AAP: Vaccines and Education Key to Preventing Flu Outbreaks

Children and adolescents age six years and older should receive annual trivalent seasonal influenza immunization, according to updated recommendations from the American Academy of Pediatrics (AAP) that focus on the prevention and control of influenza.

It is critical that pediatricians assume “a leadership role in the prevention of influenza through vaccine use and public education,” and that they are able to “promptly identify influenza infections to enable rapid treatment of influenza, when indicated, to reduce childhood morbidity and mortality,” according to the guidelines, which are published in Pediatrics.

This year’s trivalent seasonal influenza vaccine contains A/California/7/2009 (H1N1)-like antigen (derived from the 2009 pandemic influenza A [H1N1] virus); A/Perth/16/2009 (H3N2)-like antigen; and B/Brisbane/60/2008-like antigen, making it all the more critical that “special efforts” are made to immunize all family members, household contacts, and out-of-home care providers of children who are younger than 5 years; children with high-risk conditions such as asthma, diabetes, or neurological disorders; healthcare personnel; and pregnant women. These groups “are most vulnerable to influenza-related complications,” according to the AAP’s Committee on Infectious Diseases.

Although two influenza vaccines were recommended last year, only a single trivalent vaccine is being manufactured for the current 2010-2011 seasonal influenza vaccine schedule. The 2009 pandemic H1N1 train has replaced last year’s strain in the 2010-2011 trivalent seasonal influenza vaccine, which also includes two other strains of flu virus.

The AAP policy includes a concise flow chart to simplify decision-making about the number of influenza vaccine doses a child needs, which depends on the child’s age at the time of the first dose and vaccine history:

• Children younger than 6 months are too young to receive influenza vaccine.
• Children 9 years of age and older need only 1 dose.
• Children younger than 9 years need a minimum of 2 doses of 2009 pandemic H1N1 vaccine. If they did not receive the H1N1 vaccine during last year’s flu season, they will need two doses of seasonal influenza vaccine this year.
• Children younger than 9 years who have never received the seasonal flu vaccine before will need 2 doses.
• Children younger than 9 years who received seasonal flu vaccine before the 2009-2010 flu season need only one dose this year if they received at least 1 dose of the H1N1 vaccine last year. They need 2 doses this year if they did not receive at least 1 dose of the H1N1 vaccine last year.
• Children younger than 9 years who received seasonal flu vaccine last year for the first time, but only received 1 dose, should receive 2 doses this year.
• Children younger than 9 years who received a flu vaccine last year, but for whom it is unclear whether it was a seasonal flu vaccine or the H1N1 flu vaccine, should receive 2 doses this year.
• All children who need 2 doses should receive the second dose at least 4 weeks after the first dose.

For more information:

• HCPLive.com: Vaccination Resource Center
• ACIP Cautions against Use of Seasonal Flu Vaccine in Some Children
• American Journal of Managed Care: Opening and Continuing the Discussion on Influenza Vaccination Timing