• Health reform
• EMRs
• Medicare
• Liability
• AMA House
• » More

• Contract Language
• Ethics Forum
• In the Courts
• Practice Management
• Technically Speaking
• » More

• Issue dates
• Regions
• Health plans
• Sections
• News briefs
• Columns
• Editorials
• Letters
• Series
• Writers
• Other years

• Search tips
• Email alert
• RSS
• Mobile
• Subscribe
• Institutions
• Staff directory
• Advertising
• Permissions
• Reprints
• News media
• Site guide
• Useful links
• About
• Premium
• Contact

• AMA Wire
• CPT
• DMPHP
• JAMA
• JAMA&Archives
• news@JAMA
• Virtual Mentor
• Physician jobs

Physicians struggle with flu vaccination strategies for kids

Efforts are more frequently targeting children, but rates remain low and not all doctors are sold on the value for this group.

By Victoria Stagg Elliott, amednews staff. Aug. 11, 2003.

• PRINT|
• E-MAIL|
• RESPOND|
• REPRINTS|
• SHARE
•  

This fall, Anders Nelson, MD, will host many flu vaccination clinics where a shot per minute will be the norm. But his clientele won't fit the stereotype of those usually targeted for flu shots: the elderly. Dr. Nelson is a pediatrician, and most of the patients rolling up their sleeves will be children.

"Every kid in my practice is a priority patient," said Dr. Nelson, from Clarks Summit, Pa. "If you try to pick out the kids who most need it, it takes a lot of effort. We go for as close to universal immunization as we can, and it turns out to be very efficient."

Dr. Nelson is one of a growing number of doctors who are increasingly seeing flu vaccine as important, not just for the elderly, but also for the young. Public health agencies and medical societies have long urged that children with medical conditions, such as asthma or diabetes, get the vaccine, but now some groups are considering expanding their recommendations to include healthier children.

"When you do risk-based recommendations, those tend to fail," said Jon Abramson, MD, past chair of American Academy of Pediatrics' Committee on Infectious Diseases. "You only get 10% to 20% of your high-risk patients vaccinated. It's always more effective to do an age-based recommendation."

Some groups and agencies already have weighed in on the issue. Last year, the Centers for Disease Control and Prevention started encouraging flu shots for those ages 6 months to 23 months, and the AAP stated in December 2002 that universal vaccination of all children was the goal for the future.

The National Foundation for Infectious Diseases also issued a report in June outlining strategies to increase pediatric flu immunization rates. The group proposed that the most cost-effective strategy for physicians most likely was a clinic model much like Dr. Nelson uses.

But while there is significant action in this area, there also are barriers. The rationale behind vaccinating healthy children against the flu is less compelling than that for vaccinating the elderly.

Public health experts emphasize data suggesting that immunizing healthy children reduces the burden of flu in the community. They point out that even though flu mortality is not much of an issue in this group, morbidity is. Last year, several states reported school closings due to high rates of flu among their students.

Worth the effort?

Many physicians, however, are not convinced that the benefits are worth the significant investment in time, money and resources to attempt callback of all patients younger than 18 for special clinics during the short window of time that flu vaccine is available. Patients younger than 8, who require two doses at separate times, would be particularly difficult to vaccinate.

"In healthy kids, when they get influenza, they really don't do too badly," said John Dorsey, MD, a pediatrician at Beaumont Hospital in Royal Oak, Mich. "We give it to anyone on demand, but we have a big practice. It would take an enormous amount of effort to hold flu vaccine clinics."

And even if doctors believe it is a good idea, they don't necessarily have the resources to increase vaccination rates and are focusing most of their efforts on high-risk children. Of all the groups for whom vaccination is highly recommended, this one has perhaps the lowest immunization rates. Studies of asthmatic children, for example, have found that flu vaccine rates range from 10% to 31%.

"If we could get every child that has persistent asthma, diabetes or any kind of immune deficiency vaccinated, that's my first priority," said Barbara Yawn, MD, a family physician and director of research at Olmsted Medical Center in Rochester, Minn.

"If we can do that, then we can push on for other kids, but I really don't want to lose our momentum with the high-risk kids," she said. "And I'm not sure how we'd handle the volume if all children came in."

The wild card in this area, however, is the expected availability this season of the first inhaled flu vaccine, which the Food and Drug Administration approved in June for healthy people ages 5-49.

Physicians say they are buying small supplies to prepare for possible customer demand but say that screening for the contraindications may be too time-consuming. They're also skeptical that very many patients will want it because of the increased cost over the injectable version.

"It's a lot of paperwork trying to identify candidates. It's expensive. It's not being covered by insurance," said Dr. Dorsey. "If you have a family of four, that's an awful lot of money."

Back to top

 ADDITIONAL INFORMATION: