Flor M. Munoz
The AAP has announced it will recommend that parents choose the inactivated influenza vaccine, or the flu shot, for children’s vaccinations this fall.
The AAP Board of Directors made the decision after reviewing data on the effectiveness of the flu shot compared with quadrivalent live-inactivated influenza vaccine (LAIV4) , according to a press release.
“The Committee of Infectious Diseases (COID) of the AAP recommends vaccination of all children against influenza, starting at 6 months of age,” Flor M. Munoz, MD, MSc, a member of the COID, associate professor of pediatrics, molecular virology and microbiology, Baylor College of Medicine, and medical director, transplant infectious diseases, Texas Children’s Hospital, told Infectious Diseases in Children. “Achieving a high coverage of influenza vaccine in children is an important goal to protect infants and children against influenza disease and its complications.”
“The COID/AAP recommends vaccination with inactivated influenza vaccine (IIV3 or IIV4) whenever possible, and LAIV4 for children who would otherwise not be vaccinated against influenza,” Munoz added.
The AAP recommends using an injection rather than a nasal spray to immunize against influenza for the upcoming season. The organization will release a policy statement on the matter in September 2018.
After not recommending the nasal spray vaccine for the 2016-2017 and 2017-2018 flu seasons, the CDC Advisory Committee on Immunization Practices (ACIP) voted in February to make FluMist Quadrivalent (Medimmune) available to providers for the 2018-2019 influenza season.
According to AstraZeneca, the parent company of MedImmune, the ACIP vote followed a presentation that included positive study results demonstrating that the new 2017-2018 H1N1 post-pandemic strain (A/Slovenia) included in the LAIV performed significantly better than the strain used in the 2015-2016 vaccine that was associated with reduced effectiveness.
However, after the AAP reviewed the presented data, it recommends that children receive the injectable form of the vaccine because it has been more consistently effective against most strains of the flu virus, according to the release. The nasal spray can be given as a last resort for children who would not otherwise receive a flu vaccine, according to AAP.
“The live-inactivated influenza vaccine was not recommended for two seasons due to its prior poor effectiveness against the influenza A H1N1 strain, particularly in children aged 9-17 years,” Munoz said. “The manufacturer of LAIV4 has modified the strain selection process and the A/H1N1 strain in the vaccine, with the expectation that this will result in improved effectiveness, based on a study of the new formulation of the vaccine in young children. The performance of this new formulation of the LAIV4 has not been confirmed, since A H1N1 has not widely circulated recently.”
“The COID/AAP acknowledges the CDC/ACIP recommendation to utilize LAIV4 as an option for vaccination this coming season,” Munoz added. “Data from a CDC-conducted meta-analysis suggest that the effectiveness of LAIV for A H1N1 is lower than IIV, but some protection is afforded compared to not having been vaccinated; while the performance against H3N2 has been similar in both LAIV and IIV, the LAIV can be more effective against influenza B strains.”
The AAP recommends that parents discuss questions about their child’s immunizations with their pediatrician.
A formal policy statement on flu prevention and treatment will be published by AAP in September, according to the release. – by Bruce Thiel