The vaccination of children continues to be a contentious topic. The issue has polarized the public, with the supporters arguing that vaccination is beneficial to children while the critics are focusing on the adverse effects of vaccination. Influenza vaccination is often brought up in the discussions and controversies surrounding vaccination. Influenza vaccination reduces cases of flu, but with the high cases of flu in the 2017-2018 season as seen in the CDC statistics, the question of whether parents were getting their children vaccinated arose. According to the CDC 2017-2018, flu season was classified as ‘high severity’ characterized by increased levels of visits to the outpatient clinic and emergency department = for influenza-like illness (ILI). ILI began in November 2017, reaching its peak in January. 179 pediatric deaths were reported in the 2017-2018 flu season (CDC, 2020). The CDC and other health organizations state that vaccinations are the best intervention for influenza.
Statement of Problem
A person’s health is one of the most critical aspects of their lives. The use of vaccinations plays in that aspect. Influenza is an illness that can range from mild, severe, and death. According to the World Health Organization, influenza epidemics are estimated to result in about 3 to 5 million severe illnesses. Out of the 3 to 5 million cases, about 290,000 to 650,000 resulted in death. (Shi, et al., 2019) Approximately 870,000 preschool students are hospitalized around the whole world due to the influenza virus infection each year. (Flannery, et al., 2017) States are not required to report the number of deaths that result from influenza. The CDC estimates flu deaths by various data that has been collected by using a statistical model. Therefore, the literature suggests that influenza deaths are likely deaths where influenza contributed to death but was not the primary cause. It is said that the majority of the deaths are also caused by a co-bacterial infection like that of pneumonia. (CDC, 2020)
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The increasing ILI cases in 2017-2018 show that influenza is a pediatric health problem that needs to be addressed. ILI was responsible for 179 deaths and increased pediatric hospitalization in 2017-2018. According to Willis et al. (2019), influenza is a common disease in children leading to hospitalization and mortality in severe cases. Approximately 30% of the children, between 6 months and 8 years, are affected by influenza every winter season (Shi et al., 2019). Pediatric influenza mortality in the US is on the rise, which is why the CDC is changing its approach to influenza vaccination.
For years, the influenza vaccine that was administered was the trivalent inactivated vaccine given intramuscularly (IIV3). IIV3 was recently replaced by a trivalent live attenuated influenza vaccine (LAIV3). The CDC suggested the use of quadrivalent inactivated (IIV4) and live attenuated vaccines (LAIV4) for protection against seasonal influenza (Soema et al., 2015). As the number of pediatric influenza deaths increased, the effectiveness of LAIVs was questioned, and it was withdrawn from the list of recommended influenza vaccines.
As the CDC researches on better vaccines against influenza, another challenge is arising. The anti-vaccination sentiment is rising in the US. Many parents are opting not to immunize their children for religious, ideological, and personal reasons (Hussain, Ali, Ahmed & Hussain, 2018). These parents believe that vaccinations are not safe and will cause more health problems for their children.
Background to Research Problem
Scientists agree that vaccination is an effective strategy against influenza-related morbidity and mortality. Annual vaccination is also recommended to protect children against seasonal influenza. As an increasing number of parents continue to oppose immunizing their children, it is necessary to evaluate the detrimental effects of their decision for their children and others (Hussain et al., 2018. The anti-vaccination sentiment is rising due to misinformation about vaccines. Some parents decide not to immunize their children after hearing that vaccines are not effective, only to regret later when their children are seriously ill.
Purpose of the study
The study aims to explore the effects of influenza if left untreated to encourage parents to vaccinate their children. The anti-vaccination sentiment is growing in the US. It is even worsened by parents who publish alarmist reports on the harmful effects of vaccination to misinform others. Consequently, many parents are refusing to immunize their children, claiming that the vaccination will do more harm than good. Many states now allow for vaccination exemptions for religious and ideological beliefs (Hussain et al., 2018). The study will explore the effects of failing to vaccinate children using an influenza vaccine to show the importance of vaccination.
