AAP: children should have flu shot, not nasal spray

  • American Academy of Pediatrics

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Despite some changes to the quadrivalent live attenuated influenza vaccine (LAIV4) to boost effectiveness, the American Academy of Pediatrics (AAP) advises that children receive inactivated vaccine this coming season.
  • All children aged 6 months or older should be vaccinated where not contraindicated.

Key points

  • Intranasally administered LAIV4 has been a popular choice for children because it avoids an injection.
  • LAIV4 has been proven effective against strains of influenza B, less so with A/H3N2 strains, and not effective against A/H1N1 strains.
  • CDC and AAP have not recommended LAIV4 in past 2 seasons.
  • LAIV4 manufacturer MedImmune (FluMist) switched covered H1N1 strains from A/Bolivia to A/Slovenia, intended to bump antibody response.
  • Based on MedImmune data, the CDC greenlighted reintroduction of FluMist for the 2018-2019 season.
  • AAP advises that children should still receive the shot with inactivated virus.
  • Only when the shot is absolutely declined should LAIV4 be offered with the caution that children could be at higher infection risk with this option.
  • The spray is specifically not recommended for children with certain chronic medical conditions or
  • The most recent season saw 168 pediatric deaths attributed to influenza.
  • The AAP formal policy statement on influenza treatment and prevention is slated for publication in September 2018.

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