Flu shots for children may be hard to get

Flu vaccine is plentiful this year, but that doesn't mean it will be easy to get at your pediatrician's office.

For the first time, the government is recommending that all children aged 6 months and up get the vaccine. But the recommendation to vaccinate an extra 30 million kids came after many pediatricians had ordered their supply for this fall. Some fear they may not have enough to meet demand.

"I am absolutely sure that I'm going to run out of flu vaccine in my office before I can vaccinate everybody who wants to be vaccinated," said Susan Kressly, a Warrington pediatrician. Her two-physician practice has enough vaccine for about half of its 2,000 patients.

Even if doctors have enough, the logistics of getting vaccine to every child in a pediatric practice are daunting - in part, doctors said, because insurance reimbursement rates barely cover the cost. Communities ultimately may have to think of other ways to increase immunization rates, such as giving shots at schools.

"Our problem's not getting enough flu vaccine," said Curt Parnes, a doctor with Abington Pediatric Associates, a practice with about 17,000 patients at two locations. He already has ordered extra vaccine more than once. "Our problem is getting enough staff to give it to everybody," he said.

Parnes said the new recommendation was "scientifically smart and worthwhile" but added: "We'll never be able to get all our kids. We would never physically be able to do it ourselves."

The U.S. Centers for Disease Control expects that manufacturers will produce 143 million to 146 million doses of flu vaccine this year, up from 140 million last year. In all, it recommends that 261 million people get the vaccine, including those over 50 and people with chronic illnesses.

Before the new recommendation, the CDC said about 40 million children should get flu shots or FluMist, a vaccine delivered by nasal spray. The new recommendation added 30 million.

"We know all 30 million of those kids are not going to be vaccinated," said Curtis Allen, a CDC spokesman. Less than 25 per cent of children aged 6 to 23 months, who already had been on the recommended list, were getting the vaccine.

Doctors said they had been able to order more FluMist this year, and manufacturer Sanofi Pasteur said some vaccine still was available.

Vaccines also may be available at grocery or drug stores or retail clinics such as MinuteClinic. Parents will want to check the ages covered by these alternatives and whether they are covered by insurance. Middle and high school students in the Lower Merion School District can get FluMist at school for $35.

Joseph Bocchini, a Louisiana State University pediatrician who heads the American Academy of Pediatrics committee on infectious diseases, said the new recommendation would not fully go into effect until next flu season. Doctors this year are expected to do the best they can.

The recommendation, he said, is based on the idea that children get the flu most often and spread it to everyone else. Vaccinating them could reduce both school absenteeism and the number of days workdays parents have to miss. Most importantly, it protects the elderly, who are especially vulnerable to flu complications and are not protected as well by flu shots as younger people because they have weaker immune systems.

Jonathan Temte - a family-medicine doctor at the University of Wisconsin and a member of the Advisory Committee on Immunization Practices, which made the new recommendation - said immunizing even 40 to 50 percent of children could have "very dramatic effects" on flu-transmission rates.

Allen said the CDC realized it would be challenging for pediatricians to immunize all their patients each fall. Unlike practices that cater to older patients, many pediatricians are not accustomed to a big influx of flu-shot seekers each year. Many children get school physicals before fall, when the flu vaccine arrives. Adolescents tend to show up only when they are sick.

Some area doctors say they are trying to reach more patients by scheduling flu clinics on weekends or in the evening. That can be a burden because doctors have to pay staff overtime even though they make very little money on the shots. "It's difficult financially to pay the staff based on what we are getting in payment from insurers," Parnes said.

Demand for the vaccine has been strong, doctors said, though it is well below 100 percent. In Pennsylvania, for example, the Vaccines for Children program, which provides vaccine for children on Medicaid or without insurance, already has ordered an additional 30,000 doses to augment its original order of 300,510 doses.

Steven Shapiro, a pediatrician in East Norriton whose practice has 9,000 patients, said his group, Pediatric Medical Associates, gave about 1,000 shots last year. It ordered 10 to 15 percent more vaccine this year, and "so far so good." Doctors tell all the parents about vaccination, but don't insist.

The important thing about the recommendation is that it forces doctors to put new systems in place that will make them better prepared for a flu pandemic, Shapiro said.

Mark Reuben, whose practice in Reading has 28,000 patients, believes his group may go from vaccinating a quarter of patients to a third this year. The group is efficient enough that it has given 1,000 doses on a Saturday. Reuben said he had enough staff to offer only one flu-shot clinic a month.

Kressly said doctors did not want to get stuck with unused vaccine in the spring because they could not return it if patients didn't want it. "Everybody is wary of over-ordering," she said.