Status: 23.12.2022 4:45 a.m
According to the RKI, almost every fourth child in Germany is currently suffering from flu-like symptoms. The Standing Vaccination Commission recommends influenza vaccination only a few – many pediatricians vaccinate anyway.
The current wave of influenza affects all age groups, including children and young people. Around eleven percent of 0-14 year olds suffer from a respiratory disease and also develop a fever. Even if this is only an approximation, because detailed diagnostics are often not carried out on minors: Even during the violent flu epidemic of 2017/18, the rate was lower, at between eight and nine percent.
Children can spread the virus
Nevertheless, the STIKO does not expressly advocate vaccinating immune-healthy children and younger adults against influenza. She only advises the elderly and other vulnerable groups to get vaccinated. Unlike Covid-19, however, children who are infected with influenza have a significantly higher so-called Secondary attack rate as adults. That means you infect a lot more other people. And: According to the Federal Center for Health Education One third of infected children are contagious even though they do not develop symptoms.
On the other hand, anyone who argues with external protection must also see that many of the vulnerable groups in particular are not vaccinated, says Fred Zepp, STIKO member and former head of the children’s clinic at the University Hospital in Mainz. Even in the pandemic winter of 2020/21 it was noisy RKI not even every second over 60-year-old can be immunized. And even among nursing staff who work with vulnerable groups, the vaccination is not widely accepted, although one Lancet study shows that mortality from influenza in hospitals is reduced by vaccination.
External protection alone is not an argument for STIKO
“Vaccinating children primarily with the aim of protecting third parties can sometimes be justified, for example in the case of immunodeficient family members,” says Zepp. “Vaccinating a child just to reduce the economic burden on society as a whole, on the other hand, is ethically questionable.” However, some countries handle this differently. According to the European Center for Disease Prevention and Control Finland and the UK, for example, vaccinate children in different age groups.
And the STIKO itself had argued with the protection of others when recommending the chickenpox vaccination in 2004 – also to protect infected parents from absenteeism from work. However, STIKO member Zepp qualifies that this was only part of the argument. According to him, the decisive factors were serious complications such as life-threatening coagulation disorders, which it says RKI not so rare in children infected with chickenpox.
The STIKO is therefore concerned with a fundamental individual benefit for the children, because the vaccination represents a medical intervention. And she argues similarly cautiously as with the Covid vaccination: Severe courses and secondary diseases are rare in children. One study However, from 2012, a flu shot reduces the likelihood that a child will need intensive care treatment for influenza by 74 percent.
Acute overload in pediatric medicine
And even with a normal flu, many children end up at the doctor – and currently encounter overcrowded waiting rooms due to the above-average number of infections. The situation in the children’s hospitals, which have sounded the alarm several times in recent weeks due to acute overload, is particularly problematic. In this exceptional situation, statistically rare, severe courses in children become noticeable.
Many paediatricians therefore vaccinate even without a STIKO recommendation. Martin Terhardt, himself a STIKO member and pediatrician in Berlin, says: “Children seem to be particularly affected. In this respect, it makes much more sense this season to ask parents to vaccinate their small children against influenza.” Legally, this is not a problem, because the inactivated vaccine against influenza is also approved for people over the age of six months, and most health insurance companies pay for the injection vaccination for all age groups. Alternatively, there is a vaccination by nasal spray, which the health insurance companies only finance in exceptional cases.
Vaccination effectiveness varies
But STIKO members like Zepp also argue with the fluctuating effectiveness of the influenza vaccination – depending on the season, it is between 20 and 60 percent. Because the virus is constantly changing, the vaccine has to be adapted every year, and it is often difficult to predict which variants are circulating. “For children and young people with a particular risk of illness, protection against infection of perhaps only 30 percent is still an advantage,” says Zepp. The children as a whole could then only benefit to a limited extent. And Zepp also sees a herd protection effect in question.
Researchers at the University of Oxford see things differently. In a simulation study from 2012, they expected the vaccination to be between ten and 80 percent effective. At least 1200 cases, in the best case even 53,000, could be prevented according to their modeling by a vaccination program in children. The US Department of Health CDC According to reports, vaccination prevented about 6,300 deaths in the United States during the 2019-20 influenza season. However, almost half of all people in the US are vaccinated, both children and adults. According to data from the Techniker Krankenkasse, only one in five people in Germany was recently vaccinated.
Vaccination recommendation currently not a STIKO issue
In fact, the manufacturers seem to have landed a kind of hit in the current season when it comes to the pathogen: for some of the influenza viruses that Influenza A Virusesthe vaccine was apparently above average in animal experiments, for the other part, the influenza B viruses, the results are still pending.
However, the question of a general vaccination recommendation against influenza in Germany is not completely out of the question. A few years ago, STIKO had already provided advice. Shortly before the corona pandemic, the voluntary body wanted to meet again, but the pandemic consumed so many resources that there was no time left for further consultations. It is now too late to make a general vaccination recommendation for this season. However, winter has only just begun.