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Should healthy children be vaccinated against influenza?

A consensus report of the Summits of Independent European Vaccination Experts

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Abstract

Influenza is often regarded as an illness of the elderly portion of the population because most of the excess mortality associated with influenza epidemics occurs in that age group. However, evidence derived from a large number of clinical studies carried out in different countries and various settings has clearly demonstrated that the burden of influenza is also substantial in children. The attack rates of influenza during annual epidemics are consistently highest in children, and young children are hospitalized for influenza-related illnesses at rates comparable to those for adults with high-risk conditions. Especially among children younger than 3 years of age, influenza frequently predisposes the patient to bacterial complications such as acute otitis media. Children also serve as the main transmitters of influenza in the community. A safe and effective vaccine against influenza has been available for decades, but the vaccine is rarely used even for children with high-risk conditions. Despite several existing problems related to influenza vaccination of children, the current evidence indicates that the advantages of vaccinating young children would clearly outweigh the disadvantages. Considering the total burden of influenza in children, children younger than 3 years of age should be regarded as a high-risk group for influenza, analogously with the age-based definition of high risk among persons 65 years of age or older. Annual influenza vaccination should be recommended to all children from 6 months to 3 years of age.

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Abbreviations

AOM:

Acute otitis media

References

  1. American Academy of Pediatrics (2003) Influenza. In: Pickering LK (ed) Red Book: 2003 Report of the Committee on Infectious Diseases, 26th edn. American Academy of Pediatrics, Elk Grove Village, Ill., pp 382-391

    Google Scholar 

  2. Black S, Shinefield H, Fireman B, Lewis E, Ray P, Hansen JR, Elvin L, Ensor KM, Hackell J, Siber G, Malinoski F, Madore D, Chang I, Kohberger R, Watson W, Austrian R, Edwards K, and the Northern California Kaiser Permanente Vaccine Study Center Group (2000) Efficacy, safety and immunogenecity of heptavalent pneumococcal conjugate vaccine in children. Pediatr Infect Dis J 19:187–195

    Article  PubMed  CAS  Google Scholar 

  3. Bueving HJ, Bernsen RM, de Jongste JC, van Suijlekom-Smit LW, Rimmelzwaan GF, Osterhaus AD, Rutten-van Molken MP, Thomas S, van der Wouden JC (2004) Does influenza vaccination exacerbate asthma in children? Vaccine 23:91–96

    Article  PubMed  Google Scholar 

  4. Centers for Disease Control and Prevention (2002) Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices. MMWR 51(no. RR-3):1–31

    Google Scholar 

  5. Centers for Disease Control and Prevention (2004) Assessment of the effectiveness of the 2003-04 influenza vaccine among children and adults – Colorado, 2003. MMWR 53:707–710

    Google Scholar 

  6. Centers for Disease Control and Prevention. ACIP expands recommendation for vaccinating children in the 2004-05 flu season. Available at: http://www.cdc.gov/flu/professionals/acip/acipchild0405.htm

  7. Chiu SS, Lau YL, Chan KH, Wong WHS, Peiris JSM (2002) Influenza-related hospitalizations among children in Hong Kong. N Engl J Med 347:2097–2103

    Article  PubMed  Google Scholar 

  8. Chiu SS, Tse CYC, Lau YL, Peiris M (2001) Influenza A infection is an important cause of febrile seizures. Pediatrics 108:e63

    Article  PubMed  CAS  Google Scholar 

  9. Chung EK, Casey R, Pinto-Martin JA, Pawlowski NA (1998) Routine and influenza vaccination rates in children with asthma. Ann Allergy Asthma Immunol 80:318–322

    Article  PubMed  CAS  Google Scholar 

  10. Clements DA, Langdon L, Bland C, Walter E (1995) Influenza A vaccine decreases the incidence of otitis media in 6- to 30-month-old children in day care. Arch Pediatr Adolesc Med 149:1113–1117