Search History
A detailed search strategy was developed to utilize available electronic databases, including PubMed, Google Scholar, Ebscohost, and CDC website. The literature combines peer-reviewed and primary data on influenza in the US. The search limited the sources of information from 2015-2020. Due to the lack of detailed academic articles on pediatric influenza and vaccination, the search was expanded to include other non-peer reviewed sources. The search strategy combined key terms of “influenza,” “vaccination,” “statistics,” among other terms, through inclusion and exclusion criteria. The research also reviewed books, reputable organizational publications, and ‘grey’ literature on the topic. The review is a critique of 10 sources identified and included in the reference list.
Literature Review
Various research studies have been conducted on the effectiveness of vaccination. The CDC and other health organizations publish the morbidity and mortality cases that stem from the failure to immunize. According to the CDC, the key to helping the flu epidemic is prevention. “Historically, 80% to 85%of pediatric deaths have occurred in unvaccinated children 6 months and older (CDC, 2020). A CDC report on the 2017-2018 flu season found out that out of the 63 confirmed cases of child deaths from the flu, only 56 had health histories. Only 26% had gotten at least one dose of the flu vaccine, while a majority of them died from underlying conditions; the flu made them vulnerable to severe complications causing death.
Influenza-associated deaths for children under the age of 18 became nationally reportable back in 2004. CDC statistics show that there has been an increased amount of deaths over the last decade. (Blanton, et al., 2017) The 2011-2012 season calculated about 37 deaths. Whereas the 2017-2018 season calculated about 185 deaths. (Blanton, et al., 2017) However, as stated previously, these estimations are not accurate due to various reasons stated by the CDC. In contrast, while conducting research, the majority of the data points show a steady increase in deaths due to influenza.
According to Belongia et al. (2015), the risk of contracting other illnesses/complications associated with the flu are higher in children and the elderly. “Children under 5 years old are considered at high risk for serious flu complications, the highest risk is for those younger than 2 years old, with the highest hospitalization and death rates among infants younger than 6 months old.” (CDC, 2020). One of the major complications is contracting pneumonia. Pneumonia is an illness where the lungs become infected and inflamed. One-third of pneumonia cases are developed from respiratory viruses like that of the flu. The CDC stated pneumonia is the “leading infectious cause of death in children younger than 5 years old worldwide.” (CDC, 2020) Some short-term complications include dehydration, sinus problems, and ear infections (Nunes & Madhi, 2018). However, there are several long-term complications. These complications include worsening of respiratory diseases such as asthma and heart disease, brain dysfunction such as encephalopathy, and, as stated above, death.
Currently, there is no influenza vaccine approved by regulators and recommended in any country for use in infants younger than 6 months old. Infants below six months are protected from influenza by maternal antibodies transferred via the placenta during pregnancy and possibly through breastmilk postpartum (Zimmerman et al., 2016). This is a reason why pregnant women are encouraged to be vaccinated against influenza and other diseases that can affect the developing fetus. Pregnant women are given priority for influenza vaccines as per the recommendations of WHO, the CDC, and other national public health organizations.
The fact that there is no single type of vaccination for influenza could play a role in the misinformation about the ineffectiveness of flu vaccine. Influenza vaccines are generally classified as inactivated influenza vaccines (IIV) and live attenuated influenza vaccines (LAIV). Soema et al. (2015) note that there is misinformation regarding the number of times that seasonal influenza should be administered for optimal protection. The public does not understand why children and other vulnerable individuals should receive flu vaccinations annually while they receive other vaccinations once in a lifetime.
Studies on influenza vaccines among high-risk individuals such as children and the elderly continue to show that immunization is the most effective way to prevent influenza. A systematic literature review by Restivo et al. (2018) quantified data on the influenza vaccine effectiveness (VE) among high-risk individuals. Restivo et al. (2018) identified high-risk groups like children, pregnant women, and the elderly. The study concluded that the influenza vaccine is very effective among high-risk groups. Vaccinations are an evidence-based prevention measure to avoid adverse influenza outcomes. The systematic review added that children have the highest burden of influenza during each seasonal outbreak in comparison to pregnant women and the elderly. The meta-analysis also noted that influenza vaccination is effective among children for outpatient visits.
