Influenza has been called “the last great plague of humankind” because it still poses a serious health threat to our nation and the world. If a naturally occurring variant of a bird flu virus acquired the ability to replicate in the trachea and nose of humans, it would cause a pandemic, with consequences as potentially devastating as the 1918 flu, which killed 50 million people. Because influenza viruses are found in birds and many mammalian species, it will not be possible, as it was for smallpox, to wipe influenza from the face of the earth. The only way to control it is through adequate immunization programs.

In the past, public health officials have focused on immunizing the elderly, who are at greatest risk for severe illness and death from influenza. Yet the most effective way to protect the elderly, and everyone else, is to target kids. Computer-modeling studies suggest that immunizing 20 percent of children in a community is more effective at protecting those older than 65 than immunizing 90 percent of the elderly. Another study suggests that immunizing 70 percent of schoolchildren may protect an entire community (including the elderly) from flu. Schools are virus exchange systems, and children are “super-spreaders”—they “shed” more of the virus for longer periods than adults.

Perhaps the best example of the effectiveness of childhood vaccination comes from Japan. The 1957 flu pandemic prompted the Japanese to start a school-located childhood vaccination program. For at least 10 years vaccination against influenza was mandatory for all children. Excess deaths from influenza and pneumonia, a common complication, fell by half. (Death from all causes dropped, suggesting that the illness is underdiagnosed.) The study showed that for every 420 schoolchildren immunized, one life was saved, predominantly among the elderly. Once the program ended, immunization rates fell, and death rates rose dramatically over the next few years.

Mandating flu immunization for children in schools is a nonstarter in the U.S. Still, it is possible to achieve high immunization rates through voluntary community programs centered on schools. In Alachua County, Florida, the home of the University of Florida, a school-located influenza vaccination program has been in full operation since 2009. Implemented as a coalition of schools, health departments and community advocates and with the expert advice of my colleagues Parker A. Small, Jr., and J. Glenn Morris, Jr., of the University of Florida, the program administers FluMist nasal spray, a live attenuated vaccine, free of charge to students, from pre-K to 12th grade, in public and private schools regardless of insurance status. Immunization rates of elementary students have reached 65 percent—enough to reduce the incidence of influenza in Alachua County during the past two flu seasons to nearly zero.

Such a program administered in schools across the country would raise the overall immunization level, protect our communities, and provide a basis for rapidly immunizing the U.S. population against the next pandemic strain or even against a bioterrorist attack. It would save lives and money. Seasonal flu kills 36,000 people every year in the U.S. and costs more than $10 billion. The average family of four loses about $100 in wages.

School-wide vaccinations would require a big conceptual change in immunization strategies, involving schools, communities, pediatricians and health departments. Who will fund and lead such an effort? Probably not the states, which are cutting back on public health. The federal government is grappling with rising health care costs. The health insurance industry, which stands to save billions each year in reimbursements, is the logical choice, but so far it has been unwilling to take the lead. Someone will have to.

SCIENTIFIC AMERICAN ONLINE
Comment on this article at ScientificAmerican.com/oct2012

This article was originally published with the title Target the Super-Spreaders.

11 Comments

1. 1. alan6302 08:16 AM 10/2/12

   take tour meds.......sheeple
   

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2. 2. Rock LeBateau 08:38 AM 10/2/12

   What a pity you don't have a national health service like the brits. In the UK, if the minister of health decides that all kids need vaccinating against flu he(orshe) gives the order, and then it happens. It just works.

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3. 3. G. Karst 10:56 AM 10/2/12

   I never had so many colds and flu(s) as when I had three young rug rats under foot. Seems logical to target this vector. GK

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4. 4. sbscienceny 11:02 AM 10/2/12

   Maybe Kathleen Ryan should read the flu studies from Canada before suggesting mandatory flu shots. The Canadian studies have shown that a weak antibody reaction to the flu vaccine could make someone abnormally react to the flu virus. Not to mention seizures and other side effects in children. When are we going to stop using our children as shields to protect others from infectious diseases? It is highly unethical. Of course, it is good business for pharma, and they can always find a willing doctor to spout their nonsense.
   

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5. 5. Murxus 01:48 PM 10/2/12

   Fear mongering at it's best:
   
   Situation in Germany - influenca death has to be officially registered - between 1998 - 2007 there were between 3 and 34 confirmed death due to influenca, non-confirmed 63 to 330 (Austria '98-'07 6-104, Switzerland '98-'06 8-129).
   
   Still AG Influenca (a German organization to increase influenca awareness... funded by the big vaccince pharma) claims 15.000 death pA!
   How do they get to that number?
   Because they claim every death by pneunomia is a non-registered influenca death. So an HIV or cancer victim in his last days catches an infection and dies becomes an influenca death.
   Why do they do it? Money! BIG money that is...

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6. 6. Fanandala in reply to vapur 02:52 PM 10/2/12

   I will remind you when you are suffering from it. No meds for you.

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7. 7. vapur in reply to Fanandala 05:54 PM 10/2/12

   Who are you responding to? If I commented here, it was deleted because there is no room for disagreement with the intentions of Pharma.

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8. 8. vapur 05:59 PM 10/2/12

   Oh, that's right ... it had to do with not having faith in the bodies God gave us to fight off infection, instead relying on the questionable intentions of Pharma being involved with sterilization. I think using the example of Bayer being conscripted to create Zyklon B for population control was too offensive of a truth.

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9. 9. Daniel35 06:21 PM 10/2/12

   So 50 million might be killed by bird flu, probably over 6 - 12 months or more. How long would it take normal population increase to cancel that? I doubt numbers would even drop.

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10. 10. L McCall 07:39 PM 10/2/12

    Cochrane collaboration meta-analysis showed that flu shots only benefit the elderly in nursing homes, and then only slightly. Any other citation is data-mining.

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11. 11. Murxus in reply to Fanandala 02:06 PM 10/3/12

    There are enough meds against ACUTE influenca infections.
    Yearly 'global' vaccinations against an illness with this small lethality is like putting halon fire suppression systems in all cars and trucks because sometimes someone dies from in a burning car - the cost/benefit ratio is horrible - not even considering negative sideeffects of the 'solution'.
    
    The influenca agenda is driven by misleading data - claiming that everyone above 60 that died of some kind of lung infection is an influenca death is like claiming an old car broke down because it hadn't a recent oil change.
    
    Do you really believe a virus has a time schedule on his mutation? A yearly one?

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