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Recommendations for Prevention and Control of Influenza in Children

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Recommendations for Prevention and Control of Influenza in Children POLICY STATEMENT Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of all Children Recommendations for Prevention and Control of Influenza in Children, 2019–2020 COMMITTEE ON INFECTIOUS DISEASES This statement updates the recommendations of the American Academy of abstract Pediatrics for the routine use of influenza vaccines and antiviral medications in the prevention and treatment of influenza in children during the 2019–2020 season. The American Academy of Pediatrics continues to recommend routine influenza immunization of all children without medical contraindications, starting at 6 months of age. Any licensed, recommended, age-appropriate vaccine available can be administered, without preference of one product or formulation over another. Antiviral treatment of influenza with any licensed, recommended, age-appropriate influenza antiviral medication continues to be recommended for children with suspected or confirmed influenza, particularly Policy statements from the American Academy of Pediatrics benefit those who are hospitalized, have severe or progressive disease, or have from expertise and resources of liaisons and internal (AAP) and fl external reviewers. However, policy statements from the American underlying conditions that increase their risk of complications of in uenza. Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent. The guidance in this statement does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. – fl The following updates for the 2019 2020 in uenza season are discussed All policy statements from the American Academy of Pediatrics in this document: automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time. 1. Both inactivated influenza vaccine (IIV) and live attenuated influenza This document is copyrighted and is property of the American vaccine (LAIV) are options for influenza vaccination in children, with no Academy of Pediatrics and its Board of Directors. All authors have filed preference. conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process 2. The composition of the influenza vaccines for 2019–2020 has been approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial updated. The A(H1N1)pdm09 and A(H3N2) components of the vaccine involvement in the development of the content of this publication. are new for this season. The B strains are unchanged from the previous DOI: https://doi.org/10.1542/peds.2019-2478 season. PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). 3. All pediatric influenza vaccines will be quadrivalent vaccines. The age indication for some pediatric vaccines has been expanded; therefore, Copyright © 2019 by the American Academy of Pediatrics there are now 4 egg-based quadrivalent inactivated influenza vaccines (IIV4s) licensed by the US Food and Drug Administration (FDA) for To cite: COMMITTEE ON INFECTIOUS DISEASES. administration to children 6 months and older, 1 inactivated cell-based Recommendations for Prevention and Control of fl – quadrivalent inactivated influenza vaccine (cIIV4) for children 4 years In uenza in Children, 2019 2020. Pediatrics. 2019;144(4): e20192478 and older, and 1 quadrivalent live attenuated influenza vaccine (LAIV4) Downloaded from www.aappublications.org/news by guest on October 4, 2021 PEDIATRICS Volume 144, number 4, October 2019:e20192478 FROM THE AMERICAN ACADEMY OF PEDIATRICS for children 2 years and older. No influenza and transmission of 8 years of age; 70% in those 9 trivalent vaccines are expected to influenza virus to household contacts through 17 years of age), 25% against be available for children this and community members of all A(H3N2) (54% in those 6 months season. ages.1,2 Routine influenza vaccination through 8 years of age; 18% in those 4. New formulations of licensed and antiviral agents for the treatment 9 through 17 years of age), and 48% fl fl influenza vaccines with a volume and prevention of in uenza are against in uenza B (B/Yamagata 1,2 of 0.5 mL per dose have been recommended for children. predominant) (77% in those approved for children 6 through 6 months through 8 years of age; 28% in those 9 through 17 years 36 months of age. Children 6 SUMMARY OF RECENT INFLUENZA through 35 months of age may ACTIVITY IN THE UNITED STATES of age). now receive either the 0.25- or 2018–2019 Influenza Season 0.5-mL dose, with no preference, 2017–2018 Influenza Season and children $36 months of age The 2017–2018 influenza season was The 2018–2019 influenza season was (3 years and older) continue to the first classified as a high-severity the longest-lasting season reported in receive a 0.5-mL dose. season for all age groups, with high the United States in the past decade, 5. Children 6 months through 8 years levels of outpatient clinic and with elevated levels of influenzalike of age who are receiving influenza emergency department visits for illness activity for a total duration of vaccine for the first time or who influenzalike illness, high influenza- 21 consecutive weeks (compared to 6 have received only 1 dose before related hospitalization rates, and high the average duration of 16 weeks). 