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AAP Outlines Flu Vaccine Recommendations for Children

Nasal vaccine has higher efficacy among young children

The American Academy of Pediatrics (AAP) is recommending that health care providers consider giving children 2 through 8 years of age the nasal influenza vaccine rather than flu shots because a review found greater efficacy for the nasal vaccine among younger children.

But if the nasal spray (the live attenuated influenza vaccine, or LAIV), is not readily available, the injectable inactivated influenza vaccine (IIV) should be used so that vaccination is not delayed.

The CDC Advisory Committee on Immunization Practices found greater efficacy for LAIV compared with IIV, and a similar risk of adverse events, after reviewing evidence on the efficacy of the two vaccines among healthy children. However, contraindications and precautions preclude LAIV use in some children, such as those with febrile, respiratory, and immune conditions.

The nasal spray advice is just one of the AAP’s recommendations, published in Pediatrics, for preventing and controlling the flu this year among children. The academy’s key recommendation remains unchanged: All people 6 months of age and older, including all children and adolescents, should get annual flu vaccinations.

While children 9 years of age and older need only one dose of vaccine, children 6 months through 8 years of age receiving the seasonal flu vaccine for the first time should receive a second dose this season at least four weeks after the first dose.

Special effort should be made to vaccinate people with conditions that increase the risk of complications from influenza; children of American Indian or Alaska Native heritage; all household contacts and care providers of children who have high-risk conditions or are younger than 5 years; and all women who are pregnant, are considering pregnancy, are in the postpartum period, or are breastfeeding during the influenza season. Health care personnel should also be immunized themselves.

Both trivalent and quadrivalent influenza vaccines are available in the United States for the 2014–2015 season. The AAP does not endorse one over the other. Both vaccines contain an A/ California/7/2009 (H1N1)–like virus, an A/Texas/50/2012 (H3N2) virus, and a B/Massachusetts/2/ 2012–like virus (B/Yamagata lineage). The quadrivalent influenza vaccines include an additional B virus (B/Brisbane/60/2008–like virus [B/Victoria lineage]). These strains are unchanged from those in the 2013–2014 seasonal influenza vaccines.

Source: Pediatrics; September 22, 2014.

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