toddlers against the flu, but they are concerned about costs, parental vaccine fears, and how to let families know about the flu vaccine recommendations, according to a University of Rochester survey.

The 2003-2004 flu season, with its highly publicized deaths of several children and reports of vaccine shortages, drew the issue of flu shots for children into the national spotlight. But for years physicians have been debating the pros and cons of routinely including flu vaccines in an already crowded childhood immunization schedule.

Sharon G. Humiston, M.D., M.P.H., associate professor of Emergency Medicine and Pediatrics at the UR Medical Center, along with a research team from URMC and the Centers for Disease Control and Prevention (CDC), surveyed the opinions of pediatricians and family physicians before the current recommendation to routinely give all children 6 to 23 months of age influenza vaccine was made. The study results are published in the Sept. 6 edition of Archives of Pediatric and Adolescent Medicine.

The survey went to a random sampling of 1,200 American Medical Association physicians who routinely vaccinated at least five patients between the ages of 12 months and 35 months in a typical week. Of those, 846 responded and 458 eligible physicians completed the survey.

Given certain circumstances, 58 percent of the doctors would favor expanding the existing influenza immunization recommendations to include healthy infants and toddlers. About 76 percent said it would be feasible to do so and 64 percent said they believed it would reduce illness visits during flu season. Most respondents were less positive toward a recommendation down to 6 months of age.

The issues cited most often as potential barriers were:

Costs. Most survey respondents (77 percent) believed the upfront costs for vaccine purchase or vaccinating uninsured children would be a major barrier. However, after the survey was conducted, the federal government added the flu vaccine to its list of immunizations provided to eligible, uninsured children. (Less than half of the doctors thought the cost of additional personnel time would be a problem.)

Getting the word out. More than 5.5 million U.S. children are between the ages of 6 to 23 months, and would be eligible for flu vaccine within a short time. Unlike other vaccines, the flu shot must be repeated each year and for children less than 9 years old who were never previously vaccinated, a second flu vaccine must be given at least 4 weeks after the initial dose. The inability of physicians to identify and notify children to come in for a flu vaccine was considered a barrier by almost half of the respondents. Currently, only 35 percent of the doctors said they used computer files to identify children with high-risk conditions who need flu vaccines.

Parent concerns about vaccine safety. About half of pediatricians and two thirds of family physicians cited this as a potential barrier, though few physicians themselves had concerns about influenza vaccine safety.

To make routine childhood influenza vaccination feasible for families and health care providers, medical authorities need to educate consumers about influenza and minimize the financial burden of vaccination for families. Physician's offices would need to find ways to notify families of the newly eligible youngsters, and to handle the large volume of patients requesting vaccination, the survey concludes.

In 2000 Humiston published a book, Vaccinating Your Child: Questions and Answers for the Concerned Parent. A second edition was published in 2003.