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What's the Latest with the Flu?

October 2018

The American Academy of Pediatrics (AAP) policy "Recommendations for Prevention and Control of Influenza in Children, 2018-2019" offers updated recommendations for routine use of seasonal influenza vaccines and antiviral medications for the prevention and treatment of influenza in children. Highlights of the updated recommendations include:

  • The AAP recommends inactivated influenza vaccine (trivalent IIV3 or quadrivalent IIV4) given in shot form as the primary choice for children. This recommendation was made because the quadrivalent live attenuated influenza vaccine (LAIV4) given via nasal spray showed inferior effectiveness against the A/H1N1 influenza virus strain during the 2013-14 and 2015-16 flu seasons. In addition, the effectiveness of the 2018-19 LAIV4 formulation against A/H1N1 viruses has not yet been documented in the US.

  • The AAP clarifies that LAIV4 may be used for children who would not otherwise receive an influenza vaccine, if the child is at least 2 years old and healthy without any underlying chronic medical conditions.

  • Children should receive a flu vaccine each season by the end of October.

  • Children who need two doses of flu vaccine should start the vaccination process early so that they can get two doses before the end of October.

  • All children with egg allergy of any severity can receive influenza vaccine without any additional precautions beyond those recommended for any vaccine. Egg allergy is not a contraindication for influenza vaccination, nor does it require special consideration (i.e. there is no need to ask about egg allergy to decide if a child can receive the flu vaccine).

  • Pregnant women may receive inactivated influenza vaccine at any time during pregnancy; children born to women vaccinated during pregnancy receive protection against influenza and its complications for the first several months after birth.

  • Antiviral medications are important in the treatment and control of influenza, but are not a substitute for influenza vaccination.

For additional information, refer to AAP resources, including the Vaccine Status Table and Influenza Resource Page within Red Book Online, which have been updated to reflect the 2018-2019 influenza policy statement. Also see the recent AAP News article, "AAP Policy Emphasizes Importance of Vaccination after High-severity Flu Season".

Vaccine Dosing Recommendations
Children younger than 6 months of age cannot receive a flu vaccine, so they must rely on the adults around them to be vaccinated for protection from influenza. Some children 6 months through 8 years of age need 2 doses of flu vaccine if they have never been vaccinated or if they had not received at least 2 doses of any trivalent or quadrivalent influenza vaccine before July 1, 2018. The interval between the 2 doses should be at least 4 weeks. A child requires only 1dose if they have previously received 2 or more total doses of any trivalent or quadrivalent influenza vaccine before July 1, 2018. The 2 previous doses do not need to have been received during the same influenza season or consecutive influenza seasons. See the updated AAP dosing algorithm:

AAP Dosing Algorithm

a the 2 doses need not have been received during the same season or consecutive seasons.
b Receipt of LAIV4 in the past is still expected to have primed a child’s immune system despite recent evidence for poor effectiveness. There currently are no data that suggest otherwise.

Influenza Recommendations for Children: Webinar for Clinicians
In September the AAP collaborated with the Centers for Disease Control and Prevention (CDC) to conduct a Clinician Outreach and Communication Activity (COCA) webinar titled, "2018-2019 Recommendations for Influenza Prevention and Treatment in Children: An Update for Pediatric Providers." During this COCA webinar, subject matter experts from the AAP and CDC discussed strategies that primary care providers and medical subspecialists could use to improve flu prevention and control in children for the 2018-2019 season. The presenters shared AAP and CDC recommendations about influenza vaccination and antiviral treatment, including updated recommendations for the use of LAIV4 in children. The PowerPoint slides from the webinar and a recording of the presentation are posted on the webinar Web page.

Public Service Announcement on Flu Vaccine
In a new 30-second public service announcement, the AAP offers advice on annual influenza immunization. In the announcement, Ilan Shapiro, MD, FAAP, urges parents to make sure that all children ages 6 months and older are vaccinated for influenza. The public service announcement is part of a monthly series produced and distributed by the AAP. To see the entire series, visit the AAP YouTube channel.

AAP Influenza Implementation Guidance
The AAP has updated its Influenza Implementation Guidance for the 2018-2019 season. It is designed to help practitioners and pediatric office staff prevent influenza by delivering influenza vaccine according to the AAP policy, "Recommendations for Prevention and Control of Influenza in Children, 2018-19". The guidance includes information for physicians, nurse practitioners, physician assistants, nurses, medical assistants, office managers, and other office staff.

Additional Information
See the AAP Red Book Online Influenza Resource page or CDC FluView. All What's the Latest with the Flu messages are archived. Also see the What's the Latest with the Flu messages for child care providers.