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Should all children be immunised against influenza?
  1. Valtyr Thors1,2,
  2. Calum Smith1,
  3. Adam Finn1,2
  1. 1Schools of Clinical Sciences and Cellular and Molecular Medicine, University of Bristol, Bristol, UK
  2. 2University Hospital Bristol NHS Foundation Trust, Bristol, UK
  1. Correspondence to Dr Valtyr Thors, Level 6 Education Centre, Upper Maudlin Street, Bristol BS2 8AE, UK; valtyr.thors{at}

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Introduction—flu vaccines in children and indirect effects

Influenza is an important cause of morbidity and mortality, especially in combination with secondary bacterial infections.1–3 Annual influenza vaccination is recommended for everyone at risk by the WHO.4 In recent years, a number of countries have recommended influenza vaccination for all children older than 6 months although the uptake has been variable. The effectiveness of inactivated influenza vaccines in children has been questioned.5 Numerous studies have been published on the subject but outcome measures used vary with some studies using influenza-like-illness while others use culture or PCR-proven influenza, making comparison and meta-analyses difficult. In several randomised clinical trials, live attenuated influenza vaccine (LAIV) has been found safe, effective compared to placebo and consistently more effective than trivalent inactivated vaccine (TIV) in children. In 2012, UK authorities announced plans to offer annual LAIV to all children aged 2–17 years and in July 2013 that a single dose of the vaccine will be offered to all 2-year-olds and 3-year-olds from September 2013. Although the evidence base supporting this decision is robust, some important questions remain unanswered. Such a campaign, if carried out successfully, could significantly reduce the burden of disease in children and, since children are thought to be important in the propagation of infection within the population and thus development of influenza epidemics, this initiative may well impact on disease in other age groups through indirect protection. However, few studies quantifying such effects have been done to date. In this paper, aspects of the implementation of universal childhood influenza vaccination are discussed.

Disease burden, epidemiology and interactions with bacteria

Although it is widely believed to be a relatively insignificant infection in childhood, between 10% and 30% of children are infected with influenza during every annual epidemic,6–8 an attack rate higher than any other age group with a rate of complications that is especially high in the …

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  • Contributors VST conceived the content of the manuscript, co-wrote and finalised the manuscript. CS co-wrote the manuscript and contributed to the final edit. AF conceived the content of the article, co-wrote the manuscript and performed the final edit.

  • Competing interests VT is an ESPID Research Fellow and is currently undertaking research partially funded by a grant to the University of Bristol from Astra-Zeneca. AF undertakes consultancy and clinical research for all the main vaccine companies including most of those manufacturing flu vaccines. All funding related to these activities is paid to his employers, the University of Bristol and University Hospitals Bristol NHS Foundation Trust. He receives no personal remuneration related to these activities and has no other financial interest in these companies or any related intellectual property.

  • Provenance and peer review Commissioned; internally peer reviewed.

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