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Perplexed over childhood flu

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I’m guessing, I know, but maybe the next jab to be added to the ever expanding list of routine immunisations will be Botox. I say that because my brow is in serious need of de-furrowing. And that’s the result of me reading the blurb about the flu immunisation programme’s extension to children. If I was a vaccine nutter, I fear I’d have plenty of fuel for my paranoia. I’m not, so I’m just confused and vaguely depressed.

I thought I understood the rationale, but now I don’t, and I’m not sure if that’s because I’m stupid, or the people behind the programme are stupid, or both. The whole idea, or so I thought, was not so much to protect children – who, after all, generally bounce back after a bout of flu – but to reduce the spread to more vulnerable groups.

That’ll only work if there’s widespread coverage among kids, right? So why is immunisation being restricted to two and three year olds? We’re encouraged to ensure that uptake is ‘as high as possible’ but how can we promote the public health message to parents while limiting access to a small proportion of small children?

And what’s with the ‘geographical pilots’ for four to ten year olds? Since when was a national immunisation programme introduced as a piecemeal experiment? How are we going to fend off accusations of a postcode lottery? With difficulty, I reckon, given that the JCVI minutes from June 2012 state, ‘…given the availability of an effective authorized vaccine for children aged two and older and the clear evidence of the health impact and cost effectiveness of vaccinating children age two to less than 17 years, any phased implementation would be inequitable and would be likely to be challenged. Such piloting of an immunisation programme would therefore be inadvisable’.  That’s right: the advisory committee, who give advice, said it was inadvisable.

Sharing my tension headache yet? Hang on, it gets worse. Is this the most desperate justification for a vaccine ever? I quote from the blurb: ‘We anticipate that as flu immunisation for children becomes accepted as routine, this will have a positive impact on uptake rates for others who are eligible for flu immunisation…’ Paraphrased: children are to be walking, talking, immunisation-sniffing adverts for the flu campaign.

Then there’s the patient information leaflet. This helpfully advises parents that two doses are usually needed, whereas the DoH is advising only one. Just to avoid any potential clarity,obviously.

At best you’ll think the whole thing confused and confusing. At worst you’ll reckon it’s a waste of time. And you might have a point. Our LAT guidance states that we’ll be paid for doses administered between 1September 2013 and 31 March 2014. Which is odd given that the DoH points out the immunisation’s relatively short shelf life means it will all have expired by 16 January 2014.

Got all that? Good. Bet you can’t wait to explain it to parents.

Dr Tony Copperfield is a GP in Essex. You can email him at tonycopperfield@hotmail.com and follow him on Twitter @DocCopperfield.

Readers' comments (3)

  • Classic!

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  • I have too much work to do at the moment. The flu season for adults is factored in but not the children's flu and not the shingles vaccine. Just say no.

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  • Children can be seriously ill with flu. It's a common disease, so even a low rate of death and serious complications can add up to a lot of cases.

    And, yes, children are very efficient vectors of flu - a former president of the European Society for Paediatric Infectious Diseases, Ron Dagan, memorably described children as "bioterrorists" because they are so effective at transmitting gastro and respiratory infections like flu and norovirus to others. So vaccinating children reduces flu in others.

    As for the pilots... Well, first there's an issue with quantities of vaccine; and then there is genuine uncertainty as to the most efficient way to deliver the vaccine programme. Would you really have wanted to have the pilot programme implemented as a part of the national programme on top of the pre-school programme? And if it were implemented without reasonable evidence of the best way to do it, based purely on somebody's best guess, would you be happy? Or would you rather it was delayed for a year while they gather more evidence on the best way to implement it? Sometimes the DH can't win.

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder