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Girl getting vaccine

New AAP recommendations address flu vaccine guidance for 2022-’23 season

September 6, 2022

On the eve of the 2022-’23 influenza season, the AAP has released an updated policy statement and technical report with recommendations for the prevention and control of influenza in children.

The AAP continues to recommend annual influenza vaccination of all children without medical contraindications starting at 6 months of age. Any licensed influenza vaccine appropriate for age and health status can be administered, ideally as soon as possible in the season, without preference for any product or formulation.

The policy Recommendations for Prevention and Control of Influenza in Children, 2022–2023 and a companion technical report from the Committee on Infectious Diseases, are available at https://publications.aap.org/pediatrics/article/doi/10.1542/peds.2022-059274 and https://doi.org/10.1542/peds.2022-059275. They will be published in the October issue of Pediatrics.

Timely vaccination

The composition of influenza vaccines for the 2022–’2023 season has been updated to include new influenza A(H3N2) and influenza B Victoria lineage components. The influenza A (H1N1)pmd09 and influenza B Yamagata lineage components are the same as the previous season.

Prompt immunization is especially important for children who require two doses this season, including children 6 months through 8 years who are receiving influenza vaccine for the first time or who received only one dose prior to July 1, 2022, or whose vaccination status is unknown.

Although a history of severe allergic reaction (e.g., anaphylaxis) to any influenza vaccine generally is a contraindication to future receipt of influenza vaccines, children who have had a severe allergic reaction after influenza vaccination should be evaluated by an allergist to help identify the vaccine component responsible for the reaction and to determine whether future vaccine receipt is appropriate.

Inactivated and live attenuated vaccines can be co-administered with other vaccines, including COVID-19 vaccines. While the goal is to protect all children by the end of October, vaccination efforts should continue throughout the influenza season.

The vaccine formulations available for children are the same as last season. Of note, the age indication for the cell culture-based inactivated influenza vaccine Flucelvax Quadrivalent was lowered from 2 years and older to 6 months and older in October 2021.

Disease burden

In a typical influenza season, the disease burden among children is substantial.

Children of all ages may require hospitalization, although the rates are highest in children younger than 5 years. In one cross-sectional study that included data from 14 U.S. Influenza Hospitalization Surveillance Network sites collected over nine seasons, 13,235 children were hospitalized. Of these, 2,676 (20%) were admitted to the intensive care unit (ICU), 2,262 (17%) had pneumonia and 690 (5%) required mechanical ventilation. Neurologic complications in children hospitalized with flu are common and include encephalopathy and febrile and nonfebrile seizures.

Disparities, lower rates

The flu takes a disproportionate toll on families who are Black, Hispanic or American Indian or Alaska Native. In a second cross-sectional study spanning 10 influenza seasons, Black, Hispanic and American Indian/Alaska Native people had higher rates of influenza-associated hospitalizations and ICU admissions, and disparities were highest in children under age 4. Influenza-associated in-hospital deaths were three to four times higher in Black, Hispanic and Asian/Pacific Islander children compared with White children, which may be due to existing causes for disparities such as inequities in health care system access or other social determinants of health.

Although flu vaccine remains the best way to protect children against severe complications associated with influenza, immunization rates fell last year. During the 2021-’22 flu season, only 55% of children were vaccinated, and coverage levels were 8.1 percentage points lower for Black children compared with White children, according to the Centers for Disease Control and Prevention.

The policy statement and technical report provide detailed recommendations for increasing immunization rates in all children, including strategies to eliminate barriers to immunization in those experiencing higher rates of adverse outcomes from influenza.

Dr. Bryant is a lead author of the policy statement and technical report. She is a member of the AAP Committee on Infectious Diseases.

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