The AAP no longer will express a preference for the flu shot over nasal spray vaccine for children during the 2019-’20 flu season.

The recommendation comes after the Academy reviewed current data on vaccine coverage and effectiveness and flu season characteristics. It also considered the reformulation of the nasal spray vaccine. The guidance is expected to be similar to the recommendations from the Centers for Disease Control and Prevention (CDC).

The AAP recommends universal vaccination for everyone 6 months and older.

“Every effort should be made to ensure that all children receive their influenza vaccine every year before influenza viruses begin circulating in the community,” said Flor M. Munoz, M.D., FAAP, a member of the AAP Committee on Infectious Diseases (COID). “Any licensed influenza vaccine given as indicated for age and health status can be used to protect children against influenza in 2019-’20.”

The AAP and 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 to include a new strain (A/Slovenia) that it suggested would produce better antibody responses than the previous H1N1 strain (A/Bolivia).

This season, the Academy recommended using the flu shot (inactivated influenza vaccine, IIV) as the primary vaccine choice, while saying LAIV may be used for children who would not otherwise receive a vaccine. The CDC did not express a preference.

In making a recommendation for 2019-’20, the Academy reviewed U.K. data showing that the reformulated LAIV has been effective against influenza A/H1N1 for children this season, when H1N1 has been the predominant circulating strain. While U.K. effectiveness data tend to differ somewhat from U.S. data, AAP leaders said the data were encouraging. The Academy also considered reported effectiveness of LAIV against other influenza virus strains.  

“This year, we’re just feeling more comfortable with current data that (LAIV) has been effective” said COID Chair Yvonne A. Maldonado, M.D., FAAP.

U.S. data for LAIV effectiveness are not expected to be available this season due to low utilization compared to IIV. However, the CDC released interim effectiveness data for all vaccines, which showed 61% effectiveness against medically attended influenza for children and 48% for the overall population.   

H1N1 viruses have been predominant for much of the season, although H3N2 viruses recently surpassed them in some US regions. The CDC estimates 23 million to 26 million people have gotten sick and as many as 31,200have died this season.  

The CDC’s Advisory Committee on Immunization Practices is expected to discuss its flu policy in June but recently said it does not anticipate majorchanges. In that case, the CDC and AAP policies will be similar next season. The AAP policy statement on influenza immunization in children will be published later this year in Pediatrics.  

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