Updated Pediatric Flu Guidelines Released

The AAP recommends that all children older than 6 months receive the seasonal flu vaccine and has updated vaccine dosage guidelines for young children.

The American Association of Pediatrics has released its recommendations for preventing and controlling influenza in the 2012-2013 season, including updated vaccine dosage guidelines for young children. The association’s policy statement was published online on September 10, 2012, in Pediatrics.

The statement explains that the 2012-2013 trivalent flu vaccine contains antigens against 2 strains of influenza A (H1N1 and H3N2) and 1 strain of influenza B, with the influenza B strain and the influenza A (H3N2) strains differing from those included in vaccines for the previous 2 seasons.

The annual flu vaccine is recommended for all children aged 6 months or older, and there should be special emphasis on vaccinating children with conditions that increase the risk of flu complications (eg, asthma, diabetes, immunosuppression, or neurologic disorders); household visitors and care providers for children with high-risk conditions; children younger than 5 years, and especially children younger than 6 months; health care providers; and all women who are pregnant or considering pregnancy, who have recently delivered, or who are breastfeeding. (Children older than 6 months with moderate to severe illness with fever may delay getting the flu vaccine based on a pediatrician’s recommendation.)

Children younger than 2 years of age are at increased risk of hospitalization and complications due to flu. Even during the relatively mild 2011-2012 flu season, there were still 26 lab-confirmed flu-related pediatric deaths in the United States. In addition, among children who were hospitalized with flu, almost half had no known underlying conditions, and approximately a fifth had underlying asthma or reactive airway disease.

All children aged 9 years and older should receive a single dose of vaccine. Children aged 6 months through 8 years who are receiving the flu vaccine for the first time should receive a second dose at least 4 weeks after the first one. Those who have received at least 2 doses of vaccine in 1 of the last 2 seasons only need 1 dose this season, but those who received at most a single dose in each of the last 2 seasons may still need a second dose.

The flu vaccine is available in 2 forms: trivalent inactivated vaccine (TIV) and live-attenuated influenza vaccine (LAIV). TIV is available in an intramuscular version for those aged 6 months and older and an intradermal version for those aged 18 to 64 years. LAIV is available in an intranasal version for healthy individuals aged 2 to 49 years. Both TIV and LAIV are produced in eggs, but there is no indication of problems for those with egg allergy when receiving a single dose of TIV. (There is no data regarding LAIV and egg allergies.)

LAIV is not recommended for those with underlying conditions such as asthma or other chronic pulmonary diseases; hemodynamically significant cardiac disease; immunosuppressive disorders or therapy; HIV infection; diabetes; conditions that compromise respiratory function or handling of secretions or increase risk of aspiration; and those taking influenza antiviral medications and those aged 2 to 4 years with a history of recurrent wheeze or medically attended wheezing session in the previous 12 months.

The antiviral medications oseltamivir (oral) and zanamivir (inhaled) can play an important role in controlling influenza. They are appropriate for children who are hospitalized with presumed influenza or illness attributed to influenza and for children with influenza who are at high risk of complications. Antivirals can also be used as preventive measures for those at high risk of complications and for those who come into contact with those at high risk of complications.