Mother chooses to skip flu shot for her and son

Then there are groups such as Families Fight Flu working to raise awareness about the possible tragic consequence flu can have in small children.

But like many parents, I don't take the flu as seriously as illnesses such as whooping cough and pneumonia. And if I am going to subject him to another needle - the national immunization schedule recommends U.S. children receive 20 shots in the first year of life - it needs to meet certain criteria.

For starters, it must be worth the wait at the doctor's office, the germs we'll be exposed to, missed work, the stress of listening to his tortured screams that begin in the parking lot, and the physical energy it requires to get his thrashing body into the exam room.

It must be available. We've had shortages or threats of them for at least the past five years. This year the vaccine appears to be plentiful despite the American Academy of Pediatrics' initial warnings of delays and the recall of 500,000 doses headed to low-income children, because the vaccine was found frozen and could be rendered ineffective.

It must be free of the mercury preservative thimerosal, even though there is no official evidence linking the mercury in vaccines to autism. Mercury is a known neurotoxin; why take the chance? Then, I'd like the flu shot to actually work and be safe.

This is where things start to fall apart. Surprisingly, even though the flu vaccine is one of the few immunizations recommended for most of the population, we're still not certain about its efficacy, and only a few large-scale studies have been done on its safety in small children. Scientists have even raised questions about whether U.S. death figures from the flu are accurate because of the confusion between flu and flulike illnesses.

In an analysis and commentary published in last month's British Medical Journal, epidemiologist Tom Jefferson, coordinator of the Cochrane Vaccines Field research facility in Rome, found a large gap between policy and evidence. He questioned whether it's worth the enormous effort it takes to produce flu vaccines specific to each year.

For healthy children ages 6 months through 23 months, vaccines are used to reduce the number of cases, admissions to the hospital, deaths of the elderly in families with children, contacts with health care professionals and antibiotic prescriptions.

But using the gold standard of systematic reviews (studies that sum up existing evidence on a topic), Jefferson consistently found that "inactivated vaccines have little or no effect" on flu campaign objectives, including hospital stay, time off work or death from flu.

In one of the largest reviews, involving several million observations of elderly people worldwide during 96 influenza seasons, the benefits of the vaccines are exaggerated by poor study quality, Jefferson found. And after looking at the evidence on healthy children ages 6 months to 24 months, there was no difference between vaccines and placebo.

Part of the problem is the complexity of the seasonal flu virus. Some years many flu viruses circulate; other years, only a few. Each year, the flu virus changes the way it looks to our immune system, and the effectiveness of a vaccine depends partly on how closely the formulation matches the circulating virus.

Then there is the issue that flulike illnesses often are mistaken for the flu.

"Influenzalike illness is not only indistinguishable from influenza but far more common, leading to unrealistic expectations of influenza vaccine," graduate student Peter Doshi wrote in response to Jefferson's British Medical Journal analysis. Doshi published research in the periodical last year questioning whether the CDC's estimate that 36,000 people die from the flu each year is a public relations ploy to market fear.

"While it is often said that influenza poses a serious burden to health, influenza vaccines impose their own particular burden - to the tune of billions of dollars annually," he wrote.

Julie Deardorf writes for the Chicago Tribune.