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?

The passage above piglet says the children who die have clinical risk factors (so are presumably already offered flu jab). The discussion is around the reasons why HEALTHY children are to be given flu jab. As the passage above says 'most of the cases of severe death and disease that are averted from vaccinating HEALTHY children is in the elderly & at risk groups'.

They then discuss whether vaccinating HEALTHY children is a cost effective means of preventing the spread in the vulnerable groups (thus lowering hospital admissions & saving the NHS money).

You're quite welcome to take up a vaccination that is aimed to protect the elderly (the elderly more than clinical at risk groups - as clinical at risk group tend to accept the jab they are offered) and you're quite welcome to sign your HEALTHY child up for the risk that vaccination involves. I'm not prepared to. But don't kid yourself into thinking the dept of health is spending millions to prevent your child feeling a bit poorly. Cost effectiveness is central to decision making & it is hoped this jab will save the NHS millions & stop A&E departments going into crisis this winter due to elderly flu admissions.

And piglet I think my posts on here repeatedly show I am not prepared to disregard 'the few'.

*severe disease obviously

"'most of the cases of severe death and disease"

Most.

"few children die from influenza and those that do often have clinical risk factors"

Often

"number of deaths of children that would be averted from additionally vaccinating healthy children would be relatively small"

Relatively.

I'm sorry piglet, I'm a bit confused, what are you saying? I'm not suggesting that flu never ever makes a healthy child seriously ill (although the JCVI makes it clear it is very rare event indeed) I am saying that the flu programme has been introduced because - as the JCVI minutes say 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

Others have argued that older adults and those in clinical risk groups should be the ones to decide whether the risk of the vaccination is worth the potential benefit rather than vaccinating healthy children (I agree with this btw). BUT the problem for the Dept of Health, is that older adults with flu cost the NHS lots of money. So it is cost effective to vaccinate young children and school children to try and limit the spread. They don't cost much if they get it, but the elderly it spreads to do.

As this article says ministers believe that in the long-term mass vaccination programmes are a cost-effective way of reducing demand on the NHS at a time of tight financial constraint

i'm illustrating that when you said "The benefit to an individual healthy child is to not have a less severe case of the flu"

you were brushing over and ignoring the bits that don't suit you, even though you quoted them.

I didn't see the words "very rare event indeed" but is there no "very rare event indeed" that you would take pains to avoid?

Piglet - that was from a quote from the JCVI minutes. They said it not me.

Here's the original wording, which I gave Most of the benefit to children from vaccinating healthy children arises from averting a large number of cases of less severe influenza disease

"Most"

oh good grief PJ, she's never said 'all'.

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

Is not accurate. So I added the other points. Do you disagree with them?

You didn't 'add other points' you are just re-quoting what saintly has already quoted herself.

Do you mean that you think her conclusion

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

was accurate?

arkestra - the vaccine is viewed by JCVI as of direct benefit to the recipients

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

The paragraph immediately above the one SJJ choose to quote in isolation - Vaccination of children is likely to be cost effective if considering only the age group targeted.

I think reducing disease in a way that benefits the vaccinated group is a good thing. Does anyone disagree?

Piglet - take it up with the JCVI - that's their conclusions. And it's really the point of this discussion anyway.

Well if you want to read the whole JCVI reasoning on cost effectiveness it's available <a class="break-all" href="http://webarchive.nationalarchives.gov.uk/20130402145952/media.dh.gov.uk/network/261/files/2012/07/jcvi-statement-on-the-annual-influenza-vaccination-programme-25-july-2012.pdf" rel="nofollow" target="_blank">here

The study suggested that, despite the high cost, extending the influenza vaccination programme to low risk children is highly likely to be cost effective and well below the established cost effectiveness threshold when indirect protection to the whole population is taken into account, particularly over the longer- term

I disagree tbh JoTheHolt. Depends which disease we're talking about, in some cases I'd prefer natural immunity. As I said before though I tend to steer away from giving my children vaccinations introduced on economic grounds because usually they're on the whole conditions I'd rather my children developed immunity for naturally (e.g. mumps - albeit they might decide to vaccinate themselves against mumps in their late teens/early adulthood if they don't manage to develop immunity- personally I think natural immunity developed in childhood is preferable). I'd personally add seasonal flu in with that because of the benefits immunity from earlier outbreaks can provide in later adulthood. Of course the situation is different if a child has additional health problems.

