Influenza , which is more commonly known as the flu, affects 35 to 50 million Americans each flu season. Children are two to three times more likely to get the flu than adults and schools are excellent places for the flu to spread to other children. In fact, families with school-age children experience more flu outbreaks than other families.

The Centers for Disease Control and Prevention (CDC) recommends the flu vaccine as the single best way to prevent the flu. Parents who cannot easily obtain the traditional injection, or dread the thought of dragging their child in for a yearly shot, may have another option—nasally administered flu vaccine. A study recently published in the January 2004 issue of the Archives of Pediatric and Adolescent Medicine looked at a so-called live-attenuated, trivalent cold-adapted influenza virus vaccine (CAIV-T) in the form of a nasal spray to see if it could effectively protect children from the flu.

About the study

The study was a large field trial conducted in Texas from 1998 through 2001. The objective was to assess if a single dose of CAIV-T administered as a nasal spray would protect healthy children against the strain of influenza A (H1N1) and influenza B that existed during the 2000-2001 influenza epidemic. The main outcome measure was the occurrence of medically attended acute respiratory illness (MAARI). The trial was an open-label, nonrandomized study, meaning that the vaccine was offered to any eligible child and the parent or guardian elected whether or not to have the experimental vaccine.

Over the three years of the study, almost 15,000 CAIV-T doses were administered to 9,765 healthy children. (During the course of the study, children may have received the CAIV-T more than once.) Rates of MAARI in 3,794 children who received CAIV-T were compared to those of children in the same setting who did not receive CAIV-T (9,325 children) and two additional comparison communities who were not offered CAIV-T (16,264 children). Younger children had higher rates of MAARI, so the study participants were divided into three age groups: 1.5 to 4 years, 5 to 9 years, and 10 to 18 years.

The findings

The study revealed that children in all age groups who received CAIV-T were protected from MAARI during the influenza A (H1N1) and B epidemics. Specifically, the risk of developing MAARI in children vaccinated with CAIV-T dropped by 17% to 26% during three years of the study, depending on which comparison groups were used. Based on their findings, the authors conclude that one dose of nasally administered CAIV-T was effective against the strains of influenza virus predominant during that period.

The study did not discuss the types of adverse effects that may be associated with the nasally administered flu vaccine. However, other research has shown that it is generally well tolerated by the vast majority of children. Minor side effects include slight sore throat, low-grade fever and achiness. Even though CAIV-T is made from live viruses that have been rendered non-infectious, the vaccine does not cause influenza. Still, the CAIV-T is not appropriate for all children, and it is important to thoroughly discus the risks and benefits of this and any other vaccine with your child’s physician before making the decision to vaccinate.

How does this affect you?

It is hard to think of a situation more difficult for a parent than a sick child—the coughing, the fever, the aches and pains. In addition to their child being miserable, more than likely, parents of sick children will also experience the flu first-hand. In a survey of 313 school-aged children, the influenza outbreak of 2000-2001 accounted for 22 secondary illnesses in families and 20 days of missed work by parents for every 100 children.

After the flu has hit, there is not much a parent can do for a child aside from providing lots of TLC. While the flu vaccine, in either form, is never going to be 100% effective, parents who choose to vaccinate their children appear now to have two safe and reasonably effective options. And, it’s not hard to guess which one their children are going to prefer.