from Infections in Medicine ^®
Posted 11/26/2002

Infection with influenza virus significantly affects infants and children. Hospitalization rates for children with influenza, especially among those younger than 2 years, are comparable to those for persons older than 65 years (Bridges CB et al. MMWR. 2002;51[RR-3]:1-31). Influenza also has a significant impact on school absenteeism and work days missed by caregivers (Neuzil KM et al. Arch Pediatr Adolesc Med. 2002;156:986-991).

The currently available trivalent influenza vaccine, which is administered intramuscularly, effectively prevents this infection in children as young as 6 months, and vaccination is especially recommended for those children at high risk for complications from influenza. In addition, studies performed during the last decade have demonstrated the potential benefits of influenza immunization for healthy pediatric populations, including those who participate in day care and who attend school (Bridges CB et al. MMWR. 2002;51[RR-3]:1-31; Hurwitz ES et al. JAMA. 2000;284:1677-1682).

The Advisory Committee on Immunization Practices (ACIP) of the National Center for Infectious Diseases has recently adopted a resolution to expand the eligibility for influenza vaccination among children under the Vaccines for Children (VFC) program. According to this resolution, which will be in effect after March 1, 2003, all children aged 6 to 23 months, and those aged 2 to 18 years who live in households where there are children younger than 2 years, will be eligible to receive influenza vaccination under the VFC program. The committee anticipates that this measure will help reduce influenza-related hospitalizations (Bridges CB et al. MMWR. 2002;51[RR-3]:1-31; Centers for Disease Control and Prevention. MMWR. 2002;51:864, 875). This strategy also has the potential for a positive economic impact, as suggested by previous studies in which vaccination was associated with significant cost savings (Luce BR et al. Pediatrics. 2001;108:E24). Although the administration of influenza vaccine to healthy children aged 6 to 23 months is encouraged by the ACIP for the 2002-2003 season, no new recommendations for this group have been made specifically for this season.

Recommendations do exist for influenza immunization for children aged 6 months to 18 years if they belong to a high-risk group. High-risk conditions include chronic cardiopulmonary and metabolic disorders; hemoglobinopathies, such as sickle cell disease, immunosuppression, and effects of prolonged aspirin therapy; pregnancy; and residency in long-term-care facilities. Children aged 6 months to 18 years who live in a household with a person at high risk for complications caused by influenza should also be vaccinated (Bridges CB et al. MMWR. 2002;51[RR-3]:1-31; CDC. MMWR. 2002:51:864, 875).

At present, vaccination rates are not always optimal among those children at high risk for complications of influenza, which could be related to lack of awareness among parents about the need for immunization. To be successful, the implementation of new influenza vaccine recommendations in 2003 will have to be coupled with measures to increase awareness among the public about the need for this immunization. Individual providers will have to play a significant role in the dissemination of this information (James JM. Pediatrics. 2002;110:453).

New methods of vaccine delivery could be helpful in a more widespread immunization strategy. These might include the newly developed trivalent cold-adapted vaccine administered as a nasal spray; clinical trials have suggested that the nasal spray is safe and effective. Nasal administration of the influenza vaccine could not only reduce the costs associated with intramuscular vaccination, but it would also be more practical, particularly in the pediatric setting (Piedra PA et al. Pediatrics. 2002;110:662-672; Cohen GM, Nettleman MD. Pediatrics. 2000;106:973-976).