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What’s the Latest with the Flu in an Era of COVID-19

Coronavirus disease 2019 (COVID-19) symptoms are similar to those associated with influenza (fever, cough, shortness of breath). Keep up-to-date on the latest information from the American Academy of Pediatrics (AAP) by visiting the Critical Updates on COVID-19 web page. Members of the AAP can also connect with their peers on the AAP COVID-19 Discussion Board. Email with any additional questions.

Influenza Update

Laboratory-confirmed cases of influenza in the United States remains low. Recent changes in health care seeking behavior, including increasing use of telemedicine and recommendations to limit primary care, urgent care, or hospital emergency department (ED) visits, as well as increasing levels of physical distancing, are affecting the number of persons with ILI and their reasons for seeking care in outpatient and ED settings. It can be challenging for clinicians to distinguish which children are ill for which disease, so influenza testing and immunization is still critical.

As of May 9th, 174 flu-associated pediatric deaths were reported this season. Deaths among children are higher than during the same period in every other season since reporting started in 2004-2005 with the exception of the 2009 H1N1 pandemic. While much of the recent focus has been on the COVID-19 outbreak, influenza viruses are still circulating, and providers should continue to encourage annual influenza vaccination. See the AAP COVID-19 Clinical Guidance Q & A web page for information on how to plan for well child and sick visits and provide immunizations during the COVID-19 pandemic, while also protecting children and adults.

The AAP and the Centers for Disease Control and Prevention (CDC) continue to recommend annual influenza immunization of all children without medical contraindications, starting at 6 months of age. See the AAP policy statement, “Recommendations for Prevention and Control of Influenza in Children, 2019–2020.

Prepare for the Next Flu Season!

There are no changes in AAP influenza vaccine recommendations for the 2020-2021 flu season. Any licensed, age-appropriate vaccine is acceptable, and everyone 6 months and older should be vaccinated. See the AAP News article, “AAP: No Flu Vaccine Preference for 2020-’21 Season.

Lessons can be learned from the COVID-19 response that could improve preparedness plans for future outbreaks, including an influenza pandemic. Some ideas include:

  • Limiting well visits to early morning while reserving the remainder of the day for sick visits.

  • Increasing capacity to deliver, code, and be reimbursed for telehealth.

  • Dedicating specific rooms for sick visits and well visits.

Now is a good time to lay the groundwork to encourage that health care personnel plan ahead to get vaccinated for the flu next season. Take steps to implement a mandatory influenza immunization policy for your staff. See the AAP policy statement “Influenza Immunization for All Health Care Personnel: Keep It Mandatory” for strategies.

Addressing Missed Vaccination Opportunities

The AAP is working to develop new materials to assist pediatric practices with increasing flu immunization rates, addressing missed opportunities, and improving planning for seasonal flu epidemics and pandemic flu events. Please share stories of how you have addressed missed vaccination opportunities or improved influenza vaccination rates. The AAP is also looking for stories on why you think influenza vaccination and testing is important during the COVID-19 pandemic. Email

Additional Information

See the AAP Red Book Online Influenza Resource page, AAP Red Book Online COVID-19, CDC FluView, or contact

This message was supported in part by Cooperative Agreement Number 5NU38OT000282-02-00, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.