Flu vaccine for all UK kids

All UK children are to be given the flu vaccination after experts said it could save up to 2,000 lives a year.

The scheme, which is expected to be rolled out in 2014, will see all children aged two to 17 given the vaccination through a nasal spray (Fluenz® marketed by AstraZeneca).

Younger children will be given the spray by their GP and schoolchildren will receive it at school. However, flu vaccinations are unlikely to be offered to children before October 2014 because of the complexity of such a major vaccination campaign. As with current schemes already underway in the UK, vaccination is optional but strongly recommended.

The decision was made by the UK government in response to a new review published yesterday by the Joint Committee on Vaccination and Immunisation, which advises the government on vaccination policy.

The research suggests the scheme would lead to, on average, as many as 11,000 fewer hospitalisations as a result of flu, and around 2,000 fewer deaths a year.

You can read more about the vaccination scheme from NHS News.

Our colleagues at the UK SMC collected the following expert commentary. Feel free to use these quotes in your reporting. If you would like to talk to a New Zealand expert, please contact the SMC (04 499 5476; smc@sciencemediacentre.co.nz).

Prof Peter Openshaw, Director of the Centre for Respiratory Infection, Imperial College London, said:

“Although there are areas of debate, I do strongly support the proposal. Not only would it protect children against flu but it would also reduce the circulation of flu in the population and therefore protect those at high risk of severe disease.

“The statement from JCVI supports extension of vaccination to normal (low-risk) school-age children (5 to 17y) as soon as possible, and perhaps vaccination of younger pre-school children at a later stage.  The statement is explicit that delivering the vaccine to schoolchildren presents challenges that have not been resolved. There are not enough school nurses, and clearly additional resources would be needed. There is an on-going discussion about how to give the vaccines which partly explains the delay of introduction until at least autumn 2014.  However, lack of current capacity is not an argument for not recommending something that is judged beneficial. The next stage is to solve that issue. The proposal should be used to support bids for additional resources to deliver not only the Healthy Child Programme but also to allow for additional improvements.

“The assessment of the evidence underpinning this recommendation is detailed, compelling and impressive and I am sure that it is the intention of the authors of this study to publish it. I also hope that there will be ample opportunities for research to determine the impact of the introduction of live attenuated vaccines for school age children, should the change in policy be enacted.

“The proposed extension to the vaccination programme would need an intensive public education programme, which should also target GPs, nurses and others who are influential. Without full explanation, we won’t get the buy-in that we need from professionals or the public.

“I think that any reasonable person who sees the full evidence on which the recommendation is based would be keen to support it.”

 Dr Shona Hilton, Senior Research Scientist, MRC/CSO Social and Public Health Sciences Unit, said:

“Past research suggests that any new introduction into the Childhood Immunisation Programme needs to be accompanied with clear and accessible information for parents about the benefits of the vaccine for their child.

“At the Medical Research Council we are planning to use our rapid response study team to find out what kind of information parents feel they need about this vaccine.”

Dr David Elliman, Consultant in Community Child Health, Great Ormond Street Hospital, said:

“It seems that the modelling on which this decision is based is unpublished. Until that modelling is published, it is difficult for people to comment on whether this is an appropriate decision. This should be made available so that people can see for themselves the evidence.

“Apart from this, I have immense concerns in terms of the human resources required to deliver this. School nurses are already very hard stretched and come nowhere near delivering the basics from the Healthy Child Programme. If this is just added in to their workload, it will devastate their morale. If it is carried out by ‘lay personnel’ is this appropriate? Giving immunisations involves much more than just administering the vaccine, but counselling parents and, where appropriate, the young people. Lay people would not have the knowledge to do this. I am not aware of large pools of professionals able to step in. In the past, school nurses have risen to the occasion, but that has been for a blitz in a single year or for a limited cohort. This is a very different kettle of fish.

“The number of doses that are needed in children under nine years old is two according to the JCVI minutes. This is another logistical issue to be considered.

“In summary, I have not seen the evidence for this programme so cannot say whether or not I support it. Likewise the resource implications need a satisfactory conclusion before I could support it. I have no concerns about the safety or efficacy of the vaccine but I would like to be convinced of the benefits.”

Prof Adam Finn, Professor of Paediatrics, University of Bristol, said:

“I think vaccination of healthy school children with the new nasal flu vaccine is a good idea as we know it’s effective and safe and flu can be a serious illness in childhood, not just in old age. There should be time to do some more research before we introduce the vaccine to help us predict how well such a programme would be accepted and would work.

“Communication about flu and flu vaccine was made very difficult during the 2009 pandemic because it was done on a background of high levels of uncertainty. This time we have the chance to bring those uncertainty levels right down and it would be a mistake to miss that opportunity.

Why will the vaccine be given to children even though they’re healthy and not high risk?

Prof Finn: “Although children don’t die of flu as often as old people do, they can get sick enough to require hospitalisation. Many others are ill enough to require time off school which is disruptive for them and their families. Children also spread flu to other children and to adults including school staff and their families. Preventing flu in children should benefit all children and others too.”

Why now? What new information has come to light?

Prof Finn: “The main new information is the arrival of a new vaccine which is given as a nasal spray, which works well in children and is easy and painless to administer. Calculations have been done that suggest that the cost of a programme to immunise children would be money well spent because of the amount of illness and disease, and associated spending, that would be prevented.”

Is it just that each child will be given a single-shot nasal spray, or will they have to have more than one?

Prof Finn: “Normally children up to the age of 9 get two doses the first time they receive it and only one dose in subsequent years. Research may be done to find out whether giving just one dose in the first year would work ok.”

Is a nasal spray safer than a jab? If so, then why aren’t all vaccines given nasally?

Prof Finn: “It’s not any safer. Both ways of giving vaccines – by injection or by nasal spray are very safe. The nasal vaccine is different from injected vaccine. The spray contains a live but weakened form of the flu virus and actually causes a very mild flu infection. The injected vaccine contains only killed virus.”

Will it be safe for children with egg allergies? Is there an alternative for them or do they have to rely on herd immunity?

Prof Finn: “Like most other flu vaccines, the nasal vaccine contains traces of egg and should not be given to children with severe egg allergy. There are injected flu vaccines that can be used in people with serious egg allergy.”

If a child contracts seasonal flu then will the nasal spray help or is it too late?

Prof Finn: “The vaccine needs to be given in October or November before the flu season starts. Vaccine won’t prevent flu once you have got it. But if your child had flu last winter, it’s still a good to get the vaccine this autumn, because the virus, and the vaccine, can change a bit every year.”

What proportion of children will need to receive the vaccine for herd immunity to be reached?

Prof Finn: “This is not yet known for certain. It would be a good idea to do research to find this out because knowing this would help planning the new programme a lot.”

but strongly recommended.