Ottawa Canada should become the first country in the world to systematically vaccinate all citizens over the age of six months against the flu, a blue-ribbon panel of scientists recommends.
In a statement to be made public today, the Canadian Task Force on Preventive Health Care says that doing so could reduce cases of influenza by as much as 93 per cent.
Universal vaccination would sharply reduce deaths among the elderly (almost 5,000 of whom die annually in Canada from flu-related illnesses), cut sick days among workers and schoolchildren, lower health-care costs and potentially save the economy hundreds of millions of dollars each year.
"Ideally, we would like to have everyone immunized against influenza," said task force member Joanne Langley of the Department of Community Health and Epidemiology at Dalhousie University.
"Universal vaccination would likely be of great benefit and unlikely to cause any significant harm, so we are recommending this approach," she said in an interview.
The only people who should not be vaccinated against influenza are babies under the age of six months, people who are allergic to eggs or thimerosal (a mercury-based preservative used in the flu vaccine), and those who have had a severe reaction to a previous flu shot.
While the task force recommendations are not binding, they are highly influential. The panel of epidemiologists, health-care researchers and clinicians is charged with advising Canada's deputy health ministers on prevention measures.
The task force also provides a comprehensive guide, known affectionately as the red brick, that is the standard reference tool for Canadian physicians and policy makers on prevention measures.
Only Ontario and Yukon have universal vaccine programs (in which everyone is entitled to a free flu shot), but the task force is recommending the approach be extended nationwide.
Currently, health advisory groups say seniors, children aged six to 23 months and anyone with a chronic disease such as heart disease or respiratory illness should get an annual flu shot.
The National Advisory Committee on Immunization, which advises Health Canada, says people should receive flu shots if they want them, but doesn't recommend targeting everyone in the country.
Vaccinating all 32 million Canadians would cost about $125-million a year. This year, about 11 million Canadians are expected to get a flu shot, at a cost of about $45-million.
Research conducted in the United States suggests that immunization is a good investment because each vaccination against the flu will save the economy $45 (Canadian), most of it from preventing sick days.
On average, a person who comes down with influenza loses 2.8 days of work, or an average of $500 in wages, according to U.S. government statistics.
Dr. Langley said the recommendation, which is published in Tuesday's edition of the Canadian Medical Association Journal, stands despite growing concern over a shortage of vaccine.
"It's an unfortunate collision of events, but the process started way before the shortage came to light, and the recommendation remains sound even if all healthy people won't be able to get the vaccine," Dr. Langley said.
She said universal vaccination could obviously not begin until next year. In fact, orders for next year's vaccine would have to be made within months. Production of the vaccine, which is cultivated in eggs, begins in February and is completed in September.
The task force also gave its blessing to new drugs that are used to treat influenza, sold under the brand names Tamiflu and Relenza, saying they are "moderately effective" in preventing the flu in people who have not been vaccinated. They cautioned, however, that the drugs are expensive and difficult to get in Canada.
About one in five Canadians contracts influenza each year. In healthy adults and older children, the illness causes fever, cough, headache and muscle pain, which usually abates in three to four days. One-third of those who fall ill visit a physician or an emergency room, and flu is the leading cause of absenteeism at school and work during the winter months.
In those at higher risk, such as the frail elderly and people with chronic illnesses such as pulmonary and heart disease, the flu can be deadly. According to the task force report, young children are also at high risk of severe side effects from the flu.
Influenza and pneumonia claimed 4,725 lives in 2002, according to Statistics Canada. Virtually everyone who died was over 65 and had an underlying, chronic health condition.
In its report, the task force reveals that young children are also hit hard by the flu; proportionally, as many children aged six to 23 months as seniors are hospitalized with the flu.
"Children are vulnerable because it's often their first encounter with the virus and they have no immunity," Dr. Langley said.
Children, unlike adults, require two doses of the flu vaccine, one month apart.
Unlike Canada, the U.S. Preventive Services Task Force recommends only that people over age 65 and those with chronic illnesses be vaccinated against the flu. But the U.S. Centers for Disease Control has recommended the vaccine for everyone over the age of 50, for children aged six to 23 months, and for everyone in close daily contact with children under the age of 23 months, including parents, siblings and daycare workers.