News Release

Costs of influenza in children higher than previously thought

Peer-Reviewed Publication

Vanderbilt University Medical Center

protection from the yearly drubbing that the flu hands out to thousands of people nationwide. However, because of costs, concerns about effectiveness, and convenience, many children do not receive the flu vaccine annually.

A study appearing in the Thursday, January 27, New England Journal of Medicine provides evidence that not receiving the flu vaccine could cost far more then previously thought.

The study analyzed the total disease burden, including hospital visits, outpatient visits, and the use of antibiotics, in children over a 19-year period. Using records from healthy children under the age of 15 enrolled in the Tennessee Medicaid program, researchers were able to estimate the average number of hospitalizations, doctor visits, and antibiotic prescriptions due to influenza.

"We know that every year about 30% of children get the flu and school-aged children help spread flu through the community," said Dr. Marie Griffin, professor of Preventive Medicine and Medicine.

The study showed that for infants the risk of hospitalization is relatively high and actually similar to that of elderly persons. For school-aged children, hospitalizations are uncommon. However, the Vanderbilt researchers showed that flu resulted in substantial use of outpatient medical resources.

Each year, for every 100 children there are about 10 physician visits for flu itself or for the middle ear infections that develop as a result of flu illness. In addition, more than half of these visits result in an antibiotic prescription.

The researchers also noted that in addition to the few days of misery and missed school for the child, the illness can be can be expensive and inconvenient for parents or caregivers and result in time lost from work.

"This study will help determine whether recommending influenza vaccine for all children would be a cost effective national policy. Potential benefits of influenza vaccine include a decrease in physician visits, antibiotic use and decreased spread of the virus to others in the community," said Griffin.

"We have known for a long time that infections with influenza and other respiratory viruses are often followed by middle ear infections," said Griffin.

"There is a big push to decrease antibiotic prescribing since overuse has resulted in the emergence of resistant organisms. Vaccinations against respiratory viruses have great potential for decreasing antibiotic use," said Griffin.

Clinical trials have shown that influenza vaccines, including both the currently licensed flu shot and the not as yet approved nasal spray vaccine, reduce middle ear infections and associated antibiotic use by 20% to 30%.

The Advisory Committee for Immunization Practices to the Centers for Disease Control and Prevention (CDC) currently recommends influenza vaccine for: all persons age 65 years and older (soon to be changed to age 50 and older); to anyone 6 months and older with a chronic medical condition; to those who live and work with those at high risk for serious influenza illness, including all health care workers; and to anyone who wants to avoid influenza illness.

"Several factors need to be weighed before we recommend that all children receive influenza immunizations every year," said Griffin.

The influenza vaccine is different from other childhood vaccines in that it is a different vaccine every year. The influenza virus changes quickly and vaccine manufacturers make a new vaccine each year based on the best guess of which influenza virus or viruses will be circulating.

The vaccine is optimally given in the rather brief time window between October and December. Bringing healthy children to the doctor's office every year for a flu shot is inconvenient, especially for school-aged children.

The new nasally administered vaccine may make the vaccine more acceptable to children and parents. In addition, new ways of distributing the vaccine, which do not required a scheduled visit to a physician's office could make immunization more cost effective.

Griffin's study is a key step in determining future influenza recommendations. The work was done in collaboration with Dr. Kathleen Neuzil, former Vanderbilt Infectious Disease faculty member, now at the University of Washington Seattle; Dr. Beverly Mellen, biostatistician in Preventive Medicine, currently at Bowman Gray; Peter Wright, Chief of Pediatric Infectious Diseases; and Ed Mitchel, computer programmer and analyst in Preventive Medicine.


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