What’s New With the Flu: A Summary of the AAP’s 2019-2020 Flu Season Recommendations
Jordan N. Watson, MD
Thomas Jefferson University
Nemours/Alfred I. duPont Hospital for Children
Watson JN. What’s new with the flu: a summary of the AAP’s 2019-2020 flu season recommendations [published online November 21, 2019]. Infectious Diseases Consultant.
American Academy of Pediatrics Committee on Infectious Diseases. Recommendations for prevention and control of influenza in children, 2019-2020. Pediatrics. 2019;144(4):e20192478. https://doi.org/10.1542/peds.2019-2478.
During the 2018-2019 influenza season, there were 21 consecutive weeks with elevated levels of influenza-like illness, making it the longest in the past decade.1 This followed a high-severity 2017-2018 influenza season, when 186 children had died from influenza, half of whom were previously healthy; 80% of the children who had died from influenza-associated complications had not been vaccinated against influenza during the 2017-2018 season.1 It is imperative for us health care providers to keep up with the most up-to-date guidelines to advocate for our pediatric patients and improve vaccination rates to prevent these devastating outcomes.
Overview of Preventive Options
The biggest changes this year involve recommendations for influenza vaccinations. During the 2018-2019 influenza season, the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) had different recommendations regarding preference for receiving the inactivated influenza vaccination (IIV) administered intramuscularly over the live attenuated influenza vaccine (LAIV). The CDC expressed no preference, while the AAP recommended an IIV as the primary choice for vaccination.2,3 This year, however, the AAP recommendation is the same as the CDC: no preference for one over the other.
Contraindications for the LAIV include age younger than 2 years, immunocompromised condition, children aged 2 to 4 years with a diagnosis of asthma or medically diagnosed wheezing episode in the past 12 months, close contacts of severely immunocompromised patients, children who are taking aspirin or salicylate-containing medications, current or recent antiviral medication administration, pregnancy, and history of receiving another live-virus vaccine in the previous 4 weeks (with the exception of rotavirus). In some high-risk populations, the safety of the LAIV has not been established. This includes chronic metabolic disease, diabetes, chronic pulmonary or cardiovascular disease, renal disease, and hemoglobinopathies.1
Another change in the vaccination recommendations for this season is the dosing recommendations for children aged 6 through 36 months. For previous seasons, a dosing recommendation of 0.25 mL was recommended for children in this age group. This season, children aged 6 to 35 months may receive either the 0.25 mL or 0.5 mL standard dosing, with no preference for one over the other. Finally, all available vaccinations this year will be quadrivalent. The B strains are unchanged from previous seasons, while the A(H1N1) and A(H3N2) components are new for this season.1
Remaining unchanged is the recommendation that all children aged 6 months through 8 years who have received fewer than 2 doses of any influenza vaccine before July 1, 2019, should receive 2 doses of the vaccine spaced at least 4 weeks apart.1
Overview of Treatment Options
Treatment of influenza with antiviral medication is recommended for all hospitalized children with suspected or confirmed influenza, children at high risk of complications from influenza, and those with severe or complicated disease. Treatment can also be considered for children with confirmed or suspected influenza who are not at high risk of complications, and treatment can be initiated within 48 hours of symptom onset. Treatment can also be considered for children with confirmed or suspected influenza who are not at high risk of complications and have a household contact of an infant younger than 6 months or someone who is at high risk of complications from influenza.
Baloxavir is a new medication approved by the US Food and Drug Administration (FDA) for the outpatient treatment of influenza for previously healthy children and adolescents aged 12 years or older who have had symptoms for fewer than 2 days. However, oral oseltamivir remains the antiviral medication of choice for the treatment of influenza infection in pediatric patients. Other FDA-approved options include inhaled zanamivir and intravenous peramivir.1
Jordan N. Watson, MD, FAAP, is clinical assistant professor of pediatrics at the Sidney Kimmel Medical College at Thomas Jefferson University and is medical director of the Dermatology Access Clinic, Division of General Pediatrics, at Nemours/Alfred I. duPont Hospital for Children in New Castle County, Delaware.
- American Academy of Pediatrics Committee on Infectious Diseases. Recommendations for prevention and control of influenza in children, 2019-2020. Pediatrics. 2019;144(4):e20192478. https://doi.org/10.1542/peds.2019-2478.
- American Academy of Pediatrics Committee on Infectious Diseases. Recommendations for prevention and control of influenza in children, 2018-2019. Pediatrics. 2018;142(4):e20182367. https://doi.org/10.1542/peds.2018-2367
- Grohskopf LA, Alyanak E, Broder KR, Walter EB, Fry AM, Jernigan DB. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices — United States, 2019–20 influenza season. MMWR Recomm Rep. 2019;68(RR-3):1-21. http://dx.doi.org/10.15585/mmwr.rr6803a1.