By Will Boggs MD

NEW YORK (Reuters Health) - All children 6 months and older should receive the 2015-2016 seasonal influenza vaccine, according to the American Academy of Pediatrics' (AAP) Committee on Infectious Diseases.

To protect younger infants, the AAP recommends vaccination of all household contacts and out-of-home care providers, all health care personnel, all child care providers and staff, and all women who are pregnant, are considering pregnancy, are in the postpartum period, or are breastfeeding during the influenza season.

Because the virus strains used in the vaccines have changed since the last influenza season, the dosing algorithm for administration of influenza vaccine to children 6 months through 8 years of age has been updated.

They need two doses if they have received less than two doses of trivalent or quadrivalent influenza vaccine before July 1, 2015. They need only one dose if they have previously received two or more doses of trivalent or quadrivalent influenza vaccine before July 1, 2015.

Vaccinations should take place as soon as the seasonal influenza vaccine is available locally, although vaccination should be delayed in children who have a moderate to severe febrile illness, the AAP says.

Antiviral medications are not a substitute for influenza immunizations but can be important in the control of influenza. The oral neuraminidase inhibitor oseltamivir remains the treatment of choice, but the currently circulating influenza viruses continue to be sensitive to zanamivir and peramivir as well.

Egg allergy should not preclude influenza vaccination, and testing for egg allergy is no longer recommended.

While vaccine manufacturers are delivering increasing amounts of thimerosal-free influenza vaccine each year, the AAP asserts that thimerosal from vaccines has not been linked to any medical condition, including autism spectrum disorder.

Dr. Judith C. Shlay, associate director of Denver Public Health, Denver, Colorado, told Reuters Health by email, "All children need to vaccinate against influenza. For the very young (younger than 6 months) and immunocompromised children, it is critical for family members and the extended community that may interact with those children to obtain the vaccine and protect these vulnerable individuals. Finally, all health care workers need to be vaccinated, since they care for sick individuals and need to avoid spreading the disease."

"To improve influenza vaccine rates for children requires the use of traditional (provider offices) and nontraditional venues for vaccine delivery such as schools, offices, pharmacies, daycares, social service agencies, (Women, Infants, and Children) offices, homeless shelters, and other public venues such as airports, train and bus stations," Dr. Shlay said.

"The vaccine does not offer 100% protection," Dr. Shlay said. "Influenza is a serious illness, and any protection is worthwhile, particularly for the most vulnerable."

Dr. Ahdi Amer, from Children's Hospital of Michigan, Detroit, agreed. He told Reuters Health by email, "Despite the fact that flu vaccine may not be as effective as we would like (as it was evident from last season flu vaccine efficacy reaching 23% due to mismatch), vaccination against flu remains the most effective way to combat the disease and to minimize associated morbidity and mortality."

"Flu vaccine for no obvious reason seems to be singled out and refused by many parents who are not necessarily refusing to vaccinate their children with other (Centers for Disease Control and Prevention) recommended vaccines," Dr. Amer said. "I think more educational media campaigns that dispel historical misinformation about flu vaccine and its safety may help educate the public at large and parents in particular, which may increase immunization rates in children."

He added, "I think the other important point in this year's recommendations is the emphasis on the need for more pediatricians to promptly identify children who are clinically presumed to have influenza disease for rapid antiviral treatment in order to reduce morbidity and mortality."

Complete recommendations are outlined in an article online September 7 in Pediatrics.

The chair and vice chair of the Committee on Infectious Diseases did not respond to requests for comments. The authors reported no commercial funding or disclosures.


Pediatrics 2015.