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Flu Shots Now Urged for the Very Young

Vaccinations recommended for kids 6 months to 23 months old

THURSDAY, April 29, 2004 (HealthDayNews) -- Recommendations for annual flu vaccines have been expanded to include children 6 months through 23 months of age.

Both the American Academy of Pediatrics (AAP) and the U.S. Centers for Disease Control and Prevention have released their own versions of these recommendations.

Recent research has shown that children under the age of 2 have hospitalization rates from influenza that approach those of adults 65 and over, traditionally considered a high-risk group and one that is urged to get an annual flu shot.

"In the past few years it has become appreciated that hospitalization rates for flu are quite high in young children -- essentially the same as in people over 65 -- and although the death rates are much lower in children, perfectly healthy children can die from influenza," said Dr. Margaret Rennels, chairwoman of the AAP's Committee on Infectious Diseases and professor of pediatrics at the University of Maryland School of Medicine.

Last year was the first in which the CDC listed reports of pediatric deaths. In all, 140 children died of the flu during last year's season.

In the past year or so, children 6 months to 23 months were "encouraged" to get the vaccine. "Now it's a formal recommendation," said Dr. Raymond Strikas, a medical epidemiologist at the CDC's National Immunization Program. "It's not just nice to do. We think this is something they should do."

The CDC also stated that children under the age of 9 years receiving the flu vaccine for the first time will need two doses, one month apart.

Both the AAP and the CDC are also recommending that people who have a lot of contact with this young age group also get vaccinated. This would include parents, caretakers, and other people in the household.

The vaccine is already recommended for children over the age of 6 months who have chronic conditions such as asthma, cystic fibrosis, diabetes, sickle cell disease, HIV, and others.

Only one influenza vaccine, trivalent inactivated influenza vaccine (TIV), is licensed for use in children between 6 and 24 months and with high-risk medical conditions. This vaccine contains no live virus. The most common side effects are a sore arm and possibly a little achiness. "They can't get the flu because it's killed," Rennels said.

The CDC made one other change in its new recommendations -- that health-care workers receiving the FluMist vaccine only need to avoid immunosuppressed people for seven days after getting the vaccine, not 21 days, Strikas said.

Experts are hoping there will be enough vaccine to accommodate the expanded recommendations. "Enough depends on the demand, and one can't precisely predict demand," Rennels said. "Practitioners have known that these recommendations were coming. This should not surprise them, and the AAP has instructed their members to order the vaccine early."

The reports of deaths in children last year may have caused a one-time stampede, she added.

"There's an appropriate concern about influenza vaccine supply in general, although our colleagues at the FDA [Food and Drug Administration] and the vaccine companies tell us that production this year is so far going well," Strikas said.

An estimated 90 million to 100 million doses will be available, which Strikas believes will be "ample."

There will also be more vaccines available with reduced levels of thimerosal, a mercury-containing preservative.

"My understanding from the companies is that together they produced just over 3.2 million doses of [reduced thimerosal] vaccine last year, and estimates we have now are 6 to 8 million doses with reduced thimerosal," Strikas said. "There will be increased options for those concerned about this."

More information

For more on the flu vaccine, visit the National Immunization Program or the American Academy of Pediatrics.

SOURCES: Margaret Rennels, M.D., chairwoman, Committee on Infectious Diseases, American Academy of Pediatrics, and professor of pediatrics, University of Maryland School of Medicine, Baltimore; Raymond Strikas, M.D., medical epidemiologist, National Immunization Program, U.S. Centers for Disease Control and Prevention, Atlanta; American Academy of Pediatrics statement; April 30, 2004, Morbidity and Mortality Weekly Report
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