I remember one influenza epidemic of the 1990’s. We had two strains of influenza, and several in our local nursing home got the flu and almost died, so we put their contacts on one of the anti influenza medicines, and everyone did well.

But I also remember getting called to the Emergency room, where a child who had been diagnosed several days before came back with a high fever and lobar pneumonia…we helicoptered him to the nearest children’s hospital, and we also had to fly out another older girl who ended up on a respirator for her pneumonia. Both had resistent Staph pneumonia, but responded to Vancomycin…the good news is that they both made it. The bad news is that some Staph is now becoming resistent to Vancomycin…

Back then, we didn’t give kids flu shots, but after that epidemic, it was decided that infants and high risk children needed to get the vaccine. That made sense.

But this year, there is a change. The CDC will recommend that all kids get flu shots.

And not just one shot, but if the kids have never had a flu shot in the past, they will need two shots a month apart. And not just infants but older kids, and others:

  • All children from the age of 6 months up to their 19th birthday.
  • Pregnant women.

  • Anyone aged 50 and over.
  • Anyone of any age who has a chronic medical condition.
  • Health care workers, people who have household contact with those at higher risk of complications, and anyone who has regular contact, in our out of the home, with children too young to be vaccinated (under 6 months).

One problem with influenza vaccine is that it doesn’t always work: You need a crystal ball to predict what flu strains will pop up each year, and sometimes you guess wrong (last year, only 40% to 60% of the flu strains were prevented; in other years, it is as high as 90% coverage).

A second problem is immunity. Usually in the past, the flu shot was given to the sickest people, and they didn’t always have a good immune system to make antibodies from the vaccine, so it didn’t work as well. It’s like filling an old car with gasoline: If the engine is sluggish, the car won’t hit 90 mph, and if the immune system is weak, it just won’t make enough immunity to protect you.

But some studies suggest that the best way to protect Grandmom is to  give an influenza shot to her 2 year old grandchild.

You see, Influenza is spread via droplets, but if Grandmom doesn’t go to crowded places to get sneezed on, she might not catch the flu. But toddlers not only sneeze and drool, but they spread the germs to each other. And since kids might not seem sick (after all, 2 year olds often have low fevers and runny noses), they are more likely to catch it from each other at school or daycare, and bring it home to their families.

So if children don’t get the flu, the families have less chance of catching it too.

One more item: There is a “live” influenza vaccine given by nasal spray. It does not work as well for protection, but some studies showed that if you are having an epidemic and give it to all the kids, the amount of Influenza cases go down thanks to “herd immunity”: translation, if half or two thirds of the kids are immune, there are a lot less kids to give it to the ones where the spray didn’t work.

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addendum:

In the meanwhile, there is a lot of work going on to protect against influenza, and a lot of it is in a race by doctors worried if bird flu should mutate and start passing from person to person (most cases have been caught from direct contact with infected birds). The first vaccine against Avian influenza for humans has been aprroved recently in Europe, and is being included in “pre epidemic emergency plans”. The CDC website has lots of information.And if such an epidemic occurs, one could see schools and churches and many businesses shut down to slow the spread of the disease.

Although the research is early, there are reports that Doctors in Japan are working on a birdflu nasal spray. There is also work on “universal influenza vaccine” that should work despite the changing influenza virus antigen.

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Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket, and she writes medical essays at HeyDoc Xanga Blog.

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