Policy for the prevention and control of influenza is updated every year by both the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) prior to the start of influenza season. The AAP statement is pediatric-focused, while the CDC statement provides guidance for people of all ages. Through their advisory committees, the AAP Committee on Infectious Diseases (COID) and the Advisory Committee on Immunization Practices (ACIP) of the CDC have reviewed and carefully considered all influenza vaccine efficacy data available to date, and recommend both inactivated influenza vaccine (IIV) and live attenuated influenza vaccine (LAIV) as options for influenza vaccination in children for the 2020-2021 influenza season, with no preference.
The AAP recommends annual influenza vaccination for all children and youth, 6 months of age and older. Some children under the age of 9 will need 2 doses of seasonal influenza vaccine. For the 2020-2021 season, any licensed influenza vaccine appropriate by age and health status can be used for influenza vaccination in children. The AAP does not have a preference for any influenza vaccine product over another. Influenza vaccination this year is particularly important to reduce the burden of respiratory illnesses and hospitalizations of children and youth and to prevent overwhelming the capacity of the US health care system during the COVID-19 pandemic. Please refer to the AAP policy and algorithm below for more details.
For more information regarding influenza strains in the vaccine this year, changes to the influenza vaccine this year, and newly licensed influenza vaccines, please refer to the AAP influenza policy statement and AAP News articles below.
AAP News – AAP: Flu vaccination more important than ever as flu and SARS-CoV-2 co-exist
For updates throughout the season on influenza, see the AAP Red Book Online Influenza Resource Page.
AAP: The American Academy of Pediatrics Recommendations for Prevention and Control of Influenza in Children, 2020-21 (Early release September 8, 2020, published in October edition of Pediatrics.)
CDC: Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2020-2021 Influenza Season
Tools and Resources
AAP: Flu Vaccine Recommendations Speaking Points (Login required)
CDC: Flu Activity and Surveillance
This algorithm from the AAP influenza policy statement describes the number of 2020-21 seasonal influenza doses for children based on age and prior vaccination history.
* The 2 doses need not have been received during the same season or consecutive seasons.
† Administer 2 doses based on age at receipt of the first dose of influenza vaccine during the season. Children who receive the first dose prior to their ninth birthday should receive 2 doses, even if they turn 9 years old during the same season.
AAP Influenza Policy Highlights
Influenza vaccines are not licensed for administration to infants younger than 6 months and should not be used in this age group.
Children 9 years and older need only 1 dose, regardless of prior vaccination history.
Children 6 months through 8 years of age:
Need 2 doses if they have received fewer than 2 doses of any trivalent or quadrivalent influenza vaccine (IIV or LAIV) prior to July 1, 2020. The interval between the 2 doses should be at least 4 weeks. Two doses should be administered to children who receive their first dose before their ninth birthday, even when they turn nine years old during the same season.
Require only 1 dose if they have previously received 2 or more total doses of any trivalent or quadrivalent influenza vaccine (IIV or LAIV) prior to July 1, 2020. The 2 previous doses do not need to have been received during the same influenza season or consecutive influenza seasons.
Initiation of influenza vaccination before influenza is circulating in the community and continuing to vaccinate throughout the influenza season are important components of an effective influenza vaccination strategy.
Complete influenza vaccination by the end of October is recommended by the AAP and CDC. Children who need 2 doses of vaccine should receive their first dose as soon as possible when vaccine becomes available, to allow sufficient time for receipt of the second dose ≥4 weeks after the first, before the onset of the influenza season. Children who require only 1 dose of influenza vaccine should also ideally be vaccinated by end of October; however, recent data (mostly in adults) suggests that very early vaccination (July or August) might be associated with suboptimal immunity before the end of the influenza season.
Vaccine Information Statement (VIS) must be offered with every dose of vaccine administered.
DO NOT administer influenza vaccine to children younger than 6 months of age. Because the vaccine is not licensed for children under 6 months of age, other methods of protecting this population can be used. Pregnant women are recommended to receive inactivated influenza vaccine in any trimester during pregnancy because, in addition to protecting the mother, maternal flu vaccination also protects the infant through transplacental transfer of antibodies. "Cocooning" is another strategy used—family members and close contacts who receive the vaccine are less likely to get the flu and pass the disease to the infant, creating a protective "cocoon" around them. See the CDC Fact Sheet on Influenza Vaccination During Pregnancy.
Minor illnesses, with or without fever, are not contraindications to the use of influenza vaccines, including among children with mild upper respiratory infection symptoms or allergic rhinitis. In children with a moderate to severe febrile illness (eg, high fever, active infection, requiring hospitalization, etc), on the basis of the judgment of the clinician, vaccination should be deferred until resolution of the illness.
Children with confirmed COVID-19 can receive influenza vaccine when the acute illness has resolved. Children with an amount of nasal congestion that would notably impede vaccine delivery into the nasopharyngeal mucosa should have LAIV vaccination deferred until resolution.