A Tense Year for Flu Watchers in Early Care and Education

If you’re a parent or pre-K provider, sizing up the flu threat this year is a bit like watching that troubling pattern on the weather radar. You hope it doesn’t develop into a full-fledged storm and if it does, you hope it doesn’t blow your way. Seasonal flu has always been a worry for pre-K providers but this year the H1N1 flu virus presents a special challenge since young children are more vulnerable to it than the bulk of the population and this virus has the potential to mutate into a more deadly threat. The rapid spread of H1N1 flu prompted President Obama to declare a state of emergency this week and vaccine makers, who haven’t been able to supply sufficient H1N1 doses to meet demand, are being pushed to redouble their efforts.

Research has shown that vaccinating young children is an effective weapon not only in protecting them from flu outbreaks but also in protecting high-risk groups such as the elderly since young children are known to spread the virus to adults. Vaccinations for flu administered to kids early in influenza outbreaks have particularly high benefits for the rest of the population because the vaccine is relatively effective and the flu is highly infectious. One study simulating an outbreak found the benefit to be greater than one case of flu prevented in the rest of the population per influenza vaccination administered to a child.

Findings like this have prompted the Centers for Disease Control (CDC) to recommend that children between six months and 18 years old receive seasonal flu vaccinations. Of course, the CDC is not vested with the authority to require kids to receive them. That rests with the states. To date, only New Jersey has made it a regulation that kids must receive seasonal flu vaccinations (as well as pneumonia) as a condition of attending pre-K. Approved over the objections of the anti-vaccination lobby last year, the new regulation puts the state in a proactive position this flu season since getting kids vaccinated early is a key to containing outbreaks.

The vaccine for H1N1 flu, which requires two nasally administered doses to immunize children began arriving in October. Researchers looking at epidemiological models say that if a concerted effort is made to vaccinate 70 percent of children between six months and 18 years old for H1N1 flu first, it could lead to coverage of 70 percent of the entire U.S. population since kids are prime spreaders of the virus.

It is by no means clear that this goal can be reached. Much depends on how quickly adequate supplies of the vaccine arrive, how willing parents are to have their children vaccinated, and how quickly the H1N1 virus spreads. So far, the virus is moving faster than the supply of vaccine and a large proportion of parents are wary of having their kids immunized despite the impending threat. The National Poll on Children’s Health reports only 40 percent of parents plan to have their children receive the vaccine and only about one-third of parents believe H1N1 flu will be worse for their children than seasonal flu. Polls by Consumer Reports and CBS also found large segments of the population are fearful of having their kids vaccinated for H1N1 flu.

This concern has been on the increase in recent years, spurred in part by suspicion that thimerosal, a preservative in some vaccines, is linked to autism in children. British researcher Andrew Wakefield made that connection in a 1998 article in The Lancet. His data, drawn from the cases of 12 children, have since been called into question and subsequent research has found no connection between vaccines and autism. Large studies in California and Denmark found that the prevalence of autism in children increased significantly years after the use of thimerosal was discontinued.

Even so, the reluctance of parents to have their children vaccinated is a reality that increasingly concerns public health experts. In the case of H1N1 flu, the CDC is responding by mounting a public relations effort that includes sending “mythbusters” around the country to try and ease fears about vaccination. One reason vaccine makers have been unable to supply sufficient doses in the U.S. is because the U.S., unlike other countries, prohibited the use of substances known as adjuvants that increase the effectiveness of vaccines. That meant that vaccine makers had to use many times more active ingredient per dose of U.S. vaccine than they did for vaccines sent to Europe. While this was done to allay fears concerning the vaccine, there is no evidence it changed the minds of parents and the supply of vaccine continues to lag behind the spread of the virus.

Meanwhile, early care and education providers represent a critical line in the defense against this year’s flu threat. Their capabilities and decisions will largely determine whether their centers become the locus of outbreaks or of containment. Guidance from the U.S. Department of Health and Human Services and the Centers for Disease Control spells out procedures ranging from detection and isolation of kids with symptoms to managing and protecting staff and disinfecting surfaces children come in contact with. They also contain a second set of criteria decision makers should consider if infection rates become more widespread. The recommendations emphasize the importance of educating young children on proper hand and respiratory hygiene. Toward that end, they have enlisted, Sesame Street’s Elmo who appears in a series of short videos.