Flu immunisations for children – personal benefit or the greater good?

The Department of Health has just announced that all children aged two to 17 are going to be offered a flu immunisation every year. At present, annual flu immunisation is offered only to children with underlying health problems, as well as all over 65s and anyone with long term health conditions such as heart and lung disease or diabetes.

There is still a great deal of uncertainty about the details, though. The benefits, according to the Department of Health, are clear - the Chief Medical Officer for England says that even if only one in three children are immunised, hospital admissions will drop by 11,000 and 2,000 lives will be saved each year. But the full programme may not be introduced for another two years.

If the benefits are so obvious, why the delay – and who will benefit?

Although most children who suffer from influenza recover completely within a week or two, they spread the disease among the population more than any other group. Some children, of course, do get serious complications and having the immunisation will greatly reduce this risk. But the big benefit comes from increasing 'herd immunity' – if more children are protected, there will be a much smaller pool of susceptible children to pass on the virus, reducing its spread in the community. That means people most vulnerable to major complications (including pregnant women and grandparents) will also be protected.

The reason for the announcement now is that it's taken years to get good evidence from other countries of the knock-on benefits of immunising healthy children. We also have the first non-injection flu vaccine for children – the national immunisation expert committee, the JCVI, has recommended using a nasal spray for childhood immunisation. This will certainly make the procedure less uncomfortable for children, and the vaccine, called Fluenz® has now been used for several years in the USA. It has evidence from scientific trials involving 20,000 children, so we know it has a good safety record as well as being effective.

But there are huge logistical problems in immunising all children against flu every year – it will more than double the immunisations a child needs overall. Pre-school children will probably be immunised via GPs' surgeries, which are already busy at flu season. School-age children are likely to be immunised at school – but there are far too few school nurses to do this at present. In addition, the nasal spray vaccine isn't available in big enough quantities yet, and isn't likely to be for at least two years.

The overall message? Immunising your child against flu will protect them as well as the rest of the community. Once it's available, it's worth doing. Until then, taking up an invitation for a flu vaccine this October if you're in one of the groups already offered routine immunisation is your best way of protecting yourself.

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