Could flu vaccines at school keep kids well?

For years, health experts have anguished over how to get the flu vaccine to more children.

Now, some say the answer is to go where the kids are - and vaccinate them at school.

"It's a wonderful way to give flu vaccine to kids," said Dr. James King Jr., of the University of Maryland, who has studied school-based flu clinics in Minnesota and other states. "They're a captive audience."

This weekend, hundreds of families rushed to get flu shots in the Twin Cities following news that two 8-year-olds and a toddler died of influenza amid a recent rash of outbreaks in Minnesota. One clinic, at Children's Hospitals and Clinics in St. Paul, gave 1,545 free flu shots on Saturday, a spokeswoman said.

Not everyone thinks schools should be a site for flu shots because of cost and other drawbacks.

But King, a professor of pediatrics, says that vaccinating kids at school would do more than prevent children from getting the flu. It would also help protect their families and stem the spread of the disease, his research suggests.

"There is more and more evidence that kids are amazing amplifiers of flu," he said.

As parents know, children are germ magnets. They sneeze on each other in class, take the germs home - and infect several generations at once.

So, the theory goes, if you get to the kids in time, everyone may benefit.

Yet few school-age kids, as a rule, get annual flu shots, according to health experts.

Not long ago, the vaccine was mainly recommended for the elderly and chronically ill, who are most likely to die of severe complications, such as pneumonia.

But in the last few years, federal health officials have expanded the number of groups they consider a "high priority" for the flu shot - most recently, children under 5. Today, nearly two-thirds of the population falls into one of the high-risk groups as defined by the U.S. Centers for Disease Control and Prevention (CDC).

Now, debate is flourishing over whether to recommend that virtually everyone get the vaccine, said Patsy Stinchfield, a Minnesota hospital official who serves on the CDC's national advisory committee on immunization policy.

Or, short of that, they may start recommending it for all children (other than those with a medical risk).

"If we say that, then the next question is, OK, where are we going to do that?" said Stinchfield, a nurse practitioner who heads the infectious disease program at Children's Hospitals and Clinics of Minnesota. "They congregate at schools, so maybe that's appropriate."

Some say the task would overwhelm the schools.

"The problem is, for us to gear up in schools for a major deal like this in the fall would be difficult," said Ann Hoxie, a St. Paul school nurse who serves on the state's vaccine advisory panel. "That's a massive effort in a short window of time."

Two years ago, King tested the idea in four U.S. cities, including St. Cloud. More than 2,700 students got a nasal spray flu vaccine at school (with their parents' permission). Then they were compared to a control group that did not.

The results, published in December in the New England Journal of Medicine, showed that vaccinated children - and their families - had fewer flu-like illnesses.

Since then, King said, everywhere he's tried it, "they've begged us to come back."

Last fall, Stearns County offered the flu vaccine to 27,000 students at 76 schools, with the help of a $123,000 federal grant, according to Renee S. Frauendienst, the county's public health director. By December, about 9,000 kids, or a third of the students, had received it.

"It was a huge project for us," she said, and it's too early to know if the students and their families are healthier as a result. But parents seemed to appreciate it. "A lot of comments were, `If you hadn't done this in school we probably would not have had our kid vaccinated,'-" Frauendienst said.

Now school flu-shot clinics are opening around the country, according to King. Just this year, the Maryland health department decided to try to immunize all school-aged children, largely through school clinics, he said.

"It's an excellent idea," said Kris Ehresmann, head of the immunization program for the Minnesota Department of Health. "But we have to think about how we can we make it happen." The schools, she noted, "are already strapped for resources."

Sue Will, a St. Paul school nurse who is president of the National Association of School Nurses, is equally cautious. "There are huge issues of storage, permission signing, vaccine availability and I think funding as well," she said.

Parents also may balk at the idea. Some refuse to vaccinate their children because flu shots can contain thimerosal, a preservative that is half mercury.

But Nancy Schult of Cottage Grove, who watched her two children get flu shots Saturday, called it "a great idea." The schools, she said, "would be a great way to reach a lot of kids."

Joe Lastinger, who lost a daughter to the flu, says he favors any way to get more children vaccinated. Lastinger, of Ft. Worth, Texas, is a member of Families Fighting Flu, a small group with a single mission: to spread the word that the vaccine can be a life-saver.

His daughter, Emily, died just five days after developing a fever and cough in 2004. Her parents never suspected the flu would turn lethal. She developed pneumonia, and died at age 3.

"We always come back to the single thing we could have done differently," Lastinger said. "We could have had her vaccinated."

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Maura Lerner - 612-673-7384 mlerner@startribune.com

Josephine Marcotty - 612-673-7394 marcotty@startribune.com

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FIND FLU CLINICS

The Minnesota Department of Health has an Internet flu shot finder, which lets you type in a ZIP code and find places offering vaccines. It is located at www.mdhflu.com.