This flu season there's additional reason to make your little ones wash their hands and keep their noses off their sleeves. A new study in the American Journal of Epidemiology suggests that 3- and 4-year-olds drive flu epidemics -- and that flu symptoms in kids under 5, more than any other age group, are correlated with flu-related deaths in the general population.

Nothing to Sneeze At The study, which tracked more than 400,000 children and adults for four years, found that 3- and 4-year-olds on average presented with flu or flu-like illness a month earlier than adults. Harvard Medical School researchers John Brownstein and Kenneth Mandl explain that children share germs in preschool and day care, then spread the disease during, say, a visit to a grandparent's nursing home. There, patients' lowered immunity and close quarters could feed an outbreak.

Change in the Air? Although immunization recommendations have long targeted the elderly and immune-compromised, the researchers suggest a much broader approach: Immunize the frontline germ-spreaders, too. This makes sense, they argue, partly because vaccines aren't always effective in the elderly.

But don't expect the Centers for Disease Control and Prevention (CDC) to alter its recommendations anytime soon, said Carolyn Bridges, an epidemiologist with the agency's National Immunization Program. While current policy allows preschoolers to get immunized when vaccines are ample, a shift to promoting the shots for kids would require a major vaccine production and distribution effort. More data are needed to justify that move, she said.

Decisions, Decisions Preschoolers themselves are at no greater risk for serious flu complications than other healthy patients. In fact, 3- and 4-year-olds are 13 times less likely to develop flu-related problems than infants and toddlers. So, should you immunize your kid simply to serve the general good?

Parents should heed their pediatricians' advice and remember that for most healthy people the vaccine is quite safe, said Mark Weissman, chief of general pediatrics and community health at Children's National Medical Center. (Serious side effects from the vaccine, such as anaphylaxis, occur once in 4 million cases, the CDC reports.) So for households with vulnerable members -- a newborn or someone undergoing chemotherapy -- vaccinating preschoolers seems wise and not risky.

But vaccination isn't merely about altruism, Weissman argues. A child is better off facing a two-second "ouch" than a week of chills, fever and miserable sniffles. To say nothing of the parents.

-- Stacy Weiner