3–5 July 1, 2019, should receive 2 numbers of deaths. Influenza Influenza A(H1N1)pdm09 viruses doses of influenza vaccine ideally A(H3N2) viruses predominated predominated from October to mid- fl by the end of October, and vaccines through February 2018; influenza B February, and in uenza A(H3N2) fi should be offered as soon as they viruses predominated from March viruses were identi ed more become available. Children 2018 onward. Although frequently from February to May. fl needing only 1 dose of influenza hospitalization rates for children that In uenza B (B/Victoria lineage vaccine, regardless of age, should season did not exceed those reported predominant) represented also receive vaccination ideally by during the 2009 pandemic, they did approximately 5% of circulating the end of October. surpass rates reported in previous strains. The majority of characterized high-severity A(H3N2)-predominant influenza A(H1N1)pdm09 and 6. A new antiviral medication has seasons. Excluding the 2009 influenza B viruses were antigenically been licensed for treatment of pandemic, the 186 pediatric deaths similar to the viruses included in the influenza in children. reported during the 2017–2018 2018–2019 influenza vaccine, but fl Children often have the highest attack season (approximately half of which most characterized in uenza rates of influenza in the community occurred in otherwise healthy A(H3N2) viruses were antigenically during seasonal influenza epidemics. children) were the highest reported distinct from the A(H3N2) component fl of the 2018–2019 vaccine. Co- They play a pivotal role in the since in uenza-associated pediatric circulation of multiple genetically transmission of influenza virus mortality became a nationally fi 3–5 diverse clades and/or subclades of infection to household and other noti able condition in 2004. A(H3N2) was documented. close contacts and can experience Among pediatric deaths of children Circulating viruses identified morbidity, including severe or fatal 6 months and older who were eligible belonged to clade 3C.2a, subclade complications from influenza for vaccination and for whom 3C.2a1, or clade 3C.3a, with 3C.3a infection.1 Children younger than vaccination status was known, approximately 80% had not received viruses accounting for .70% of the 5 years, especially those younger than the influenza vaccine during the A(H3N2) in the United States. The 2 years, and children with certain 2017–2018 season.3 2018–2019 vaccine’s A(H3N2) virus underlying medical conditions are at belonged to subclade 3C.2a1. This increased risk of hospitalization and Overall vaccine effectiveness (VE) likely contributed to an overall lower complications attributable to against both influenza A and B VE against influenza A(H3N2) for that influenza.1 School-aged children bear viruses during the 2017–2018 season influenza season and supported the a large influenza disease burden and was estimated to be 38%, with higher recommendation to change the are more likely to seek influenza- VE (64%) in children 6 months to A(H3N2) virus strain for the related medical care compared with 8 years of age compared with those 9 upcoming season’s vaccine. healthy adults.1,2 Reducing influenza to 17 years of age (28%).4 Overall VE virus transmission among children against influenza A(H1N1) was 65% The 2018–2019 season was of decreases the burden of childhood (87% in those 6 months through moderate severity, with similar Downloaded from www.aappublications.org/news by guest on October 4, 2021 2 FROM THE AMERICAN ACADEMY OF PEDIATRICS hospitalization rates in children as known underlying medical 231% to 43%) for A(H3N2). These seen during the 2017–2018 season, conditions. are preliminary data and not vaccine fi which were higher than in those • Among 89 children who were speci c. observed in previous seasons from 6 months or older at the time of 2013–2014 to 2016–2017. The illness onset and, therefore, would INFLUENZA MORBIDITY AND MORTALITY cumulative hospitalization rates per have been eligible for vaccination IN CHILDREN 100 000 population were 72.0 among and for whom vaccination status children 0 through 4 years old and was known, most (70%) were Pediatric hospitalizations and deaths fl 20.4 among children 5 through unvaccinated. Only 30 (34%) had caused by in uenza vary from one 6 17 years old. Among 1132 children received at least 1 dose of influenza season to the next. Historically, up to fl hospitalized with in uenza and for vaccine (25 had complete 80% of pediatric deaths have whom data were available, 45% had vaccination, and 5 had received 1 of occurred in unvaccinated children fl no recorded underlying condition, 2 ACIP-recommended doses).
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