Monday, January 21, 2013

Influenza: Vaccinating Kids Could Save Thousands of Infants and Seniors

Adapted from Flick Image by Immer_Lebend
Flu season arrived early this year and is turning out to be a particularly bad one, with several states (including New York) having already declared public health states of emergency. As usual, only a small fraction of Americans have been vaccinated. Yet seasonal influenza continues to be one of the deadliest diseases in the world, killing an average of 35,000 people per year in the U.S. alone, while every 20-40 years, a particularly deadly new pandemic variety of influenza evolves killing far more than this. The 1918 pandemic was the worst, with worldwide mortality estimated at 50 million.

A similar deadly outbreak could happen again at any time and scientists predict that such an outbreak is inevitable. Some believe it could be far worse than in 1918, as it is much easier to travel long distances to spread the disease and there are far more large crowded slums in which germs can easily spread from person to person and far more malnourished individuals with weakened immune systems. There are also more people selling and buying at “wet markets” where highly infectious avian strains of influenza sometime proliferate. Furthermore, there are several deadly avian strains still circulating among wild birds for which we have little or no immunity. Scientists have recently shown that it would only take a few random mutations to make one of these strains (H5N1) easily transmissible between people.

With seasonal flu, the majority of deaths occur among the elderly, infants and immune-compromised (including the malnourished). However, even for the majority of those who get the disease and survive, the consequences are serious, including costly hospital and doctor’s visits, lost income and missed school days. It is estimated that the U.S. loses $10 billion per year due to influenza.

There is no reason why so many people must die from this disease or even be sickened from it. Contrary to the delusions of the anti-vaccination movement, seasonal flu vaccines are generally quite effective, especially when 70-80% of community members are vaccinated, as this leads to “herd” immunity which protects those who have not been vaccinated as well as those who received the vaccine but still did not get immunity. Furthermore, serious side effects from flu vaccines are rare, while mild side effects are generally quite mild (e.g., soreness, headache, fever).

While the oldest and youngest members of our society are the most vulnerable to influenza deaths, school-age children continue to be the most fertile incubators of the virus, spreading the germ at school and day care centers with their peers and then bringing the germ home to share with their families and neighbors. Not only do small children tend to put their fingers in their own (and each other’s) noses, eyes and mouths more often than adults (and wash less frequently), they are also “super-spreaders,” according to a recent piece in Scientific American, since they “shed” more virus particles for longer periods of time than do adults.
Image from Flickr, by MilitaryHealth
 Consequently, the most effective way to protect seniors, as well as the rest of us, is to vaccinate children. According to the Scientific American article, studies indicate that immunizing 20% of children in a community is more effective at protecting seniors than immunizing 90% of the seniors, while immunizing 70% of schoolchildren may protect everyone in the community (including the elderly).

There is actually hard evidence to support this. One of the last deadly flu pandemics occurred in 1957 (there was another deadly one in 1968 that killed 500,000 worldwide). In response, the Japanese launched a mandatory vaccination program for all schoolchildren that lasted for the next ten years (1957-1967). During this time, excess deaths from influenza and complications related to influenza fell by half. Once the program ended, however, vaccination rates declined and death rates increased significantly, Scientific American reports.

Requiring mandatory flu vaccines is not likely to happen in the U.S. (except for health care workers), even though other vaccinations (e.g., measles, mumps, polio) are required before kids can go to school and despite the fact that so many lives could be saved by initiating such a program. Anti-vaccination propaganda and misinformation continue to fuel a hysteria that has resulted in a powerful lobby against vaccinations. Furthermore, flu vaccines must be reconfigured each year, which means that, unlike polio and measles vaccines, one must receive a new flu inoculation each year. Lastly, only a couple of companies are currently producing flu vaccines in the U.S. and few are willing to start because of fears of liability and low profitability (they must produce the vaccine well in advance of flu season based on scientific predictions and models and then hope that enough consumers will later purchase the vaccine).

Nevertheless, sufficiently high immunization rates can be obtained through voluntary community programs centered on schools, particularly with an effective outreach program. Some schools already offer FluMist nasal spray free of charge to students. In one district in Florida, vaccination rates have reached 65% as a result of their free immunization program, while the incidence of influenza over the last two years has been reduced to nearly zero. The consequences for kids are far fewer absences and more time in school learning. For the rest of us, it means fewer days lying in bed with fevers and chills, and fewer hospital visits and deaths for our infants and grandparents.

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