Q&A: New Flu Vaccine Recommendations for Children

This age group was also prioritized as one of the top target populations for the H1N1 vaccine currently in development by the CDC's Advisory Committee on Immunization Practices Wednesday.

Dr. Meg Fisher, medical director of the Children's Hospital at Monmouth Medical Center and chair of the American Academy of Pediatrics Section on Infectious Diseases, spoke with the Online NewsHour about the CDC's new seasonal flu vaccine recommendations and H1N1.

What was the reason for the change in seasonal flu recommendations for young people?

It was a way to try to phase in a pretty dramatic extension of our recommendations for influenza.

For this year, it's recommended for ages 6 months to 18 years. Last year, it was "as feasible" for 6 month to 18 years, the year before that it was 6 months to 5 years, and the year before that was 6 months to 2 years. So it's been a gradual increase.

There's been a discussion for more than 5 years about expanding this to just universal immunization — everybody at all ages. We are actually relatively close to that now because, remember , we recommend it for anybody at high risk, anyone with an underlying condition that influenza would make them sicker than usual, we recommend it now for all children that are old enough to get it – the vaccine is not licensed for children under 6 months. We recommend it for family members of children under 6 months so they are protected and don't give it to these young babies, and then it is recommended for household members or caregivers of anyone with underlying risk factors and finally for anyone who wants to decrease their likelihood of getting the flu.

So essentially you could say we really shouldn't think about who to immunize, but the question would be why not to immunize someone. And the reason not to immunize would be if you have a severe egg allergy and might have a reaction to the vaccine.

Why is flu vaccination for schoolchildren emphasized?

Young children don't have the lifetime of experiences with influenza virus to give them antibody that would protect them or partially protect them. So when they get influenza it's their first time. So not only do they get illness that lasts longer because they don't have those protective antibodies to shut off the virus, but the virus can replicate to higher levels.

They are more contagious because they are shedding more virus and the big deal is that they are much more likely to share their secretions. If their nose is running and snot is coming out of their nose they will rub it on their hands and they'll be happy to hand it to you.

Will this year's seasonal flu vaccine include H1N1?

No, that is one thing we know for sure. It will be a separate vaccine.

Should parents be concerned that the H1N1 vaccine is being created and tested relatively quickly?

Yes and no – we want parents to be concerned and involved – the good news is that because of our current abilities, there will be a vaccine this year – but we won't have years of experience with it before we use it.

We do have years of experience with influenza vaccines so parents should feel comfortable with the concepts and the vaccines.

There may be some new adjuvants [additives in the vaccine] used to help boost the response, and so that less vaccine can be used per person and more is available to treat more people. Adjuvants have been used for many, many years to boost the immune response, so we do have experience with them.

Parents should speak with their pediatricians with questions and to be sure they are aware of when a vaccine is available.

What new information do we know about the severity and spread of H1N1?

What we know now is that this virus is acting in the same manner as seasonal influenza. It appears to be spreading in the same way and causing, to date, relatively mild disease.

Of course, there have been more serious complications with respiratory failure with bacterial infections and with death. That's the same thing though that happens with seasonal flu every year.

The problem with any pandemic strain is you can't predict whether its going to gain more virulence, or whether its going to gain more momentum as it goes down to the southern hemisphere and comes back to the northern hemisphere.
This new strain may continue to cause relatively mild illness or it may mutate into a more vicious virus. We just don't know yet so parents have to stay informed.

Is H1N1 any more deadly for children than other flu strains?

To date it has not been more deadly, if anything it has been relatively mild. What people forget is that regular seasonal influenza causes about a quarter million hospitalizations each year, in excess of 30,000 deaths per year and as far as pediatric deaths we think it's somewhere between 200 and 300 deaths a year due to influenza. Most of the deaths are in patients that have underlying problems … unfortunately influenza can also cause death in previously perfectly well children. So we always have unexpected deaths among children due to influenza.

This summer there were several reports of camps shutting down because of H1N1, is this unusual for flu to remain a factor during the summer?

This virus and this [flu] season is lasting much, much longer than we would normally expect …We suspect that almost all of this is H1N1, not the usual strains because they normally take a vacation in the summer.

This particular strain, has continued to circulate through the summer. It started in late spring and has continued, so that is really what makes it unique and different.
It's acting like seasonal flu except out of season.

For additional information and resources on the recommendations visit:
The Centers for Disease Control and Prevention http://www.cdc.gov/
The American Academy of Pediatrics http://www.aap.org/

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