American Academy of Pediatrics says all kids' flu vaccine this year will be 4-strain

Sept. 9, 2019

In new guidance, the American Academy of Pediatrics (AAP) reiterated having no preference to the live-attenuated influenza vaccine (LAIV) or inactivated influenza vaccines (IIV) for children, but it said both types will be quadrivalent (four-strain) and widely available for the upcoming flu season.

All children 6 months and older are encouraged to get a flu vaccine in the coming months, the AAP said in childhood flu vaccine recommendations published in Pediatrics. The organization said that although the two influenza B strains included in the vaccine are the same as last year, this year's vaccine contains new components of the H1N1 and H3N2 strains, which are influenza A viruses.

The AAP said there is no preference of IIVs or LAIVs, based on existing studies of vaccine efficacy.

"Pediatricians should administer whichever formulation is available in their communities to achieve the highest possible vaccination coverage," Flor M. Munoz, MD, said in an AAP News summary of the recommendations.

The AAP had already made the no-preference statement in March. For the 2018-19 season it had stated a preference for IIV over LAIV when possible.

American pediatricians will be offering four egg-based quadrivalent IIVs licensed by the FDA for children 6 months and older; one cell-based quadrivalent IIV for children 4 years and older; and one quadrivalent LAIV for children 2 years and older who are otherwise healthy, the AAP said.

Children who require two doses of the vaccine are those ages 6 months to 8 years who are receiving the flu vaccine for the first time, or have had only one dose of the vaccine prior to Jul 1, 2019.

In its recommendation, the AAP also offered more details about the 2018-19 flu season. Though moderately severe, it was the longest flu season in the past decade, at 21 weeks. H1N1 viruses predominated from October to mid-February, followed by H3N2 until May.

A total of 116 children died from the flu, and nearly half of those deaths occurred in previously healthy kids. Seventy percent of the patients who died from the flu were not vaccinated.

"Although national influenza vaccination coverage among children has not declined in the past 3 seasons, overall vaccination coverage remains suboptimal," the AAP said in its recommendations.

In addition to offering vaccine guidelines, the AAP also addressed antiviral treatments, saying treatment should be considered among children with suspected or confirmed influenza disease whose siblings or household contacts are younger than 6 months or belong to a high-risk group that predisposes them to flu complications.

The AAP also noted that baloxavir is now FDA-approved for children, offering a third antiviral drug option for this age group in addition to oseltamivir (Tamiflu) and zanamivir (Relenza).

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