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Lisa Black

Pediatricians advise that children get their influenza vaccine before the end of October.

ITASCA, IL­­— As researchers race to develop a vaccine for COVID-19, there is already a safe, effective way to - protect children from another common and unpredictable infection – influenza -- which can cause severe illness and death. This fall, pediatricians recommend that it is more important than ever for everyone over 6 months old to be vaccinated.

The American Academy of Pediatrics in its policy statement, “Recommendations for Prevention and Control of Influenza in Children, 2020–2021,” offers the option of a flu shot or nasal spray flu vaccine this season. Any licensed, age-appropriate vaccine is acceptable, according to the recommendations, which are similar to those of the last flu season. Public health officials warn that hospital beds and emergency services could quickly extend beyond capacity in communities where coronavirus transmission remains high.

“As a pediatrician, I am very concerned about the health of children and their families this fall if these two potentially deadly viruses are circulating in the community at the same time,” said Flor Munoz, MD, FAAP, lead author of the recommendations, developed by the AAP Committee on Infectious Diseases.

“Children play a pivotal role in the transmission of influenza to others in their household. They can also get seriously ill from influenza without a vaccination.”

Over the past flu season, 188 children and teens under 19 died of complications from influenza, according to the Centers for Disease Control and Prevention (CDC). Typically, about 80% of children who die are not vaccinated.

The AAP recommends:

  • An annual influenza vaccine for everyone 6 months and older.
  • Children should receive the flu vaccine as soon as it is available in their community and complete their vaccinations ideally by the end of October.
  • Both the flu shot and nasal spray vaccines are recommended to prevent influenza in children, with no preference given to one or the other. This year, all influenza vaccines for children will be quadrivalent vaccines, including two A and two B flu virus strains, to protect against the four strains of the influenza virus expected to circulate this season. All licensed vaccines contain the same influenza viruses.
  • The quadrivalent inactivated influenza vaccine (IIV4) is available for intramuscular injection for everyone 6 months of age and older, including healthy persons and those with high-risk conditions; the live attenuated influenza vaccine (LAIV4) is a nasal spray mist that is also appropriate for healthy children 2 years of age and older.
  • There are various licensed formulations of inactivated influenza vaccine (IIV4) for infants and young children 6 to 35 months of age, including a 0.25 ml per dose and a 0.5 ml per dose formulation. The 0.5 ml formulation is the most widely available this season. Studies have shown that both doses are well tolerated and result in similar immune protection. Therefore, both formulations can be used, with no preference of one over another.
  • The number of recommended doses of influenza vaccine depends on a child's age at the time of the first administered dose and on their vaccine history. Children 6 months to 8 years of age should receive two doses if this is the first time they are being vaccinated against influenza, or if they have only received one dose of flu vaccine ever before July 1st, 2020.
  • Only one dose is necessary for children 9 years and older, regardless of whether they have been vaccinated before, and for children up to 8 years of age who have received at least two doses of influenza vaccine before July 1st, 2020, even if not given in the same season.
  • All children with egg allergy of any severity can receive influenza vaccine without any additional precautions beyond those recommended for any vaccine. Egg allergy is not a contraindication for influenza vaccination. 
  • Pregnant women may receive influenza vaccine (IIV only) at any time during pregnancy. Maternal vaccination can protect infants in the first few months of life, which is important because there are no vaccines available for infants 0 to 6 months of age.
  • All health care personnel should receive an annual seasonal influenza vaccine to prevent influenza and reduce health care-associated influenza infections.

Antiviral medications are important in the treatment and control of influenza but are not a substitute for influenza vaccination.

“During a pandemic, we can work together to reduce the risks of infection and of spreading illness to others,” Dr. Munoz said. “Besides getting our vaccine to prevent influenza, we can be vigilant in making sure we and our children continue to maintain COVID-19 precautions, including social distancing, face coverings and frequent handwashing.”


The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

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