Spanish pediatricians are urging expanded flu vaccination efforts, citing children’s notable role in transmitting the virus-ofen without displaying severe symptoms themselves. The Spanish Association of Pediatrics (AEP) is advocating for publicly funded vaccinations for all individuals up to age 17, arguing that increased coverage is critical to protecting both young people and the wider community from the possibly serious complications of influenza. the call comes as health officials continue to address the ongoing impact of respiratory viruses, including a recent decrease in bronchiolitis cases following the approval of a new treatment for RSV.
Children are not immune to the flu, and in fact, can spread the virus more easily and for a longer duration than adults, even after their symptoms have subsided. Pediatricians are emphasizing the importance of vaccination and advocating for publicly funded flu shots for all individuals up to age 17. This highlights the critical role children play in the transmission of influenza and the need for preventative measures to protect both them and the wider community.
Children as Key Spreaders
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The Spanish Association of Pediatrics (AEP) asserts that children are the age group most affected by the flu and are a “fundamental factor in the chain of transmission” of the disease, serving as its primary vector.
Francisco Álvarez, coordinator of the AEP’s vaccine advisory committee, explained that while there are differences between the flu in children and adults, the potential for contagion is a significant one. “There’s an important characteristic: children spread the virus more than adults, meaning they shed much higher viral loads through the respiratory system compared to an adult,” Álvarez noted.
Children with the flu can be contagious up to six days before symptoms appear, whereas adults typically become contagious about a day before symptom onset. Furthermore, even after recovery, children continue to shed the virus for up to two weeks, while adults generally stop shedding after four or five days. “This is a key difference,” Álvarez explained, “and why the AEP wants to prevent the flu in children, not only to protect them but also to prevent them from infecting others.”
Complications in Children
Álvarez also pointed out that half of the children hospitalized with flu complications are otherwise healthy, with no underlying medical conditions or risk factors. “This doesn’t typically occur in adults until age 60-65, when a previously healthy individual might experience severe complications,” he added, explaining that the virus tends to be more aggressive in children.
Prior to the inclusion of the flu vaccine in the standard vaccination schedule for children aged 6 months to 59 months, there were approximately 4,000 hospitalizations, 800 severe cases, 250 intensive care unit admissions, and 8 deaths due to flu complications in children under 5, according to Álvarez. Expanding this coverage to include adolescents could significantly reduce these numbers. “If we look at the adolescent age group, that number of deaths increases to between 10 and 20 each year. It’s a problem we need to prevent because we have a highly effective and safe vaccine,” he asserted.
Symptoms
The symptoms of the flu in children are similar to those in adults. Initially, it can be difficult to distinguish from other viral infections, as other viruses like rotavirus or respiratory syncytial virus (RSV) are also circulating at the same time.
Álvarez noted a recent positive development regarding RSV, stating that with the approval of a monoclonal antibody for infants under 6 months, cases of bronchiolitis have “decreased dramatically.” He added, “It has changed the lives of children and healthcare professionals, because emergency rooms and health centers were previously overwhelmed with children suffering from bronchiolitis.”
Returning to flu symptoms, Álvarez said they include a very high fever, lasting approximately a week, and respiratory symptoms such as mucus, cough, and sore throat. Vomiting and diarrhea can also occur. “And a general feeling of malaise, as if a train has run over you,” Álvarez added with a touch of irony, noting that there is no cure for the flu.
“With treatment, it lasts seven days, and without treatment, a week,” he joked.
The expert stressed the importance of convincing families that the flu is not just a cold with a fever, but can lead to complications and hospitalization.
The Importance of Vaccination
Therefore, the AEP is advocating for expanding the age range for vaccination within the national health system from the current limit of 59 months to 17 years. “The idea is to incorporate it as another routine vaccination, just like we vaccinate against pneumococcus or meningococcus, so that all children are vaccinated against the flu up to age 17 free of charge, because that’s the best way to increase coverage,” he explained.
Following a flu infection, there is a decrease in defenses that can increase the risk of bacterial complications, such as pneumonia or otitis media. “If we vaccinate, we also prevent that bacterial complication, which would require antibiotics, and thus avoid overuse and the development of antibiotic resistance,” he highlighted.
In the first year of the pediatric flu vaccination campaign, the vaccination rate was “disappointing,” with an average of 36%. In the second year, the rate rose to 45%, with some autonomous communities reaching 65%. The AEP would like to see coverage between 6 and 59 months reach 75% in the current campaign.
Injection and Nasal Spray
There are two types of vaccines available: an injection, for children up to two years of age, and a nasal spray, for those up to 59 months.
Álvarez reflected that one of the challenges is that many families don’t take the flu seriously, whereas they are more concerned about RSV, which is reflected in a much higher immunization rate of over 90%.
Furthermore, he noted that the flu vaccine is often perceived as ineffective, “which is untrue, as it has a very good effectiveness rate, between 60 and 70%.”
“What do we need to do? Public health campaigns to educate people that the flu is not just a cold with a fever, and to ensure accessibility, meaning making it easy for parents to take their children to get vaccinated without having to ask for time off work. If we can achieve those two things, vaccination rates will increase,” said the AEP member.
