Back-to-school in 2020 looks quite different from previous years, but what hasn’t changed is the annual need for the seasonal flu vaccine. And while experts discuss and sometimes bicker over the role children can play in spreading COVID-19, there’s no doubt that they can pick up the influenza virus and spread it to others at home and in the community.

Influenza is highly contagious. It's spread through droplets in the air from coughing, sneezing or even talking – much like COVID-19. Depending on the year, between 3% and 11% of people in the United States contract the flu. The Centers for Disease Control and Prevention estimate that every year, between 12,000 to 61,000 people die from influenza.

What can make this year's influenza season more difficult is the similarity of many symptoms between COVID-19 and the flu. "Parents should definitely get their child vaccinated against the flu this season," Ashanti Woods, MD, told Medical Daily. "The influenza virus shares many characteristics and symptoms with COVID-19. These symptoms include fever, fatigue, shortness of breath, cough, and other vague upper respiratory symptoms. Both viruses also can cause gastrointestinal symptoms as well. If children are vaccinated against the flu, we hope that fewer children will become infected by the flu, and can potentially minimize any confusion should a child become ill (in determining whether this is the flu or COVID-19)." Dr. Woods is a pediatrician at Mercy Medical Center in Baltimore.

School Vaccine Programs Increase Compliance

Experts believe that children are responsible for a good portion of the influenza spread so, aside from keeping children healthy, immunizing them from the flu can help keep the community healthier. The authors of a study published in PLOS Medicine wrote that if at least 80% of children were vaccinated, it would have a positive effect throughout the community. But to have vaccination compliance, it was important to have them available in the schools.

The study looked at the 4-year history of city-wide vaccination programs that were provided in at least 95 preschools and elementary schools in Oakland, California. They compared vaccination rates with schools that did not have such programs, as well as how many children were absent from school because of the flu and how many were hospitalized. The schools were located in diverse, urban and primarily lower income parts of the city.

The researchers found that the first 2 years of the program didn’t show much difference between the schools with vaccination programs and those without, but by the third and fourth years, the schools with the programs saw not only an increase in vaccinations of 7% to 11%, but there were fewer missed days of school. In addition, there were 17 fewer hospitalizations for every 100,000 people among everyone in the community, not just the children. And among people 65 years and older, there were 160 fewer influenza-related hospitalizations for every 100,000 people. “A city-wide [school-located influenza vaccination] intervention was associated with increased influenza vaccination coverage, decreased illness-specific school absences among students, and lower influenza transmission community-wide, suggesting that the intervention may have produced herd effects,” the authors concluded.

"Where children typically have less severe consequences from both the flu and COVID-19, the fact still remains that children can pass either virus to those helping taking care of them whether it be their parents or elderly grandparents," Dr. Woods pointed out. "Also because of our new environment, and families having to perhaps shift around due to the financial impact of COVID on the country, one could argue that a child positive for the flu or COVID-19 poses more of a risk now that more family members are inside the household."

The Take-Away

Some parents may feel that the extra precautions taken to prevent infection from COVID-19 might be sufficient to prevent the flu too. So why bother with the vaccine? "We hope that parents are correct in their assumption that fewer kids will indeed become ill due to increased hygiene precautions taking place. However, because we are dealing with children, a population who is not 100% guaranteed to follow hygiene techniques, we can anticipate that there will still be passage of the flu," Dr. Woods said. "Also, while a child may wear his or her mask at school, he or she is not necessarily wearing their mask when engaging in play or sports activities with their friends, opening the possibility of becoming infected by the influenza virus. The point is there will still be risks for infection."