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What's the Latest with the Flu?

​November 2017​

Flu activity is still low in the US, but flu cases have now been reported in several southern states. Because flu is unpredictable, it's not possible to say when, where, or how quickly flu activity might increase, how severe it will be, or which viruses will predominate.

As with each influenza season, the American Academy of Pediatrics (AAP) urges all clinicians to take action to ensure that all children get vaccinated against flu. Clinicians should review influenza prevention and control strategies and take steps to educate others. The AAP has worked with the Centers for Disease Control and Prevention (CDC) to produce messaging and resources, including new letters and a fact sheet for health care providers. The AAP also provides a Web page for parents that explains why the nasal spray flu vaccine (live attenuated influenza vaccine or LAIV4) is not recommended for the second season in a row due to poor vaccine effectiveness the past few years.

2017-2018 Flu Season

The AAP and CDC recommend that all children 6 months and older receive a flu vaccine each year. Vaccination is especially important for children with special health care needs, such as conditions that increase the risk for complications from influenza, including children with chronic medical conditions such as pulmonary diseases like asthma, metabolic diseases like diabetes mellitus, hemoglobinopathies like sickle cell disease, hemodynamically significant cardiac disease, immunosuppression, or neurologic and neurodevelopmental disorders. Children younger than 5 years of age, but particularly children younger than 2, are also at an increased risk of hospitalization and complications attributable to influenza.

Although children with chronic medical conditions are at high risk of influenza complications, their immunization coverage rates are lower than that of the general population. More work is needed to raise awareness about the importance of influenza vaccination for these children. Take steps to increase vaccination rates among children at high risk:

  1. Talk with parents about the importance of influenza immunization and advise them to vaccinate their child as soon as possible.
  2. Consider using a tracking mechanism or registry to flag children with certain conditions, as this may be useful for getting high risk patients in to be vaccinated.
  3. Talk about the importance of "cocooning" or immunizing family members and child care providers who spend time with children who are at high risk or who cannot get vaccinated. Immunization of close contacts of children at high risk reduces their risk of contagion. Immunizing mothers and all family members is especially important to protect infants younger than 6 months, because they are too young to receive an influenza vaccine.

See the AAP policy "Recommendations for Prevention and Control of Influenza in Children, 2017 - 2018" for updated recommendations on the routine use of seasonal influenza vaccines and antiviral medications for the prevention and treatment of influenza in children. Also see the recent AAP News article noting an update to the policy to provide the latest dosage and administration information for intravenous peramivir, a neuraminidase inhibitor.

How to Code for Influenza Vaccine in the 2017-2018 Flu Season

It is important for clinicians to know the specific vaccine product being administered in their office and to ensure that each patient meets the recommended age for each vaccine. See the recent AAP News article for details on code descriptors.

CDC COCA Webinar

On November 7, 2017, the AAP collaborated with CDC to conduct a Clinician Outreach and Communication Activity (COCA) webinar titled, "What's New for the 2017-2018 Flu Season: Recommendations for Children." During this COCA webinar, subject matter experts from the AAP and CDC highlighted critical information about this flu season and discussed strategies that primary care providers and medical subspecialists could use to improve flu prevention and control in children. The PowerPoint slides from the webinar and a recording of the presentation will be posted on the webinar Web page.

Interactive Map Highlights Child Vaccination Rates Across America

The AAP developed an interactive digital map that highlights state immunization rates for vaccine-preventable diseases, as well as state laws regarding vaccine exemptions. The map, available at, includes data on how each state measures up against immunization thresholds that are important to ensure protection for all.

When a high number of people in a community are vaccinated, it is less likely that a virus will spread, lowering the risk posed by that disease for the entire community. This "community immunity" threshold varies for each vaccine-preventable disease, which is illustrated in the map.

The AAP supports increasing immunization rates by raising awareness about the protection vaccines offer not only to the public at large, but also for the most vulnerable people. These include infants younger than 6 months of age who cannot receive some vaccines themselves and children with chronic medical conditions. The map illustrates that much work remains to increase vaccination coverage rates, particularly to guard against influenza.

​Additional Information

See the AAP Red Book Online Influenza Resource pageCDC FluView, or the CDC Digital Media Toolkit: 2017-18 Flu Season. Each "What's the Latest with the Flu" messages will be archived.

