The AAP’s Committee on Infectious Diseases has suggested immunization with an inactivated influenza vaccine as a first line of defense against illness for the 2018-2019 flu season. Although the AAP did not fully endorse the live-attenuated influenza vaccine because of its inferiority during past seasons against H1N1, it may be used in certain pediatric populations.
The CDC’s Advisory Committee on Immunization Practices, or ACIP, recommended that the quadrivalent live-attenuated influenza virus (LAIV4) could be used to vaccinate against influenza in the upcoming season. They previously did not recommend the vaccine for the 2016-2017 and 2017-2018 flu seasons.
“For the 2018-2019 influenza season, the AAP recommends LAIV4 to be used for children who would not otherwise receive an influenza vaccine, such as those who would refuse an [inactivated influenza vaccine (IIV)], and for whom it is appropriate according to age — healthy children without any pre-existing chronic medical condition aged 2 years and older,” the committee said. “This recommendation represents a change from the 2016-2017 and 2017-2018 influenza seasons, when intranasal LAIV4 was not recommended in any setting in light of the evidence of its poor effectiveness in previous seasons against influenza A(H1N1)pdm09 viruses.”
Children aged younger than 2 years and those with moderate to severe febrile illness, nasal congestion and a history of recurrent wheezing in the past year or asthma should not be administered LAIV4, according to the recommendation.
The suggestions follow last year’s severe flu season, which ranked as the third most severe season since the 2003-2004 season. It was the first season in which illness was highly severe for all age groups.
According to the policy statement issued by the AAP, everyone 6 months of age and older should be vaccinated during the season, especially those born preterm, those with medical conditions that leave patients at risk of complications from infection, all child care providers and health care personnel. Additionally, the organization recommends vaccination for all pregnant women, those considering pregnancy, those who have recently given birth and those who are breastfeeding during the influenza season.
The committee mentioned that no decline in vaccination coverage was observed in years when LAIV4 was not recommended. However, immunization rates in the U.S. are “suboptimal,” and the increased number of options for child vaccination may increase coverage among the pediatric population. The committee specifically recommends focusing on vaccination of all children and adolescents with underlying medical conditions who may be at higher risk of complications from influenza with an IIV.
“Achieving high coverage rates of influenza vaccine in infants and children is a priority to protect them against influenza disease and its complications,” the committee wrote. “Additional experience over multiple influenza seasons will help to determine optimal use of the available vaccine formulations in children.”
Immunizations should begin once vaccines are locally available to pediatricians and vaccine administrators. Once received, these health care providers should inform parents and caregivers of children of the annual vaccination recommendation for those 6 months of age and older. The first dose should be administered as soon as possible to provide adequate time before the second dose is needed. The committee said that this dose should preferably be received by the end of October at least 4 weeks following the first dose.
“The onset and duration of influenza circulation is unpredictable,” the committee said. “To effectively protect children, prompt initiation of influenza vaccination and continuing to vaccinate throughout the influenza season, regardless of whether influenza is circulating or has circulated, in the community are important components of an effective vaccination strategy.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.