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GP experts call for universal child flu vaccination

Pressure is mounting for the UK to introduce universal influenza vaccination for young children, with leading experts arguing that it could reduce consultations for lower respiratory infections by a fifth and deter inappropriate antibiotic prescribing.

The case for universal flu vaccination for children aged six months to five years is made in an editorial published in the July edition of the British Journal of General Practice.

The RCGP's immunisation lead Dr George Kassianos went further, arguing that all children up to the age of 18 should receive the seasonal vaccine.

The Joint Committee for Vaccinations and Immunisation (JCVI) is due to consider the evidence and mathematical models at its next meeting in October, following an influenze subgroup meeting in September.

JCVI chairman Professor Andrew Hall told Pulse that the six months to five years age range was 'not necessarily optimal' and a number of possible age ranges were being considered for universal coverage.

Although older people's uptake of the seasonal flu jab was 50.4% in England in patients aged six months to 65 years in clinical risk groups in 2010/11, and the authors said the vaccine was only given to one in four at-risk children aged six months to five in the previous flu season - during the 2009 H1N1 pandemic.

Professor David Mant, a GP and professor of general practice at the University of Oxford's department of primary healthcare and epidemiologist Dr Richard Mayon-White, admitted that 'the additional logistic task [of providing universal vaccination] is not trivial', especially as GPs would need to run extra clinics at times convenient for parents

'The additional work would be offset by the reduction in the number of children consulting with lower respiratory infections, probably around 20%, depending on the vaccination uptake and efficiency achieved.

'Universal vaccination will be an effective mechanism for reducing inappropriate antibiotic prescribing in children, and thereby antibiotic resistance in the community.'

Scepticism among parents and even primary care staff would need to be overcome, they admit. 'We believe that parents would almost certainly support universal vaccination against influenza if they were better aware of the safety record of the vaccine and understand that influenza causes a third of chest infections in their children.'

If selective vaccination of children is maintained, the authors suggest that paediatricians could share responsibility for delivering 'opportunistic' vaccinations with GPs. They also propose a clinical trial to assess if the policy reduces hospital referrals.

But RCGP lead on immunisation, Dr George Kassianos, went further. ‘I can't understand why we are sitting on the fence and have not done this already. Children under five fare very badly from influenza, and they are prolific spreaders of infection.

‘By immunising young children we are not only protecting them but also protecting the elderly by herd immunity. We should not just do it for children up to five but all school children up to 18.'

The drive would need to be supported by an information campaign from the Department of Health, he added, but Dr Kassianos predicted that general practice would rise to the challenge. ‘When GPs are given a job and it is financed well they do it. GPs find it no problem to open Saturdays and between surgeries, but we need the Department of Health to lead on this.

‘In the UK we have to show that any vaccination is terribly cheap to introduce. But doing nothing is more expensive than doing something about it.'

BJGP 2011;588:428-429.

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