Behind The Headlines: Should under-twos have flu jabs?

Experts are now assessing how much under-twos would benefit from flu vaccination.

WHAT IS THE STORY?

Health experts are considering offering flu jabs to all children under two, sparking fears of 'immunisation overload', according to some newspapers.

Based on the minutes of the September meeting of the Joint Committee on Vaccination and Immunisation (JCVI) influenza subgroup, newspapers reported that a two-dose flu vaccination schedule was being considered for all children aged under two years (GP, 27 January).

This prompted several of the newspapers to question whether infants' immune systems would be able to cope with an additional vaccine, suggesting that vaccines given to the very young could overload the immune system, and resurrecting the type of furore that dogged the MMR vaccination campaign.

WHAT DOES THE REPORT SAY?

The report to the JCVI assessed the possible impact of routine pre-school influenza vaccination on the health of children and the wider population.

It considered the impact of annual vaccination for children aged six to 11 months, six to 23 months, six to 35 months and six to 59 months.

The model assumed 50 per cent vaccine efficacy and 60 per cent coverage in the elderly, and 65 per cent efficacy and 92 per cent coverage in children, providing effective protection of 30 and 60 per cent respectively. It estimated that pre-school influenza vaccination would significantly reduce the number of influenza infections, particularly in the targeted age groups. It also found a greater impact on influenza B infections than on influenza A.

Although it estimated a vaccine programme for the under- twos would reduce a 'significant number of hospitalisations for influenza A in those under five years old', the largest benefit would be increased prevention of cases in the elderly.

A UK programme would only be cost-effective if vaccinating under-twos resulted in significant reduction in adult influenza, the report said. If 92 per cent coverage of the under-twos were achieved, using a vaccine of 60 per cent effectiveness, the cost for each life saved would be £515. Were there to be no effect on adults, this cost would be more than £30,000.

However, previous studies do support the notion that influenza in children drives influenza in all age groups.

WHAT DO RESEARCHERS SAY?

The experts told the committee that the burden of influenza in children is significant, with large numbers of GP consultations, hospitalisations and some deaths each year.

Although a programme for infants is now under serious consideration, the JCVI influenza subgroup concluded that further information was required. They said more data were needed on the efficacy of the vaccine in the very young because little information was available.

They acknowledged that the evidence to support childhood flu vaccination pointed to the elderly as the biggest winners, not the children themselves.

'Studies would need to show real benefits for young children,' they concluded.

The JCVI experts will look to the US for more data because a programme of influenza vaccine in pre-school children is already under way there.

WHAT DO OTHER EXPERTS SAY?

Dr Richard Halvorsen, a GP in London who was in the media spotlight after offering patients single jabs as an alternative to MMR, criticised the proposals.

'We are talking about delicate babies who are probably more vulnerable to any side-effects than anyone else, when there is no evidence they will benefit,' he told the Daily Mail.

But Dr George Kassianos, immunisation spokesman for the RCGP, who supports a vaccine campaign for the under- twos, said there was no evidence to substantiate such a claim.

'There is no question of overloading the baby's immune system. Neonates develop the capacity to respond to foreign antigens before they are born. Once born, babies are capable of generating both humoral and cellular immune responses to pathogens.

'The immune system of children and infants can respond to large numbers of antigens at the same time. Researchers have estimated that an infant could respond to at least 10,000 antigens at once,' he said.

He added that the influenza vaccine in question was an inactivated vaccine that was extremely unlikely to produce significant adverse events.

'A decision to vaccinate children aged six to 36 months is overdue. This would benefit the children and everyone else.'

http://www.advisorybodies.doh.gov.uk/JCVI/mins-flu-080905.htm

INFORMING PATIENTS

- Health officials are now considering a campaign to immunise under-twos against influenza.

- The programme will not be rolled out until there are more data showing the vaccine is of benefit.

- An infant vaccine campaign would have the knock-on effect of reducing flu among the entire population.

- There is no evidence to support the hypothesis of immune system overload.

WHAT THE PAPERS SAID
'Babies may get flu jab to save adults' - The Times
'Toddlers targeted for flu jab' - The Independent
'Docs: give all kids flu jab' - The Sun

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