[The time has come to change the influenza vaccination strategy]

The traditional approach of immunizing defined risk groups for influenza has not achieved the desired results, and the disease incidence remains high. The reasons for this, among others, include the low vaccination coverage and the limited efficacy of the vaccine, particularly among the elderly. Immunizing populations other than risk groups, such as healthy children of kindergarten and school age (2-18 years) would reduce the incidence of morbidity in the general population--in particular those at risk. Children are infected relatively easily and transmit the infection very rapidly to a wide range of contacts at their homes and in the community. In Japan, immunization of school aged children for influenza reduced the incidence of influenza and pneumonia amongst adults. Similar outcomes have been observed with other vaccines, such as the septavalent pneumococcal vaccine administered to infants in the United States, and the introduction of the hepatitis A vaccine into the routine immunization schedule for toddlers in Israel. Those strategies have led to a decrease in the incidence among age groups other than those vaccinated. A policy change of this kind would increase the demand for the vaccines, and would require reorganization and rethinking. Therefore, the authors suggest the use of the nasal live attenuated influenza vaccine, as the ease of use would increase its acceptance.