Universal influenza vaccination and live attenuated influenza vaccination of children.

Influenza is an uncontrolled epidemic disease that is vaccine preventable. Each winter the peak of medically attended acute respiratory illness coincides with the peak of influenza virus activity. The anatomy of an urban influenza epidemic is presented highlighting the role of children in the spread of influenza. The efficacy and safety of the live attenuated influenza vaccine (LAIV) for children are documented and the indirect effectiveness (herd protection) of vaccinating schoolchildren is demonstrated. Children have the highest attack rates during influenza epidemics and the consequences of influenza virus infection can be severe regardless of the virus type--A(H1N1), A(H3N2), or B. Early in the epidemic, over one-half of the culture-positive illnesses will occur in school-aged children demonstrating their role in spreading the virus in the community. LAIV has been shown to be superior to inactivated vaccine for children and is safe even for children with mild intermittent asthma. One dose of LAIV is effective and gives almost immediate protection. LAIV administered by nasal spray is readily accepted by children. Several studies have demonstrated herd protection by immunizing schoolchildren. These studies have shown that immunizing schoolchildren is more efficient than vaccinating elderly and high-risk patients directly. Current recommendations for influenza vaccine give priority to more than 200 million persons in the United States, but vaccine coverage has not improved since 1997. Systematic delivery of influenza vaccine in school-based and workplace-based clinics would greatly enhance the control of epidemic influenza and help prepare for the next pandemic.