    October 2017

    ​The American Academy of Pediatrics (AAP) policy "Recommendations for Prevention and Control of Influenza in Children, 2017-2018" offers updated recommendations for routine use of seasonal influenza vaccine and antiviral medications for the prevention and treatment of influenza in children. Highlights of the updated recommendations include:

    • Vaccination is the best available preventive measure against influenza.
    • Annual seasonal influenza vaccination is recommended for everyone 6 months and older.
    • Both trivalent and quadrivalent inactivated influenza vaccines are available in the US.
    • Quadrivalent live attenuated influenza vaccine (LAIV4) is not recommended for use in any setting in the US during the 2017-2018 influenza season.
    • Children should receive their influenza vaccine by the end of October, if possible.
    • The number of recommended doses of influenza vaccine depends on a child's age at the time of the first administered dose and vaccine history.
    • All children with egg allergy of any severity can receive influenza vaccine without any additional precautions beyond those recommended for any vaccine. As such, there is no need to ask specific questions regarding history of egg allergy prior to influenza vaccination.
    • Pregnant women may receive influenza vaccine at any time during pregnancy.
    • All health care personnel should receive an annual seasonal influenza vaccine, a crucial step in preventing influenza and reducing health care-associated influenza infections.
    • Antiviral medications can reduce the duration of symptoms and prevent serious complications of influenza, but they are not a substitute for influenza vaccination.

    For additional information, refer to the updated Vaccine Status Table and Influenza Resource Page within Red Book Online, which have been updated to reflect the 2017-2018 influenza policy statement. Also see the recent AAP News article for an overview of these expanded recommendations.

    Both trivalent and quadrivalent inactivated influenza vaccines are available in the United States for the 2017-2018 season. Neither inactivated vaccine formulation is preferred over the other. Although manufacturers anticipate an adequate supply of quadrivalent vaccine, pediatricians should administer whichever formulation is available in their communities in order to immunize as many people as possible this influenza season. Both inactivated vaccine formulations contain an A/Michigan/45/2015 (H1N1)pdm09-like virus, an A/HongKong/4801/2014 (H3N2)-like virus, and a B/Brisbane/60/2008-like virus (B/Victoria lineage). Quadrivalent influenza vaccines also contain the B/Phuket/3073/2013-like virus (B/Yamagata lineage). The influenza A (H1N1) virus in both formulations differs from that contained in the 2016-2017 seasonal vaccines.

    Children 6 months through 8 years of age need two doses of flu vaccine if they have never received at least two doses of any trivalent or quadrivalent influenza vaccine before July 1, 2017. A child 8 years of age and younger requires only one dose if they have previously received two or more total doses of any trivalent or quadrivalent influenza vaccine before July 1, 2017. The two previous doses do not need to have been received during the same influenza season or consecutive influenza seasons. See the updated AAP dosing algorithm:

    The 2 doses need not have be​en received during the same season or consecutive seasons.

    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.

    Upcoming Influenza-Focused Webinar
    Plan to participate in the Centers for Disease Control and Prevention (CDC) Clinician Outreach and Communication Activity (COCA) pediatric-focused influenza prevention and control webinar on Tuesday, November 7, 2017, at 2:00pm ET/1:00pm CT. Flor Munoz, MD, FAAP, member, AAP Committee on Infectious Diseases, will present on behalf of the AAP. Angela Campbell, MD, MPH, FAAP, will present on behalf of the CDC. To receive a calendar appointment, Additional information will be provided in the next "What's the Latest with the Flu" message.​

    Flu Deaths in Children for 2016-17 Season
    106 flu-associated deaths in children were reported to the CDC during the 2016-2017 influenza season. While full information on the vaccination status of these children is not yet available, in past seasons, between 80% and 85% of flu-associated pediatric deaths have occurred in children who had not gotten a flu vaccine that season. According to a recent CDC study, flu vaccination can reduce the risk of flu deaths in children.

    Article - The Role of Patient Engagement in Addressing Parents' Perceptions About Immunizations
    In July 2017, a viewpoint was published in JAMA Pediatrics titled, "The Role of Patient Engagement in Addressing Parents' Perceptions About Immunizations". The article describes how physicians, nurses, and other health care professionals should increase efforts to build relationships with parents, especially when they express hesitation or have misconceptions about vaccinations.

    New Vaccine Adverse Event Reporting System Website
    The Vaccine Adverse Event Reporting System (VAERS) is a national early warning system to detect possible safety concerns in US-licensed vaccines. This system is co-managed by the CDC and the US Food and Drug Administration (FDA). Anyone can report an adverse event to VAERS. Health care professionals are required to report certain adverse events, and vaccine manufacturers are required to report all adverse events that come to their attention.

    Additional Information
    See the AAP Red Book Online Influenza Resource pageCDC FluView, or the CDC Digital Media Toolkit: 2017-18 Flu Season