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Thinking Ahead Of The Flu

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Pediatrician Anders Nelson of Clarks Summit, Pa., is a man ahead of his time.

Though a panel of health experts only last week advised the Centers for Disease Control and Prevention to start recommending annual flu shots for healthy babies next fall, Nelson has been doing that for years during flu season.

In his office, tucked into the foothills of the Poconos 125 miles north of Philadelphia, he operates flu vaccine clinics four days a week, half an hour in the morning and half an hour in the afternoon, starting in mid-September and continuing until all his patients who want the shots are immunized.

Parents make appointments to bring their children in just for flu shots. Because babies and children under 9 who are getting the vaccine for the first time require two doses a month apart, the first dose often is given as part of a routine visit, Nelson says, but some patients get both doses during the clinic sessions.

Nelson figures the whole visit takes less than five minutes a patient. It adds up: Last year, he gave 2,165 flu shots to his young patients, and he has given more than 1,200 so far this year.

He decided to encourage flu vaccine for all his patients about eight years ago. ''I started listening to parents,'' he says. ''They said their kids who got flu shots each year were about the healthiest kids in their families.''

Under current CDC recommendations, flu vaccine is fully recommended only for children age 6 months and older who have heart or lung disorders or chronic diseases such as diabetes, kidney dysfunction or suppressed immune systems. The vaccinations are ''encouraged'' for healthy children 6 months to 23 months old.

The Advisory Committee on Immunization Practices, which makes policy recommendations on vaccines to the CDC, debated for months whether moving to a full recommendation for annual flu shots for healthy babies would place too much of a burden on pediatricians. Panel members decided to go ahead after reviewing safety data and studies that show babies suffer severe illness from flu.

But years earlier, Nelson conducted his own mini clinical trial to see whether flu vaccine would make any difference in his patients' overall health. With the consent of parents, he gave flu shots to 200 children who had recurring ear infections the previous year and monitored them the next winter. ''The results were phenomenal,'' he says.

He saw a drop in ear infections and antibiotic use, even though the vaccine offers protection only against influenza viruses. ''My feeling is that if you reduce the number of respiratory infections, flu being one, you reduce the number of secondary infections of the ears and sinuses,'' Nelson says.

The change recommended by the advisory committee won't take effect until next year, giving doctors a chance to prepare. The new system represents a ''big change,'' says Samuel Katz, a professor at Duke University Medical Center in Durham, N.C. Pediatricians usually schedule patients for routine immunizations by age rather than by season, he says, and getting all their patients into the office during a three-month window when flu vaccine is available could be tricky. Getting many of them in a second time for the second dose could mean extra staff, paperwork and costs.

And, he says, adding another vaccine to the already crowded immunization schedule will require educating parents. ''There may be anxiety on the part of parents, who say, 'look, you're already giving my kid 20 vaccines and now you want him to get another?' '' Katz says. But, he adds, ''I don't think there is any doubt in the minds of people who have looked at it'' that there is good reason to immunize babies against flu.

For one thing, it's more common in the very young than most people realize, says pediatrician Margaret Rennels of the University of Maryland. ''Probably in most years, 15% of children under 5 get flu,'' she says.

In a paper published last December by the American Academy of Pediatrics, Rennels and co-authors wrote that it has only recently been understood that the risk of flu-related hospitalizations is as high for healthy young children as it is for people in ''high-risk'' groups, including the chronically ill and elderly. Flu is a factor in middle ear infections, and its complications lead to a 10% to 30% jump in antibiotic use during flu season.

And when children do get the flu, studies say, they spread it around more efficiently than adults do, infecting parents, grandparents and siblings. That can put the tiniest babies in jeopardy.

''Unfortunately, the highest hospitalization rates are in babies under 6 months of age, and there is no vaccine for them,'' Rennels says. ''The best way to protect those kids is to vaccinate other kids in the house, or the mother during late pregnancy.''

Still, some doctors don't encourage parents of babies to get the vaccine. Adrienne Dever of Brookhaven, Pa., mother of 1-year-old Richard, said her pediatrician ''said it wasn't necessary because (the baby) hasn't had a history of respiratory problems.'' He also said it was expensive and might not be covered by insurance.

Nelson says most private insurers cover the vaccine, which costs $10 to $15 a dose, and the federal Vaccines for Children program covers children who are poor, uninsured or underinsured. Giving shots at his daily flu clinics keeps costs to the bare minimum, he says. Besides, he says, the extra effort it takes to make sure his patients are ready for flu season is well worth it.

''I always figure in pediatrics, it comes down to it being your job to help your patients to stay healthy.''

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© Copyright 2003 USA TODAY, a division of Gannett Co. Inc.

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