The Japanese program of vaccination of schoolchildren against influenza: implications for control of the disease.

In 1970, vaccination of the schoolchildren of the town of Tecumseh, MI, against influenza was shown to protect not only the children of the town, but all of its citizens from influenza-derived illness. Subsequently, models suggested that not only illness, but hospitalizations and mortality might be reduced as well. However, influenza control programs in developed countries focused on direct vaccination of the elderly. Only in Japan was a program of schoolchildren vaccination undertaken. Measures used to gauge the effectiveness of that program were insufficiently sensitive to demonstrate value, set against the large social and healthcare gains in that country. The program was discontinued; but this discontinuation revealed that excess mortality had been dramatically reduced. The demonstration of this reduction has prompted expression of several lines of concern. In this review, I have examined these concerns and provided additional detail, bolstering the findings of the hidden success of the Japanese program. In addition, the implications of the vaccination of schoolchildren for augmented control of influenza are explored.