 5. “One of the deterrents to vaccination for parents is they hate to see their child stuck,” says CDC spokesman Curtis Allen. “FluMist is an excellent alternative to a flu shot for those 2 to 5 years of age, unless they have episodes of wheezing or asthma.”
The spray vaccine, initially approved for healthy people between the ages of 5 and 49, is a pain free alternative which may hold benefits over other vaccines on the market. “The influenza virus changes a little from time to time. There’s now quite good data suggesting the nasal spray vaccine gives better protection against drifted influenza,” says Vanderbilt’s Schaffner. “The nasal spray vaccine is better protection against those aberrant strains.”
When FluMist first hit the market, its manufacturer MedImmune blundered in placing a premium price on the vaccine. “Individuals weren’t willing to pay and third party payers said no way,” says Schaffner. However, the cost of the vaccine has since declined and a refrigerator-stable version has been introduced, making it easier to stock for pediatricians. FluMist now costs around $20 a dose, versus $12-15 for other vaccines on the market, says Maryland ’s King, who was involved with early research studies involving FluMist and children.
Both King and Schaffner, who has no involvement with FluMist, agree that the nasal spray could allow for speedier vaccination of children in clinic settings. King says schools using the spray can vaccinate 100-200 children an hour. “It’s easier to use (FluMist) if you’re vaccinating a lot of kids. Much easier than a needle and syringe program as you can imagine,” notes Schaffner.
Since the FDA’s Advisory Committee on Immunization Practices approved FluMist for children 2 to 5, insurance companies will likely cover its usage from this point forward. “Now that it’s a recommended population, insurers are kind of forced to cover that,” says King. “However, if you’re ten years old, an insurer may not pay for it.”
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