Pediatricians once again can use either flu shots or nasal spray flu vaccines for their patients during the 2020-’21 season.
The AAP is keeping its recommendation the same as this season’s, saying any licensed, age-appropriate vaccine is acceptable, and everyone 6 months and older should be vaccinated.
“Given that vaccine effectiveness can vary year-to-year and the lack of any U.S. data to change the recommendation, we thought it would be really prudent to maintain the vaccine schedule the way it is,” said AAP Committee on Infectious Diseases (COID) Chair Yvonne A. Maldonado, M.D., FAAP.
The AAP and Centers for Disease Control and Prevention (CDC) did not recommend using the nasal spray (live attenuated influenza vaccine, LAIV) in 2016-’17 or 2017-’18 due to poor effectiveness against H1N1 strains. LAIV manufacturer AstraZeneca has since changed the formulation of the vaccine.
In 2018-’19, the AAP recommended the flu shot (inactivated influenza vaccine, IIV) as the primary choice and LAIV for children who would not otherwise receive a vaccine. After reviewing U.K. effectiveness data for the reformulated LAIV, the AAP did not express a preference between vaccines this season, and it will not express a preference next season.
Vaccine effectiveness in preventing medical visits due to flu this season has been 55% for children and 45% for the overall population, according to preliminary data from the CDC. However, those data are not broken down by vaccine type, and COID plans to watch for additional data sources.
“We keep a very close eye on influenza trends around the world for children on an ongoing basis,” Dr. Maldonado said.
Influenza A (H1N1)pdm09 has been the most commonly reported strain circulating in the U.S. this season despite an early surge in influenza B/Victoria viruses.
However, influenza B has taken a toll on children. There have been 155 pediatric deaths, higher than during the same period in every other year since reporting started in 2004-’05 with the exception of the 2009 H1N1 pandemic, according to data from the CDC.
Hospitalization rates for children also are unusually high. Children ages 4 and under have been hospitalized at a rate of 93.9 per 100,000 children, the highest on record for this point in the season. Rates for children ages 5-17 are 24.4 per 100,000 children, the highest in recent seasons except the 2009 H1N1 pandemic.
Overall, the CDC estimates about 39 million people have gotten sick, 400,000 have been hospitalized and 24,000 have died this season.
While much of the recent focus has been on the coronavirus disease 2019 (COVID-19) outbreak, Dr. Maldonado stressed the importance of being protected against flu as well. Unlike COVID-19, people can do that by getting vaccinated.
“We want to make sure we protect people against everything that’s out here that can really put people in the hospital and compromise their own health,” she said. “Influenza is not a simple cold. It’s a devastating disease that can lead to hospitalization and other bad health outcomes.”
The CDC’s Advisory Committee on Immunization Practices is expected to discuss its flu policy in June and is not expected to make major changes. If that is the case, the CDC and AAP vaccine policies will be similar next season. The AAP policy statement on influenza immunization in children will be published later this year in Pediatrics.
