Wednesday, October 05, 2005

School-age flu

Results based on reasonable models of disease spread have suggested vaccinating school-age children (5 to 18 years old) may be a more effective strategy than targeting the "high risk" elderly (over 65 age group). Now a real-time respiratory disease surveillance system at Boston's Children's Hospital shows with actual data that the school-age group gets sick about a month before the adults.
The study doesn't prove preschoolers actually drive each winter's flu epidemic, just that they're harbingers for waves of illness.

"What we think is most likely is that three- and four-year-olds are early spreaders of influenza because of the preschool setting," said John Brownstein, an epidemiologist at Children's Hospital of Boston and co-author of the new study.

Brownstein calls the close quarters of preschool and day care, full of kids who don't yet cover their sneezes and are apt to pick their noses, "hotbeds of infection." ( News)
Other lines of evidence also point to school-age children as "highly connected nodes" where control might be applied effectively both in vaccination strategies and timely school closing:
  • Some 85 per cent of school-age children in Tecumseh, Mich., were vaccinated just before the 1968 influenza pandemic, resulting in 67 per cent less flu-like illness in that community than in a neighbouring one.

  • Researchers now are giving the nasal flu vaccine FluMist to school-age children in two Texas towns, Temple and Bolton, to see if it lowers influenza's toll compared with similar communities. Once a quarter of the schoolchildren were immunized, researchers recorded an eight per cent to 18 per cent decline in adults seeking care for respiratory illnesses.
What we lack, in our decrepit public health infrastructure, is a timely infectious disease surveillance system to warn us when it is time to close the schools. The Children's Hospital group has one of the few such systems in the country. It is a research unit. Surveillance is usually one of the first things to get cut when money is tight. It is just bread and butter public health, the kind of thing that gets savaged with the kind of budget cuts we have seen in public health in the last ten years. This is not solely a product of the Bush years, although his Administration has accelerated and hastened the decline dramatically.

Local communities should be giving special thought to how they can handle the school situation. It is not an easy solution. Closing schools puts a special burden on parents who lack adequate childcare, so this kind of decision cascades through the economy and daily life.

The time to plan for this is now. Creative solutions needed.