AAP: Flu Shot, Not Nasal Spray, Recommended for 2016-2017

Troy Brown, RN

September 06, 2016

The inactivated influenza vaccine (trivalent or quadrivalent) is recommended for the upcoming influenza season because it was 63% effective against circulating strains in 2015 to 2016, according to a new policy statement from the American Academy of Pediatrics (AAP). In addition, the group continued to recommend mandatory influenza vaccination for all healthcare workers.

The policy statement, published online September 6 and in the October 2016 issue of Pediatrics, specifically recommends against the use of the live attenuated influenza vaccine nasal spray this year because it was only 3% effective during the previous influenza season.

The new recommendations are in line with those of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. In June, that group recommended removing the nasal spray from the vaccine supply for the 2016 to 2017 season after data showed it had been ineffective against some strains of the influenza virus that had been most prominent during the last three seasons.

"New research shows that the flu shot provided significantly better protection in recent flu seasons compared with the nasal spray vaccine," Henry H. Bernstein, DO, MHCM, coauthor of the AAP policy statement, said in a news release. "We want to provide children with the best protection possible against flu, and these recent studies show the flu shot is likely to provide a higher level of protection."

AAP recommends that everyone aged 6 months and older receive a seasonal influenza shot during the 2016 to 2017 influenza season.

In addition, the group supports mandatory influenza vaccines for all healthcare personal. "Mandatory influenza immunization for all [healthcare providers] is ethical, just, and necessary to improve patient safety. Employees of health care institutions are obligated to act in the best interests of the health of their patients and to honor the requirement of causing no harm," the authors write.

The group also calls for a special effort to vaccinate children and adolescents with social or medical conditions that make them particularly vulnerable to infection, as well as their household contacts and caregivers.

Other recommendations include the following:

  1. A trivalent or quadrivalent (no preference) inactivated vaccine may be used for the 2016 to 2017 influenza season.

  2. The influenza strains used in the 2016 to 2017 season differ from those used in the 2015 to 2016 season in several ways:

    • The influenza A (H3N2) strain contained in the 2016 to 2017 vaccine differs from that contained in the 2015 to 2016 vaccine, and the influenza B vaccine (Victoria lineage) strain contained in the 2016 to 2017 trivalent vaccine differs from the strain contained in the 2015 to 2016 seasonal trivalent vaccines (Yamagata lineage).

    • The 2016 to 2017 trivalent vaccine contains an A/California/7/2009 (H1N1)pdm09–like virus, an A/Hong Kong/4801/2014 (H3N2)–like virus, and a B/Brisbane/60/2008-like virus (B/Victoria lineage).

    • Quadrivalent vaccine contains an additional B virus (B/Phuket/3073/2013-like virus [B/Yamagata lineage]).

  3. Do not use the quadrivalent live attenuated influenza vaccine in any setting during the 2016 to 2017 season.

  4. Children with egg allergy can receive the influenza vaccine without additional precautions from those taken during routine vaccination.

  5. All healthcare providers should be vaccinated against influenza annually to prevent exposing patients to healthcare-associated influenza infections because they may live with or care for those at high risk for influenza-related complications.

  6. Pediatric clinicians should attempt to promptly identify children suspected of having influenza to provide rapid antiviral treatment when appropriate.

"Pregnant women can help protect themselves and their unborn children by getting the vaccine," Wendy Sue Swanson, MD, MBE, Seattle Children's Hospital, Washington, explained in the news release. "Breastfeeding also offers newborns added protection against the flu. Because the flu virus is common and unpredictable, it can cause serious complications even in healthy children."

The AAP encourages healthcare providers to begin providing the influenza vaccine no later than October 2016 because early influenza vaccination is expected to protect against the virus for the entire season. The length of the season is unpredictable, and outbreaks can occur late in the season, so the AAP encourages healthcare providers to continue offering the vaccine until June 30.

"The influenza vaccine is an essential, every-year vaccine for infants beginning at 6 months, children and teens," Dr Swanson said. "Protecting children from influenza with the vaccine, early in the respiratory season, is the best protection pediatricians and parents can provide."

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online September 6, 2016. Full text

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