Guidelines Updated for Influenza Vaccination and Antiviral Therapy in Children

Pediatrics. Published online August 30, 2010.
From MedscapeCME Clinical Briefs

News Author: Laurie Barclay, MD
CME Author: Laurie Barclay, MD

08/30/2010

Clinical Context

During the 2010-2011 influenza season, the AAP recommends annual trivalent seasonal influenza immunization for all children and adolescents who are at least 6 months old.

Special outreach efforts should target all children 6 months or older, including healthy children and those with conditions increasing the risk for complications from influenza. Other groups to be targeted include household contacts and out-of-home care providers of children with high-risk conditions or of healthy children younger than 5 years, healthcare personnel, and pregnant women.
Study Highlights

* Children younger than 6 months are too young to receive influenza vaccine.
* Children 9 years or older need only 1 dose.
* Children younger than 9 years require the following vaccination schedules:
o They need at least 2 doses of 2009 pandemic H1N1 vaccine.
o They require 2 doses of seasonal influenza vaccine this year if they did not receive the H1N1 vaccine last year.
o They need 2 doses if they have never before received seasonal influenza vaccine.
o If they received seasonal influenza vaccine before the 2009-2010 season, they need only 1 dose this year if they received at least 1 dose H1N1 vaccine last year, but they need 2 doses this year if they did not receive at least 1 dose H1N1 vaccine last year.
o If they received seasonal influenza vaccine for the first time last year but only received 1 dose, they require 2 doses this year.
o Those who received influenza vaccine last year should get 2 doses this year if it cannot be determined whether it was a seasonal influenza vaccine or the H1N1 influenza vaccine.
* For all children who need 2 doses, the second dose should be given at least 4 weeks after the first dose.
* All children 6 months or older, especially those at high risk for influenza complications, should receive trivalent seasonal influenza vaccine each year.
* Immunizing close contacts of children at high risk should lower the risk for influenza exposure for these children.
* Annual trivalent seasonal influenza vaccine is important for household members and out-of-home care providers of children and adolescents at high risk, healthy children younger than 5 years, and infants younger than 6 months.
* Only 1 trivalent seasonal influenza vaccine is being made for the current 2010-2011 seasonal influenza vaccine schedule, with the 2009 pandemic influenza A (H1N1) strain replacing the 2009 seasonal influenza A (H1N1) strain.
* The recommended trivalent vaccine for 2010-2011 contains A/California/7/2009 (H1N1)-like antigen (derived from 2009 pandemic influenza A [H1N1] virus); A/Perth/16/2009 (H3N2)-like antigen; and B/Brisbane/60/2008-like antigen.
* During the 2010-2011 season, the only antiviral medications routinely recommended for chemoprophylaxis or treatment are the neuraminidase inhibitors oseltamivir and zanamivir.

Clinical Implications

* The number of influenza vaccine doses each child requires is based on the child's age when receiving the first influenza vaccine dose and vaccination history.
* Only a single trivalent seasonal influenza vaccine is being made for the current 2010-2011 seasonal influenza vaccine schedule, with the 2009 pandemic influenza A (H1N1) strain replacing the 2009 seasonal influenza A (H1N1) strain. The recommended trivalent vaccine for 2010-2011 contains A/California/7/2009 (H1N1)-like antigen (derived from 2009 pandemic influenza A [H1N1] virus); A/Perth/16/2009 (H3N2)-like antigen; and B/Brisbane/60/2008-like antigen.