AAP Recommends Flu Vaccine for All Kids Older Than 6 Months

Troy Brown, RN

September 05, 2017

The American Academy of Pediatrics (AAP) recommends everyone aged 6 months or older should receive an influenza vaccine, saying it significantly reduces the risk for serious illness and death during the influenza season.

The AAP's Committee on Infectious Diseases published the policy statement online September 4 and in the October issue of Pediatrics.

"Getting a flu shot as soon as the vaccine is available in your community should be on every parent's checklist, along with other back-to-school routines," recommendation coauthor Flor Munoz, MD, said in a news release. "We know that the flu should not be taken lightly. Everyone in the household, including pregnant women, grandparents, and child care providers, should be vaccinated to help prevent its spread."

More than 100 children died of influenza during the 2016-2017 season, and thousands more required hospitalization for severe illness or complications from influenza. Most (80%) of those who died of influenza were unvaccinated.

The AAP urges pediatricians to offer the vaccine to all children aged 6 months and older, as soon as the vaccine is made available, so children are protected before the influenza season begins.

Inactivated Vaccine

The inactivated influenza vaccine (IIV) is an intramuscular injection. Because it is fully inactivated, it does not cause the flu. It comes in two forms: The trivalent form protects against three strains of the influenza virus (two A and one B), and the quadrivalent form protects against four strains (two A and 2 B).

"To vaccinate as many people as possible for this influenza season, neither inactivated vaccine formulation is preferred over the other. Although manufacturers anticipate an adequate supply of quadrivalent vaccine, pediatricians should administer whichever formulation is available in their communities," the authors explain.

Recommendations

  • Children should receive their vaccination or vaccinations by the end of October, if possible.

  • Those who require two vaccines (children aged 6 months through 8 years who have not previously been completely vaccinated) should get their first vaccine early during the season for the best protection.

  • This year, for the second year in a row, the AAP supports the recommendation of the Centers for Disease Control and Prevention 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 IIV. Infants younger than 6 months should also not receive the IIV vaccine.

"Vaccination is the best available preventive measure we have against influenza," recommendation coauthor Henry Bernstein, MD, MHCM, said in the news release. "Yet, there is lots of room for improvement in influenza vaccination because overall influenza vaccination rates have been suboptimal in both children and adults during the past 7 seasons."

Antiviral Medications

Antiviral medications help control influenza, but they "are not a substitute for influenza vaccination," the authors write. The only antiviral medications recommended during the 2017-2018 season for chemoprophylaxis or treatment of influenza in children are the neuraminidase inhibitors oral oseltamivir (Tamiflu, Roche Laboratories) and inhaled zanamivir (Relenza, GlaxoSmithKline).

"Pediatricians should attempt to promptly identify children suspected of having influenza for timely initiation of antiviral treatment, when indicated, to reduce morbidity and mortality," the authors write.

"Clinical judgment is an important factor in treatment decisions for children who present with influenza-like illness," said Dr Bernstein. "The best results are seen when treatment is started within 48 hours of symptom onset."

The authors have disclosed no relevant financial relationships.

Pediatrics.  Published online September 4, 2017. Full text  

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