BOSTON, Jan. 26 (UPI) -- The flu bug can bite babies as hard as it
does their grandparents, say two new studies that support annual flu
shots for the very young as well as the very old and chronically ill,
groups known to be at high risk of serious complications from the
virus.
Routine vaccination for healthy children could keep thousands out of
the hospital each year, the scientists say. Yet, relatively few
youngster are given a flu shot, partly because of the perception that,
as miserable as it is, flu is a relatively benign disease in the young.
"Influenza is a preventable disease. We're underusing the vaccine in
these children," says internist Kathleen Maletic Neuzil, a co-author of
one study, which was conducted at the University of Washington School
of Medicine and the Department of Veterans Affairs.
But, Neuzil says her group also found that the most vulnerable were
babies younger than six months, a group for which no effective vaccine
is currently available.
Other experts say more convincing data are needed to justify the
costs of a recommendation of annual flu vaccination for all children.
Both reports appear in Thursday's issue of The New England Journal of
Medicine. In epidemic years, scientists say flu hits about 30 to 40
percent of children. They are also a major cause of the spread of the
disease, because they introduce the bug to their parents and other
family members.
In the studies, two teams of researchers examined health records of
hospitalizations and use of antibiotics that could be attributed to
lung diseases, including flu and respiratory syncytial virus -- the
most common cause of serious childhood upper respiratory infections.
In one study, the Seattle group examined hospitalizations, outpatient
visits and courses of antibiotics given from 1974 to 1993 in healthy
children enrolled in the Tennessee Medicaid program. They compared the
flu season, which stretches from fall to spring, to other parts of the
year.
Neuzil says the researchers looked only at healthy children, those
with no chronic conditions such as asthma, sickle cell anemia and
congenital heart disease. They studied the records of approximately 100,
000 children per year.
Children younger than one were hospitalized at rates similar to
adults considered to be at high risk of pneumonia or other serious flu
related complications. More than 100 per 10,000 children per year in
babies younger than six months and 50 per 10,000 in those under a year
old had severe bouts of flu that ended in a stay at the hospital, the
researchers found.
She says the vaccine -- given in two doses instead of a single shot
-- might help in children over six months. But for the youngest
children, those born at the start of the flu season, there is no
vaccine available.
Until science develops a more effective one, the only thing parents
can do is to protect their babies from exposure to the virus, and that
may mean getting flu shots themselves.
Fewer hospitalizations were seen in older children, with just four
per 10,000 per year among five-to-fifteen-year olds, but the scientists
say that antibiotic use and visits to the doctor were high for all age
groups.
For every 100 children, flu accounted for an average of six to
fifteen visits to the doctor and three to nine courses of antibiotics.
In the second study, conducted by scientists at the federal Centers
for Disease Control and Prevention in Atlanta, scientists examined
hospitalization records from 1992 to 1997 at Kaiser Permanente Medical
Care Program of Northern California and the Group Health Cooperative of
Puget Sound. They found that healthy children under age two were 12
times more likely to be hospitalized because of the flu than those
between the ages of five and 17.
In an editorial accompanying the studies, Dr. Kenneth McIntosh of
Children's Hospital and Dr. Tracy Lieu of Harvard Pilgrim Health Care,
both in Boston, say larger studies would be needed to prove the value
of adding flu shots to the battery of childhood vaccines.
"Up to 16 injections are currently recommended during the first two
years of life, and the introduction of the pneumococcal conjugate
vaccine, expected later this year, will add four more," they write.
Also, they say, majority of hospitalizations from respiratory
infections are caused by other bugs, most commonly the respiratory
syncytial virus (RSV). At most, only 20 percent can be pinned on the
flu.
Neuzil points out there is no vaccine for RSV, and says it is
worthwhile for doctors to use what tools are available to prevent even
a smaller percentage of hospitalizations.
"In children from six months to five years old we should be
advocating more influenza vaccination," she says.
But, she agrees that more research, into the issues of cost and
whether manufacturers could keep up with the increased demand, is
needed before the government can issue broad-based recommendations.
Until then, it is up to parents to decide, says Neuzil, who makes
sure her own young children get annual flu shots.
