What are the American Academy of Pediatrics (AAP) guidelines on influenza vaccination in children?

Updated: Aug 07, 2020
  • Author: Hien H Nguyen, MD, MS; Chief Editor: Michael Stuart Bronze, MD  more...
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The following are the American Academy of Pediatrics guidelines on influenza vaccination in children: [96]

  • Children should receive their vaccination or vaccinations by the end of October, if possible.
  • Children who require 2 vaccines (children aged 6 months through 8 years who have not previously been completely vaccinated) should receive their first vaccine early during the season for the best protection.
  • For the 2017-2018 influenza season, the AAP supported the recommendation of the CDC to not use the live attenuated intranasal influenza vaccine, which provided poor protection against influenza A (H1N1) pdm09 viruses during recent influenza seasons.
  • Clinicians should make special effort to vaccinate all children aged 6 months and older who have medical conditions that put them at increased risk for influenza complications. These include babies born preterm; those with chronic medical conditions, such as asthma and other chronic lung disorders, cardiac disease, diabetes, and other metabolic problems; and those with weakened immune systems.
  • All women who are pregnant, considering pregnancy, postpartum, or breastfeeding during influenza season should receive the influenza vaccine. Studies have shown that infants born to vaccinated mothers have better influenza outcomes if they contract the disease.
  • All those who care for children should also receive an influenza vaccine.
  • Influenza vaccine is not contraindicated in children with mild febrile or afebrile illness, especially those with mild upper respiratory tract infection symptoms or allergic rhinitis. Children in whom the clinician diagnoses a moderate to severe febrile illness should wait until resolution of the illness to be vaccinated with inactivated influenza vaccine (IIV). Infants younger than 6 months should also not receive the IIV vaccine.
  • Antiviral medications recommended during influenza season for chemoprophylaxis or treatment of influenza in children are the neuraminidase inhibitors oral oseltamivir (Tamiflu) and inhaled zanamivir (Relenza). Baloxavir, a cap-dependent endonuclease inhibitor, may be used in children aged 12 years or older.

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