Flu Prevention in Children With Special Needs: A Call to Action

Georgina Peacock, MD, MPH


October 07, 2013

Editorial Collaboration

Medscape &

This feature requires the newest version of Flash. You can download it here.

Hello. I am Dr. Georgina Peacock, a developmental-behavioral pediatrician with CDC's National Center on Birth Defects and Developmental Disabilities. I am pleased to speak to you as part of the CDC Expert Commentary Series on Medscape.

My message is a simple one and just in time for flu season. Although CDC recommends yearly vaccination of all children 6 months and older (with very rare exceptions), we especially encourage parents and caregivers of children with special needs to have their children vaccinated against the flu every year. Furthermore, when special needs children show flu-like symptoms, they need treatment with the influenza antiviral drugs oseltamivir or zanamivir as soon as possible.

Today I want to share more information about why these recommendations are especially important for children with special needs, and give some insight into where parents look for information and advice about influenza vaccine. I will also comment on some of the concerns parents have shared about vaccine that may act as barriers to vaccination, and what you can do to help improve the number of children who receive flu vaccinations each year.

We learned much from the 2009 H1N1 pandemic, including that more than 40% of children reported to have died from flu-related causes had an underlying neurologic condition -- the most common 2 conditions being intellectual disability and epilepsy.[1] To give this some context, children with special needs make up a small number of the pediatric population. Recently, CDC released a Morbidity and Mortality Weekly Report,[2] for caregivers and physicians about influenza vaccination practices for use with children who have neurologic and neurodevelopmental conditions. Findings from this report reflect the United States 2011-2012 influenza season and show that only 50% of parents of children with special needs intended to vaccinate their child or had their child vaccinated against flu, in spite of the increased risk for serious complications and death from flu for children in this group. The report also showed that physician awareness about this risk was low. Since 2005, the Advisory Committee on Immunization Practices (ACIP) has included cognitive dysfunction, epilepsy, and other neurologic disorders as high-risk conditions associated with complications from influenza.

We surveyed the parents and healthcare providers of more than 1000 children older than 6 months with conditions that ACIP defines as high-risk to learn more about their influenza knowledge, attitudes, and practices. Healthcare providers were cited by 75% of parents as their source of information about influenza vaccination. As a healthcare provider, you play a vital role in educating these families.

The reasons that parents of children with special needs give for not vaccinating their children against flu are similar to those given by parents of all children and include:

Not being able to get to the doctor or other healthcare provider;

Concerns about vaccine safety; and

Concerns about vaccine effectiveness and adverse reactions if they do get their child vaccinated.

It is part of CDC's mission to help children reach their full potential. As the most cited source of information about influenza vaccination, your voice is important. Join us by encouraging all parents and caregivers, including those who have children with special needs, to have their children vaccinated to prevent flu each and every year. For children who show flu-like symptoms, seek treatment as soon as possible. Even though protection afforded by flu vaccination can vary, it's the best way we have to prevent the flu.

Web Resources

CDC. Influenza vaccination practices of physicians and caregivers of children with neurologic and neurodevelopmental conditions - United States, 2011-12 influenza season.

Key Findings: Influenza vaccination practices of physicians and caregivers of children with neurologic and neurodevelopmental conditions - United States, 2011-12 influenza season.

Letter to Healthcare Providers

Blanton L, Peacock G, Cox C, Jhung M, Finelli L, Moore C. Neurologic disorders among pediatric deaths associated with the 2009 pandemic influenza. Pediatrics. 2012;130:390-396.

Flu and Children with Neurologic Conditions

What You Should Know for the 2013-2014 Influenza Season

Children, the Flu, and the Flu Vaccine

Key Facts About Seasonal Flu Vaccine

Children and Antiviral Drugs

Influenza Antiviral Medications: Summary for Clinicians

Georgina Peacock, MD, MPH, is a developmental-behavioral pediatrician with the Division of Birth Defects and Developmental Disabilities in the Centers for Disease Control and Prevention's National Center on Birth Defects and Developmental Disabilities. Dr. Peacock promotes children's health and development. She is recognized as a developmental disabilities expert and continues to see patients in a developmental clinic at the Good Samaritan Health Center.

Dr. Peacock publishes and presents nationally about the "Learn the Signs. Act Early" program and promotes awareness of developmental milestones and autism among parents, teachers, and healthcare professionals. She also addresses specific public health issues in children, including those with special healthcare needs. In 2009, she co-led CDC's Children's Health Desk for the H1N1 influenza response and has published multiple articles about its effects on children with chronic medical conditions. She currently promotes flu prevention and early treatment for children with neurologic conditions, who are at a higher risk of death and hospitalization from the flu. Dr. Peacock also helps guide CDC's emergency preparedness and response planning for children.

Dr. Peacock received her doctor of medicine and master of public health degrees from the University of Kansas. She is also a former Leadership Education in Neurodevelopmental & Related Disabilities (LEND) trainee who completed her developmental-behavioral pediatrics fellowship at Developmental Disabilities Center at the University of Kansas Medical Center. She initially joined CDC as an Association of University Centers on Disabilities (AUCD) fellow.