Flu vax for kids: early success, but room for more

Immunisation providers should offer annual influenza vaccination for children aged 6 months to less than 5 years and report it to the Australian Immunisation Register (AIR), according to the authors of a perspective published online by the Medical Journal of Australia.

Influenza causes a substantial number of hospitalisations and deaths each year in Australia. Hospitalisation rates for influenza are highest in young children, with annual rates about 200 per 100,000 in children aged 0–5 months, and 100 per 100,000 in those aged 6–23 months, wrote the authors, led by Dr Frank Beard, a public health physician at the National Centre for Immunisation Research and Surveillance (NCIRS) and a senior lecturer at The University of Sydney. According to the authors, these numbers likely underestimate the true burden of disease because of underascertainment, particularly of influenza-related complications.

While the Australian Immunisation Handbook strongly recommends that children aged 6 months to less than 5 years should receive annual influenza vaccination, the influenza vaccine is only funded under the National Immunisation Program (NIP) for children in this age group who are Aboriginal or Torres Strait Islander or who have medical conditions that increase the risk for severe influenza.

National influenza vaccine coverage for young children increased in 2018, reaching 25.6% overall and 29.5% in Aboriginal and Torres Strait Islander children, which represents a 5-fold increase for non‐Indigenous children and a 2-fold increase for Aboriginal and Torres Strait Islander children compared with the coverage in 2017.

The authors identified barriers to achieving better vaccine uptake in young children, including insufficient awareness of potential severity of disease, uncertainty regarding the safety and effectiveness of the influenza vaccine and concerns about increased numbers of childhood vaccines, as well as practical barriers to accessing immunisation service. Negative publicity about the influenza vaccine, particularly related to the 2010 temporary suspension of the program, was also identified as an issue. 

Extensive ongoing surveillance data (from Therapeutic Goods Administration Adverse Events Monitoring System and AusVaxSafety) have demonstrated that the influenza vaccines used in Australia have an excellent safety profile.

The authors have made the following three recommendations for immunisation providers:

• offer ready access to annual influenza vaccination for all children aged 6 months to less than 5 years, ensuring that a second dose is received in the first year of vaccination;
• provide evidence‐based information on the benefits of influenza vaccination, addressing any potential misconceptions; and
• ensure that all vaccinations given, including all influenza vaccines, are reported to the AIR.

A nationally consistent approach could potentially reduce confusion among providers and parents around the importance of influenza vaccination for children. If the influenza vaccine could be included on the NIP for all young children, this may also contribute to facilitating higher uptake, concluded Dr Beard and colleagues.