Over the last decade, pediatric vaccination against influenza increasingly has become part of national immunization policies. In the US, pediatric influenza vaccination was included in the national immunization program for children aged 6 to 23 mo in 2004, expanded to all children aged six to 59 mo of age in 2006, and then finally up to 18 y In Ontario, Canada, a universal influenza immunization program was set up in 2000, while in Taiwan, influenza vaccination policy targeted children aged 6 to 23 mo in 2004, followed by a school-based program in 2007. In Finland, influenza vaccination for children aged 6 to 35 mo has been fully subsidized since 2007. In Mexico, a pediatric influenza vaccination program was implemented gradually between 2004 and 2006 for populations aged up to 35 mo, and lastly a recent decision has been made in Columbia to vaccinate children under 2 y old.
Health authorities’ decisions to implement such pediatric vaccination programs are based upon several factors including an estimation of the potential economic and public health benefits for vaccinated children as well as for other community members.1
The individual burden of influenza in children is not limited to the viral infection itself but is also linked to complications of the illness, such as otitis media, pneumonia and exacerbation of pulmonary diseases such as bronchitis and asthma, which frequently develop in very young children.2,3
Children also contribute significantly to virus transmission4-6
since the contact patterns of children tend to be inter-generational7
they tend to act as a “backbone of transmission” in the family and, consequently, in the general population.8
Vaccination is the most effective measure for preventing influenza. The results of both empirical and modeling studies have shown that pediatric vaccination programs in school and day-care settings can reduce the influenza attack rate in families of vaccinated children and in the community,4,9
and that vaccination of 50% to 70% of children could help in containing annual influenza epidemics.10-12
Health economic evaluations conducted previously have found influenza vaccination programs targeting children to be at the least cost-effective and very often cost-saving, due to disease prevention, particularly when impact on transmission had been considered.8,13
Argentina was one of the countries in South America most affected by the 2009 pandemic of A/H1N1 virus (pH1N1), with cases seen as early as May 2009. The A/H1N1 2009 disease burden exerted a substantial impact on the operational capacities of local health care systems. School-aged children in Buenos Aires and surrounding areas were affected first, with high rates of transmission. Later, other populations (mainly young adults, pregnant women and young children) were affected, and the infection spread to the general population of the metropolitan area, the Province of Buenos Aires and the rest of the country. A recent study in Argentina showed that death rate due to influenza for children during the pandemic was ten times higher than during previous influenza seasons.14
By early 2010, six months after the start of the pandemic spread, more than 1.4 million cases of influenza-like illness had been officially reported.15
Before the 2009 A/H1N1 pandemic, seasonal influenza vaccination was recommended and funded for Argentineans from six months of age having chronic comorbidities and the elderly population aged 65 y and over.2,16
During the pandemic, the Argentinean Ministry of Health recommended influenza vaccination for all children less than five years of age. It has been demonstrated that improved public awareness and strong recommendations are key to increasing vaccination coverage rates.17
Accordingly, in 2010, Argentinean vaccination against influenza is expected to increase due to greater awareness generated by the recent pandemic.
The objective of the present study was to show if the recent routine vaccination for children from 6 to 23 mo is cost-effective and to evaluate the public health and economic impact of allocating public funds to broader pediatric groups in Argentina, taking into consideration the reduction of the transmission from children to the general population.