Biblical Integration
The Bible does not talk about vaccination, as it was yet to be invented. However, throughout the Bible, many verses state the importance and need to care for our bodies. 1 Corinthians 6:19-20 states, “Do you not know that your bodies are temples of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you were bought at a price. Therefore, honor God with your bodies.” Human beings must take care of their bodies, especially for young children who are incapable of caring for themselves.
Some individuals who are against vaccinations cite religious reasons. The main argument is that universal vaccines, including influenza vaccine, use live attenuated viruses cultured in aborted fetal cell lines. The argument has merit as Christians are against abortion, and yet again, this belief has led to the deaths of many children due to failure to vaccinate them. The fetal cell origin of vaccines can be traced to the 1960s (Hussain et al., 2018). A US cell biologist, Leonard Hayflick of the Wistar Institute in Philadelphia, partnered with a Swedish scientist to procure fetal tissue from an elective abortion because he thought they were the “cleanest” types to use in vaccines. The abortion cells were used to grow weakened viruses for rubella and rabies vaccine. Since then, researchers do not procure fetal cells from abortion to make vaccines.
Conclusion
Influenza is one of the leading causes of pediatric deaths. Children are at a higher risk, and the presence of other conditions worsens the prognosis. Vaccination is the only effective strategy for preventing influenza, as well as minimizing human-to-human transmission. All studies and available data show the effectiveness of the influenza vaccine in reducing hospitalization, outpatient visits, morbidity, and mortality. All of the sources discussed the importance of prevention and the role it plays in controlling the spread of the illness to the community. Therefore, the articles shined a light on all the dark areas of the disease to bring awareness to the illness. Failure to immunize children and other vulnerable groups against influenza is out of ignorance, and the consequences are dire. Researchers and health organizations are disseminating information on the need for influenza vaccination. This literature review adds to the vast knowledge of the importance of vaccination with the hope of finally putting an end to the anti-vaccine sentiment.
References
Belongia, E. A., Sundaram, M. E., McClure, D. L., Meece, J. K., Ferdinands, J., & VanWormer, J. J. (2015). Waning vaccine protection against influenza A (H3N2) illness in children and older adults during a single season. Vaccine , 33 (1), 246-251.
Blanton, L., Alabi, N., Mustaquim, D., Taylor, C., Kniss, K., Kramer, N., & Flannery, B. (2017). Update: influenza activity in the United States during the 2016–17 season and composition of the 2017–18 influenza vaccine. MMWR. Morbidity and mortality weekly report , 66 (25), 668.
Centers for Disease Control and Prevention. (2020, Feb. 14). Influ enza (Flu). (Retrieved from https://www.cdc.gov/flu/index.htm
Flannery, B., Reynolds, S. B., Blanton, L., Santibanez, T. A., O’Halloran, A., Lu, P. J., & Singleton, J. A. (2017). Influenza vaccine effectiveness against pediatric deaths: 2010– 2014. Pediatrics , 139 (5), e20164244.
Hussain, A., Ali, S., Ahmed, M., & Hussain, S. (2018). The anti-vaccination movement: a regression in modern medicine. Cureus , 10 (7).
Nunes, M. C., & Madhi, S. A. (2018). Prevention of influenza-related illness in young infants by maternal vaccination during pregnancy. F1000Research , 7 .
Shi, T., Nie, Z., Huang, L., Fan, H., Lu, G., Yang, D., & Zhang, D. (2019). Mortality risk factors in children with severe influenza virus infection admitted to the pediatric intensive care unit. Medicine , 98 (35).
Soema, P. C., Kompier, R., Amorij, J. P., & Kersten, G. F. (2015). Current and next generation influenza vaccines: formulation and production strategies. European Journal of Pharmaceutics and Biopharmaceutics , 94 , 251-263.
Willis, G. A., Preen, D. B., Richmond, P. C., Jacoby, P., Effler, P. V., Smith, D. W., ... & Blyth, C. C. (2019). The impact of influenza infection on young children, their family and the health care system. Influenza and other respiratory viruses , 13 (1), 18-27.
Zimmerman, R. K., Nowalk, M. P., Chung, J., Jackson, M. L., Jackson, L. A., Petrie, J. G., & Murthy, K. (2016). 2014–2015 influenza vaccine effectiveness in the United States by vaccine type. Clinical Infectious Diseases , ciw635.
