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. The AAP and the CDC work together to try to harmonize the recommendations every year. Unlike the last two seasons, the Academy recommends the limited use of quadrivalent intranasal live attenuated influenza vaccine (LAIV4). This recommendation represents a change from the 2016-’17 and 2017-’18 influenza seasons when intranasal LAIV4 was not recommended in any setting in light of the evidence for its poor effectiveness in prior seasons against influenza A (H1N1) pdm09 viruses.
The AAP Committee on Infectious Diseases (COID) and the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) have reviewed and carefully considered all influenza vaccine efficacy data available to date, as well as new information regarding an updated LAIV4 formulation, for each to provide their latest recommendations.
ACIP voted to recommend LAIV4 as an option for anyone in whom it is otherwise appropriate and stated that no vaccine effectiveness estimates are available for the new formulation of LAIV4.
While the AAP and CDC each support the use of LAIV4 for the 2018-’19 influenza season with the aim of achieving adequate vaccination coverage and optimal protection in children of all ages, the AAP is making the following recommendations:
Annual influenza vaccination is recommended for everyone 6 months and older.
For the 2018-’19 season, the AAP recommends inactivated influenza vaccine (IIV) – trivalent or quadrivalent – as the primary choice for all children because the effectiveness of LAIV4:
LAIV4 may be offered for children who would not otherwise receive an influenza vaccine (and for whom it is appropriate by age and health status).
As always, families should receive counseling on these revised recommendations for the 2018-19 season.
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.
This algorithm describes the number of 2018-19 seasonal influenza doses for children 6 months through 8 years of age. *The two doses need not have been received during the same season or consecutive seasons.
The number of seasonal influenza vaccine doses to be administered in the 2018-19 influenza season depends on the child's age at the time of the first administered dose and his or her vaccine history (Figure above):
Children 9 years and older need only 1 dose.
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, 2018. The interval between the 2 doses should be at least 4 weeks.
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, 2018. The 2 previous doses do not need to have been received during the same influenza season or consecutive influenza seasons. Despite recent evidence for poor effectiveness of LAIV4, receipt of LAIV4 in the past is still expected to have primed a child's immune system. There currently are no data that suggest otherwise. Therefore, children who received 2 or more doses of LAIV4 prior to July 1, 2018 may receive only 1 dose of influenza vaccine for the 2018-2019 season. weeks.
Vaccination should begin as soon as flu vaccine is available. Vaccination should not be delayed to obtain a specific product for either dose. Any available, age-appropriate trivalent or quadrivalent vaccine can be used. A child who receives only 1 of the 2 doses as a quadrivalent formulation is likely to be less primed against the additional B virus.
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 the vaccine 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, 2018-19 for more information.