Playing tag with FLU
Children are among those at high risk for influenza
Studies have consistently shown that very young children are among the groups most vulnerable to the extreme ill effects of an influenza infection. Even when compared with older kids with high-risk conditions, rates of hospitalization in this group (aged six months to four years) are similar or even higher.
Among one-year-olds, the rates are akin to those among the 65-years or older bracket, a group with very high risk for complications, hospitalization, and death.
A significant number of older children aged up to 17 years with medical conditions associated with increased risk for influenza-related complications also add up to the seriousness of influenza infection among the pediatric population.
Because symptoms tend to be often worse in children (for example, fever is often higher), their illness also tends to be prolonged, making them susceptible to complications, of which pneumonia seems the most malevolent.
According to the latest Department of Health (DoH) reports, "pneumonia now ranks third among the leading causes of both morbidity and mortality in all age groups. In the under five age group, the 1995 baseline data show that pneumonia afflicts 506 children per 100,000 and kills 140 per 100,000 (Medical Observer July 2001)."
Late last year, in addition to the anthrax scare going around because of the September 11 World Trade Center tragedy, a flu scare exploded in the midst of exclusive schools in Greenhills and Ortigas. Notwithstanding the DoH's assertion that what happened was not an epidemic, too many children got sick and became hospitalized for the idea to be so easily dismissed.
Influenza expert Dr. Veronica Chan says that, when her team of World Health Organization (WHO) authorities investigated the outbreak, it was able to isolate two variants of the flu virus (from separate individuals) simultaneously circulating among the school children-the H1N1 and the B virus.
The WHO and the US Advisory Committee on Immunization Practices (ACIP) both agree that children are much more prone to influenza infection, whether leading to complications or not.
And despite the supposedly lesser virulence of the B variant, the accumulated susceptibility posed by the new batch of growing children each year practically ensures infection of a good number of them.
Influenza B's inability to shift antigenically may remove much of its potential for a pandemic, nevertheless, a population previously uninfected, which certainly qualifies school children, will continue being agents for the virus's spread and mischief.
Influenza A, meanwhile, possessor of a nature so changeable that acquaintance made by the body's immune system could only incite production of antibodies that are destined to be ineffective anyway against the virus's next reincarnations.
These factors-and the very nature and habits of school children-make this population ideal jump off points for the influenza virus. Explained Dr. Chan: "The flu builds up in the population of children...the children bring it home...and adults get it from the children."
Children are also known to shed virus longer-they can be contagious for more than a week after symptoms start, increasing the risk of infecting others, perhaps to individuals most in danger of the influenza complications.
Blocking
To control the spread of influenza, vaccination of school age children is advisable. Already, target groups for vaccination include (source: Recommendations of the Advisory Committee on Immunization Practices ):
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children >6 months of age with chronic disorders of the pulmonary or cardiovascular systems, including asthma;
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children > 6 months of age who need regular medical follow-up or hospitalization during the previous year because of chronic metabolic diseases (including diabetes mellitus), renal dysfunction, hemoglobinopathies, or immunosuppresion (including immunosuppression caused by medications or by the human immunodeficiecy virus (HIV); and
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children and adolescents (aged 6 months to 18 years) who are receiving long-term aspirin therapy and, therefore, might be at risk for developing Reye syndrome after the flu.
Children living with individuals who are at high risk for influenza complications should also get vaccinated in view of their risk of passing on the virus to the influenza-vulnerable companion. Studies have already shown that where nursing home health care workers are vaccinated, deaths among the nursing home patients decrease.
And although the flu shot can safely be administered to infants as young as six months, the vaccination of infants ages six to 23 months is not yet fully recommended by leading health organizations like the ACIP, American Academy of Pediatrics, and the American Academy of Family Physicians.
A recommendation, may be out by next year or in 2005.
However, if it is feasible, they also say, why not? They also encourage the vaccination of this pediatric group's caretakers (household or out-of-home), again, so they will avoid giving the flu to their charges.
This unofficial recommendation also holds true for the caretakers of children under six months, who are not yet indicated for influenza vaccination by any medical groups, including the US Food and Drug Administration. Numerous and extensive studies attest to the strength of the maternal antibodies, transferred to the infant via breast milk.
Catch!
Dr. Lily Lao, pulmonologist and pediatrician at the Philippine Lung Center, backs up these recommendations: "It is very important to include [flu vaccination] in the immunization program for kids. Even though flu is supposed to be a self-limiting disease, the complications are sometimes fatal. [The complications] include pneumonia. Some patients could really be hospitalized."
Because undertaking viral studies for each influenza-like illness is presently beyond our country's resources, we do not have the numbers to reveal the true instigation of influenza on pneumonia-related morbidity and mortality among young people. But the death toll from pneumonia and influenza's ill effects among pediatric patients both rate high. And from this, much can be gathered.
Dr. Chan herself prioritizes schoolchildren among those that should be immunized. "Vaccinate the population at risk, specially the schoolchildren and those high risk population...The normal healthy adults-maybe we can skip them, but the schoolchildren should be because they are the ones that spread [the influenza virus]."
Dr. Lao says that although our country does experience peak seasons-June to September (rainy season) and December to February (cold season)-the vaccination can be at any time of the year since a person can catch the flu anytime.
Some concerns have arisen regarding the inclusion of the flu vaccine in the immunization program for kids. One is regarding the safety of the vaccine's composition. Children are now immunized using the split-virion vaccine made from highly purified egg-grown viruses.
This form of vaccine induces high antibody production without the adverse affects associated with previous forms of the inactivated vaccine. It might contain some residual egg proteins, however, that could be a contraindication for patients with hypersensitivity to eggs.
Vaccines distributed in other countries might contain thimerosal-a mercury-containing compound, which some quarters object to. Their concerns over mercury exposure do not apply in our case, however, as they come from one manufacturer that does not distribute vaccines in the Philippines.
Simultaneous administration of the flu vaccine with other childhood vaccines is also no cause for worry. According to the ACIP, the vaccine does not interfere with the immune response to other inactivated or live vaccines. Dr. Lao also explains that as long as the administration is at different sites, the efficacy of the vaccines will not suffer.
Home Safe
Studies have demonstrated that vaccination is economically advantageous because it substantially lowers rates of absenteeism and hospitalization among adults and the elderly. The same advantage applies to children, who will definitely incur days away from school if the flu takes them. These are days spent sick in bed, which could otherwise be spent learning and, basically, having quality time with friends and role models.
The most important aspect of vaccinating against the flu, however, is it will reduce the risks of influenza-related respiratory illness, ear infection, physician visits, hospitalization, and even death among our children.
So vaccinating our children against the flu just seems another wise investment in their protection against a potentially life-threatening disease and insuring them against time-away from time well spent.
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