The Academy does not recommend the nasal spray vaccine this flu season, after studies show poor effectiveness

The American Academy of Pediatrics recommends that all children ages 6 months and older receive a seasonal flu shot during the 2016-17 season, as vaccination remains the best available preventive measure against influenza, according to an updated policy statement in the October 2016 Pediatrics.

The policy statement, “Recommendations for Prevention and Control of Influenza in Children, 2016–2017,” will be published online Sept. 6. The statement supports the recommendation by federal health officials not to use the live attenuated influenza vaccine (LAIV), administered by intranasal spray.

The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention found that the nasal spray vaccine did not protect against certain strains of the flu virus that were most prominent the past three seasons. The nasal spray vaccine effectiveness among children 2 through 17 years was 3 percent in 2015-16, compared with 63 percent for the injected vaccine.


“New research shows that the flu shot provided significantly better protection in recent flu seasons compared with the nasal spray vaccine,” said Henry H. Bernstein, DO, MHCM, FAAP, who co-authored the statement. “We want to provide children with the best protection possible against flu, and these recent studies show the flu shot is likely to provide a higher level of protection.”


The AAP calls the mandatory immunization of all health care personnel an “ethical, just, and necessary” means to improve patient safety. A special effort also should be made to vaccinate children and adolescents with medical conditions that could increase the risk of complications from flu, as well as household contacts and out-of-home care providers of children with high-risk conditions, according to the AAP. The Academy calls for vaccinating American/Indian Native children, and household contacts and out-of-home providers of children under age 5, especially those younger than 2 years.


Women who are pregnant or breastfeeding are encouraged to be vaccinated. Women can safely receive the influenza vaccine at any point during pregnancy, and are of special concern because of the high risk of complications from flu. Their vaccination also provides protection for their infants during the first six months of life through a transplacental transfer of antibodies, according to recent research.


“Pregnant women can help protect themselves and their unborn children by getting the vaccine,” said Wendy Sue Swanson, MD, MBE, FAAP. “Breastfeeding also offers newborns added protection against the flu. Because the flu virus is common and unpredictable, it can cause serious complications even in healthy children.”


Health care providers are encouraged to begin offering flu vaccine no later than October; immunization early in the influenza season is expected to provide protection for the entire season. Because the flu season is unpredictable and outbreaks can occur late in the season, providers are encouraged to continue offering flu vaccine until June 30.


“The influenza vaccine is an essential, every-year vaccine for infants beginning at 6 months, children and teens,” Dr Swanson said. “Protecting children from influenza with the vaccine, early in the respiratory season, is the best protection pediatricians and parents can provide.”


Both trivalent and quadrivalent inactivated flu vaccines are available for the 2016-17 season, either of which may be used (no preference), according to the AAP. Both contain three of the same strains, and the quadrivalent formulation contains an additional fourth strain. Both vaccines are designed to be well-matched to circulating strains to provide optimal protection. Patients with an allergy to eggs do not need to receive any special consideration, as recommended in prior years. A 2012 review of published data found the amount of egg protein in the vaccine did not increase the risk of anaphylaxis among 4,172 egg-allergic patients.


The AAP also offers guidance for treatment of influenza. Pediatricians should promptly treat children presumed to have the flu with antiviral medication. Oral oseltamivir or inhaled zanamivir remain the drugs of choice for influenza infections. Antiviral resistance may emerge, so additional guidance may be provided based on ongoing assessments conducted by the CDC.


“The good news is we know that the flu shot does provide good protection,” Dr. Bernstein said.

“Immunizing your child is the best way to prevent influenza and the serious complications that can result from an infection.”

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