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Flu wave: How important is vaccination for children? | > – Guide

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Flu wave: How important is vaccination for children?  |  > – Guide

As of: January 26, 2024 4:00 p.m

The number of flu cases in Germany has increased since the beginning of the year. Who is recommended to be vaccinated against the influenza virus and does it still make sense now? What role do children play in the flu epidemic?

by Korinna Hennig

The data from the Robert Koch Institute speak for themselves: the influenza infection curve has been pointing steeply upwards since the beginning of the year. While the number of Covid cases is slowly declining, the flu season has now clearly begun. Schoolchildren are particularly affected. This was also the case with the flu epidemic in the southern hemisphere during our summer months. The course there is generally considered an indicator for the course of the infection season in Europe.

Severe but short flu season in Australia

“In Australia we saw an early, very severe influenza season, with a very steep increase, but which was unusually short for Australian conditions,” says Tobias Ankermann, chief physician of the clinic for pediatric and adolescent medicine at the Kiel Municipal Hospital. Almost a third of confirmed influenza infections in Australia have been in children under the age of nine. Worrying: The number of deaths among them was also particularly high compared to influenza epidemics that were observed before the corona pandemic. Nevertheless, Gülsah Gabriel from the Leibniz Institute for Virology in Hamburg cannot derive any unusual threat situation for Europe from this, because the data, for example, does not show how particularly unvaccinated children with previous illnesses were affected.

The number of infections is not determined solely by the type of virus

Various factors are important when it comes to determining how severely an influenza epidemic affects the population. “This cannot be explained solely by the intrinsic virulence of the virus,” says the influenza researcher – i.e. by the disease-causing properties of the virus. “There is also no indication that the virus has changed in such a way that it particularly infects children.”

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Catch-up effects from the corona pandemic in Australia could have played a role. Because many people have not had contact with influenza viruses for a longer period of time, the immunity in the general population has changed, which also shifts the dynamics of infection. Sometimes it also plays a role when the season of the different pathogens shifts and they come into contact with each other, says Gabriel. “Theoretically, one could not rule out a double infection or successive infections.”

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So far there are no signs of a serious flu wave in Germany

The Kiel pediatrician Tobias Ankermann sees the current course of influenza in his clinic – but also with other viruses – in more normal channels than in previous years, for example with RSV infections, which are particularly dangerous for infants and small children: “Only now, with At the beginning of the year, the season begins. The increase kinetics and also the age distribution currently correspond to a normal influenza season. We currently have individual children with influenza. The leading pathogen was previously RSV, and now individual influenza cases are coming.”

It could also be reassuring that an influenza A pathogen is currently dominating in Germany, which is, strictly speaking, an old acquaintance and has been circulating repeatedly since 2009. “These H1N1 influenza viruses are mainly responsible for mild illnesses,” explains virologist Gabriel. This is because they primarily infect the upper respiratory tract and are therefore transmitted particularly efficiently via droplets and aerosols, but are less likely to cause primary pneumonia. In second place, but significantly rarer, is another subtype that also affects the lower respiratory tract.

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The wave is just beginning

According to pediatrician Ankermann, only developments over the next two weeks will show how severe the flu wave can become in Germany. “I think we can say more in seven to 14 days, we are now at the beginning of the increase.”

According to Mainz pediatrician Fred Zepp, who is also a member of the Standing Vaccination Commission (Stiko), an estimated 20 to 30 percent of children get influenza every year, which is roughly comparable to the disease burden with Covid. Life-threatening courses are very rare.

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Vaccination can also be useful for younger people

Many pediatricians are already vaccinating against influenza without a Stiko recommendation, and most larger health insurance companies voluntarily cover the costs. Pediatrician Ankermann says there are good reasons to protect your child from the flu with a vaccination. “If you’ve seen children who get influenza, even without complications – that’s a serious viral infection. And if you can spare the children from that or mitigate it, that’s good.”

Infants and small children in particular are considered to be at risk if their mothers have not been vaccinated during pregnancy. The WHO recommends vaccination for all children aged six months to five years. Some countries in Europe also follow this recommendation. Similar to Covid, long-term damage can also occur after an influenza infection, emphasizes Markus Rose, medical director of the pediatric pulmonology department at the Olga Hospital at the Stuttgart Clinic. According to a US study, the risk for the lungs is even greater than after a corona infection.

Special role of children

Nevertheless, the Stiko has not yet wanted to give a general vaccination recommendation for healthy children. Pediatrician Fred Zepp also argues with the fluctuating effectiveness of the vaccine: Because the virus changes quickly and several subtypes usually play a role, even the annual adjusted vaccine often does not cover all pathogens. The effectiveness against illness therefore varies from year to year and is sometimes 70 percent, but in bad years it is only 30 percent.

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The professional association of pediatricians and some epidemiologists still argue that children could pass the viruses on unnoticed to people at risk such as grandparents because they have many more contacts than adults. And a third of all people infected with influenza usually develop no symptoms at all.

Low vaccination rates among older people

However, the virologist Gabriel emphasizes that the individual well-being of the children must be the priority. Finally, there is a vaccination recommendation for older people, but in Germany the vaccination is not even used by half of the affected age group – in Denmark, for example, there are almost twice as many. Children should not have to compensate for this deficit, says Gabriel, especially since it is difficult to determine to what extent a vaccination still has an effect even on asymptomatic infected people.

The Stiko has nevertheless addressed the question of indirect effects through child vaccination for this year. One thing is clear: the more people get vaccinated, the better they protect older people for whom the vaccination does not work so well, as evidence and intervention studies from other countries show.

A new Stiko decision would no longer come in time for the current season. Nevertheless, a flu vaccination could still make sense for the individual, as the season usually lasts until April, and initial WHO data show that the vaccine has a high hit rate this year.

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NDR Info | Knowledge | 01/25/2024 | 07:53 am

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