All children should be immunised against flu, JCVI says

All school-age children should be immunised against flu, the Joint Committee on Vaccination and Immunisation (JCVI) has said.

Dr Kassianos: the JCVI’s support for expanding the immunisation programme is ‘extremely welcome’.

Healthy children should be given a single dose of the Fluenz nasal spray vaccine as part of a school-based programme, the committee said.

The proposal to introduce immunisation of healthy children was made in the minutes of a special JCVI meeting held last month to discuss possible expansions of the annual flu immunisation scheme. The JCVI said it would 'consider its recommendations further and produce a statement'. Currently only children in at-risk groups are vaccinated.

The move to vaccinating all school-age children against flu would be ‘very costly’ and ‘a huge expansion of the childhood vaccination programme’, the JCVI said. It recommended that any such programme should not start until autumn 2014.

JCVI comment
The JCVI said: ‘Members considered that an extension of the annual influenza vaccination programme should include school-aged children (eg reception to school year 12 in England) using, within its market authorisation, the live attenuated intranasal vaccine (Fluenz) as the vaccine of choice but with arrangements made for children that cannot receive this vaccine. Such an extension to the programme would be best delivered in schools.’

A DH spokeswoman said that the JCVI has not yet made a final decision on this issue and that the recommendations would be considered at the committee’s June meeting.

She said there were a number of issues that the JCVI believed need further consideration, for example the public response to such a programme.

'Extending the vaccination programme to healthy children would be a huge undertaking, increasing the number of people who get the vaccine, so it is important that we get this decision absolutely right,' she said.

'In the meantime, we continue to recommend that people in at risk groups, 65s and over and pregnant women do get vaccinated — they are the most at risk from suffering complications.'

RCGP immunisation spokesman and Berkshire GP Dr George Kassianos said the JCVI’s support for expanding the immunisation programme was ‘extremely welcome’.

‘It will be beneficial to children and will benefit other patients as well,’ he said. ‘If we can reduce the infection rate among children we can reduce the morbidity and death rate in the community generally, and especially among the elderly.’

Dr Kassianos said he thought GPs could have a role in delivering vaccinations to healthy school-age children. ‘GPs need to start thinking about working together with schools on vaccinations,’ he said. GP practices could open on Saturday mornings to help support school-based vaccination, he suggested.

At its February meeting the committee said that GP practices  had an ‘important role in mop-up vaccinations’ after school-based vaccination schemes.

‘Challenges’ to immunisation schemes
The JCVI warned about the ‘challenges’ presented to immunisation schemes by the NHS current reforms and said any expanded flu vaccination programme should be delayed until 'the new system was running smoothly'.

But Dr Kassianos said that was ‘no reason not to start it this year’. ‘I don’t expect the NHS to be settled in 2014,' he said. 'It has never been settled. We have had changes every year.’

The JCVI said there were ‘far few school nurses currently’ and that posts would need to be increased ‘several-fold’ to support a school-based flu programme.

In the absence of a sufficient number of school nurses, the JCVI has asked the DH to look at the possibility of using ‘other suitably qualified or non-qualified but adequately trained staff’ to deliver the programme.

Rosemary Cook, director of Queen’s Nursing Institute, said school nurses were now ‘quite used’ to vaccination programmes but would need support from GP practices.

‘GP practices and practice nurses have a huge role to play as there are always children who are away from school for a variety of reasons.’

She also said some parents continued to worry about vaccination and that the use of a nasal spray, rather than an injection, might alleviate these concerns.

‘For parents and children it would really weigh in their favour,’ she said.

The JCVI acknowledged that parents and health professionals would have ‘very mixed opinions’ about vaccinating health children against flu. Information and education campaigns would be needed before and alongside a vaccination programme, it said.

Last November, the committee had said that more evidence was needed to show that vaccinating all healthy children against seasonal flu was worthwhile.

A study published at the end of last year suggested that immunising healthy children would prevent 80% of flu infections and free up 790,000 GP appointments a year.

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