“When we think of the major threats to our national security, the first to come to mind are nuclear proliferation, rogue states and global terrorism. But another kind of threat lurks beyond our shores, one from nature, not humans – an avian flu pandemic.” – Barack Obama, June 2005.

I remain a proponent of vaccination irrespective of the controversies that keep coming up. I think anybody who has seen a child with a tetanus infection will be. India continues to have killer infectious diseases and though I admit that there is a need for the health
ministry to delve into the storage and administration of vaccines with a little more vigilance I cannot agree with withholding any of the mandatory vaccines. The Indian Academy of Paediatrics makes recommendations only after a review of current published literature on various parameters that include need for the vaccine, its efficacy and safety. Having said that I do acknowledge that there are contentious issues involved – we cannot inject a plethora of microorganisms and chemicals into the bodies of our young children without considering the strain on their immune systems. Therefore, while certain vaccines are imperative, others can be administered as per the physician’s recommendation.

The vaccination for influenza falls into the second category. Flu is a seasonal occurrence and yet pandemics occur because a virus emerges and starts spreading easily because we have no pre-existing immunity. This is one characteristic of the flu virus, which mutates rapidly into new forms. So we have H1N1, H3N2 and so on. Sometimes two flu viruses can attack the same animal and their proteins get mixed up and re-assorted to form new forms. That is why we can never predict what the next pandemic will bring forth-a benign selection or a lethal one. Once a fully contagious virus emerges, its global spread is inevitable. Countries might, through measures such as border closures and travel restrictions, delay arrival of the virus, but they cannot stop it.

A flu vaccine takes two weeks to produce an effective protective response in the body. Protection decreases by about 50% over the next six months (the decrease is less for older adults), and remains stable for two to three years. Antibodies made by the immune system in response to vaccination with one strain of influenza viruses can provide protection against different, but related strains. But eradicating flu altogether is not possible.

Serious side effects with modern vaccines are extremely unusual. Some people experience a slight soreness at the point of injection, which resolves within a day or two. People who have never been exposed to influenza, particularly children, may experience one to two days of a slight fever, tiredness, and muscle pain.

What does this mean in terms of choice?

Vaccinations will not protect against all forms of the flu unless the same viruses that are contained in the vaccine infect the child. Considering the nature of the flu virus, this is not likely to happen. Since we do not know which virus will attack next we cannot be complacent thinking that since we have been exposed to milder attacks we are protected from danger. Other precautions cannot be sidelined during the episodes just because a child has been vaccinated. But vaccination can offer some protection from the flu becoming life threatening and from being prolonged.

There are certain vulnerable groups in whom influenza has a propensity to become lethal. Annual vaccination is compulsory for them, so that even if they are infected, the infection will not become life-threatening. This group includes:

• Children under age two (but not under six months of age where the immune system is unlikely to produce a sufficient response by itself)
• All people 65 years and older
• Residents of nursing homes and chronic-care facilities (regardless of age)
• Adults and children who have chronic heart or lung problems, such as asthma, heart malformations
• Adults and children who have chronic metabolic diseases, such as diabetes and obese children
• Children and teenagers who are on long-term aspirin therapy
• Children with blood related disorders
• Pregnant women who will be in their second or third trimester during flu season or women who are nursing
• Anyone who is immunocompromised (HIV-infected persons, cancer patients, organ transplant recipients)
• Anyone in contact with the above groups, such as teachers, care givers, healthcare personnel, and family members
• Travellers to foreign countries

For the others, it is a question of choice based on finance and the surrounding environment. Anyone wanting forego the discomfort and inconvenience of an influenza attack may receive the vaccine by choice. Simply put, you lose nothing by vaccinating your child but you cannot expect complete protection from influenza. I haven’t vaccinated my ten month old with a flu shot yet but she will get one before she enrols in her playgroup.

Re-published with permission from the blog of ParentEdge, a bi-monthly parenting magazine that aims to expose parents to global trends in learning and partner with them in the intellectual enrichment of their children. This blog was written by Dr. Krishna Mahathi holds diplomas in Pediatrics and in the management of allergies and asthma.

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