    PubMed  CAS  Google Scholar 

  11. Cohen GM, Nettleman MD (2000) Economic impact of influenza vaccination in preschool children. Pediatrics 106:973–976

    Article  PubMed  CAS  Google Scholar 

  12. Eskola J, Kilpi T, Palmu A, Jokinen J, Haapakoski J, Herva E, Takala A, Käyhty H, Karma P, Kohberger R, Siber G, Mäkelä PH, Finnish Otitis Media Study Group (2001) Efficacy of a pneumococcal conjugate vaccine against acute otitis media. N Engl J Med 344:403–409

    Article  PubMed  CAS  Google Scholar 

  13. France EK, Glanz JM, Xu S, Davis RL, Black SB, Shinefield HR, Zangwill KM, Marcy SM, Mullooly JP, Jackson LA, Chen R (2004) Safety of the trivalent inactivated influenza vaccine among children. Arch Pediatr Adolesc Med 158:1031–1036

    Article  PubMed  Google Scholar 

  14. Frank AL, Taber LH, Wells CR, Wells JM, Glezen WP, Paredes A (1981) Patterns of shedding of myxoviruses and paramyxoviruses in children. J Infect Dis 144:433–441

    PubMed  CAS  Google Scholar 

  15. Glezen WP, Couch RB (1978) Interpandemic influenza in the Houston area, 1974–76. N Engl J Med 298:587–592

    Article  PubMed  CAS  Google Scholar 

  16. Glezen WP, Decker M, Joseph SW, Mercready RG Jr (1987) Acute respiratory disease associated with influenza epidemics in Houston, 1981–1983. J Infect Dis 155:1119–1126

    PubMed  CAS  Google Scholar 

  17. Glezen WP, Decker M, Perrotta DM (1987) Survey of underlying conditions of persons hospitalized with acute respiratory disease during influenza epidemics in Houston, 1978–1981. Am Rev Respir Dis 136:550–555

    PubMed  CAS  Google Scholar 

  18. Glezen WP, Greenberg SB, Atmar RL, Piedra PA, Couch RB (2000) Impact of respiratory virus infections on persons with chronic underlying conditions. JAMA 283:499–505

    Article  PubMed  CAS  Google Scholar 

  19. Hall CB, Douglas RG Jr, Geiman JM, Meagher MP (1979) Viral shedding patterns of children with influenza B infection. J Infect Dis 140:610–613

    PubMed  CAS  Google Scholar 

  20. Heikkinen T, Ruuskanen O (2004) Effectiveness of influenza vaccine to prevent acute otitis media. JAMA 291:692–693

    Article  PubMed  CAS  Google Scholar 

  21. Heikkinen T, Ruuskanen O, Waris M, Ziegler T, Arola M, Halonen P (1991) Influenza vaccination in the prevention of acute otitis media in children. Am J Dis Child 145:445–448

    PubMed  CAS  Google Scholar 

  22. Heikkinen T, Silvennoinen H, Peltola V, Ziegler T, Vainionpää R, Vuorinen T, Kainulainen L, Puhakka T, Jartti T, Toikka P, Lehtinen P, Routi T, Juvén T (2004) Burden of influenza in children in the community. J Infect Dis 190:1369–1373

    Article  PubMed  Google Scholar 

  23. Heikkinen T, Ziegler T, Peltola V, Lehtinen P, Toikka P, Lintu M, Jartti T, Juvén T, Kataja J, Pulkkinen J, Kainulainen L, Puhakka T, Routi T (2003) Incidence of influenza in Finnish children. Pediatr Infect Dis J 22:S204–S206

    PubMed  Google Scholar 

  24. Hoberman A, Greenberg DP, Paradise JL, Rockette HE, Lave JR, Kearney DH, Colborn DK, Kurs-Lasky M, Haralam MA, Byers CJ, Zoffel LM, Fabian IA, Bernard BS, Kerr JD (2003) Effectiveness of inactivated influenza vaccine in preventing acute otitis media in young children: a randomized controlled trial. JAMA 290:1608–1616

