Recommendations for prevention and control of influenza in children, 2018-2019

The authors of this statement update the recommendations of the American Academy of Pediatrics for the routine use of infuenza vaccine and antiviral medications in the prevention and treatment of infuenza in children. Highlights for the upcoming 2018-2019 season include the following: 1. Annual infuenza immunization is recommended for everyone 6 months and older, including children and adolescents. 2. The American Academy of Pediatrics recommends an inactivated infuenza vaccine (IIV), trivalent or quadrivalent, as the primary choice for infuenza vaccination in children because the effectiveness of a live attenuated infuenza vaccine against infuenza A(H1N1) was inferior during past infuenza seasons and is unknown for this upcoming season. 3. A live attenuated infuenza vaccine may be used for children who would not otherwise receive an infuenza vaccine (eg, refusal of an IIV) and for whom it is appropriate because of age (2 years of age and older) and health status (ie, healthy and without any underlying chronic medical condition). 4. All 2018-2019 seasonal infuenza vaccines contain an infuenza A(H1N1) vaccine strain similar to that included in the 2017-2018 seasonal vaccines. In contrast, the infuenza A(H3N2) and infuenza B (Victoria lineage) vaccine strains included in the 2018-2019 trivalent and quadrivalent vaccines differ from those in the 2017-2018 seasonal vaccines. a. Trivalent vaccines contain an infuenza A(Michigan/45/2015[H1N1]) pdm09-like virus, an infuenza A(Singapore/INFIMH-16-0019/2016[H3N2])- like virus (updated), and an infuenza B (Colorado/60/2017)-like virus (B/Victoria lineage; updated). b. Quadrivalent vaccines contain an additional B virus (Phuket/3073/2013- like virus; B/Yamagata lineage). 5. All children with egg allergy of any severity can receive an infuenza vaccine without any additional precautions beyond those recommended for all vaccines. 6. Pregnant women may receive an infuenza vaccine (IIV only) at any time during pregnancy to protect themselves as well as their infants, who beneft from the transplacental transfer of antibodies. Postpartum women who did not receive vaccination during pregnancy should be encouraged to receive an infuenza vaccine before discharge from the hospital. Infuenza vaccination during breastfeeding is safe for mothers and their infants. 7. The vaccination of health care workers is a crucial step in preventing infuenza and reducing health care-associated infuenza infections because health care personnel often care for individuals at high risk for infuenza-related complications. 8. Pediatricians should attempt to promptly identify their patients who are suspected of having an infuenza infection for timely initiation of antiviral treatment when indicated and on the basis of shared decision-making between each pediatrician and child caregiver to reduce morbidity and mortality. Although best results are seen when a child is treated within 48 hours of symptom onset, antiviral therapy should still be considered beyond 48 hours of symptom onset in children with severe disease or those at high risk of complications (see Table 2 in the full policy statement).