Department of Pediatrics, University Denis Diderot Paris VII, Paris, France.
Hum Vaccin Immunother. 2012 Jan;8(1):107-18. doi: 10.4161/hv.8.1.18278. Epub 2012 Jan 1.
Based on an increasingly extensive literature expressing the large interest in the field, this paper gives an overview of different aspects of influenza prevention in children. It relies on paradoxes. First, the heaviest part of the burden is well demonstrated in the youngest infants by numerous epidemiological data elsewhere. On the contrary, with older children, the prevention by influenza vaccines is more efficacious-without notable side effects. Second, the available TIV vaccines are 60 years old and the requests of registration and regulation of vaccines have evolved. There is a specific need in children: it is time to re-discuss the pragmatic utilization of influenza vaccines (full dose in the youngest patient? More flexibility regarding the interval between the two required doses in vaccine-naïve children), and to change from a compassionate use to a targeted research and adapted vaccines considering the limits of TIV in the youngest children. Third, influenza virus transmission is the highest in children in semi-close communities (day-care centers, schools), diffusing to households and more largely to the population. A restricted policy on high risk groups (roughly 10% in a pediatric population, all medical conditions including asthma, for whom influenza vaccine coverage is a 15-75% range) is far below the estimated threshold of 45% coverage rate to limit the virus circulation by an indirect impact during seasonal epidemics. Fourth, public health decisions in the vaccination field are usually taken from top to bottom. The pandemic A/H1N1 has toughly demonstrated that "forgetting" about the perception and expectations of the public and the parents nearly created conflicts and at least a strong resistance impeding the quality of a program worked on for a long time ahead. Fifth, and not the least, HCPs are pivotal in influenza vaccination mostly trusted by the parents. Too often, they are not backed by a national and clear support and they need to reinforce their knowledge on the disease and the vaccines.
基于越来越多的文献表达了人们对这一领域的浓厚兴趣，本文概述了儿童流感预防的不同方面。它依赖于悖论。首先，大量流行病学数据表明，婴儿期的负担最重。相反，对于年龄较大的儿童，流感疫苗的预防效果更好——且没有明显的副作用。其次，现有的 TIV 疫苗已有 60 年的历史，疫苗注册和监管的要求也在不断发展。儿童有特殊的需求：是时候重新讨论流感疫苗的实际应用（最小的患者使用全剂量？对疫苗初种儿童两剂之间的间隔更灵活），并从同情用药转向有针对性的研究和使用适合儿童的疫苗，考虑到 TIV 在最小儿童中的局限性。第三，在半封闭社区（日托中心、学校）中，儿童流感病毒传播率最高，病毒会扩散到家庭，甚至更广泛地传播到人群中。针对高危人群（在儿科人群中约为 10%，包括哮喘在内的所有医疗条件，流感疫苗覆盖率为 15-75%）的有限政策远低于估计的 45%覆盖率阈值，无法通过间接影响在季节性流行期间限制病毒传播。第四，公共卫生决策通常是自上而下的。大流行 A/H1N1 流感强有力地表明，“忘记”公众和父母的看法和期望，几乎会引发冲突，至少会产生强烈的阻力，阻碍长期以来一直在努力实施的计划的质量。第五，也是不可忽视的一点，卫生保健提供者在流感疫苗接种中起着关键作用，他们是父母最信任的人。他们往往得不到国家和明确的支持，需要加强他们对疾病和疫苗的认识。
