AAP finds the inactivated influenza vaccine to be more consistently effective against most strains of flu, but says the nasal vaccine may be a last resort for kids who otherwise will not be vaccinated.

ITASCA (May 21, 2018) – The American Academy of Pediatrics will advise families to choose the inactivated influenza vaccine (IIV) — the flu shot – when they vaccinate their children this fall. The decision was made by the AAP Board of Directors after reviewing data on the effectiveness of the flu shot compared with the nasal spray flu vaccine, which has not worked as well in recent flu seasons.

AAP will publish its formal policy statement on flu prevention and treatment in September. This decision was announced now because physicians are placing orders for vaccine.

“We really want to immunize as many children as we can against the flu with what we think will be the most effective vaccine. That’s why we’re recommending the flu shot,” said Henry H. Bernstein, DO, MHCM, FAAP, associated editor of the AAP Red Book Online. “Influenza is unpredictable from season to season, which means vaccine effectiveness can vary by age, health status, and type of vaccine. Recent history has shown the injected form of the vaccine to be more consistent in protecting against most strains of flu virus.”

The quadrivalent live attenuated influenza vaccine (LAIV4), which is given by intranasal spray to healthy patients ages 2 through 49 years, was a popular option for those reluctant to get a shot. However, in 2016, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) and the AAP reviewed data showing that it was not effective against H1N1 strains of the flu virus, and that it was less effective than expected against the H3N2 virus. They did not recommend it for the 2016-’17 and 2017-’18 seasons.

In February 2018, ACIP decided to make LAIV4 available for the 2018-2019 flu season, based on indirect study data from the manufacturer suggesting their new formulation would be effective, as well as a review of other published research.

However, upon review of the same data, the AAP recommends children receive the injectable form of the vaccine, which was shown to be more consistently effective against most strains of the flu virus over the past several flu seasons. For those children who would otherwise receive no flu vaccine, the AAP says the nasal spray vaccine can be given as a last resort, though it could leave them at higher risk for flu than if they had received the flu shot. The nasal spray vaccine is not recommended for children under 2 years or children with chronic medical conditions like asthma.

“The data reviewed showed that receiving the nasal spray vaccine is better than not getting any vaccine at all,” said Flor Munoz, MD, FAAP, member of the AAP Committee on Infectious Diseases. “If you get the nasal spray vaccine, just be aware that, depending on the performance of the new vaccine formulation, there might be a chance you will not be fully protected against H1N1 strains of flu. The efficacy of this new formulation has not yet been determined.”

The AAP recommends families talk with their pediatrician if they have any questions about their child’s immunizations.

“The flu virus is common, but unpredictable. It can cause serious complications even in healthy children, which is why we strongly recommend annual flu vaccine for all people ages 6 months and older,” said Dr. Bernstein. “Immunization is the best way to protect children from influenza.”


The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org and follow us on Twitter @AmerAcadPeds.

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