New Intranasal flu vaccine for Toddlers . Yes or no ?

[IAmADonkeyOnTheEdge]

Just had a letter asking us to bring our 3.5 yr Dd for a flu vaccine ( up the nose !). No idea how they will persuade to sniff it up and also not sure if we should go for it or not.... Anyone else having it?

I rather worry it encourages cutting corners.

Yes, I agree and that is where the stringent standards, which must be mandatory come in - as a quid pro quo. Non of this - you do what you like and we'll pick up the tab. If the drugs' companies are prepared to reassure us that their products are safe then this should not be a problem, should it?

BeetleBugBaby you wrote:

"they play god with these flu jabs as it is, my dp has usually had one every year, but last year they decided he wasn't using his inhaler enough to have it!?"

Criteria for vaccination when identifying 'at risk' groups is nothing to do with "playing god". If an individual is not using a regular inhaled steroid (for example) then they are not considered 'at risk' any more than a person without asthma.

Any adult can choose to have a flu vaccine - just pitch up at Asda and pay your 7 quid or whatever it will be this year. You will only be eligible to receive one under NHS criteria if you are considered 'at risk' by virtue of your age or health.

OK I don't have time to search through everything, but if you go back through the minutes piglet I'm fairly sure you will find that the biggest benefit is not to the healthy kids in receipt of the jab. I did find this on a two minute search: A spokesperson from the JCVI said The biggest benefit will be protecting very young infants, older people and those in at risk groups such as those with asthma, multiple sclerosis or heart disease from the NHS website Note the 'very young infants' are not being given the jab.

It is viewed by JCVI as of direct benefit to the recipients. Also as a (partial) transmission block to help at-risk groups. Of the at-risk groups, the over-65s are highest uptake at about 75%. Other at-risk groups are more like 50% uptake.

I would take it personally if it was offered to me. But I'm not a school kid so am not enough in the mainstream of transmission for it to be worth the NHS paying for it.

Well it depends what you mean by direct benefit -most of the quotes regarding the benefit for healthy toddlers have been of the 'save them from a being poorly with the flu' type whilst talking about serious illness in the elderly and young infants rather than anything more for the healthy child.

Incidentally - the JCVI minutes from this year raise the possibility of egg allergy and the new vaccination not being a great mix so if your child is anaphylactic to egg it might be worth doing some further research/talking to your doctor before agreeing to it. Specifically the minutes note a published study may have underestimated the risk.

Incidentally I am not sure telegraph is correct at 7 of 100,000 for Pandemrix.

I see the relative risk in the EU study as being 7, against a background level of 0.56 per 100,000 so that is more like 4 per 100,000. The latest UK study shows 2 per 100,000. It seems there may be some dependence on local genetics.

Still not trivial in any case.

EU Study

The EU summary says this:

The CHMP considered that the epidemiological studies relating to Pandemrix in Finland and Sweden were well designed and the results show an association between Pandemrix vaccination and narcolepsy in children and adolescents in those countries. The results indicate a six- to 13-fold increased risk of narcolepsy with or without cataplexy in vaccinated as compared with unvaccinated children and adolescents, corresponding to about an additional three to seven cases in every 100,000 vaccinated subjects. This risk increase has not been found in adults (older than 20 years). A similar risk has not been confirmed but cannot be ruled out in other countries

which is pretty similar to the Torygraph's wording of: Its analysis found that for every 100,000 adolescents who are given the injection, up to seven are likely to develop narcolepsy

Ok they've replaced the range of additional cases with 'up to' but still.

Sounds like the Telegraph are doing a fine job of reporting, and are using a different source to the one I was looking at.

I am a Guardian reader and remember the Grauniad saying gravity was a repulsive force. On their front page, Oh, the humanity.

Guardian reader

Me too, and I wince with pain at most some of their science reporting.

santly

you mention young infants

" A spokesperson from the JCVI said The biggest benefit will be protecting very young infants, older people and those in at risk groups such as those with asthma, multiple sclerosis or heart disease from the NHS website
Note the 'very young infants' are not being given the jab."

and some people consider it is immoral to seek to protect young infants by immunising the people around them?

Can't see the immorality myself. To me it would seem immoral to refuse to protect others.

Piglet I think many of the people who aren't keen are holding back because they think it's risky.

I don't agree with the point of view that you shouldn't get the vaccination even if it's zero-risk. But I think that point of view is pretty rare.

With most people anti-flu-vaccine it's that they have real reservations about having the vaccination? E.g. they think the risk of having something bad happen as a consequence is significant enough to put them off.

It's often hard to sort that one out because it so frequently shades into people mistrusting the JCVI, CDC, IOM etc, at which point it's hard to present any evidence they'll agree with. As soon as people reckon others are acting in bad faith (on either side) it's very hard to keep the whole discussion going. Applies to people on my side slagging off Wakefield etc too.

OK time for me I think

Well piglet I did make a point about young infants and the general effects of vaccination (eg babies are now often born with very poor, or even no immunity to measles, which wasn't the case when I was born - this is accepted btw, it's not a controversial comment). So mass vaccinating against flu might decrease the immunity of future generations of newborns to flu. Presumably?

