Preventing influenza in children

Selected by Pietro Cazzola, MD

influenzaMy research team and I have spent the last 2 years charting the effects of influenza within a school district. Influenza definitely makes its presence known through illness and absenteeism. During the 2015–2016 influenza season, influenza deaths were reported for 85 children across the country. The vast majority (80%–85%) of pediatric deaths, however, occur in unvaccinated children. Whereas influenza has significant effects on children with underlying medical conditions (eg, asthma, diabetes mellitus, hemodynamically significant cardiac disease, immunosuppression, neurologic and neurodevelopmental disorders), 50% of pediatric hospitalizations last year were for children with no underlying factors. Recently, the American Academy of Pediatrics (AAP) provided their updated recommendations for the routine use of seasonal influenza vaccine and antiviral medications for the prevention and treatment of influenza in children. First and foremost, AAP recommends annual seasonal influenza immunization for everyone 6 months and older, including children and adolescents. Other recommendations include:  

  • Either trivalent or quadrivalent (no preference) inactivated vaccine should be used for annual universal influenza immunization.
  • Quadrivalent live attenuated influenza vaccine (LAIV4) should not be used in any setting during the 2016–2017 influenza season.
  • Children aged 6 months through 8 years need 2 doses if they have received fewer than 2 doses of any trivalent or quadrivalent influenza vaccine before July 1, 2016, but require only 1 dose if they have previously received 2 or more total doses of influenza vaccine before July 1, 2016.
  • Older children (≥9 years) require only 1 dose regardless of vaccination history.
  • All children with egg allergy can receive influenza vaccine with no additional precautions beyond those of routine vaccinations.
  • All healthcare providers should receive an annual influenza vaccine to reduce healthcare–associated influenza.
  • Clinicians should attempt to promptly identify children suspected of having influenza for rapid antiviral treatment.
  • Oral oseltamivir remains the antiviral drug of choice for the management of influenza infections. 

Influenza circulates at low levels throughout the year. Increases in the numbers of clinical cases typically occur in late autumn (November–December). This is a great time to review your approaches to influenza, get your patients of all ages vaccinated, and review current guidelines for influenza prevention and control.

Jonathan Temte MD, MS, PhD
Professor, University of Wisconsin School of Medicine and Public Health, Department of Family Medicine, Madison, WI