Influenza Immunization of Schoolchildren: Can We Interrupt Community Epidemics?

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Abstract
In this month's issue of Pediatrics electronic pages, White et al discuss the potential cost savings of immunizing schoolchildren.1 White and colleagues report that immunization of schoolchildren may have substantial benefits to society, particularly if performed in a group-based setting. Specifically, influenza immunization resulted in net savings of between $4 to $35 in their best-case scenario. Importantly, the cost savings were markedly robust through a range of sensitivity analyses, particularly for group-based as opposed to individual-initiated immunization. In addition, they suggest other potential beneficial effects, such as reduced school absenteeism, decreased transmission of influenza to others (including parents and the cost of missing work), and a reduction in the incidence of otitis media and its associated costs (at least in young children), likely would result from such a program. Currently, the Advisory Committee on Immunization Practices2 and the Red Book 3advise influenza immunization for children 6 months of age and older who are at high risk for complications of influenza. Immunization of children who do not have risk factors is not routinely recommended, emphasized, or particularly encouraged. Nonetheless, interest in the idea of immunizing otherwise healthy children against influenza is engendered by several observations and concerns: 1) Because children are the primary source of the “spread” of influenza, can we interrupt influenza outbreaks by mass immunization of schoolchildren? 2) Considering the huge direct and indirect costs of the yearly outbreaks of influenza does mass immunization of children make economic sense? 3) Because influenza illness is a universal experience, can we prevent a major cause of pain, suffering, and death in the population by mass immunization of school-aged children? 4) Should immunization of all school-aged children against influenza be elective or required? Would mass immunization of schoolchildren interrupt the spread of influenza leading to control of influenza in …