The HAS has come out in favor of access for all to the seasonal vaccine from the age of 2 years.
In 2022, no less than twelve European countries, as well as Australia, Canada, the United States and New Zealand, recommended vaccination once morest influenza for healthy children. Will France join them? While the vaccine is currently only recommended for children at risk of developing a serious form due to a pre-existing disease (asthma, congenital heart disease, type 1 diabetes, etc.), the High Authority for Health (HAS ) has just issued a balanced, but positive, opinion in this regard. Independent scientific experts, requested by the Directorate General of Health, recommend making vaccination of all children aged 2 to 17 possible, but not compulsory.
The challenge is plural, explains the HAS. First of all, proportionally more children consult a doctor in town or in the emergency room for this illness than other age groups. This is particularly true of 2-5 year olds, who make up 23% of consultations for flu-like illness in the emergency room, even though they represent only 5% of the population. Beyond the individual benefit for each child, HAS also anticipates collective benefits. If children were less affected by the flu, French pediatrics, in great difficulty, would be relieved of part of its activity. Moreover, we know that children are the first affected by the epidemic and produce much more virus than an adult when they are contaminated; by limiting the number of cases among them, we should reduce the epidemic among those over 65, to whom they can transmit this disease which kills some 8,000 elderly people each year on average. This is at least what two “real life” studies in Japan and the United Kingdom have shown, indicates the HAS.
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The opinion of the sages is advisory, but their conclusions are generally followed by the Ministry of Health, the only one able to register vaccination on the calendar and to validate reimbursement by Social Security. There are 5 influenza vaccines authorized in France, but the HAS advises children to favor Fluenz Tetra, because it is the only nasal spray, more easily acceptable for children, especially if the vaccination is repeated each year. Note, however, that this vaccine is not currently marketed in France. The HAS also emphasizes that all vaccines are generally well tolerated. On the other hand, the question of a decline in their effectiveness over the years, due to repeated injections, is not settled, note the experts.
More hospitalizations before 5 years
For the Pr Emmanuel Grimprel, head of the pediatrics department at the Trousseau hospital in Paris (AP-HP), HAS has maintained a subtle balance by requesting access to flu vaccination for all children, « without recommending it textually ». In question, certain limits specific to vaccines and their context. « Unquestionably, there is an increased risk of hospitalization for influenza in children under 5 years, and particularly among children under 6 months, for which it is recommended that the mother be vaccinated during pregnancy so that she transmits her antibodies », underlines the pediatrician. However, the HAS opinion misses part of the target since it only concerns children from the age of 2, for lack of data on the benefits of vaccines in the youngest, says the report. Also, note the Pr Grimprel, vaccines once morest influenza have in children, as in adults, a variable and overall average efficacy.
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But other data must be taken into account in the risk-benefit balance, continues the pediatrician. Expanding the vaccination target to children might both help reduce health inequalities, « because we know that the underprivileged social classes pay a heavier price for infectious diseases, whatever they are »and also support access to care. « When we see that it is more and more difficult to get an appointment with a doctor, and that by default many families go to the emergency room which is struggling to meet the demand, vaccination prevention clearly has a role to play. Especially since the situation is not regarding to improve. »
