Pediatrics Group Recommends Inactivated Flu Vaccine Over Live Version

While live attenuated influenza vaccine is returning this season, the American Academy of Pediatrics is continuing to recommend the inactivated influenza vaccine (IIV) over the live version for children and adolescents.

In its guidance in Pediatrics, the group notes that the intranasal live vaccine has been less effective in youth in recent years, and its efficacy is unknown for this season. The vaccine has been reformulated with a new H1N1 component for 2018–19.

They recommend that the live vaccine be used for children «who would not otherwise receive an influenza vaccine (e.g., refusal of an IIV) and for whom it is appropriate because of age (2 years of age and older) and health status (i.e., healthy and without any underlying medical conditions).»

Among the other recommendations:

  • For children receiving the IIV, either trivalent or quadrivalent is acceptable.
  • Pregnant women should receive an inactivated vaccine.
  • Children with egg allergy have no restrictions on which flu vaccine they may receive.

For those who would like additional information, I provide the abstract of the policy statement by the American Academy of Pediatrics:


The authors of this statement update the recommendations of the American Academy of Pediatrics for the routine use of influenza vaccine and antiviral medications in the prevention and treatment of influenza in children. Highlights for the upcoming 2018–2019 season include the following:

1. Annual influenza immunization is recommended for everyone 6 months and older, including children and adolescents.

2. The American Academy of Pediatrics recommends an inactivated influenza vaccine (IIV), trivalent or quadrivalent, as the primary choice for influenza vaccination in children because the effectiveness of a live attenuated influenza vaccine against influenza A(H1N1) was inferior during past influenza seasons and is unknown for this upcoming season.

3. A live attenuated influenza vaccine may be used for children who would not otherwise receive an influenza vaccine (eg, refusal of an IIV) and for whom it is appropriate because of age (2 years of age and older) and health status (ie, healthy and without any underlying chronic medical condition).

4. All 2018–2019 seasonal influenza vaccines contain an influenza A(H1N1) vaccine strain similar to that included in the 2017–2018 seasonal vaccines. In contrast, the influenza A(H3N2) and influenza B (Victoria lineage) vaccine strains included in the 2018–2019 trivalent and quadrivalent vaccines differ from those in the 2017–2018 seasonal vaccines.

  • a. Trivalent vaccines contain an influenza A(Michigan/45/2015[H1N1])pdm09–like virus, an influenza A(Singapore/INFIMH-16-0019/2016[H3N2])–like virus (updated), and an influenza B (Colorado/60/2017)–like virus (B/Victoria lineage; updated).

  • b. Quadrivalent vaccines contain an additional B virus (Phuket/3073/2013–like virus; B/Yamagata lineage).

5. All children with egg allergy of any severity can receive an influenza vaccine without any additional precautions beyond those recommended for all vaccines.

6. Pregnant women may receive an influenza vaccine (IIV only) at any time during pregnancy to protect themselves as well as their infants, who benefit from the transplacental transfer of antibodies. Postpartum women who did not receive vaccination during pregnancy should be encouraged to receive an influenza vaccine before discharge from the hospital. Influenza vaccination during breastfeeding is safe for mothers and their infants.

7. The vaccination of health care workers is a crucial step in preventing influenza and reducing health care–associated influenza infections because health care personnel often care for individuals at high risk for influenza-related complications.

8. Pediatricians should attempt to promptly identify their patients who are suspected of having an influenza infection for timely initiation of antiviral treatment when indicated and on the basis of shared decision-making between each pediatrician and child caregiver to reduce morbidity and mortality. Although best results are seen when a child is treated within 48 hours of symptom onset, antiviral therapy should still be considered beyond 48 hours of symptom onset in children with severe disease or those at high risk of complications (see Table 2 in the full policy statement).

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