In its update, AAP now recommends influenza vaccine shot and nasal spray

USA: Updating its last season's recommendations of 2018-2019 that recommended children receive the injectable vaccine and only get the nasal spray in situations when they might not otherwise get vaccinated. The American Academy of Pediatrics (AAP) has now recommended that both the injectable vaccine (inactivated vaccine; IIV) and the nasal spray vaccine (quadrivalent live attenuated influenza vaccine; LAIV4) are acceptable for the 2019-2020 season. The AAP will release a formal policy statement on the prevention and treatment of influenza later in the year.

This AAP recommendation on March 14, 2019, comes after the Academy reviewed current data on vaccine coverage and effectiveness and flu season characteristics.

The decision is being announced now to allow healthcare providers time to place vaccine orders, AAP says.

“All children six months and older should receive the flu vaccine, in whatever form their pediatrician recommends,” Bonnie Maldonado, chair of the AAP Committee on Infectious Diseases, said in an AAP press release. “Every year, we are never sure if the vaccine strains are going to be perfectly matched up with incoming flu strains, but based on the information that we have now, we believe the nasal spray is an acceptable option.”

The US Centers for Disease Control and Prevention (CDC) recommended either the injectable or nasal spray vaccines during the 2018-2019 season. The AAP's updated influenza vaccine recommendation is now consistent with CDC's.

AAP did not recommend the nasal spray during the 2016-17 and 2017-18 flu season since the spray did not work as well against influenza A/H1N1 strain during the 2013-2014 and 2015-2016 flu seasons. Vaccine effectiveness can vary from one flu season to the next.

The AAP Board of Directors reviewed the latest data on the IIV and LAIV4 vaccines and approved both on March 14, 2019. The nasal spray is indicated for healthy individuals aged 2 through 49 years, the AAP explained in the news release.

In the 2013-2014 and 2015-2016 influenza seasons, the LAIV4 formulation was not as effective against the A/H1N1 strain as the IIV formulation; therefore, the AAP did not recommend it during the 2016-2017 and 2017-2018 seasons.

The manufacturer of the LAIV4 changed the formulation to include a new A/H1N1 strain in 2017, and new data from Great Britain, based "on a limited number of cases in other countries," support the effectiveness of the nasal spray vaccine against some influenza strains, according to the news release.

More children were vaccinated against influenza during the fall of 2018 than the year before; however, there is still room for improvement. By November 2018, approximately 45% had been vaccinated, up from 38% in November 2017, the AAP noted in the news release.

Parents should talk with their child's pediatrician if they have questions about immunizations.

"The flu virus is unpredictable and can cause serious complications even in healthy children," Flor M. Munoz, a member of the AAP Committee on Infectious Diseases, said in the news release. "Children who have been immunized are less likely be hospitalized due to flu."