Influenza, or the “flu” as it is more commonly called, is one of the major causes of death and illness in the United States (US). Each year, several thousand people in the US are hospitalized due to influenza. During the 2014-2015 flu season, the Centers for Disease Control (CDC) estimated that nearly 710,000 individuals were hospitalized for flu-related illness. Complications due to flu-related illness can lead to death. The CDC estimated that nearly 80,000 people died from influenza and flu-related illness during the winter of 2017-2018 flu season – the highest death toll in 40 years. While healthy, young adults may be able to personally avoid the worst effects of influenza, our youngest and oldest members of society may not be so lucky. In fact, these two groups are the most likely to suffer hospitalization or death related to influenza.

Sickness and death are not the only risks related to influenza. Being sick can be very expensive – in terms of both time and money. Influenza can result in having to take time off from work to care for a sick loved one, a child missing time in school, and medical care for the sick individual. Children who get sick more often, miss more days of school, which makes them more likely to fall behind. Parents with sick children must take time off work or arrange childcare for those children to care for them. These parents also must provide transportation to and from medical care providers. Such associated costs could potentially be reduced through preventive measures.

One of the ways to reduce the chance of contracting the flu as well as reduce the chances of spreading it to others is receiving an annual flu vaccine. And one of the most effective ways to reduce the spread of influenza overall is vaccinating children and adolescents. Groups such as the Advisory Committee on Immunization Practices recommend that everyone over the age of 6-months get vaccinated against the flu, since children are often vectors of disease who can unknowingly spread illnesses to vulnerable populations, such as the elderly. Recent research has suggested that vaccinating 80% of children and adolescents could reduce the total number of influenza-related cases by 91%. This reduction is likely because vaccinating children helps to create herd immunity, thus protecting those who are unable to get vaccines due to weakened immune systems or allergies.

Unfortunately, not everyone gets vaccinated. While influenza vaccinations for children between the ages of 6-months and 4-years have steadily grown, the consistency of getting vaccinated declines as children enter school. This is unfortunate since this period is usually when children begin to interact more often with people outside of their immediate family, which results in a higher risk of exposure to different illnesses. As children approach the teenage years, the rate of vaccination significantly drops. The result: adolescents have the lowest rate of influenza vaccination of any other age group.

Research has shown that there are also significant differences between racial groups when it comes to receiving vaccinations. Among adults, white adults are immunized at higher rates (45%) than black (37%) or Hispanic (34%) adults. This has significant consequences for those populations, as black and Hispanics have higher rates of influenza-related death than white populations. Since unvaccinated children and adolescents may interact more often with older unvaccinated members of these populations, the chances of spreading influenza or other diseases may dramatically increase. Vaccinating the children and adolescents of these groups may provide a buffer of protection for these adults.

These findings have remained relatively consistent over time, even following the passage of major healthcare reform, such as the Affordable Care Act (ACA) in 2010.

A research team led by Dr Noah Webb (2018) examined how vaccination rates have changed for adolescents by racial/ethnic group between 2010 and 2016. While influenza vaccinations increased steadily for all adolescents immediately following the ACA’s passage, these rates peaked in 2014 and have been declining, even when we account for other factors, including sex, health insurance status, socioeconomic status, maternal education level, and region of residence. For most of the study, Hispanic adolescents had higher rates of vaccination coverage; however, that tapered off. And now, white and Hispanic influenza vaccination rates are very similar to each other. More concerning, though, is that after the rates of vaccination peaked in 2014, significant differences between white and black adolescents began to surface. Since black adolescents and adults have consistently worse health profiles than their white and Hispanic counterparts, disparities in influenza vaccinations could further burden the black community as they more strongly feel the economic and health impacts of flu and flu-related illness. Many physicians preferentially recommend influenza vaccinations to the most vulnerable populations, such as the very young and very old, and even groups like the Advisory Committee on Immunization Practices heavily emphasize that the priority should be vaccinating those under 4-years-old and those over 65. Shifting the focus of vaccinations from these populations to teenagers could reduce the impacts of influenza across society because school-aged children and adolescents are more likely to come into contact with members of the more vulnerable populations. Not only could this potentially reduce the number of hospitalizations and deaths associated with flu-related illness, vaccinating school-aged children and adolescents could reduce the economic costs associated with missed work and doctor’s visits.

The featured image is from the Arizona Capitol Times.