Recommendations for Prevention and Control of Influenza in Children, 2018–2019

Abstract

The authors of this statement update the recommendations of the American Academy of Pediatrics for the routine use of influenza vaccine and antiviral medications in the prevention and treatment of influenza in children. Highlights for the upcoming 2018-2019 season include the following:1. Annual influenza immunization is recommended for everyone 6 months and older, including children and adolescents.2. The American Academy of Pediatrics recommends an inactivated influenza vaccine (IIV), trivalent or quadrivalent, as the primary choice for influenza vaccination in children because the effectiveness of a live attenuated influenza vaccine against influenza A(H1N1) was inferior during past influenza seasons and is unknown for this upcoming season.3. A live attenuated influenza vaccine may be used for children who would not otherwise receive an influenza vaccine (eg, refusal of an IIV) and for whom it is appropriate because of age (2 years of age and older) and health status (ie, healthy and without any underlying chronic medical condition).4. All 2018-2019 seasonal influenza vaccines contain an influenza A(H1N1) vaccine strain similar to that included in the 2017-2018 seasonal vaccines. In contrast, the influenza A(H3N2) and influenza B (Victoria lineage) vaccine strains included in the 2018-2019 trivalent and quadrivalent vaccines differ from those in the 2017-2018 seasonal vaccines.a. Trivalent vaccines contain an influenza A(Michigan/45/2015[H1N1])pdm09-like virus, an influenza A(Singapore/INFIMH-16-0019/2016[H3N2])-like virus (updated), and an influenza B (Colorado/60/2017)-like virus (B/Victoria lineage; updated).b. Quadrivalent vaccines contain an additional B virus (Phuket/3073/2013-like virus; B/Yamagata lineage).5. All children with egg allergy of any severity can receive an influenza vaccine without any additional precautions beyond those recommended for all vaccines.6. Pregnant women may receive an influenza vaccine (IIV only) at any time during pregnancy to protect themselves as well as their infants, who benefit from the transplacental transfer of antibodies. Postpartum women who did not receive vaccination during pregnancy should be encouraged to receive an influenza vaccine before discharge from the hospital. Influenza vaccination during breastfeeding is safe for mothers and their infants.7. The vaccination of health care workers is a crucial step in preventing influenza and reducing health care-associated influenza infections because health care personnel often care for individuals at high risk for influenza-related complications.8. Pediatricians should attempt to promptly identify their patients who are suspected of having an influenza infection for timely initiation of antiviral treatment when indicated and on the basis of shared decision-making between each pediatrician and child caregiver to reduce morbidity and mortality. Although best results are seen when a child is treated within 48 hours of symptom onset, antiviral therapy should still be considered beyond 48 hours of symptom onset in childre...

Evidence update on vaccine allergy

“…The current recommendations for vaccination has been based on these claims. The American Academy of Paediatrics recommendation for prevention and control of influenza in children for 2018-2019 states that children with egg allergies can receive any licensed and recommended age-appropriate influenza vaccine without any additional precautions beyond those recommended for all vaccines [11]. However, the CDC guidelines recommend that patients with severe egg allergy should be vaccinated in a medical setting under supervision [12].…”

Immunization update 2019

“…The American Academy of Pediatrics (AAP) is recommending that children receive IIV for the 2018-19 influenza season because of LAIV's inferior efficacy during past influenza seasons and its unknown efficacy for the upcoming season. 12,13 According to the AAP Recommendations for Prevention and Control of Influenza in Children, 2018-2019, "A live attenuated influenza vaccine may be used for children who would not otherwise receive an influenza vaccine (e.g., refusal of an IIV) and for whom it is appropriate because of age (2 [to 49] years of age or older) and health status (i.e., healthy and without any underlying chronic medical condition)." 12,13 AAP recommended IIV as the primary vaccine for use in children until LAIV's effectiveness against A(H1N1) is determined.…”

“…12,13 According to the AAP Recommendations for Prevention and Control of Influenza in Children, 2018-2019, "A live attenuated influenza vaccine may be used for children who would not otherwise receive an influenza vaccine (e.g., refusal of an IIV) and for whom it is appropriate because of age (2 [to 49] years of age or older) and health status (i.e., healthy and without any underlying chronic medical condition)." 12,13 AAP recommended IIV as the primary vaccine for use in children until LAIV's effectiveness against A(H1N1) is determined. 12,13 LAIV is indicated for healthy individuals aged 2 years to 49 years.…”

“…12,13 AAP recommended IIV as the primary vaccine for use in children until LAIV's effectiveness against A(H1N1) is determined. 12,13 LAIV is indicated for healthy individuals aged 2 years to 49 years. 14 There are differences between the contraindications and precautions listed in the package insert and those in the ACIP recommendations; see Table 1 in this CPE article for a comparison.…”

The Importance of Vaccinating Children and Pregnant Women against Influenza Virus Infection

“…For individuals who are less than 5 years of age, pediatric influenza-associated infections are estimated at 90 million cases per year, with 1 million cases of influenza-associated severe acute lower respiratory tract infection and 28,000-111,500 deaths, the majority of which occur in developing countries [3]. Children less than a year of age are particularly susceptible to infection as they have little pre-existing immunity and may be too young to be vaccinated, relying upon transferred maternal immunity to protect against infection [4][5][6][7].…”