E-Paper
Why India’s youngest need consistent influenza protection
This article is authored by Dr Vijay Yewale, senior consultant paediatrician, Apollo Hospital CBD Belapur, Navi Mumbai.
Influenza is still one of the most underestimated diseases in children under five years of age. It is often regarded by parents to be a transient fever, but in children under five it can rapidly develop into serious respiratory illness resulting in hospitalisation. The immune system is developing at a dramatic pace during the first five years of life but it’s also when the greatest “loss to follow-up” in influenza vaccination occurs.
According to the latest surveillance, similar high level of flu activity is being reported from all across the country. The National Centre for Disease Control (NCDC) reported over 22,000 cases with laboratory-confirmed influenza and over 130 deaths in the first half of the year, including a large number needing hospital care in children. Globally, the World Health Organization reported that in 2024 in South East Asia influenza virus positivity among samples tested ranged between 10-30%. Not just numbers, these figures represent children staying home from school that they can’t afford to miss, parents who can’t come into work and in the worst of cases overworked hospitals receiving even more admissions.
Unlike measles or polio, which are prevented for life after one or two vaccines, people need an annual flu shot even if they received one the year before. This is because the virus evolves constantly, and immunity from previous vaccines seems to last only for a few months. The 2025 southern hemisphere vaccine, for example, already carries new influenza A and B strains that are unlike the ones circulating last year.
But many children never come back for their next dose. Reminders from clinics are overlooked, or parents incorrectly believe that one vaccination is sufficient for a couple of years. This “loss to follow-up” results in a significant proportion of children with no coverage whatsoever. Data of Asian paediatric cohorts also imply that only a third of children who initiate influenza vaccination are back for their booster the next season and India is no exception.
If you skipped just one year’s vaccine, the result could be more than a cold — it might be hospitalisation. Young children have narrower airways and less reserve, so they are more likely to develop complications like bronchiolitis and pneumonia. Children younger than five years contribute to approximately 20% of the total global burden of influenza-related hospitalisation and 15% of deaths annually (WHO data). And these could be avoided with an annual injection.
In addressing loss to follow-up, we require ongoing communication. Parents need to be reminded that child health includes influenza vaccination, and should not be viewed as an optional extra for the flu season. Hospitals and paediatric clinics can attach reminders to growth-monitoring visits or digital health apps. Schools and preschools can promote annual flu drives prior to the monsoon season when flu is at its worst in India.
The opportunity to afford protection is lost with each missed dose of influenza. We as paediatricians need to emphasise that prevention is not a one-off but an ongoing effort. And as parents, seeing influenza as a vaccine-preventable disease is step one in enacting change. What you are actually preventing is not only a child’s lungs but their entitlement to a normal, disease-free childhood.
This article is authored by Dr Vijay Yewale, senior consultant paediatrician, Apollo Hospital CBD Belapur, Navi Mumbai.
