National childhood flu-vaccine programs should include evaluation component

If the United States were to launch an annual influenza-vaccination program among the nation's school children, resources also should go to evaluate the program's success in reducing community-wide flu transmission, according to a "Policy Forum" editorial in Science authored by researchers based at Fred Hutchinson Cancer Research Center.

Performing such an evaluation would be a crucial step in laying the groundwork to help the nation stage an organized response to a flu pandemic, assert M. Elizabeth Halloran, M.D., D.Sc., and Ira M. Longini Jr., Ph.D., both members of the Hutchinson Center's Public Health Sciences Division and professors of biostatistics at the University of Washington School of Public Health and Community Medicine.

"The Advisory Committee on Immunization Practices and several states are considering recommending annual influenza vaccination in groups beyond the currently recommended high-risk groups," the authors write. "This offers an opportunity that should not be missed: to conduct a nationwide study of the effectiveness of vaccinating school children against influenza as a means of reducing community transmission." The 15-member Advisory Committee on Immunization Practices advises the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention on the most effective means to prevent vaccine-preventable diseases.

Children between the ages of 5 and 18 are considered to be the most important source of community-wide transmission of the influenza virus, and so vaccinating them, write Halloran and Longini, would be the "most efficient approach to reduce overall influenza cases." A large-scale vaccination program also would provide the incentive for vaccine manufacturers to increase and stabilize vaccine production - a move that could improve the nation's ability to staunch the human-to-human spread of a highly pathogenic virus such as avian influenza A(H5N1).

The authors acknowledge that many logistical details would need to be worked out to undertake such a study, from determining who would pay for the immunizations and how they would be distributed to who would be liable for potential injury due to vaccination. They suggest that the conduct of such a large study be a collaboration of academia, which would provide study design and coordination; government, which would provide public-health access, guide procedures and policy, and help fund such an initiative; and industry, which would provide vaccine and evaluate its safety.

"Vaccination of school children will be a massive effort if introduced nationwide. Why not plan for its proper evaluation now," the authors conclude.

Prior to joining the faculties of the Hutchinson Center and UW in January, Halloran and Longini were longtime collaborators in biostatistics at Emory University in Atlanta.