Influenza: Vaccinate Kids as Soon as Possible, AAP Says

Laurie Barclay, MD

September 02, 2013

All children at least 6 months of age should be vaccinated against influenza as soon as trivalent or new quadrivalent vaccine is available, according to an updated statement from the American Academy of Pediatrics (AAP).

The statement, published online September 2 and in the October issue of Pediatrics, updates recommendations for routine use of seasonal influenza vaccine and antiviral medications to prevent and treat influenza in children.

"Parents should not delay vaccinating their children to obtain a specific vaccine," lead author Henry Bernstein, DO, said in a news release. Dr. Bernstein is the Red Book Online associate editor. "Influenza virus is unpredictable, and what's most important is that people receive the vaccine soon, so that they will be protected when the virus begins circulating."

For the 2013 to 2014 season, the trivalent influenza vaccine contains an A/California/7/2009 (H1N1) pdm09-like virus (same as 2012-2013), an A/Texas/50/2012 (H3N2) virus (antigenically similar to the 2012-2013 strain), and a B/Massachusetts/2/2012-like virus (a B/Yamagata lineage, similar to 2012 - 2013, but a different virus).

The US Food and Drug Administration has licensed new quadrivalent influenza vaccines containing an additional B virus (B/Brisbane/60/2008-like virus [B/Victoria lineage]).

The updated statement calls for annual universal influenza immunization, with no preference regarding the trivalent vs the quadrivalent vaccine.

Recent evidence suggests that inactivated influenza vaccine may be safely given to most persons allergic to eggs. A single, age-appropriate dose of inactivated influenza vaccine is well tolerated by those with egg allergy, but the AAP recommends consultation with an allergist for any child with a history of a severe reaction.

For children aged 6 months through 8 years, the dosing algorithm for administration of influenza vaccine is the same as in 2012-2013. If a child has received a seasonal vaccine previously, he or she needs only 1 dose of the current vaccine. If there is no prior vaccination or no clear record of prior vaccination, then the child should receive 2 doses, 4 weeks apart. Similarly, children who have not received 2 or more doses of the seasonal vaccine since July 1, 2010, should also receive 2 doses of the 2013-2014 vaccine.

Clinical Implications

The AAP recommends that clinicians make a special effort to vaccinate persons in vulnerable groups. These include children with chronic health conditions, children of American Indian or Alaskan Native heritage, healthcare workers, pregnant or breast-feeding women or those who may become pregnant, and household contacts and caregivers of children in high-risk populations.

The statement also recommends that pediatric offices consider offering vaccination to parents or other adults who care for children.

"As always, pediatricians, nurses, and all health care personnel should promote influenza vaccine use and infection control measures," the statement authors write. "In addition, pediatricians should promptly identify influenza infections to enable rapid antiviral treatment, when indicated, to reduce morbidity and mortality."

For children with influenza and severe symptoms or underlying chronic conditions, or for those who are hospitalized, the AAP still recommends treatment with oseltamivir or zanamivir. The safety profile of oseltamivir allows its use in both term and preterm infants from birth. However, chemoprophylaxis should be considered only in term infants, and chemoprophylaxis should not be considered a substitute for immunization.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online September 2, 2013.

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