    Article  PubMed  CAS  Google Scholar 

  25. Hurwitz ES, Haber M, Chang A, Shope T, Teo S, Ginsberg M, Waecker N, Cox NJ (2000) Effectiveness of influenza vaccination of day care children in reducing influenza-related morbidity among household contacts. JAMA 284:1677–1682

    Article  PubMed  CAS  Google Scholar 

  26. Hurwitz ES, Haber M, Chang A, Shope T, Teo ST, Giesick JS, Ginsberg MM, Cox NJ (2000) Studies of the 1996–1997 inactivated influenza vaccine among children attending day care: immunologic response, protection against infection, and clinical effectiveness. J Infect Dis 182:1218–1221

    Article  PubMed  CAS  Google Scholar 

  27. Izurieta HS, Thompson WW, Kramarz P, Shay DK, Davis RL, DeStefano F, Black S, Shinefield H, Fukuda K (2000) Influenza and the rates of hospitalization for respiratory disease among infants and young children. N Engl J Med 342:232–239

    Article  PubMed  CAS  Google Scholar 

  28. James JM, Zeiger RS, Lester MR, Fasano MB, Gern JE, Mansfield LE, Schwartz HJ, Sampson HA, Windom HH, Machtinger SB, Lensing S (1998) Safe administration of influenza vaccine to patients with egg allergy. J Pediatr 133:624–628

    Article  PubMed  CAS  Google Scholar 

  29. Juvén T, Mertsola J, Waris M, Leinonen M, Meurman O, Roivainen M, Eskola J, Saikku P, Ruuskanen O (2000) Etiology of community-acquired pneumonia in 254 hospitalized children. Pediatr Infect Dis J 19:293–298

    Article  PubMed  Google Scholar 

  30. Kramarz P, Destefano F, Gargiullo PM, Chen RT, Lieu TA, Davis RL, Mullooly JP, Black SB, Shinefield HR, Bohlke K, Ward JI, Marcy SM, Vaccine Safety Datalink team (2001) Does influenza vaccination prevent asthma exacerbations in children? J Pediatr 138:306–310

    Article  PubMed  CAS  Google Scholar 

  31. Laundy M, Ajayi-Obe E, Hawrami K, Aitken C, Breuer J, Booy R (2003) Influenza A community-acquired pneumonia in East London infants and young children. Pediatr Infect Dis J 22:S223–S227

    PubMed  Google Scholar 

  32. Maricich SM, Neul JL, Lotze TE, Cazacu AC, Uyeki TM, Demmler GJ, Clark GD (2004) Neurologic complications associated with influenza A in children during the 2003–2004 influenza season in Houston, Texas. Pediatrics 114:e626–e633

    Article  PubMed  Google Scholar 

  33. McIntosh K, Lieu T (2000) Is it time to give influenza vaccine to healthy infants? N Engl J Med 342:275–276

    Article  PubMed  CAS  Google Scholar 

  34. Monto AS, Davenport FM, Napier JA, Francis T Jr (1970) Modification of an outbreak of influenza in Tecumseh, Michigan by vaccination of schoolchildren. J Infect Dis 122:16–25

    PubMed  CAS  Google Scholar 

  35. Monto AS, Sullivan KM (1993) Acute respiratory illness in the community: frequency of illness and the agents involved. Epidemiol Infect 110:145–160

    Article  PubMed  CAS  Google Scholar 

  36. Morishima T, Togashi T, Yokota S, Okuno Y, Miyazaki C, Tashiro M, Okabe N, Collaborative Study Group on Influenza-Associated Encephalopathy in Japan (2002) Encephalitis and encephalopathy associated with an influenza epidemic in Japan. Clin Infect Dis 35:512–517

    Article  PubMed  Google Scholar 

  37. Neuzil KM, Dupont WD, Wright PF, Edwards KM (2001) Efficacy of inactivated and cold-adapted vaccines against influenza A infection, 1985 to 1990: the pediatric experience. Pediatr Infect Dis J 20:733–740

