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Influenza vaccination in young children: what’s the latest?

By Jane Lewis
A study of influenza vaccines registered for use in young children in Australia has offered reassurance to parents and healthcare providers, declaring them ‘safe and well tolerated.’

Published in the Medical Journal of Australia, the research follows the widespread reporting in 2010 of higher than expected rates of fever and febrile seizures in children given one brand of influenza vaccine, which led to a loss of confidence in the safety of influenza vaccines and a decrease in their uptake.

The active prospective surveillance study, conducted with the parents and carers of 893 children aged 6 months to <10 years who received influenza vaccination during 2013, found that only 5.5 to 6.5% of children had fever after vaccination, and temperature elevations were generally low-grade. Injection site and systemic reactions occurred in about one in five recipients; however, these were generally mild.

One of the study authors, infectious diseases paediatrician Dr Chris Blyth, from Perth’s Princess Margaret Hospital for Children and the University of Western Australia, said influenza causes hospitalisations and deaths in children every year.

‘We have an effective influenza vaccine and this study gives further evidence that it is safe,’ he said. ‘It is as effective in young children as it is in adults, and if we gave it to all, we could reduce influenza hospitalisations by about two-thirds.’

The author of an accompanying editorial noted that ‘in the light of unexpected safety signals and sometimes low estimates of effectiveness, annual monitoring of the safety and effectiveness of influenza vaccines now seems like good public policy,’ an approach Dr Blyth said he agreed with entirely.

A second study, published online in The Lancet Respiratory Medicine, claimed that guidelines in several countries do not make it clear which children are at higher risk of influenza-related complications and therefore should be prioritised for vaccination and other interventions. Such children include those born prematurely, those aged 2 years or below, and those with immunosuppression, neurological disorders, sickle cell disease or diabetes, the authors wrote.

Commenting on this Lancet study, Dr Blyth said that although Australian guidelines do not distinguish between children and adults with specific risk factors for severe influenza, and do not specifically mention children born prematurely, ‘there is often crossover’ with other risk groups identified. ‘For example, premature children can have neurological or respiratory disorders.’ Whether children born prematurely without complications should be the subject of an individual recommendation is under discussion, he added.
Med J Aust 2014; 201: 596-600.
Med J Aust 2014; 201: 560-561.
Lancet Resp Med 2014;