I am interested in the uptake of this vaccination amongst younger children. Their own minutes suggest they feel views amongst parents and even health care professionals might be mixed. It is rather unfortunate timing given the narcolepsy & Pandemrix news this week. (And although I didn't take up the offer of a swine flu jab the reasoning for introducing it was fair enough imo, even if the potential risk from swine flu was over-estimated)

SJJ

Do you mean that you found the conclusion "The benefit to an individual healthy child is to not have a less severe case of the flu"

in a JCVI document?

Be so kind as to show me where.

Sorry piglet, you seem to be arguing against something I'm not saying. My argument has been about the reasons why this is being introduced not what the effect might be on an individual child. Of course the occasional healthy child might get much sicker than expected from the flu (and of course that could be my child, they're not teflon coated), that's so obvious I didn't think it needed spelling out. The discussion is around the reasons for introducing this as a mass vaccination of children who are not as a group at high risk of damage from the disease, rather than targeting vulnerable groups. The reasoning behind introducing it to every 2-17 year old in the land is not to protect the occasional healthy child who gets sicker than expected, (and those who are vulnerable are already offered the jab) it is to decrease the transmission of the disease, prevent illness in elderly who refuse to be vaccinated and reduce the costs of flu to the NHS. Of course reducing GP visits from otherwise-healthy-children with flu will also decrease costs to the NHS, even if the savings per person are not as much as the costs saved from having to treat an elderly person who has refused the jab.

From a public health perspective this is not problematic. In fact it makes perfect sense, there is nothing wrong with the reasoning at all - from a public health perspective . However, I take an individual approach to vaccination with my children and family and cannot see the particular benefit to me or my children. So we won't take up the offer.

Sorry piglet, you seem to be arguing against something I'm not saying

Not at all.

I am arguing that your statement
"The benefit to an individual healthy child is to not have a less severe case of the flu"
is not accurate.

Just that.

Sorry piglet you seem to have misunderstood what I was saying. I hope my previous post clarifies it.

I think I understood what you meant when you said
"The benefit to an individual healthy child is to not have a less severe case of the flu"
and it is not accurate. Did you mean something different from what you said?

Well the benefit to the vast majority of individual healthy children is to have a less severe case of the flu. And the benefit to a vanishingly small number of healthy children is to not have a serious case of the flu. Or as the JCVI said Most of the benefit to children from vaccinating healthy children arises from averting a large number of cases of less severe influenza disease I don't think the small number of healthy children who develop a severe case of the flu had much impact on JCVI decision making (which was the point of the discussion)

Can you please explain why you are so interested in all this because it's completely irrelevant to any discussion going on on this thread.

The whole thrust of the JCVI report was cost. The cost of the vaccination programme is less than the cost of treating those who get sick with flu.

I'm entitled to comment on a misleading and inaccurate statement.

Instead of inaccurately writing
"The benefit to an individual healthy child is to not have a less severe case of the flu"
you could have written
"The benefit to the vast majority of individual healthy children is to not have a less severe case of the flu; the number such previously healthy children that die is relatively small"
but that statement would have had a quite different impact.

I'm sorry piglet that I didn't use wording you understood. As the line that came immediately before was Most of the benefit to children from vaccinating healthy children arises from averting a large number of cases of less severe influenza disease I would have thought any confusion might have been cleared up before it arose. And as whether an individual healthy child ever gets a severe case of the flu isn't actually relevant to the discussion I probably didn't give that particular sentence the attention it deserved.

Anyway, all cleared up now, with lots of different clarifications. And in the meantime the point about the public health benefit to vaccinating ever 2-17 year old (versus the individual health benefit to vaccinating healthy 2-17 year olds) remains.