MADELEINE BRAND, host:
This is Day to Day. I'm Madeleine Brand.
ALEX CHADWICK, host:
I'm Alex Chadwick. Every child between the ages of six months and 18 years should get a flu shot every year. This is according to the committee that helps decide these things for the Centers for Disease Control. Some people consider that a pretty radical recommendation. Here to help us think about it is our resident pediatrician Dr. Sydney Spiesel. He's also a professor at Yale Medical School, and he comes to us through the online magazine Slate. Syd, welcome back.
Dr. SYDNEY SPIESEL (Pediatrics, Yale Medical School): Thank you, like to be here.
CHADWICK: So every child between six months and 18 years, an annual flu shot? That's a lot of kids, a lot of shots.
Dr. SPIESEL: It sure is a lot of kids and a lot of shots. People estimate that it will add 30 million shots a year to the total number of flu shots needed. And that is a huge number, and it's going to have consequences because there are problems of manufacturing that much flu vaccine. As we know, it's hard to distribute. It's hard to give.
CHADWICK: What's the rationale, then, for this decision really radically expanding what you would deliver for kids - decision by this CDC advisory committee?
Dr. SPIESEL: It's the kids who are the spreaders of flu.
Dr. SPIESEL: And so if you immunize the kids, even up to 18, you're going to have a much lower rate of infection of other people, including middle-age people who are ill, elderly people who are at great risks for the complications of flu. So it's going to cut down from an epidemiological standpoint. It's going to have great benefit for the whole community.
CHADWICK: Does an epidemiologist also have to think about that manufacturing process, and what are the answers there?
Dr. SPIESEL: Well, they certainly have to think about it a lot, and this committee is called the ACIP - has surely talked to manufacturers, and found that it was possible for them to do. The flu vaccine is grown, actually, in fertile chicken eggs, and I guess they're going to be talking to the chicken farmers about cranking up the production of fertile eggs just for this purpose.
CHADWICK: And then all those injections are going to have to go through schools, aren't they?
Dr. SPIESEL: Well, we don't know where it's going to go. I mean, traditionally the shots mostly go through offices. Sometimes there's been increasing probability that shots are going to be given even in pharmacies or in these big box stores. And now one person - it's been proposed that the flu shot may be shifted to schools. It's not clear that the traditional family practices or pediatric practices are really going to be big enough and fast enough and energetic enough to account for - I'm not exactly happy about having immunizations off loaded someplace else. It's a time when we get to be in contact with kids. We can pick up problems that no pharmacist is going to pick up, and we can just reinforce a relationship, even though sometimes it's sort of unpleasant because the kids are often not happy about getting their shots. So I'm a little bit worried about this sort of off loading. I think it's a serious psychological problem in a way, and I think there's a medical problem too. But I don't know how else they're going to do it. I don't know if the medical system as we have it now is going to be able to accommodate those additional shots.
CHADWICK: Explain the process here for me, could you? This committee has made a recommendation to the CDC. Are we going to see this, what, a year from now? The schools, the doctors are all going to be saying hey, we've changed everything. It's up to age 18. Will it be that quick?
Dr. SPIESEL: Yeah, the answer is that the recommendation is strong that it be started for next year, but it says it must be in place by two years from now.
CHADWICK: And the CDC has said yes to this?
Dr. SPIESEL: Well, this is their recommendation, and the moment that it becomes official is when it's published in a wonderful magazine that the CDC puts out for doctors and epidemiologists, which will come shortly no doubt.
CHADWICK: Well, Syd, if it's kids up to 18 now, when is it going to jump to, hey, we think adults should have this as well?
Dr. SPIESEL: Well, I know some of the players in this business, and I can tell you that the real feeling among epidemiologists is that everybody - that in the ideal world, which we can't have, that everybody ought to have an annual flu shot, that except the people who are strongly allergic to egg components, but everybody else ought to have a flu shot, that it would dramatically change the rate of flu in our community. And the consequences - in some years, in some strains, it's clearly a much more dangerous disease than people - you know, people will sort of casually say oh, it's the flu, but doctors don't always think that way.
CHADWICK: Syd Spiesel, he's a pediatrician and Yale professor. You can read his Medical Examiner column at slate.com, and he's a regular contributor to Day to Day. Syd, thank you again.
Dr. SPIESEL: Thanks, Alex.
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