    PubMed  CAS  Google Scholar 

  38. Neuzil KM, Mellen BG, Wright PF, Mitchel EF Jr, Griffin MR (2000) The effect of influenza on hospitalizations, outpatient visits, and courses of antibiotics in children. N Engl J Med 342:225–231

    Article  PubMed  CAS  Google Scholar 

  39. Neuzil KM, Wright PF, Mitchel EF, Griffin MR (2000) The burden of influenza illness in children with asthma and other chronic medical conditions. J Pediatr 137:856–864

    Article  PubMed  CAS  Google Scholar 

  40. Neuzil KM, Zhu Y, Griffin MR, Edwards KM, Thompson JM, Tollefson SJ, Wright PF (2002) Burden of interpandemic influenza in children younger than 5 years: a 25-year prospective study. J Infect Dis 185:147–152

    Article  PubMed  Google Scholar 

  41. Nichol KL (2003) The efficacy, effectiveness and cost-effectiveness of inactivated influenza virus vaccines. Vaccine 21:1769–1775

    Article  PubMed  Google Scholar 

  42. Nicholson KG (1998) Human influenza. In: Nicholson KG, Webster RG, Hay AJ (eds) Textbook of influenza. Blackwell Science, Oxford, pp 219–264

    Google Scholar 

  43. O’Brien KL, Walters MI, Sellman J, Quinlisk P, Regnery H, Schwartz B, Dowell SF (2000) Severe pneumococcal pneumonia in previously healthy children: the role of preceding influenza infection. Clin Infect Dis 30:784–789

    Article  PubMed  CAS  Google Scholar 

  44. Peltola V, Heikkinen T, Ruuskanen O (2002) Clinical courses of croup caused by influenza and parainfluenza viruses. Pediatr Infect Dis J 21:76–78

    Article  PubMed  Google Scholar 

  45. Peltola V, Ziegler T, Ruuskanen O (2003) Influenza A and B virus infections in children. Clin Infect Dis 36:299–305

    Article  PubMed  Google Scholar 

  46. Periodic survey of fellows: American Academy of Pediatrics, Division of Health Policy Research. Available at: http://www.aap.org/research/periodicsurvey/ps45aexs.htm

  47. Ploin D, Liberas S, Thouvenot D, Fouilhoux A, Gillet Y, Denis A, Chapuis F, Lina B, Floret D (2003) Influenza burden in children newborn to eleven months of age in a pediatric emergency department during the peak of an influenza epidemic. Pediatr Infect Dis J 22:S218–222

    PubMed  Google Scholar 

  48. Poehling KA, Speroff T, Dittus RS, Griffin MR, Hickson GB, Edwards KM (2001) Predictors of influenza virus vaccination status in hospitalized children. Pediatrics 108:e99

    Article  PubMed  CAS  Google Scholar 

  49. Principi N, Esposito S, Gasparini R, Marchisio P, Crovari P, for the Flu-Flu Study Group (2004) Burden of influenza in healthy children and their households. Arch Dis Child 89:1002–1007

    Article  PubMed  CAS  Google Scholar 

  50. Principi N, Esposito S, Marchisio P, Gasparini R, Crovari P (2003) Socioeconomic impact of influenza on healthy children and their families. Pediatr Infect Dis J 22:S207–S210

    PubMed  Google Scholar 

  51. Quach C, Piché-Walker L, Platt R, Moore D (2003) Risk factors associated with severe influenza infections in childhood: implication for vaccine strategy. Pediatrics 112:e197–e201

    Article  PubMed  Google Scholar 

  52. Reichert TA, Sugaya N, Fedson DS, Glezen WP, Simonsen L, Tashiro M (2001) The Japanese experience with vaccinating schoolchildren against influenza. N Engl J Med 344:889–896

