2010-2011 Influenza vaccine –  guidlines for children

By Dra Joanna Karamon [email protected]

Dr Joanna Karamon is a General Practitioner and is Assistant Director of Luzdoc International Medical Service in Praia da Luz, Lagos.

Flu is more dangerous than the common cold for children. Each year, seasonal flu places a large burden on the health and well-being of children and families.

Because children commonly need medical care because of influenza, especially before they turn five, each year an average of 20,000 children in the USA under five are hospitalised because of influenza and its complications, the most severe of which are more prevalent in children under the age of two.

The CDC (the American Centre for Disease Control) reported recently that during the 2009 H1N1 pandemic, more than 340 deaths in children were notified from April 26, 2009 to May 22, 2010.

This is in stark contrast to the data collected during the flu seasons 2003-2004 to 2009-2010. The number of pediatric deaths reported to CDC over that period of time ranged from 46 to 153 per year, depending on the severity of the particular flu season.

This disproportionate morbidity and mortality of the H1N1 virus is what prompted the drive for children and young adults being the prime targets of the 2010-11 vaccination campaign.

At a recent meeting in Atlanta, Georgia, the Advisory Committee on Immunisation Practices (ACIP), a 15-member committee that advises the Centers for Disease Control and Prevention on vaccine issues, released the new recommendation for children aged six months to eight years.

Double Vaccination

Commenting on the main change in the vaccination guidelines Dr Anthony Fiore, MD, MPH, medical epidemiologist for the CDC’s Influenza Division said: “The underlying principle is that all children age six months through to eight years need to have at least two doses of the 2009 H1N1 antigen.”

According to Dr. Fiore, the double vaccination recommendation was based on several studies conducted in 2009 and 2010 which indicated that young children often need two doses of a vaccine containing the 2009 H1N1 antigen.

The studies showed 44 per cent to 93 per cent of children aged three to nine had antibody levels considered protective after receiving one dose of H1N1.

He said that administering a second dose of the H1N1 antigen to infants and young children provides 80 per cent or more with protection.

There was a fair amount of debate and concerns were raised as to whether the new guidelines would complicate the existing vaccination schedules, especially if parents couldn’t remember whether their child had received at least one dose of the H1N1 vaccine, or if in fact the previous season’s vaccine had even contained the 2009 H1N1 antigen.

The basic answer to that question was, if in any doubt, vaccinate as if there had been no previous vaccination against the 2009 H1N1 strain.

The ACIP also discussed the safety of the H1N1 vaccine, focusing on reported cases of Bell’s palsy, Guillain-Barré syndrome and seizures in patients following immunisation.

Presenters said there is no significant difference in safety between the H1N1 and seasonal flu vaccines. Researchers are continuing to monitor reported effects of the H1N1 immunisation.


So here follow the basic guidelines to the 2010-11 influenza vaccination guidelines for children:

Children under six months are too young to vaccinate

Only one dose is needed for children over the age of nine (same applies to adults).

All children under nine will require two doses of the flu vaccine containing the 2009 H1N1 strain. This applies to all children even if they have been previously vaccinated with the seasonal flu vaccine.

Children under the age of nine who received at least one documented dose of the pandemic H1N1 flu vaccine last year and the seasonal vaccine are the only group who will be recommended a one-dose vaccination with this year’s trivalent flu vaccine.

All children who require the two doses, the second dose should be administered at least four weeks after the first one.

The pandemic H1N1 vaccine was the specific Influenza A “Swine Flu” H1N1 single strain vaccine, which became available towards the end of the 2009 flu pandemic. Last season’s flu vaccine did not contain this strain, hence the need for further vaccination at the time against that specific H1N1 type.

This year’s seasonal flu vaccine will be the trivalent vaccine, which will contain the 2009 H1N1 strain, making extra vaccination with a single strain vaccine unnecessary.

Other key points relevant to the 2010-11 influenza season include:

All children with chronic conditions (eg: asthma or other lung disease, diabetes, heart disease, chronic kidney disease, morbid obesity, immunosuppresion, anaemia, long-term aspirin use and neurologic disorders), are at high risk of developing influenza complications, and as such should be priority candidates for this year’s trivalent Influenza vaccine.

“Cocooning”, or immunisation of close contacts and house-hold members of high risk children should lower the risk of influenza exposure for these children, especially infants younger than six months old, as they are too young to vaccinate.

In addition, CDC recommends that all health care workers and home care-givers be vaccinated each year to keep from spreading the flu to their patients.

The Northern Hemisphere flu season is from November to April, with most cases occurring between late December and early March, but the vaccine is usually offered between September and mid-November (and may be given at other times of the year, especially if you are going to be travelling into a flu season in the Southern Hemisphere).

Getting the shot before the flu season is in full force gives the body a chance to build up immunity to, or protection from, the virus.

Although you can get a flu shot well into flu season, it’s best to try to get it earlier rather than later. However, even when there are only two or three months left in the flu season, it’s still a good idea to get protection.

So don’t delay, and contact your doctor to find out when they will have the vaccine available in their surgery.