And anyway I'm afraid if you want to vaccinate one of my healthy children against something that isn't very likely to harm them, however much it might help a hypothetical person we might never meet (I can't remember the last time any of my kids saw a newborn) then as their mother I want to know how safe it is (which rules out giving pretty much any new vaccinations). I do indeed have problems with vaccinations given mainly for the benefit of someone else when there is no adequate compensation system if the shit hits the fan. If you look at the narcolepsy articles you will see that compensation has been refused because the affected 'aren't disabled enough', never mind that their narcolepsy will change their lives beyond recognition and they may never work. If the government wants me to take a risk on my child they have to be prepared to help out when it all goes wrong. They don't.

So yes, safety first. Having a teenager who can't speak and regressed and all that. Makes one a little a bit cautious about anything that might lead to history repeating itself. I think I would be failing my own children if I wasn't that cautious tbh.

Of course it is different if they are taking a risk to get a large benefit themselves.

arkestra - that quote I have about the EU data is from your link. In the summary.

Oh and I concur, the Guardian is truly dreadful when it comes to Science.

saintly - found it - section 9.11, page 152. "Other studies/data: European Medicines Agency and data from spontaneous reports" - thanks. I was just looking in the main body of the report itself. Clearly there is a risk there in any case.

This gives some insight into how difficult it is to claim for vaccine injury compensation btw. The fact that you can put a claim into the VDCS if you were injured by Pandemrix before August 2010, but not after (despite it being the er same vaccination) is somewhere beyond bonkers. Although the claim will probably be refused anyway as 'not disabled enough'. But the scheme is full of anomalies like that (so you can claim compensation if your child dies from a vaccination injury aged 2 years and 1 day, but not if they're aged 1 year and 364 days).

PigletJohn, the immorality or otherwise isn't in protecting or not protecting the infants, it is in injecting(or in this case squirting up the nose) a chemical cocktail into my child with the aim of protecting an other child. It means I have to consent to my child receiving this chemical cocktail, knowing that there is a risk that my child may never be the same again. The child who takes no risk, I.e. The infant not having the vaccine gets all the benefits for none of the risk. That is what is immoral, not protecting the infants as such.

I think if an elderly person refuses a flu jab and then gets flu they have only themselves to blame.

I know several elderly people who have been very ill for several weeks immediately after having their flu jab. Not only have they sworn to never have it again, but also my dh (offered as high risk group) has refused it after seeing how ill his friends were, and I'm sure he's not the only one who would react like that. I think that must be a big part of why lots of elderly people would rather take their chances.

Frontdoorstep, the vaccine is viewed by JCVI as of direct benefit to the recipients. And also as a (partial) transmission block to help at-risk groups. So they reckon anyone should rationally want to take it, and additionally that it's worth the NHS paying for school-age kids to have it.

It is not (from the JCVI point of view anyway) intended as the recipient taking a net risk on the behalf of others. This is quite clear from their discussions.

I would take myself if it was free, irrespective of considerations around at-risk groups. And when it's rolled out to my children I'm happy for them to have it too.

I realise others might have different views for a whole bunch of reasons. Eg I don't draw a distinction between acts of omission (you don't vaccinate and what happens, happens) and acts of commission (electing to take the vaccine). To me, doing nothing is just as much of an action as doing something. And autonomy. And distrust of Pharma etc.

But the JCVI line is not that the intended not-at-risk recipients are taking a net loss on the behalf of others.

Pixel: if a vaccine made me, or lots of my friends, sick then I would think twice too.

But upthread there's results from a survey of the actual reasons people give for refusal. Perceived harm is not the major one. Think "I don't get ill" was top. Well, there's a first time for everything I guess...

Arkestra - the stats you quoted did say:

"Perception vaccine makes them ill: 25%" Not the major reason, but not a trivial number either.

Mine are too old, and have had every other vaccine (and a few extra for travel - yellow fever, rabies, typhoid) but they wouldn't get this.

I have a rare chronic neurological disability. One of the side effects of the flu vaccine is my disability, which didn't cause mine, but there may be a genetic component. I'm not willing to risk acute or chronic Guillan-Barre syndrome to avoid flu.

That's not how I read the JCVI reasoning at all arkestra.

I read it as them saying that it will avert cases of flu in children which (quote) can be a 'miserable disease' BUT "extending flu vaccination to healthy children will provide most health benefits to others".

It depends whether you really think they're trying to avoid healthy children catching a disease that makes them feel miserable (but is self limiting and not dangerous) or whether they might be spending these millions for another reason.

I wouldn't risk GBS either Weegiemum.

The April 2012 minutes are the ones to read re introduction of the flu vaccine. It's mainly about cost effectiveness (which ties in with newspaper reports describing the decision as part of a plan to reduce winter burdens on the NHS and A&E). It includes this paragraph:

As few children die from influenza and those that do often have clinical risk factors, the number of deaths of children that would be averted from additionally vaccinating healthy children would be relatively small. As most severe influenza disease and influenza-related deaths occur in older adults and those in clinical risk groups, most of the cases of severe disease and death that would be averted from vaccinating children would be of older adults and those in clinical risk groups. Most of the benefit to children from vaccinating healthy children arises from averting a large number of cases of less severe influenza disease.

So there we have it. The benefit to an individual healthy child is to not have a less severe case of the flu. Incidentally it also states that attitudinal research suggests that people might not be keen on a flu jab for the under 5's and suggests starting with 5 year olds in combination with an 'education' programme. I guess that's what we're seeing.

I've been offered flu jab for years (carer - ha ha ha - wonder how I ended up one of those) - haven't taken up the offer.

"The benefit to an individual healthy child is to not have a less severe case of the flu"

except for the "relatively small" number that die. Perhaps you are willing to disregard them as they are "few"