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Vaccinating Children Against the Flu May Help the Elderly

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WebMD Health News

March 21, 2001 -- The vast majority of the roughly 20,000 Americans who die of flu-related illnesses during a typical flu season are elderly. Now an intriguing study from Japan suggests the best way to protect the old may be to vaccinate the young.

The study's authors contend that widespread flu vaccination of Japanese schoolchildren during a 25-year period between 1962 and 1987 prevented between 37,000 and 49,000 flu deaths among the elderly and other at-risk groups per year in that country. That equals one death per every 420 children vaccinated. When mandatory school-based immunization ended, they note, flu deaths began to rise. The findings were published in the March 22 issue of The New England Journal of Medicine.

Although all age groups get the flu, complications from the illness resulting in hospitalizations and death are common only among the elderly and people with compromised immune systems. The researchers suggest that "herd immunity" -- the idea that you can protect at-risk populations by immunizing those around them -- played a major role in Japan's declining flu-related deaths during the years that school-based immunizations were common.

"We have demonstrated that there is an extraordinary benefit to society to be gained by vaccinating school-aged children," study author Thomas A. Reichert, MD, PhD, tells WebMD. "It may be time to rethink the policy of vaccinating only those considered at risk for complications from the flu. While nobody is suggesting that we stop vaccinating older people, we think these findings show that you can achieve even more protection for them by vaccinating children."

Currently, the CDC recommends flu shots for people over the age of 50; most healthcare workers; those of all ages with chronic diseases of the heart, lung, or kidneys; people with diabetes or anemia; pregnant women; people with compromised immune systems; and those living in chronic-care facilities.

Japan is the only nation ever to adopt a policy of immunizing children against the flu. Flu vaccinations were mandatory for schoolchildren between 1977 and 1987. In the 15 years prior to that, flu shots were strongly encouraged in the young, but not adults or the elderly. With the initiation of school-based vaccination, Reichert and colleagues write, death rates from the flu dropped from roughly four times that of the U.S. to about the same.

"If it just came down to a question of vaccinating children to protect older people, I am not sure you could make an argument for it," Bruce Gellin, MD, MPH, executive director of the Infectious Disease Society of America's National Network for Immunization Information tells WebMD. "But there is compelling evidence that healthy children might benefit from routine vaccination."

Recent studies suggest very young children -- those under the age of 3 -- are at increased risk of complications from the flu. Officials with the CDC and the American Academy of Pediatrics are currently discussing whether to recommend routine flu vaccinations during the first years of life. In fact, the American Academy of Pediatrics' figures show that children under 5 have the second highest rate of hospitalizations due to the flu, exceeded only by those over 65. Between 10% and 40% of young children get the flu annually, with 1% ending up in the hospital.

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