Annual AAP Influenza Policy

​Influenza ​Impleme​ntation Guidance

Updated September 2019

Annual AAP Influenza Policy

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). The AAP statement is pediatric-focused, while the CDC statement addresses 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 2019-2020 influenza season, with no preference.

The AAP no longer will express a preference for the inactivated influenza vaccine over the live attenuated influenza vaccine this season. In previous years, the AAP and CDC did not recommend LAIV in 2016-17 or 2017-18 due to poor effectiveness against H1N1 strains. In 2018-19, the AAP and CDC each supported the use of LAIV but AAP recommended IIV as the primary choice for all children because of previous effectiveness of LAIV4. LAIV manufacturer AstraZeneca has since changed the formulation of the vaccine to include a new strain (A/Slovenia) that it suggested would produce better antibody responses than the previous H1N1 strain (A/Bolivia).

  • The AAP recommends annual seasonal influenza immunization for all people 6 months and older, including all children and adolescents. Some children will need 2 doses of seasonal influenza vaccine. Refer to the AAP policy and algorithm below for more details.

  • A Vaccine Information Statement (VIS) must be offered with every dose of vaccine administered.

Influenza News

AAP News – AAP: No flu vaccine preference for 2019-'20 season (March 14, 2019)

AAP News – ACIP approves recommendations on MenB, HepA, flu vaccines (June 28,2019)

AAP News –  Updated AAP flu policy offers more options this year

For updates throughout the season on influenza, see AAP "What's the Latest With the Flu" messages.

Influenza Policies

AAP: The American Academy of Pediatrics Recommendations for Prevention and Control of Influenza in Children, 2019-20 (Early release September 2, 2019, 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, 2019–2020 Influenza Season  

Tools and Resources

Red Book Online Influenza Resource Page

Flu Vaccine Recommendations Speaking Points (Login required)

CDC: Flu Activity and Surveillance


This algorithm from the AAP influenza policy statement describes the number of 2019-20 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 nine years during the same season.

  • 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, 2019. 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, 2019. 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.

  • 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.  CDC Fact Sheet on Influenza Vaccination During Pregnancy.

Please see the AAP Recommendations for Prevention and Control of Influenza in Children, 2019 - 2020 for more information.

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