Children and adolescents

Of all age groups, children are among the most susceptible to succumbing to seasonal influenza infection, especially during the initial stages of the influenza season.12,13 Therefore, vaccination is currently recommended in children aged as young as 6 months. 

In spite of this recommendation, however, influenza vaccination rates in the pediatric population remain low; in the state of Washington, for example, only 58.3% of children received an influenza vaccine in the 2012-2013 season.13 Of the studies that explore theories explaining the suboptimal vaccination rate in children, most agree that parents play the largest role in determining whether their offspring will be vaccinated against the influenza virus.7 Among parents who vaccinate their children each year, common reasons influencing their decision include recommendation by their child’s healthcare provider to get the vaccine each year, their belief that the vaccine will prevent acquisition of influenza virus, and their understanding that if their children do end up contracting influenza, the symptoms will not be as severe if their children have been vaccinated.7,14

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Common reasons why parents decide not to vaccinate their children against influenza include the belief that children should acquire a natural immunity to influenza, that the vaccine can cause influenza, and that receiving multiple vaccines during one visit to the doctor may harm the child.7,14 Additional reasons include the belief that children have a low chance of contracting influenza, that the vaccine can cause unwanted side effects, such as a runny nose and muscle aches, and that some components of the vaccine may be toxic (Table 4).7,14

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Although their parents play a large role in deciding whether or not they get vaccinated against influenza, children may also have substantial influence on the overall decision to get vaccinated. Therefore, clinicians should also understand some of the common perceptions children have about the influenza vaccine. One study comparing the different opinions children have regarding the vaccine found that, in general, children younger in age (6-8 years) are less likely to agree to get vaccinated as compared with older children. Reasons for the greater opposition to vaccination include the severity of pain that comes with getting the shot and a general lack of understanding of the benefits that come with getting the influenza vaccine.6 For those who did receive the vaccine, common reasons why they thought influenza vaccines were helpful included the belief that vaccination prevents influenza, that vaccination can lower the chance of acquiring influenza, and that vaccination can help them avoid missing school, which would allow them to spend more time with friends.5,12 Furthermore, these studies also observed that children may carry a particular bias against the different methods of vaccine delivery; most children, especially those of younger age, tended to prefer the intranasal route of vaccination, primarily to avoid any pain associated with the shot.5,12

Interestingly, many of the perceptions both adolescents and their guardians have regarding the influenza vaccine are similar to those expressed in the younger age group. In the same study previously noted, some of the most common reasons why either the adolescent or the parent refused the influenza vaccine included the belief that the adolescent did not need the vaccine, the vaccine is ineffective and may even cause influenza, the vaccine can cause unwanted side effects, and the adolescent’s natural immunologic response is enough, or even preferred, to fight an influenza virus infection.15,16 Of note, if the adolescent had a minor illness, almost 25% of parents surveyed refused the option of giving their child the vaccine, primarily due to the belief that the vaccine would not work as effectively because the child was sick and the fear that the child’s immune system would be overwhelmed if given a vaccine while fighting an illness, therefore causing unwanted and potentially more severe side effects (Table 5).15

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Consent from parents or guardians is no longer an issue for individuals aged 18 years and older. Despite the relatively recent shift in the recommendation to provide annual influenza vaccines to healthy adults aged 18 to 49 years, there still remains a lag in the number of young adults who actually get the vaccine yearly.17 One study observing how proactive college students are in getting their yearly influenza vaccine found that a suboptimal percentage of students reported obtaining their vaccination, even when such shots were made readily available on campus. Theories explaining the lack of participation include nonacceptance of the insurance coverage provided to students by their parents or guardians at some vaccination venues or that the students may not be able to afford the cost of the shot.17 General indifference was also reported as a significant reason for not getting vaccinated, as well as not knowing where to obtain the vaccine, either on campus or in the community.17