    Article  PubMed  CAS  Google Scholar 

  53. Ruuskanen O, Arola M, Putto-Laurila A, Mertsola J, Meurman O, Viljanen MK, Halonen P (1989) Acute otitis media and respiratory virus infections. Pediatr Infect Dis J 8:94–99

    PubMed  CAS  Google Scholar 

  54. Szucs TD (1999) Influenza: the role of burden-of-illness research. Pharmacoeconomics 16[Suppl 1]:27–32

    Article  PubMed  Google Scholar 

  55. Terebuh P, Uyeki T, Fukuda K (2003) Impact of influenza on young children and the shaping of United States influenza vaccine policy. Pediatr Infect Dis J 22:S231–S235

    PubMed  Google Scholar 

  56. Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, Fukuda K (2003) Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA 289:179–186

    Article  PubMed  Google Scholar 

  57. Togashi T, Matsuzono Y, Narita M, Morishima T (2004) Influenza-associated acute encephalopathy in Japanese children in 1994-2002. Virus Res 103:75–78

    Article  PubMed  CAS  Google Scholar 

  58. Treanor J (2004) Weathering the influenza vaccine crisis. N Engl J Med 351:2037–2040

    Article  PubMed  CAS  Google Scholar 

  59. Weigl JA, Puppe W, Schmitt HJ (2002) The incidence of influenza-associated hospitalizations in children in Germany. Epidemiol Infect 129:525–533

    Article  PubMed  CAS  Google Scholar 

  60. Whitley RJ, Hayden FG, Reisinger KS, Young N, Dutkowski R, Ipe D, Mills RG, Ward P (2001) Oral oseltamivir treatment of influenza in children. Pediatr Infect Dis J 20:127–133

    Article  PubMed  CAS  Google Scholar 

  61. Wright PF, Ross KB, Thompson J, Karzon DT (1977) Influenza A infections in young children: primary natural infection and protective efficacy of live-vaccine-induced or naturally acquired immunity. N Engl J Med 296:829–834

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Turku University Hospital, 20520, Turku, Finland

    Terho Heikkinen

  2. Centre for Child Health, Institute of Community Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary and Westfield College, University of London, London, UK

    Robert Booy & Stephen Teo

  3. Servicio de Medicina Preventiva y Epidemiologia, Hospital Universitari Vall d’Hebron, Barcelona, Spain

    Magda Campins

  4. Institute of Child Health, UBHT Education Centre, University of Bristol, Bristol, UK

    Adam Finn

  5. Department of Clinical Microbiology, Örebro University Hospital, Örebro, Sweden

    Per Olcén

  6. Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland

    Heikki Peltola

  7. Department of Paediatrics, University Hospital "Germans Trias I Pujol", Barcelona, Spain

    Carlos Rodrigo

  8. Centre for Preventive Paediatrics, Johannes Gutenberg University, Mainz, Germany

    Heinz-Josef Schmitt

  9. Clinica Pediatrica, Università degli Studi di Brescia, Brescia, Italy

    Fabian Schumacher

  10. Service de Pádiatria Générale, Hôpital Louis Mourier, Colombes, France

    Catherine Weil-Olivier

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  1. Terho Heikkinen
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  2. Robert Booy
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  3. Magda Campins
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  4. Adam Finn
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Correspondence to Terho Heikkinen.

Additional information

This report is based on the evaluation of data and discussions at and following the Summits of Independent European Vaccination Experts that were held in Oxford, UK, Nierstein, Germany, Valencia, Spain, between September 2003 and May 2005. The sole financial supporter of the meetings was Stiftung Präventive Pädiatrie, Johannes Gutenberg University, Mainz, Germany. No pharmaceutical company or vaccine manufacturer had any role in the initiation, design, data collection, data analysis or interpretation, or writing of the report. The decision to submit this report for publication was made solely by the authors.

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Heikkinen, T., Booy, R., Campins, M. et al. Should healthy children be vaccinated against influenza?. Eur J Pediatr 165, 223–228 (2006). https://doi.org/10.1007/s00431-005-0040-9

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