American Academy of Pediatrics Releases Recommendations for Prevention of Influenza for 2021-22

Pediatricians: Influenza vaccine is the best way to protect children against the flu and is another layer of protection during pandemic

The American Academy of Pediatrics recommends that all healthy children 6 months and older are vaccinated for influenza this fall as the best protection against the flu, especially now that many children have returned to in-classroom learning.

The AAP policy statement, “Recommendations for Prevention and Control of Influenza in Children, 2021–2022,” will be published in the October 2021 Pediatrics (published online Sept. 7). A detailed review of the evidence supporting the recommendations is published in an accompanying technical report.

“During the COVID-19 pandemic, it’s important to remember that influenza is also a highly contagious respiratory virus that can cause severe illness and even death in children,” said Flor Munoz, MD, FAAP, lead author of the policy statement and technical report, developed by the AAP Committee on Infectious Diseases. “The flu vaccine is safe, effective, and can be given alongside other routine immunizations and the COVID-19 vaccine.”

AAP recommends that all children aged 12 years and older receive the COVID-19 vaccine now approved for children 12 years to 17 years old and adults. AAP recommends all children age 6 months and older be vaccinated annually with influenza vaccine. AAP has no preference for a specific type of flu vaccine; depending on the child’s age and health, they may receive either the inactivated influenza vaccine (IIV), given by intramuscular injection, or attenuated influenza vaccine (LAIV), which is a nasal spray.

The AAP also recommends:

• Children with acute, moderate or severe COVID-19 should not receive influenza vaccine until they have recovered; children with mild illness may be vaccinated.
• Children in high-risk groups should receive a vaccine for flu, unless it is contradicted.
• Children with an egg allergy can receive influenza vaccine (IIV or LAIV) without any additional precautions beyond those recommended for all vaccines.
• Pregnant women should receive an inactivated influenza vaccine at any time during pregnancy to protect themselves and their infants. Women in the postpartum period who did not receive vaccination during pregnancy should receive influenza vaccine before discharge from the hospital.
• Influenza vaccination during breastfeeding is safe for mothers and their infants.
• The AAP supports mandatory vaccination of health care personnel as a crucial element in preventing influenza and reducing health care-associated influenza infections.

If children do get sick with the flu, those who have been vaccinated are less likely to have severe illness or be hospitalized. In prior years, about 80% of children who died of influenza had not been vaccinated, according to research. Similarly, about half of the deaths from influenza occur in children who are otherwise healthy, with no underlying medical conditions. In 2017-18, there were 188 pediatric deaths reported to the Centers for Disease Control and Prevention. During the 2018-19 flu season, 144 children died from influenza, while 199 deaths occurred in the 2019-2020 season.

The 2019–2020 influenza season was unusual and complicated by the emergence of the COVID-19 pandemic in early 2020. Flu activity began early in October 2019, continuing through mid-March 2020, with an abrupt decline after the implementation of physical distancing measures.

With school back in person, public health experts are concerned about a resurgence of flu activity this winter.

“This year it will be especially important to keep our children healthy, as we’ve seen hospital beds and emergency services fill beyond capacity in communities where transmission of SARS-CoV-2 and other respiratory viruses remains high,” Dr. Munoz said. “This means catching up on all immunizations, including the flu vaccine, and making sure children wash hands frequently, wear masks in school and during indoor group activities, and maintain physical distance from others.”

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The American Academy of Pediatrics is an organization of 67,000 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.